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.

 

Our initiative presented at the Global Fund Board meeting

The Developing Country NGO Delegation at the Global Fund published a statement with the 42nd Board Meeting highlights, including 8 important matters they pushed for at the meeting, with ways that civil society can move them forward. The statement is available following this link>>>

The initiative of the three regional networks: Correlation – European Harm Reduction Network, Eurasian Harm reduction Network and Drug Policy Network South East Europe to respond to the critical situation concerning the sustainability of harm reduction services in Albania, Bosnia and Herzegovina, Bulgaria and Romania was among the issues that the Delegation raised at the Global Fund Board meeting. It is mentioned in the point 4 of the statement:

Addressing civil society concerns: The Developing Country NGO brought to the Board and bilateral meetings concerns raised by civil society organisations including those by nearly 100 NGOs about the ending of multi-country grants in West Africa; cases of the failed transitions and interruption of services for key populations, including the lack of funding for harm reduction programs in Albania, Bosnia and Herzegovina , Romania and Bulgaria; and exploring next steps to ensure access to health services, treatment and care in Venezuela.

We hope that the Global Fund will make some concrete steps in helping us find a quick response to the urgent needs and building a sustainable solution in these countries.

 

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>>>

 

The International Overdose Day marked around SEE

On the occasion of the International Overdose Awareness Day (IOAD), DPNSEE issued a press release underlining the importance of awareness and fighting stigma on overdose and presenting data about the issue worldwide and especially in Serbia. The release was published by the national Press agency Tanjug and several other media and portals.

The press release is downloadable following this link>>>

In Montenegro, NGO Juventas also issued a press release (supported by the NGO 4 Life) and held a press conference where Marija Mijović, coordinator of Programme of direct assistance to the people in risk of social exclusion presented situation in the country. A movie “Overdose”, directed by Mladen Vujović, outreach worker at the Drop-in Centre of NGO Juventas, Montenegro in cooperation with the Hungarian Drug reporters, was screened at the Green Montenegro International Film Festval.

Our colleagues from the Romanian Harm Reduction Network created a special video for this year’s IOAD campaign. Have a look at “Voices of the drug users. Episode 1”

Association AREAL and AREALTRIBE group from Slovenia organized a workshop dedicated to the International overdose awareness day on 1 September 2019 in Ljubljana, Slovenia. Participants were educated how to respond if an individual finds himself or herself in that position.

Our colleagues from the Healthy Options Skopje (HOPS) promoted widely their webpages related to overdose and drugs

Thousands of people die each year from drug overdose and the fact is, overdose is an increasing global problem. Spreading the message that the tragedy of overdose and injury is preventable, International Overdose Awareness Day raise awareness of overdose and reduces the stigma associated with the drug-related death. Also, the day of awareness is providing support to families and loved ones of overdose victims, so that no one is forgotten.

Time to remember – time to act.

Romanian Support Don’t Punish YouTube channel launched

The Romanian Harm Reduction Network (RHRN) launched a YouTube channel with videos from users and professionals presenting the Support. Don’t Punish campaign messages “Sprijin. Nu pedepse“. A long-term video campaign started on the Global Day of Action 26 June under the S.DP umbrella.

A special campaign promotional video was prepared and posted at the channel

One of the first clips include a specific message which Professor Michel Kazatchkine, member of Global Commission on Drug Policy, sent to Romania.

A public event was held where activists from various organisations gathered to express their positions on discrimination and stigmatisation of drug users.

The stating videos at the channel will be followed by periodic episodes with practical harm reduction advices.

There are still several videos to be finished and released each couple of weeks, so stay tuned!

To see more photos from the public event, follow this link>>>. Follow the Romanian campaign Facebook page here>>>.

 

Transition of TB program in Romania

Source: Regional Civil Society and Community Support, Coordination and Communication Platform – EECA

35 participants including civil society representatives, CCM members, Global Fund Portfolio Manager, experts from neighbouring countries and representatives of the governmental structures gathered in Bucharest on 13 – 14 of June at a workshop “Transition from the Global Fund support of TB program to national funding: understanding the role, opportunities and priorities for civil society in Romania” to discuss what they can do for a greater sustainability of the country’s responses to the TB and HIV epidemics.

Based on the Global Fund Board’s decision in November 2016 on the allocation of resources for the 2017-2019 allocation period, Romania has been allocated € 4,052,972 for tuberculosis and building resilient and sustainable systems for health. The implementation of this new TB grant in Romania formally started in March 2019 and it is planned to finish its implementation in March 2021. This grant is being considered as the last TB grant for the country to support the transition processes. Although the new Global Fund 2019 Eligibility List does mention Romania as being eligible for TB funding again, yet, the eligibility does not guarantee an allocation, and it is not clear if Romania will be allocated any further funding to support the TB response in 2020 – 2022.

