Black days for harm reduction in Bulgaria

June 2020 saw alarming situation in Bulgaria: all harm reduction services with public funding stopped for the second time in three years. The oldest, biggest, and most experienced harm reduction organisation, Initiative for Health Foundation, DPNSEE member organisation, shut down too after a few years of struggling to ensure sustainability. As a consequence, no needle and syringe programs remained open in the country. The only working harm reduction facility for people who use drugs is in Sofia – the Pink House, the drop-in centre run by the Centre for Humane Policy, also DPNSEE member organisation, which covers its costs mainly by individual donations.

More about these black days for harm reduction in Bulgaria is available in the article prepared by Yuliya Georgieva and published by the Drug Reporter you can access following this link>>>.

 

DPNSEE have already warned about the alarming situation last autumn. We have launched an advocacy campaign with our colleagues from Correlation – European Harm Reduction Network and Eurasian Harm reduction Network about the situation with sustainability of harm reduction services in Albania, Bosnia and Herzegovina, Bulgaria and Romania. 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 sent an appeal to the Global Fund to review their eligibility model of supporting middle income countries and a project proposal to the Radian call of the Elton John AIDS Fund. Unfortunately, our efforts were not successful. And the result is here.

Even more, it is expected that the only harm reduction service in Bosnia Herzegovina provided by the organisation Margina will also close as from September.

 

Tool for Gender-Responsive Harm Reduction Services for Women who Use Drugs

The International Network of People who use Drugs (INPUD) and the International Network of Women who use Drugs (INWUD), in collaboration with the United Nations Office of Drugs and Crime (UNODC) HIV/AIDS Section and Koalisi Satu Hati, a community advocacy group in Indonesia, developed On the A-Gender: Community Monitoring Tool for Gender-Responsive Harm Reduction Services for Women who use Drugs. It aims to be a resource for community advocates to begin documenting, evidencing and addressing this state of play. The tool acknowledges the diversity and intersectionality of women who use drugs – including sex workers, lesbian and transwomen.

Worldwide, women who use drugs are vastly underserved within health and social services and programmes. National and international research, services, guidelines, and training programmes are either gender-neutral or male-focused. As harm reduction services are primarily tailored to men, women who use drugs often find their specific needs being unacknowledged and unaddressed, leading to non gender-responsive harm reduction services.

This resource can be a useful and a practical first step towards developing advocacy strategies to introduce and scale up gender-responsive harm reduction services in various settings around the world. In this way, the right to health of women who use drugs can be respected and better promoted.

To read full and download the tool, follow this link>>>

TripApp – guide to a safer journey

Youth Organisations for Drug Action in Europe (YODA) have released the Android version of TripApp – a mobile application designed to reduce the harm associated with drugs.

TripApp includes:

  • Rapid information system sending you alerts from the laboratories that we cooperate with, about particularly dangerous drugs (contaminated, adulterated, high potency) in your area
  • Map of over 1.200 harm reduction services across 15 European countries, such as needle and syringe programs, party-outreach projects, HIV testing, OST etc.
  • Option to submit the results of the colorimetric drug testing that you conduct, into our database, warning other people in your area about dangerous batches
  • Legal info about criminal laws on use, possession, and trafficking of drugs in 30 European countries
  • Harm reduction info

And this all in 16 languages.

More information is available at http://tripapp.org/
Android download here https://play.google.com/store/apps/details
iOS download is expected soon.

Have a look at more

 

First Civil Society Monitoring Report

Taken from the Correlation website

The Correlation – European Harm Reduction Network (C-EHRN) published the first monitoring report covering certain areas of drug policy and practice. The purpose of this report is to enrich the information and knowledge base of harm reduction interventions in Europe from the viewpoint of civil society organisations, meaning organisations that directly work for, and with, people who use drugs. Correlation believe that this approach is a necessary, and useful, contribution to the development of drug policy in the region.

Correlation plan to repeat this reporting on an annual basis to identify developments and changes over time. A lot is being learned in this first pilot phase and adaptations to the focus and questions will be made, accordingly, as well as a recognition of certain limitations with regards to coverage and validation which we cannot easily overcome. Consequently, the information provided in this report is sometimes anecdotal and represents the situation in a particular city or region and informs us as to the experiences of a specific organisation in the field. Such ‘real life’ information can contribute significantly to an understanding of the advantages, barriers and challenges of drug policy.

Correlation will use the insights and information collected in this report within their advocate efforts to strengthen harm reduction policies in Europe and, hopefully, their partners and contributors will do the same in their environment at a regional and national level.

More than one hundred organisations and individuals from 35 European countries have contributed to the collection of data with an amazingly high response rate. All contributors deserve tanks for their great work and commitment. Without their engagement, this work would never have been undertaken at all.

