Monitoring Report 2020 Executive Summary

A civil society-led monitoring of harm reduction can play an essential role in improving service delivery and contribute to the generation of crucial data for advocacy purposes. Civil society organisations (CSO’s) work directly for, and with, people who use drugs (PWUD) and have a good understanding of their daily needs. Their inside knowledge is critical in developing adequate drug policies and practices.

To complement the work of other monitoring agencies, and to bring insight into how the implementation of harm reduction occurs, Correlation -European Harm Reduction Network (C-EHRN) has published a report on Civil Society Monitoring of Harm Reduction in Europe since 2019. It gathers data on the experiences of harm reduction service providers and service users at ground level, building on a network of national Focal Points (FPs) in Europe. For the 2020 monitoring, C-EHRN includes 35 FPs in 34 countries, as shown in the map below. To get insight at the implementation level, and to profit from the experiences and expertise of FPs, the 2020 monitoring focuses mostly on cities rather than countries.

To read the Executive Summary, available also in several languages, follow this link>>>.

 

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.

 

Civil Society Perspective on Harm Reduction in Europe

Europe represents one of the regions of the world with the greatest number of harm reduction services.

There is no other region in the world where more than 90% of the countries have at least one NSP or OST site, and more than 90% of the countries reference harm reduction in their national drug policies. Nevertheless, stigma and discrimination against people who use drugs continue to exist, and much is needed in terms of supporting and securing access to services and human rights to all different groups of people who use drugs.

More such data can be exclusively found in the second civil society-led monitoring of harm reduction report The Civil Society-led Monitoring of Harm Reduction in Europe 2020 published by the Correlation – European Harm Reduction Network. With more than one hundred contributors and Focal Points from 34 European countries involved, the report aims to make a necessary and useful contribution to the development of drug policy in the region.

Compared to 2019’s report, the information provided in 2020, brings to the forefront of the situation in particular cities or regions showing the experiences of harm reduction providers on the ground. It also bring direct perspectives of people who use drugs. This significant approach will hopefully provide an understanding of the successes and challenges of drug policy and harm reduction implementation.

To read the Report, please follow this link>>>.

Global State of Harm Reduction 2020

Harm Reduction International, an NGO dedicated to reducing the negative health, social and legal impacts of drug use and drug policy, publishes report that provides an independent analysis of harm reduction in the world. Now in it’s the seventh edition, the Global State of Harm Reduction 2020 is the most comprehensive global mapping of harm reduction responses to drug use, HIV and viral hepatitis.

The 2020 report includes:

  • A chapter which looks at the impact of the COVID-19 pandemic and related lockdowns on the provision of harm reduction services worldwide
  • Additional thematic chapters on hepatitis C and tuberculosis
  • Examples of progress in harm reduction from across the world
  • Examples of legal and policy changes which impact harm reduction service provision
  • Foreword by Dr Tlaleng Mofokeng, United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
  • Data on the number of people who inject drugs and the number of people in prison for drug use globally

The report can be downloaded and read in full or by chapter following this link>>>.

DPNSEE have prepared a table with information on Epidemiology of HIV and viral hepatitis, and harm reduction response in South East Europe.

The document is available in PDF format following this link>>>.

 

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>>>