ARAS alarms on harm reduction crisis in Romania

ARAS – The Romanian Anti-AIDS Association sent an appeal to stakeholders in Romania to join forces in finding solution for the harm reduction crisis which hardly hits this country. Here is the translation of the appeal.

 

ARAS – The Romanian Anti-AIDS Association invites on this occasion to 21 days of action “Support, Don’t Punish”, in which we will contact the decision-makers at central and local level, the executive and legislative bodies, and we will initiate a public dialogue around this topic.

 We are inviting all stakeholders to take a position on the issues raised, to open the communication for solutions and to find support in initiating concrete actions to remedy this situation, which has become chronic.

 For a better explanation of the context and history of the chronic lack of national / local funding in risk prevention and harm reduction services, we send you, below, some relevant information and we are at your disposal for any further questions.

 In the last 20+ years, ARAS has provided harm reduction services for intravenous drug users in Bucharest, based on the recommendations of UNAIDS and WHO and within the limits of available funds. During all this time, we drew the attention of public institutions that, in order for these services to be constant and efficient, they must be supported by policies in the field and funding from the state budget, both at the central and local level.

 At present, ARAS implements harm reduction activities (testing and counselling, referral and support, social assistance), but does not have the funds necessary to provide prevention materials for injecting drug users (sterile syringes) and to cover the real need in the field. The pandemic caused by Covid-19 also strongly affected our area of intervention, especially access to testing, which decreased dramatically, as well as access to treatment and medical services. At the Titan Community Centre (opened by ARAS in 2008) we can no longer carry out harm reduction services, such as offering 1 ml syringes (which cannot be found in pharmacies either), because of lack of funds.

 Therefore, injecting drug users in Bucharest reuse syringes or share them with other users. The result is that HIV infection and viral hepatitis are already spreading, affecting again this category of vulnerable people and hence the community as a whole.

 We remind that the national authorities (Ministry of Health, National Anti-Drug Agency) have always relied on the support of external funding contracted directly by non-governmental organizations and which practically ceased to exist in 2020; still, the responsibility for the health of the citizens is with these institutions, and not with the NGOs.

 We are also stressing that many of the programs supported by public funds are exclusively for people who have an identity card, and some only for those who have health insurance. When public institutions have funded services implemented by NGOs, the contracts contained some limitations that make them completely inappropriate for working with vulnerable people. Moreover, local authorities do not include or budget in their strategies (clearly and explicitly) activities to prevent HIV and HBV and HCV infections, tuberculosis, dedicated to vulnerable people.

 Another important drawback: the National AIDS Plan drafted within a project funded by the Global Fund for AIDS, Tuberculosis and Malaria has been waiting to be approved by the responsible institutions since 2017 (!!).

 ARAS has drawn attention numerous times on these crises and on the optimization of access to services, and we even went to court (together with three intravenous drug users) against the Directorate of Public Health, which is supposed to give syringes for harm reduction. We lost our case and at present we are preparing our file for the European Court of Human Rights (ECHR).

 Romania is part of the global network International Drug Policy Consortium that promotes the objective and open debate on drug policies, and Bucharest is a signatory of the Fast Track cities initiative. The National Anti-Drug Strategy includes the principles of the European Union Strategy on Drugs. Still, the reality proves the contrary.

 On this occasion, we would like to open a dialogue on the need to update these national policies and strategies in order to align with international initiatives in this field, to secure the necessary budget for harm reduction and for prevention in general, and thus to promote the “support, don’t punish” approaches, both in the official documents and in the field.

 

New Correlation Steering Committee elected

Correlation – European network on Social Inclusion and Health, held their first election of the Steering Committee after the reconstruction and enlargement they had in 2018. The Steering Committee is the primary governance and decision-making body of Correlation and consists of the two network coordinators and 6 elected representatives, including at least one community representative.

During the two weeks long open and transparent election process, members of the network had an opportunity to vote among 25 candidates from all around Europe, grouped in three geographic areas. 11 of them were from Central Europe and Balkan and 8 from DPNSEE member organisations.

The result of voting is that almost half of the Committee comes from our region: Péter Sárosi, Mariannela Kloka and Alina Bocai (from our member organisation ARAS). Other Committee members elected are John-Peter Kools, Jose Queiroz, Dirk Schaeffer and Tuukka Tammi.

We congratulate members of the Steering Committee and hope to have a good and fruitful cooperation in the future.