To read the report, follow this link>>>

 

New case study on HIV prevention in Albania

Eurasian Harm Reduction Association (EHRA) just published the case study “The Challenges of Global Fund Transition in Albania: HIV Prevention Services for Key Populations on the Brink of Collapse” which looks at the challenges which could be faced by country in sustaining HIV prevention programmes among KAPs, implemented primarily by civil society organisations (CSO’s), as a result of the withdrawal of the Global Fund through the transition period.

The purpose of this report is to identify gaps and challenges faced by CSO’s in the transition from Global Fund assistance to government support of services for key populations (KP) under the 2017-2019 grant. Whilst the funding commitment by government institutions is to absorb all costs, the methodology to prepare for this transition, and also the strategy to transfer costs, is unclear.

We hope that the information and arguments presented in this case study as well as the recommendations could be used by the civil society and communities representatives to support their sustainability and transition related advocacy activities as well as to establish the communication with other potential donors to persuade them to establish a ‘safety net‘ through which bridging funds can be made available to address the sustainability related challenges faced by KPs services in country.

HIV Prevention Services for Key Populations on the Brink of Collapse

This case study is available at EHRA’s webpage following this link>>>

 

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 Eastern 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.

Alarming situation in Bosnia Herzegovina

With delay in establishing political structures in the country and reduced international donor support, the situation with harm reduction services in Bosnia Herzegovina became alarming. Here is what we heard from Denis Dedajić, Chairman of the Association Margina and DPNSEE Board member:

The current situation is as follows: the Margin Association is the only survivor with the services and we provide them now and on a larger scale because no other service provided by other NGOs is active, so all clients have turned to us. We are taking over users and equipment from Sarajevo and we shall organise distribution with support of few gatekeepers who used to work for us recently.

I estimate that we will endure until the end of October and after that we shall have no more materials for distribution. The salaries of our staff need not be talked about, as of May we are all volunteers and the funds we had are already spent on transportation and rents of the space we use.

The situation is further complicated by a few things. What concerns us most are the indolence of the authorities and the large waves of migrants coming to Bosnia and Herzegovina. Yesterday, I was in contact with asylum officers and they informed me that about 1.000 immigrants a day enter northern Bosnia and in different ways move west to the border with Croatia and the EU respectively. They aim at Western Europe, but their psycho-physical condition is very poor. There is an increasing number of fatalities, both as a result of illness (quite a large number of TB and Hepatitis C), which is due to conflicts between groups from different countries (Afghanistan Pakistan, Algeria Morocco, Syria, Bangladesh). These conflicts generally end with very serious injuries by knives or other cold weapons. We have had about 100 contacts so far and have been using sterile injection supplies. According to asylum officers, many drug users have been around for several years.

NO one is doing anything on this issue, and we are simply waiting for when a major incident will occur so that everything will surface.

We sincerely hope that a solution will be found soon to revitalize the harm reduction services and ensure health support needed.

Awareness video on human rights and harm reduction approach

Our member organisation Labyrinth invite to check out awareness video-animation they produced on Human rights and Harm reduction approach for people who use drugs in Kosovo.

The video was a part of the project that Labyrinth implemented “Enhancing drug user’s rights and entitlements” and was supported by the EU Office in Kosovo. The purpose of the “ENDURE” project was to create a more appropriate environment for people from marginalized communities to realize health, social and legal rights and to be involved in all processes of social life.

The project aimed to address the needs of discriminated and stigmatized groups by strengthening their capacities to invoke anti-discrimination law. The “ENDURE” project also aimed to raise awareness against discrimination providing legal and psychological support to drug users and improve access to drug users.

In scope of the ENDURE project, Labyrinth prepared two publications (both in Albanian):

Have a look at this excellent video. Subtitles are available both in English and Serbian language.

UNAIDS calls for greater urgency as global gains slow and countries show mixed results towards 2020 HIV targets

Taken from a UNAIDS press release

The pace of progress in reducing new HIV infections, increasing access to treatment and ending AIDS-related deaths is slowing down according to a new report released on 16 July 2018 by UNAIDS. UNAIDS’ Global AIDS Update, Communities at the centre, shows a mixed picture, with some countries making impressive gains while others are experiencing rises in new HIV infections and AIDS-related deaths

We urgently need increased political leadership to end AIDS,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., “This starts with investing adequately and smartly and by looking at what’s making some countries so successful. Ending AIDS is possible if we focus on people, not diseases, create road maps for the people and locations being left behind, and take a human rights-based approach to reach people most affected by HIV.”

