Emergency situation concerning the sustainability of harm reduction services in Albania, Bosnia and Herzegovina, Bulgaria and Romania

The three regional networks: Correlation – European Harm Reduction Network, Eurasian Harm reduction Network and Drug Policy Network South East Europe were informed by our members organisations about the situation with sustainability of  harm reduction services in Bosnia Herzegovina which is characterised by lack of strategy, policy and funding caused by the delay in establishing national Government for more than a year after the elections, withdrawal of international donors and misunderstandings and low level of cooperation between the governmental institutions and civil society, but also inside the civil society sector providing harm reduction services. The national Strategy for prevention and control of HIV and AIDS has ended (2016) and the Transition plan, developed by the Country Coordinating Mechanism during implementation of The Global Fund funded programme has not been implemented. As a result, the harm reduction services are closed in Sarajevo, Mostar, Bihać and Banja Luka and exist only in Zenica and Tuzla relaying on voluntary work of unpaid Staff and with all supplies already on minimum.

The three Networks expressed our deep concern about the situation and willingness to give contribution to finding solution and ensuring both quick response to the urgent needs and building a sustainable solution. We are ready to provide non-partisan support in identification and advocacy for the best possible approaches to urgently start provision of services to the populations of people who use drugs, sex workers and prisoners and other affected populations and to properly advocate for the sustainability of governmental funding.

The urgent action we are taking is to explore opportunities for emergency bridging funding to ensure survival of existing harm reduction services in the country. The situation is alarming and requires direct action and mobilisation of the international community. The three network have limited resources, so we are now contacting some of our partners and donors, explaining the situation and calling for immediate and urgent support. This could include short-term funding and technical support to ensure a minimum of harm reduction services. So far, we have a promise from the Open Society Foundations for a small grant which would cover basic need for the month of November.

We plan to develop and implement a comprehensive process to achieve sustainable long-term solutions. The activities for long-term solutions target local governments and policy-makers with the aim to ensure sustainable funding for harm reduction services. We already offered our expertise and support in this process, In addition, we would like to engage and involve other relevant stakeholders, such as donors and funders.

As the first concrete long term action we decide to send an appeal to the Global Fund to review their eligibility model of supporting middle income countries, besides Bosnia Herzegovina also Albania, Bulgaria and Romania.

In advance of the upcoming 42nd meeting of the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) as well as the Global Fund Regional Meeting for Eastern Europe and Central Asia to take place in Istanbul on 26-27 November, 2019, we – civil society and community organisations and networks working in the Eastern Europe and Central Asia (EECA) region for the benefit of key affected populations, including people who use drugs – would like to express our profound concern as to the current lack of sustainable harm reduction services in the South East European countries of Albania, Bosnia and Herzegovina, Bulgaria and Romania, respectively. Taking into consideration the successful results of the recent Sixth Replenishment Conference, we would like to invite the Global Fund to safeguard a part of the catalytic investment funds available for the 2020-2022, including multi-country grants, matching funds and strategic initiatives, in order to sustain life-saving services for people who inject drugs and other vulnerable groups and to incentivise domestic investment in harm reduction in each of these post-transition countries.

41 civil society organisations from Easter Europe and Central Asia supported the letter. We hope that the Global Fund shall understand the situation and support our proposal.

The letter to the Global Fund is available following this link>>>

 

Drug overdoses in Europe

Drug overdose deaths in Europe have risen for the fifth consecutive year, with a record 9 461 lives lost in 2017 (EU 28, Turkey and Norway). Reducing drug-related deaths is therefore a major public health challenge. Fighting this problem, the EU drugs agency (EMCDDA) launches today three new resources looking at drug overdoses in Europe and the interventions in place to prevent them.

Most overdose deaths in Europe are linked to the use of opioids (heroin or synthetic opioids), although cocaine, other stimulant drugs and medicines also play a role. In a new online resource, Prevention of drug-related deaths in Europe, the agency provides an overview on the issue and the risk factors involved.