Situation in Romania full of challenges

Delegation of the Drug Policy Network South East Europe with Nebojša Đurasović, Vice-President, Denis Dedajić, Secretary of the Board, and Milutin Milošević, Executive Director, visited Romania on 19 November 2018. It was one of the two remaining in the serial of visits aimed to present DPNSEE to the society, build strong relationships with the authorities, institutions and services and explore opportunities for partnerships.

The situation in the country is far from good with no harm reduction services available outside Bucharest, no support for MSM services and no HIV strategy and strategic plan (a proposed document is in the Ministry of Health for one year but not approved). Opioid Substitution Therapy funding is a nightmare (procedurally), therefore hospitals do not want to engage in that, and Harm Reduction is in a survival mode. State institutions and civil society organisations have different data on key populations, with number of drug users ranging from 9.000 to 19.000.

At the meeting with Sorin Oprea, Director of the Agency for Combating Drugs, in a friendly atmosphere created through recent contacts, we discussed about the potential to raise drug policy higher on political agenda during the Romanian presidency over EU starting in January. We were informed about forthcoming purchase of 900.000 syringes for harm reduction services, the data collecting system that operates well in Romania and will be offered to Turkey, a 3 Million Euro programme that is planned for civil society organisations and plans to develop a system of alternative sanctions. Our interest in protection of personal data of drug users was replied with assurance that the problem was solved and that anonymity is guaranteed. The optimistic situation presented by the Agency was questioned by our civil society colleagues during the next meetings.

Discussion with our colleague Dragoş Roşca, director of the Romanian Harm Reduction Network, presented a bit different and challenging situation in the country. Among others, Dragoş gave us a good insight in functioning of country coordinating mechanism after departure of Global Fund. RHRN mainly functions as a watchdog for state institutions. He informed us that out of 15.500 people living with HIV, 14.000 are on treatment.

Dan Popescu from our member organisation ARAS took us to two methadone centres where they serve almost 500 people. The most vulnerable 100 of them get the service for free, while other can choose to pay 3 Euro for a daily service or 120 Euro for monthly package. We instantly commented that the country should provide the services for free – otherwise people’s basic right for health is not respected! In the centre situated in a large hospital, 11 committed activists work from 7:00 AM to 6:00 PM, supported by a doctor, nurse and social worker. This service operates for 12 years already.

We also had an opportunity to see one of two their outreach team and their van which cruises the streets of Bucharest and provides service on the spot.

The visit was really good opportunity to learn about a variety of issues related to drug policy in this complex and segmented country.

Shall Romania become eligible for Global Fund HIV allocation again?

Today, Romania spends about 70 million euros for HIV treatment, care and support towards reaching universal access, covering 12,247 people with HIV out of 15,212 as of 2017. However, “the Romanian authorities invest practically no money in HIV prevention”, says Nicoleta Dascalu, project manager from the Romanian Association Against AIDS – ARAS. That is why becoming ineligible for the Global Fund’s support of HIV became yet another dramatic episode in Romania’s HIV history.

The Global Fund’s Revised Eligibility Policy was approved at the 39th Board Meeting. In the revised version, the OECD DAC ODA requirement unfortunately was left as it was – but the term “political barriers” in the same provision was replaced with just “barriers,” with a note that eligibility for funding under this provision will be assessed by the Secretariat as part of the decision-making process for allocations. In addition, the Secretariat will look specifically at whether there are laws or policies that influence practices and seriously limit and/or restrict the provision of evidence-informed interventions for key populations.

It is not clear yet if the replacement of the term “political barriers” with just “barriers” will somehow influence Romania’s chance to receive an allocation for its HIV component within the next allocation period; speculation suggests probably not. The only chance for the Romanian HIV component to become eligible again for Global Fund funding is the elimination of the relevant requirement in the Eligibility Policy, says Dragos Rosca, the Executive Director of the Romanian Harm Reduction Network.

Read more in the analysis Ivan Varentsov prepared for the Aidspan website following this link>>>>

Harm reduction, priority theme in Romanian society

In 2018, RHRN – Romanian Harm Reduction Network organized several events within Support. Don’t Punish campaign.

