Harm Reduction services in Romania

Photo source: comunicate.mediafax.biz

In Romania, the first harm reduction programs appeared in the context of an imminent HIV epidemic among heroin users, through injection. So, the first initiatives were developed in order to attract injecting drug users to specialized medical and social services through needle exchange. In 1999, Romanian Association Against AIDS (ARAS) started in Bucharest the first HIV prevention program among sex workers, a program which also contacted drug users and provided them sterile syringes. In parallel, Alliance for the Fight Against Alcoholism and Drug Abuse (ALIAT) opened a fixed needle exchange service, which became the first permanent system specifically created to help these people.

In 2002, the prevalence of HIV and hepatitis C among injecting drug users was almost unknown. The medical and social services were in an early stage and capability was very weak, except for rehab and substitution centers of Bucharest, which were overwhelmed.
The staff of these services were poorly trained, most of them were doctors and staff from psychiatric wards, without experience or training in working with drug users. Although the first needle exchange services were developed by NGOs (and appeared in 2000), they had limited resources and could cover only a small number of the injecting drug users. Access to syringes in pharmacies was poor: because of some incidents caused by drug users (they were seen as difficult customers, representing a danger to the security of pharmacy staff etc.), more pharmacies refuse to sell insulin syringes to customers who were suspected of using drugs.

At present:
There are only two NGOs still doing needle exchange programs:
1. Aras (Two Drop in centers: Colentina and Titan, Social Ambulance for outreach)
2. Carusel (Caracuda Ferentari Drop-in center)

Available harm reduction services for drug users:
Social assistance
Primary medical care
Counseling and testing for HIV and Hepatitis B,C
Pregnancy tests
Distribution of syringes, distilled water, disinfectant wipes and condoms
Collection of used syringes
Referral to other medical and / or social services

In this moment, Romania is facing a new wave of HIV infections. In 2008 there were just three confirmed cases with HIV infection, but in 2012 there were 237 new, confirmed cases ( National Institute of Infectious Diseases, Prof.Dr.M.Bals). In September 2012, the Romanian Angel Appeal Foundation, in collaboration with the National Antidrug Agency and the Carusel Association, performed a Behaviour Surveillance Study among injecting drug users in Bucharest and Ilfov, Romania. Out of 417 participants tested in this study, 52,5% were HIV positive, 85% with Hepatitis C virus, and 20% with Hepatitis B virus (National Anti-Drug Agency, Report for 2013).

At that time, drug users started moving away from heroin and towards legal highs - new psychoactive substances (NPS), and from 3-4 times injections/day, they reached at 10-15 injections. The results were: low immunity, HIV and Hepatitis infection increased, unknown deaths provoked by NPS, mental health problems, endocarditis (an inflammation of the inner layer of the heart) or other infections.

"People living with HIV In Romania do not benefit from universal access to treatment, they are affected by stocks running out several times per year, sometimes for longer periods, due to the budget which is too small, or due to the poorly managed auctions.Doctors have to choose between patients, which one will receive treatment. Injecting drug users lose to PLHIV (people living with HIV) with fewer vulnerabilities. Those without a risk behavior, therefore those who don't choose to kill themselves slowly, are receiving treatment" declared Alina Dumitriu, president at Sens Pozitiv Association.

In Romania the harm reduction services can't cover all the targeted population. Drug users don't have the opportunity to live a normal, crime-free life. Other important challenges drug users are facing:
- limited access to medical and social services deepens social exclusion of drug users and for some this could mean death;
- police violence and abuse committed in an attempt to obtain information on traffickers;
- stigma and discrimination against drug users is high in the general population;
- lack of access for methadone treatment;
- the prospect of going to prison, which further reduces the chance of leading a normal life.

Moreover, a lot of them are injecting themselves in public spaces therefore, in unhygienic conditions. In general, drug-users have double or triple vulnerability (Figure 1):
Ex 1: IDU + H
Ex 2: IDU + roma
Ex 3: IDU +SW
Ex4: IDU + roma + SW
Ex 5: IDU + H +SW
Ex.6: IDU + H + roma

Fig. 1
IDU - injecting drug user; H - homeless; SW - sex worker
Source: Generated by Me

ANA, (2011), Strategia națională antidrog (National Anti-drug Strategy) 2006-2012, Raportul național privind situația drogurilor Romania (National report regarding drugs situation in Romania), Bucureşti, s.n.
Advocacy for Harm Reduction services development, RHRN UNICEF Experience, Available at: http://www.rhrn.ro/public/uploads/file/71/studiu-de-caz-rhrn-advocacy-sc... last accessed: 10.03.2014
Crina Teodora Din, The Role of Drug Consumption Rooms in HIV Prevention, Revista de Asistenţă Socială, Numar: 1, 2014., Available at: http://www.swreview.ro/index.pl/the_role_of_drug_consumption_rooms_in_hi..., last accessed: 10.03.2014