From Japan to Hungary: Harm Reduction in Politically Challenging Environments

Goro Koto (centre left) and Peter Sarosi (centre right) speaking on a panel about harm reduction

The 25th Harm Reduction International conference took place in Montreal in mid-May, and many attendees discussed the unique challenges that they face in advocating for, or implementing, harm reduction services in their countries. While harm reductionists face significant challenges in their work in all corners of the world, individuals working in certain politically or socially hostile environments can experience unique barriers.

In a busy afternoon conference session, Goro Koto of the Japan Advocacy Network for Drug Policy (JANDP) described how the “very strong moral standard” of Japanese culture – deeply entrenched social and cultural norms - has hindered attempts at implementing the most basic harm reduction measures.

“Society is prioritised very much over individuals … [and] social morality is prioritised over human rights”, he claimed. This has led to severe and institutionalised discrimination against people who use drugs, as well as people with HIV/AIDS. For example, Koto said, people who use drugs that visit a hospital to get treatment for issues relating to their drug use are likely to be reported to police by medical staff, and are thus likely to be criminalised. Consequentially, many people who use drugs will be too afraid to seek medical help, which in turn may lead to a worsening of their health issues – drug-related or not.

According to Koto, this high level of stigma pushes drug use so far from the public eye that many people in Japan, including the public and policymakers, do not even understand the harms of drug use or the concept of harm reduction. Drug use continues to be seen almost exclusively through a criminal lens, rather than one of health.

“If you ask people ‘What is the harm [of drug use]?’, they say ‘crime’. If you ask ‘What is [harm] reduction?’, they say ‘punishment’,” Koto remarked.

The lack of awareness and understanding of, or support for, harm reduction in Japan has created a drought of resources for those like Koto who want to promulgate the harm reductionist ideology. JANDP has begun translating foreign-language publications on the subject because, as Koto lamented, “we have no [Japanese] harm reduction resources because harm reduction doesn’t exist [in Japan]”.

Koto was joined in his session by Peter Sarosi of the Hungarian Civil Liberties Union. Unlike Japan, Sarosi described, Hungary has actually implemented some successful harm reduction initiatives. However, this has gradually changed over the past decade, with a rise in populist politics driving increasingly punitive policies and the closure of numerous life-saving services.

Hungary was once ahead of the trend on harm reduction; the country established its first needle exchange in 1993. However, under Prime Minister Viktor Orbán who has held the post since 2010, the country’s past progressive approach to drug use has been eroded.

In 2011, the number of sterile needles being distributed to people who use drugs dropped by an estimated 40 per cent from the previous year, Sarosi described. More recently, between 2014 and 2015, two needle syringe programmes – which provided 55 per cent of the country’s sterile needles – closed down. Expectedly, there have been dire consequences.

“We are facing a new HIV epidemic among people who inject drugs (PWID),” Sarosi told the session, adding that the rate of Hepatitis C infection among PWID had risen from 34 per cent to 60 per cent in the past three years. Despite this clear rise in harms following the scale back of harm reduction services, Hungarian policymakers are seemingly disinterested in reform.

“Sometimes scientific evidence is not enough to support harm reduction,” Sarosi bemoaned. “Politicians just say ‘I don’t believe your data or trust your data because its collected by needle-syringe programmes’. [They’ll say] ‘I don’t care’”.

Despite the challenges he faces, Sarosi seems cautiously optimistic about the future of harm reduction in his country. He described one instance of meeting a man who opposed harm reduction, and easily convincing him to support the installation of sharps bins in his community. The public, Sarosi insists, are far easier to convince of harm reduction’s benefits than politicians.

“We realised the key is to convince local people who are being manipulated [by local politicians],” Sarosi asserted. “We try to convince people how harm reduction is good for them, even if they don’t use drugs, [and to recognise that] people who use drugs are part of the community”.

Similarly, Goro Koto also appeared hopeful about the future of harm reduction in Japan, despite the current social and political climate.

“I feel very excited to deal with this challenge because I feel motivated by all of you here,” Koto told the audience of harm reduction experts and enthusiasts, “I know how [many] difficulties you’ve dealt with so far, so I can learn a lot from you”.

The encouraging optimism and dedication demonstrated by Koto and Sarosi, and countless other attendees of the Harm Reduction International conference, highlight the potential for progressive change, even in some of the most hostile environments.