The report shows that key populations and their sexual partners now account for more than half (54%) of new HIV infections globally. In 2018, key populations – including people who inject drugs, gay men and other men who have sex with men, transgender people, sex workers and prisoners – accounted for around 95% of new HIV infections in eastern Europe and central Asia and in the Middle East and North Africa.

However, the report also shows that less than 50% of key populations were reached with combination HIV prevention services in more than half of the countries that reported. This highlights that key populations are still being marginalized and being left behind in the response to HIV.

Globally, around 1.7 million people became newly infected with HIV in 2018, a 16% decline since 2010, driven mostly by steady progress across most of eastern and southern Africa. South Africa, for example, has made huge advances and has successfully reduced new HIV infections by more than 40% and AIDS-related deaths by around 40% since 2010.

However, there is still a long way to go in eastern and southern Africa, the region most affected by HIV, and there have been worrying increases in new HIV infections in Eastern Europe and Central Asia (29%), in the Middle East and North Africa (10%) and in Latin America (7%).

Disconcertingly, the report shows that the gap between resource needs and resource availability is widening. For the first time, the global resources available for the AIDS response declined significantly, by nearly US$ 1 billion, as donors disbursed less and domestic investments did not grow fast enough to compensate for inflation. In 2018, US$ 19 billion (in constant 2016 dollars) was available for the AIDS response, US$ 7.2 billion short of the estimated US$ 26.2 billion needed by 2020.

To continue progress towards ending AIDS, UNAIDS urges all partners to step up action and invest in the response, including by fully funding the Global Fund to Fight AIDS, Tuberculosis and Malaria with at least US$ 14 billion at its replenishment in October and through increasing bilateral and domestic funding for HIV.

Progress is continuing towards the 90–90–90 targets. Some 79% of people living with HIV knew their HIV status in 2018, 78% who knew their HIV status were accessing treatment and 86% of people living with HIV who were accessing treatment were virally suppressed, keeping them alive and well and preventing transmission of the virus.

Communities at the centre shows however that progress towards the 90–90–90 targets varies greatly by region and by country. In Eastern Europe and Central Asia for example, 72% of people living with HIV knew their HIV status in 2018, but just 53% of the people who knew their HIV status had access to treatment.

AIDS-related deaths continue to decline as access to treatment continues to expand and more progress is made in improving the delivery of HIV/tuberculosis services. Since 2010, AIDS-related deaths have fallen by 33%, to 770 000 in 2018.

Progress varies across regions. Global declines in AIDS-related deaths have largely been driven by progress in eastern and southern Africa. In Eastern Europe and Central Asia however, AIDS-related deaths have risen by 5% and in the Middle East and North Africa by 9% since 2010.

Communities at the centre shows that the full range of options available to prevent new HIV infections are not being used for optimal impact. For example, pre-exposure prophylaxis (PrEP), medicine to prevent HIV, was only being used by an estimated 300 000 people in 2018, 130 000 of whom were in the United States of America. In Kenya, one of the first countries in sub-Saharan Africa to roll out PrEP as a national programme in the public sector, around 30 000 people accessed the preventative medicines in 2018.

The report shows that although harm reduction is a clear solution for people who inject drugs, change has been slow. People who inject drugs accounted for 41% of new HIV infections in Eastern Europe and Central Asia and 27% of new HIV infections in the Middle East and North Africa, both regions that are lacking adequate harm reduction programmes.

Gains have been made against HIV-related stigma and discrimination in many countries but discriminatory attitudes towards people living with HIV remain extremely high. There is an urgency to tackle the underlying structural drivers of inequalities and barriers to HIV prevention and treatment, especially with regard to harmful social norms and laws, stigma and discrimination and gender-based violence.

Criminal laws, aggressive law enforcement, harassment and violence continue to push key populations to the margins of society and deny them access to basic health and social services. Discriminatory attitudes towards people living with HIV remain extremely high in far too many countries. Across 26 countries, more than half of respondents expressed discriminatory attitudes towards people living with HIV.

The report highlights how communities are central to ending AIDS. Across all sectors of the AIDS response, community empowerment and ownership has resulted in a greater uptake of HIV prevention and treatment services, a reduction in stigma and discrimination and the protection of human rights. However, insufficient funding for community-led responses and negative policy environments impede these successes reaching full scale and generating maximum impact.

UNAIDS urges countries to live up to the commitment made in the 2016 United Nations Political Declaration on Ending AIDS for community-led service delivery to be expanded to cover at least 30% of all service delivery by 2030. Adequate investments must be made in building the capacity of civil society organizations to deliver non-discriminatory, human rights-based, people-centred HIV prevention and treatment services in the communities most affected by HIV.

To read full report follow this link>>>

DPNSEE have made an excerpt with the country data for 10 countries of the region, which you can download following this link>>>