Drug-induced deaths in the European Union, Norway and Turkey, 2017

The EMCDDA illustrates how overdose prevention can be addressed on three levels: reducing vulnerability to overdose (e.g. accessible treatment and services); reducing the risk of overdose (e.g. retention in opioid substitution treatment, prison aftercare and overdose risk assessments); and reducing the likelihood of fatal outcomes (e.g. take-home naloxone policies and supervision of drug consumption). Currently, 87 supervised drug consumption facilities exist in 8 EU Member States, Norway and Switzerland providing a safer drug-using environment.

While naloxone – a medicine used to reverse opioid toxicity – has been used in hospitals for over 40 years, it is also now available in the community in many countries. The EMCDDA launched its first overview of Take-home naloxone (THN) programmes in Europe.

Practical solutions have been found to allow non-medical personnel to receive and administer injectable naloxone and enable the distribution of the medication to the homes of potential bystanders. Some countries now make the emergency medication available without a prescription to, or have lifted prescription regulations for, specific establishments or those registered as formally trained. The resource summarises the different products used in THN programmes, including naloxone nasal spray, authorised in 2017 by the European Commission for marketing in all EU countries.

Where have drug-related deaths increased most over the last 10 years? Are women and men affected equally? What are the current concerns in Europe? These are some of the questions answered in new Frequently asked questions (FAQs): drug overdose deaths in Europe published on the EMCDDA website. These present the overdose situation and trends as well as a range of maps and graphics. The EMCDDA monitors closely alerts on harms related to fentanyl and its derivatives due to the very high toxicity of these substances and their potential to result in large clusters of incidents and deaths.

Through its Strategy 2025, the EMCDDA is committed to contributing to a healthier Europe. While opioids are involved in the vast majority of overdose fatalities, other substances (e.g. cocaine, benzodiazepines, synthetic cannabinoids) also contribute to the overdose burden and should not be neglected. The resources contribute to a better understanding of drug overdoses and responses to them in Europe to support sound policymaking in this area.

Transition from Global Fund support to national funding: role, opportunities and priorities for civil society in Albania

Source:

The workshop “Transition from Global Fund support of HIV and TB programs to national funding: role, opportunities and priorities for civil society in Albania” took place in Tirana, the capital city of Albania, on 23 – 24 of October and gathered 29 participants including civil society representatives, CCM members, representatives of the Global Fund CRG Team and CCM Hub (online), experts from neighbouring countries and representatives of the governmental structures.

Albanian HIV and TB components became ineligible for regular funding after the 2014–2016 allocations were announced and therefore Albania became eligible to receive transition funding. It will receive a three-year transition grant within the 2017-2019 allocation period. This transition grant is expected to start in January 2020 and will be a significantly lower level of investment—about one third the value of current Global Fund grants. The implementation of the current Global Fund HIV and TB grant is ending in December 2019.

According to the estimated annual needs to sustain HIV and TB responses prior to submitting the transition grant request, Albania’s needs approximately US $3 million to address its two epidemics effectively. Hence US $9 million is required over 2020-2022, the three-year period of the transition grant. With an allocation of just under US $6 million within the current HIV and TB grants, roughly 60% of the funding need is currently being met. Without significant increases in domestic funding, the funding gap is expected to grow in the coming years. Moreover, the services for key affected populations (KAPs) are largely implemented by civil society. Their scale, quality and delivery models are to be improved under the new transition grant. So far, these services have not been funded from domestic resources, though there is an office for civil society and general funding for civil society groups in the country. The national strategies on HIV and TB are expiring in 2019. The Global Fund, under its pilot ‘CCM Evolution Project,’ supports Albania’s HIV and TB governance reforms although with no clear outcome so far.

Community and civil society advocacy is critical at this conjunction of processes to ensure sustainability of the response. But at the same time the transition Funding Request 2020- 2022 poses a direct challenge to the services provided by NGOs being sub-recipients of the Global Fund grant. It is expected that starting from 2020 the number of NGOs supported by Global Fund will become twice lower, decreasing from 12 to 5. It is not clear what happens with the activities implemented by those 7 NGOs left behind and which exactly NGOs this will be.

Taking this context into account, the Eurasian Harm Reduction Association (EHRA) in coordination with the Global Fund Secretariat, decided to organize a workshop for civil society and community representatives in Albania. The workshop aimed to help improve the understanding of local civil society representatives involved in the country’s HIV and TB responses, of the Global Fund transition-related processes currently taking place in country and also to stimulate ideas, plans and opportunities for their meaningful engagement into such processes to ensure the sustainability of HIV and TB response among key affected populations in Albania.

