We can name five key words in order to understand the current situation around harm reduction in the Eastern Europe and Central Asia region.
The first word is “transition”, or “transitioning”. This is a complex process in which states must take responsibility for services that were previously funded by the Global Fund and international donors. Over the past two years there have been some positive changes in this process in Montenegro, North Macedonia, Ukraine and other countries, but changes are slow and difficult. And, unfortunately, the transition to government funding is often associated with the so-called “optimization” of the package of services, which is presented as sustainability. But in fact, behind such “resilience” there is often a narrowing of the package of services to such a minimum, which often only includes redirecting a person to HIV testing and treatment.
We must understand that harm reduction is not only a response to HIV, but a much wider range of services. Harm reduction is the opportunity to receive assistance in the field of health care, psychological assistance, social protection, employment, as well as the opportunity to obtain shelter in case of danger or violence. Therefore, when we talk about the sustainability of budgets, we must talk not only about the medical sector, but also about the sustainability of financing social services. And a very important point is that these are not costs, they are investments in the lives and well-being of people and local municipalities.
Another important word that is relevant for our region is “limitation of the opportunities and democratic freedoms of civil society.” In countries such as Russia, Belarus, Azerbaijan, and the countries of Central Asia, over the past two years we have seen monstrous limitations on the capabilities of public organizations providing harm reduction services. These are restrictions on work, dissemination of information, legal assistance to people, and participation in political processes. These organizations are called “foreign agents”, “undesirable organizations”. The law against drug propaganda is used against organizations working in the field of harm reduction.
An important word for us is “European values”. Harm reduction is about human rights and European values. Now “Fortress Europe” is once again closed due to the COVID-19 pandemic. We see this even in the example of access to vaccinations for people who use drugs, the inability to obtain visas and travel.
The last, and probably the most important term for the EECA region is “criminalization”. It is repressive drug policies and the criminalization of drug use and possession for personal use that are a key barrier to access to medical care and harm reduction. We are confident that without decriminalization, not only a healthy community of people who use drugs, but also our society as a whole is impossible.
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