Although Romania is ineligible to receive Global Fund funding for HIV response since 2010 when its last Global Fund HIV grant came to an end, the current “transition grant”, as well as all previous TB grants to Romania, includes a significant component on HIV prevention among key affected populations (KPs). Therefore, civil society mobilization for joint advocacy to ensure the domestic funding of HIV prevention activities among KPs is essential.

At the same time, according to the Global Fund’s Eligibility List 2019 Romania may be eligible for an allocation for HIV/AIDS for non-governmental or civil society organizations if the country demonstrates the barriers to providing funding for interventions for key populations, as supported by the country’s epidemiology. The Global Fund Secretariat will assess whether the criteria have been met at the time of determining allocations for the 2020-2022 allocation period. The decision on the countries‘ allocations within the next 2020-2022 allocation period to be made by the Global Fund Board in November 2019.

Youth Studies South East Europe

The Friedrich Ebert Stiftung (FES) published reports on the experiences and aspirations of youth in Southeast Europe. The FES carried out a representative region-wide survey on a sample of more than 10.000 young people aged 14 – 29 from ten countries in Southeast Europe in early 2018.

“FES Youth Studies Southeast Europe 2018/2019” is an international youth research project carried out simultaneously in ten countries in Southeast Europe: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Kosovo*, North Macedonia, Montenegro, Romania, Serbia and Slovenia. The main objective of the surveys has been to identify, describe and analyse attitudes of young people and patterns of behaviour in contemporary society.

A broad range of issues were addressed, including young peoples’ experiences and aspirations in different realms of life, such as education, employment, political participation, family relationships, leisure and use of information and communications technology, but also their values, attitudes and beliefs.

Findings are presented in ten national and one regional study and its accompanying policy papers, which have been published in both English and the respective national languages.

The most important results are grouped under headlines:

  • A wish to belong to Europe
  • Migration and mobility do not have to be zero-sum
  • Fighting corruption as a crime, not as a concept
  • Employment discourse shifting towards the quality of work
  • A different kind of ‘political’…
  • …which has to do with ‘the social’
  • Give youth a say in Europeanisation

To download the regional study and its accompanying policy papers following this link>>>

You can read the national studies at this webpage.

#SoS_project launched

Alliance for Public Health, leading a regional consortium uniting Network of People living with HIV/AIDS 100% Life, Central-Asian PLH Association and Eurasian Key Populations Health Network (EKHN), manages the multi-country project ‘Sustainability of services for key populations in Eastern Europe and Central Asia region’, funded by the Global Fund in amount up to USD 13 million. The project will be implemented throughout 2019-2021 and aims to reduce the HIV epidemic in the Eastern Europe and Central Asia and South East Europe regions through accelerating progress on Fast-Track by 2020 and to ensure the sustainability of HIV services for key populations in 14 countries of the regions: Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Montenegro, North Macedonia, Romania, Russia, Serbia, Tajikistan, Ukraine and Uzbekistan.

The project launch meeting was held on 26 March 2019 in Kyiv, Ukraine. It gathered all implementing partners, regional and global stakeholders, donors active in the region to discuss the program approaches and plans, get strategies advise and coordinate with other regional initiatives to maximize impact of investment.

At the project coordination meeting on 27 March all regional consortium members, project sub-recipients, implementing and technical partners in the region to discuss and coordinate the concrete plans and timelines for project activities among the implementers.

To achieve the expected savings, the project will develop strategies for optimizing the cost of ART regimens, which will lead to a decrease in the average cost of first-line ART. Advocacy activities will also be carried out aimed at reducing prices for ARVs and using savings to finance the needs of prevention and care services for the Key Groups and PLHIV. In addition, work to optimize clinical guidelines for ART, a list of drugs in accordance with WHO guidelines is planned, as well as advocacy to include countries in voluntary licensing and registration of generic manufacturers.

Andriy Klepikov, the Executive Director of the Alliance for Public Health, said that almost half of these funds ($ 5.6 million) will go to the advocacy of the reduction of prices for ARV drugs and optimization of procurement mechanisms.  Another quarter of the project budget ($ 3.2 million) is planned for budget advocacy. $ 1.6 million is provided for the removal of legal barriers, the same amount for project management. Another $ 1 million will go to operational research.

“The idea is not only to throw in some initiatives, but simultaneously with such interventions to launch operational research, which will help identify and prove their effectiveness,” explained Klepikov. – “It worked, in particular, in Ukraine. But we would not want other countries to take it on faith. In each country for advocacy, before the Ministry of Health will start funding, it is important to get a serious evidence base, which is collected through operational research”.

DPNSEE member organisations Cazas and Timok Youth Centre will be sub-recipients of the project in Montenegro and Serbia, while HOPS is involved in project implementation in North Macedonia.