The participants first heard the information about the steps being taken by the government to prepare for transition of HIV/TB prevention interventions from the Global Fund’s support and also about the transition-related risks for HIV response and civil society services. Representatives of the Ministry of Finance and Ministry of Health updated the participants on the work being done to secure funding and social contracting from national and local authorities including on the public budget cycles, possibilities to advocate and influence the budget at central and local level. Guest activists from North Macedonia and Montenegro shared their lessons learnt from the transition experiences of their countries with regard to budget advocacy efforts being taken by civil society in these countries to sustain HIV response among KAPs. The representative of the Agency for Support of Civil Society informed the participants about the opportunities of funding available for NGOs, including those related to public health. On the second day of the event the participants also had the opportunity to discuss and plan the advocacy steps need to be taken by civil society in nearest future to ensure the sustainability of services for KAPs as well as to discuss their Global Fund related TA needs and plan the possible content of the potential requests for the support within the Global Fund CRG TA Program.

DPNSEE President Vlatko Dekov presenting lessons learnt from North Macedonia

Genci Muçollari, Executive Director at DPNSEE member organisation Aksion Plus who participated in the workshop, thinks that “It was an interesting workshop though we were expecting high level presentation from the GF and the Ministry of Health and Social Protection (MHSP). World Health Organisation representatives were attending, other NGOs as well. Above all discussions among partners, the role of the MHSP and the Albanian government is very important to ensure a gradual transition from Global Fund to state funds through social contracting and other ways of contribution both in money and in kind to programs and activities covered before by GF. The workshop organizers presented some of the funding opportunities from other regional donors and call for proposals in order to support activities after the GF.

The event was organized by the Regional Platform for Communication and Coordination for the EECA Region, hosted by Eurasian Harm Reduction Association (EHRA).

Regional Forum on Drug Addiction and Recovery

With over 240 member organisations World Federation Against Drugs (WFAD) organises a World Forum Against Drugs every two years and hosts regional conferences together with members throughout the year. The regional Forums against Drugs are hosted in strategic location throughout the world. This year, Belgrade, Serbia has been selected to host the First Regional Forum on Drug Addiction and Recovery for the Balkan region, to be held in Belgrade, Serbia, 19 – 20 of November 2019. The Forum is being organised as part of the ongoing regional project which is a joint cooperation between World Federation Against Drugs and three leading Civil Society organisations in the Balkan region: Izlazak, Celebrate Recovery and Preporod. The three organisation are working within the recovery field and providing support services to active users, individuals in recovery and members of their families, and they are actively involved in shaping drug policies in their countries.

The Forum will focus on Drug Addiction and Recovery within the Balkan region, bringing together representatives of civil society and local authorities. During a two-day Forum, participants are welcomed to a mixture of speeches, testimonies and workshops highlighting the main theme which are addiction and recovery, but will, among other, cover areas such as prevention, the legal status and decriminalization of cannabis and many other. The Forum will further present the results of joint project entitled “Choose Recovery” in Bosnia & Herzegovina, Montenegro and Serbia.

With knowledge of your excellent work, organisers extend a formal invitation for participation in the Regional Forum. The hosts will cover accommodations.

More information and updates are available on the following link http://forum.biramoporavak.com/ (only in local languages).

A publication about our project

In the last decade, an increasing number of donors are withdrawing their support for healthcare. This has been especially true for middle-income countries, where the growth of domestic resources was one of the triggers for donor funding reduction. The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has termed this process as “transition”.

In 2018 the Open Society Foundations, through the Eurasian Harm Reduction Association (EHRA), initiated the project Budget Advocacy and Monitoring in countries of South East Europe. It provided funding to three transitioning countries in the Balkan region – Bosnia and Herzegovina, Montenegro, and Serbia – through the sub-regional network organization, Drug Policy Network South East Europe (DPNSEE), to support budget advocacy for harm reduction services. The local coordinating organisations are Margina, Juventas and Prevent.