On June 26th, RHRN’s R3 – Revista de Reducere a Riscurilor/ R3 – Harm Reduction Journal was launched within the debate “Harm reduction, priority theme in Romanian society”. Ionut Alexandrescu, president of RHRN, moderated the panel around topics such as peer educators within harm reduction services, legislation for recreational cannabis users, alcohol use and services for people who abuse alcohol and connections between availability and costs of needle exchange programs, methadone treatment and HIV treatment. The event was attended by professionals working in the field and by the manager of Bucharest Ambulance Service.

OLYMPUS DIGITAL CAMERA

For the evening of June 26th, RHRN also scheduled an open air projection of A day in the life: the world of human who use drugs, which was postponed due to weather conditions.

From June 27 to June 29, RHRN – Romanian Harm Reduction Network, ALIAT – Alliance for the Fight against Alcoholism and Addictions, ARAS – Romanian Association against AIDS and PARADA Foundation opened their doors for press and those interested in prevention, harm reduction and rational, human and evidenced-based policies regarding substance use. Open Doors’ motto was (L)egality for health – Drug addiction should be treated at the hospital, not in prison.

A dialogue between civil society and donors

The Open Society Foundations convened civil society activists from HIV, harm reduction, sex worker and LGBT communities from South Eastern Europe and health and human rights donors to discuss opportunities for strategic collaboration to sustain HIV prevention services for key populations and facilitate transition to domestic financing of these programs. The half-day meeting was held on 18 January 2018 in Belgrade, Serbia.

The aims of the meeting were:

  • Share examples of civil society advocacy towards domestic financing of HIV services, including efforts to push national governments to commit to provision and financing of services for key populations;
  • Discuss current challenges sustaining programming for key populations in the region with a specific focus on the threats to the human rights movements, programs, and advocates that were directly and indirectly supported by the Global Fund when it was still active in the region;
  • Present examples of how targeted donor support for civil society engagement in transition and sustainability process can bolster government ownership of the HIV response;
  • Discuss strategies and opportunities to address the service gap and enable civil society to navigate the transition process, as well as roles that donors, regional networks and technical agencies can play.

DPNSEE member organisations representatives were panellists: Denis from Margina and Dragos from RHRN presenting situation in Bosnia Herzegovina and Romania, Ivana from Juventas presenting the promising case study of Montenegro and Milutin, together with two other networks (ERA – LGBTI Equal Rights Association for Western Balkans and Turkey and SWAN – Sex Workers’ Rights Advocacy Network) on possibilities for work together to strengthen national and regional advocacy.

Many organisations were at the list of potential invitees. Finally, around 35 CSO participated. Besides DPNSEE, 9 member organisations were present: Aksion Plus, Margina, Viktorija, Labyrinth, Cazas, Juventas, ARAS, RHRN and Prevent.

The meeting was mainly about presenting situation and needs, with not many questions and comments from the floor. Most of the results were achieved in informal exchanges with other participants. Besides OSF and Global Fund representatives, donors included Embassy of France in Serbia, Mama Cash and Reconstruction Women’s Fund (Serbia). Representatives of other Networks included Eurasian Harm Reduction Network and Eurasian coalition on male Health.

Just after the main meeting of the dialogue, an Informal dialogue on LGBTI and HIV in South-Eastern Europe was organised by the ERA – LGBTI Equal Rights Association for Western Balkans and Turkey. Most of the DPNSEE member organisations participated in the meeting that addressed the current work done, gaps and challenges in collaborating towards protecting LGBTI rights and addressing HIV and needs and opportunities for a regional approach and support of this work.

Representatives of the DPNSEE member organisations at the Dialogue

Street event in Bucharest

The Romanian Harm Reduction Network has organized on the 26th of July 2017 a public event in the old town part of Bucharest, as part of the “Support. Don’t Punish” campaign. There were participants from the Anti-AIDS Romanian Association (ARAS), the Alliance to Fight Alcoholism and Addictions (ALIAT), the Parada Foundation and Totem Association, that distributed flyers and stickers with SDP logo, “The Decriminalisation saves lives!” message, with harm reduction and health centered messages for 7 hours. The Forbidden comics and condoms were distributed.

Street event in the old town part of Bucharest

Organisers posted 3 roll-ups with information on drug use, health and decriminalisation needs. The Totem association was present with their drums, inviting people to sit down, join the singing and find out about the campaign. The street children trained at Parada Foundation joined with Totem in providing a joint circus/drums show.

Geplaatst door Dragos Petru Rosca op Dinsdag 27 juni 2017