Global Fund eligibility list 2019

The Global Fund to Fight AIDS, Tuberculosis and Malaria has recently published its updated country eligibility list for 2019. The list reflects the eligibility determinations for the year 2019 (a non-allocation year) and is for information purposes only. Allocations are made once every three years following the outcomes of the Global Fund’s replenishment The 2020 Eligibility List will determine which country components are eligible for an allocation for the 2020-2022 allocation period.

SEE countries affected by changes are Bulgaria, Kosovo*, North Macedonia and Romania. Montenegro and Serbia remain eligible for HIV disease component due to high disease burden.

Bulgaria and Romania may be eligible for an allocation for HIV/AIDS for non-governmental or civil society organizations if there are demonstrated barriers to providing funding for interventions for key populations, as supported by the country’s epidemiology for the 2020-2022 allocation period.

Kosovo is newly classified as an Upper-Middle Income country based on the latest three-year average of GNI per capita data. As Kosovo’s HIV/AIDS and TB burden are ‘Not High’, both the HIV/AIDS and TB components are now eligible for Transition Funding for the 20202022 allocation period.

North Macedonia‘s HIV/AIDS disease burden classification changed to ‘Low’ in 2018 to ‘High’ in the 2019 Eligibility List, resulting in one determination of eligibility. Country components must be eligible for two consecutive eligibility determinations to be classified as eligible on the Eligibility List.

According to the GF Eligibility Policy “Upper-middle income countries meeting the disease burden criteria, but some may be eligible for an allocation for HIV/AIDS to directly finance non-governmental and civil society organizations, if there are demonstrated barriers to providing funding for interventions for key populations, as supported by the country’s epidemiology. Eligibility for funding under this provision will be assessed by the Secretariat as part of the decision-making process for allocations. As part of its assessment, the Secretariat, in consultation with UN and other partners as appropriate, will look at the overall human rights environment of the context with respect to key populations and specifically whether there are laws or policies which influence practices and seriously limit and/or restrict the provision of evidence-informed interventions for such populations”.

To read full document with the eligibility list follow this link>>>>

The South East Europe pre-Conference Meeting held in Bucharest

With the support from the Open Society Foundations, the Drug Policy Network South East Europe organised the South East Europe Meeting on 20 November in Bucharest, Romania, prior to the 4th European Harm Reduction Conference. The event aimed to get together activists working on harm reduction services, exchange experiences and promising ideas for the future, meet with international partners and discuss future opportunities for collaboration. 36 representatives of harm reduction organisations and institutions from countries of the region and from various international organisations attended this meeting: Albania, Bosnia and Herzegovina, Bulgaria, Greece, Kosovo*, Macedonia, Montenegro, Romania, Serbia and Slovenia.

Nebojša Đurasović, Vice-President of the DPNSEE Board opened the Meeting with welcome note and agenda review and announced first session Where is South East Europe now? Sofia Galinaki from Diogenis, the member of the IDPC Members’ Advisory Council, moderated this session. She presented the results of the Harm Reduction Survey. Dragoş Roşca, Romanian Harm Reduction Network, continued this session and spoke about current situation in Romania, Denis Dadajić, from Margina, explained situation in Bosnia and Herzegovina and Silvana Naumova from HOPS, presented current situation in Macedonia.

Facilitating the second session What do we actually do?, DPNSEE Executive Director Milutin Milošević, reminded on some dilemmas, including those of quality in the times of transition and integrated services for all vs. those specific for key sub-populations. Ivica Cekovski from HOPS spoke about the concept of quality in Macedonia. The session continued with Dr Vera Kerleta-Tuzović, Agency for Healthcare Quality and Accreditation in FBiH who presented accreditation of drop-in centres Bosnia and Herzegovina and session was closed with Tomaž Koren, from Alliance of NGOs for Drugs and Addictions, from Slovenia, who talked about quality of services in Slovenia, with special view on harm reduction in nightlife and festival settings.

The pre-conference meeting continued with third session that was moderated by Jelena Čolaković, from the DPNSEE member organisation Juventas, Montenegro. The speakers crossed over specific topic Where do we go from here? and was centred around opportunities for collaboration, including a regional program on sustainability supported by the Global Fund. Vladan Golubovic, from Chairman sent a presentation about the Regional Coordinating Mechanism. Tetyana Deshko, from Alliance for Public Health presented upcoming Global Fund supported regional project “Sustainability of services for key populations in Eastern Europe and Central Asia region”. Then, Mišo Pejković from Cazas spoke about experiences in cooperation in the region. The session was closed by Amarildo Fecanji, from ERA, who talked about potential cooperation between the networks and organisations.

At the last session What else we need to talk about? Ganna Dovbakh from Eurasian Harm Reduction Association emphasized potentials for advocacy in the process of EU Enlargement on national level.

Closing the Meeting, Nebojša Đurasović thanked all for contributing to the Meeting which he found successful. He noted a very friendly and open atmosphere and hoped that the experiences and ideas presented will be a good basis for future cooperation and partnerships.

Photos: Snežana Šundić – Vardić and Sanja Đurasović