The case study looks at the implementation of this project as one of the demonstrations of the SBF mechanism, with the objectives to:

  • Document the pilot in 3 Balkan countries and to analyse the strengths and weaknesses of this approach and to develop suggestions for improvement; and,
  • Document the results, successes, and challenges of the budget advocacy projects supported through this approach.

Our project serves as a pilot for the Sustainability Bridge Funding (SBF), an idea that has been discussed among donors and civil society organizations as a way of mitigating the negative effects of transition and in providing support for key essential services for communities and key populations. As a safety net mechanism, it should respond to gaps in funding and mitigate adverse effects of donor funding withdrawal.

Please find the document following this link>>>

Radian – a new fund to meaningfully address new HIV infections

To address the challenges in EECA and ensure no one is left behind in the global effort to end the HIV/AIDS epidemic, the Elton John AIDS Foundation and Gilead Sciences have partnered together in a ground-breaking initiative called RADIAN. RADIAN aims to meaningfully address new HIV infections and deaths from AIDS related illnesses in EECA through focussed action, investment and resourcing to improve the quality of prevention and care for people at risk of or living with HIV in the region.

The RADIAN ‘Unmet Need’ fund will support local initiatives across the EECA region. Initiatives selected will focus on prevention and care, education, community empowerment, and novel partnerships. The programme will be implemented locally, working with key stakeholders and partners.

The grant will support two grant types:

  • Breaking barriers: Innovating healthcare delivery
  • Building bridges: Community involvement and education

The Fund is welcoming concept notes for evidence-informed solutions implementing in Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Estonia, Georgia, Kosovo, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Montenegro, Republic of Moldova, Russian Federation, North Macedonia, Romania, Serbia, Slovenia, Tajikistan, Turkmenistan, Ukraine, or Uzbekistan. The Fund welcomes concept notes for multi-country projects.

The projects should last under 36 months. Applications are accepted until 15 December 2019. Projects are expected to start from July 2020.

More about the grant is available following this link >>>

Too bad politics and prejudice keep getting in the way

Photo: Aris Messinis/AFP via Getty Images

DPNSEE Board member Marios Atzemis contributed to the article

“We know how to end AIDS”, published by Politico

Greece was never known for the quality of its health system. But in 2009, at least among drug users, HIV was not a major threat – just 15 were diagnosed with the virus that year.

Then came the financial crisis and the harsh austerity that followed. In 2011, another 256 drug users learned they had HIV. In 2012, the number was 484. The reason for the explosion: the Greek financial crisis and the harsh austerity measures that followed.

Marios Atzemis was one of the Greek drug users diagnosed with HIV in 2011. He had been addicted to heroin and a regular in Athens’ open-air drug markets well before the crisis. Then in 2010, street services to help drug users stay safe lost a third of their funding. Atzemis stopped seeing the vans that used to distribute fresh syringes, even as new users were entering the scene, shooting newer, cheaper drugs.

As a community of drug users, we didn’t have an effective means of defense,” said Atzemis, now a harm-reduction coordinator with the Association of People Living with HIV Greece Positive Voice) “It was very easy for us to be targeted and to be scapegoats.”

The doctor refused to put him on anti-AIDS antiretroviral medication until he got clean at a rehab clinic – even though the clinic was on the brink of being shut down for lack of funding.

For Atzemis, now 44, this was enough motivation to wean himself off the drugs. “It didn’t work the same for other people,” he said.

For better or worse, Greece shows that a country doesn’t need to fix its entire health system to deal with HIV. As a case in point, its progress on AIDS hasn’t translated into progress on correlated problems like hepatitis C. Those rates rose during the debt crisis and haven’t ebbed much; based on 2017 data, around 62 percent of drug users in Greece have tested positive for hepatitis C.

The crisis-era HIV outbreak marked “the first time that all the stakeholders – NGOs, state structures, every single one – worked together to face this epidemic,” said Atzemis. “And probably the last time.”

To read full article, follow this link>>>

Ninth European drugs summer school

The University Institute of Lisbon (ISCTE-IUL) and the EU drugs agency (EMCDDA) will be joining forces once again next summer to hold the ninth European drugs summer school (EDSS) on ‘Illicit drugs in Europe: demand, supply and public policies’. Registration is now open for the two-week course, which will take place in the Portuguese capital from 29 June to 10 July.

Through a multidisciplinary and interactive approach to the drugs problem, EMCDDA scientific experts, leading academics, guest speakers, policymakers and professionals having participated in previous rounds of the EDSS, will prepare participants to meet the complex policy challenges in this field – both in Europe and beyond. The focus of the 2020 course will be hepatitis C.

Week 1 of the summer school, focusing on the ‘Drugs problem: substance use and problems, substance characteristics, and market’, will feature lectures on: the global burden of drug-related problems; drug markets in Europe; detecting new drugs; and prevention approaches in demand-reduction interventions. This session will also focus on the EMCDDA’s epidemiological indicators and their use in informing drug policy.

Week 2, dedicated to ‘Policymaking for drug-related issues’, will include lectures on: drug policies and new challenges (concepts, issues and analysis); the use of evidence to inform decision making; drug laws; and monitoring supply reduction and drug enforcement activity. It will also include group discussion exercises on how to use the knowledge acquired during the course, to sustain drug-related debates. Finally, students will be guided through an analysis of the link between evidence and decision-making, including examples of implementation.

Study visits to outreach facilities and to one of the Portuguese commissions for dissuasion will be organised over the two weeks. During the course, students will also participate in interactive workshops to discuss their own projects and views. The course will conclude with an open debate with guest speakers.

The target audiences for the EDSS are: university students, researchers, professionals and administrators interested in working on drug issues. The previous rounds of the summer school brought together students from the EU Member States as well as from Africa, Asia, Australia and the Americas.

In 2020, students will again be able to apply for scholarships and ‘early-bird’ reductions are also available.

Information and registration is available following this link>>>

Have a look at the promotional video of the European drugs summer school below

Record seizures hit synthetic drugs during Europol action

Between 16 and 20 September and on the 25 September, Europol coordinated the EMPACT large-scale Joint Action Days 2019. The actions targeted synthetic drugs and new psychoactive substances and human trafficking, migrant smuggling, document fraud and environmental crime and involved law enforcement authorities from EU Member States, third-party countries and EU bodies.

Joint efforts of 16 Member States, led by the Polish Central Bureau of Investigation have targeted drug traffickers across Europe. These activities brought in an important hit on drug trafficking networks pulling drugs worth more than €85 million out of the illegal market. As an example, 11.3 tonnes of MAPA pre-precursor were seized, disrupting the consequent production of amphetamines. Depending on production methods, this quantity of pre-precursors would have been enough to produce 6.3 tonnes of amphetamine worth nearly €63 million on the European market. This, added to the drugs worth €85 million seized, represents a serious hit against the European drug market.

Other major seizures of narcotics within the drug trafficking hit include:

  • 1 300 kg of cocaine;
  • 22 kg and 1 107 cannabis plants;
  • 19 601 ecstasy pills;
  • 63 kg of amphetamine;
  • 6 kg of MDMA

The overall results from all actions targeting drug and human trafficking, migrant smuggling and environmental crime include:

  • 411 arrests;
  • 54 potential victims of human trafficking identified;
  • 1 million cigarettes and 1 223 kg of tobacco seized;
  • 374 new investigations initiated;
  • 37 000+ law enforcement officers participating;
  • 475 000+ checks of persons (250 000+), means of transportation, postal packages, houses and warehouses;
  • 166 wildlife species seized;
  • 2 471 kg of illegal fisheries.

As the European hub for law enforcement cooperation, Europol coordinated the 2019 large-scale Joint Action Days and supported the operational activities with secure information exchange, cross-checking of data against Europol’s databases and operational analysis, as well as on-the-spot operational support.

The latest action days, JAD Danube 4 and JAD Western Balkans together resulted in 301 arrests and multiple seizures, including 163 forged or falsified documents, 57 weapons and firearms and more than 900 pieces of ammunition.

Third conference of the Slovenian NGO Alliance

ZvezaThe Alliance of Non Governmental Organisations for Drugs and Addictions in Slovenia holds its third conference on 19 November 2019 in Ljubljana under the headline “Unconditional shelter for all: Needs and housing for people with psychoactive substance disorder“.

Participation at the Conference is free. Deadline for applications is 31 October 2019. The application form is available following this link>>>

Have a look at the videos from the last year’s conference following this link>>>