Harm Reduction in Romania Valentin Simionov Romanian Harm

Harm Reduction in Romania Valentin Simionov Romanian Harm Reduction Network Budapest, 15 th of December 2014

Who we are? • Umbrella organization representing professionals, service providers and drug users promoting harm reduction • Initiated in 2002, as a networking project with ARAS • Officially registered in 2006 • Constituency: 12 organizations + 12 individual members

What do we stand for? • RHRN mission is to promote harm reduction services and to facilitate the implementation of effective policies and programs targeting people who use drugs and other vulnerable groups by: • rising stakeholders awareness with regards to human rights in relation to drug-related issues; • promoting effective drug policies based on human rights and public health principles; • organizing public campaigns to fight discrimination and stigma associated with people who use drugs and related groups; • advocating for innovative harm reduction services.

Harm reduction principles Needle exchange service management Drugs and related harms Overdose prevention PUD and human rights Brochures on needle exchange and treatment

2013: campaign to STOP HIV among PWID

Advocacy • Amending the current law on drugs • Decriminalization of possession for personal use • Reduced sentences for petty sellers • Alternatives to incarceration • Harm reduction services • Access to public funding for NGOs • Quality standards for drug services • Access to services – underage drug users • Elimination of parental consent for emergency situation (life or health threats) • Coordination between child care and drug services

2000: the beginning of harm reduction in Romania

Overview: 2000 -2003 • Outreach services for SWs – first contact with PWID • the first needle exchange centre in Romania • Introduction of anonymous code: OLI 78 VAL 09 M • HIV prevention: sex education / drug information and education / syringe distribution and exchange • Police harassment • Clients reluctance in their first contact with the service • Needle exchange programs available in three cities

Overview: 2004 -2006 • Cooperation protocols – Police acknowledges the role of harm reduction • Increased reach – 5000 clients (all areas in Bucharest) • Focus on service quality: harm reduction kit, distilled water distributed, rapid testing • 2007: funding crisis

Overview: 2007 -2010 • 2007: OST scale-up – 8 centres are opened • Needle exchange – 9, 000 clients reached (2009) • Beginning of legal highs craze (2008) • Regional Conference on OST – 2008 (SEE) • Decreasing of funding (2010) • 6 NGOs provide harm reduction services in Bucharest

Overview: 2010 -2013 • Harm reduction scale-down • Structural funds (reporting with personal ID) • 2011: 62 HIC cases among PWID are reported by Mo. H • Cooperation with local authorities – reporting with ID info – cofinancing • Users mobilizing • SEP in prisons stop functioning (due to ”lack of demand”) • Needle exchange available in three cities

Formula of the epidemic (Novel psychoactive substances + increased injection rates) – decreased availability of syringes = HIV among PWID

2013: PWID and harm reduction professionals protest to draw public attention over harm reduction scale-back

HIV cases in People Who Inject Drugs: 2008 -2014 800 716 700 640 600 500 407 400 300 155 200 100 3 10 24 2008 2009 2010 0 2011 Series 1 2012 2013 2014

Challenges in controlling the epidemic • The public procurement system determines the procurement of poor quality injection equipment, undermining the harm reduction objective • Overall harm reduction scale-back following the closure of international projects or administrative changes / procedures • Decreased access to HIV testing and treatment for PWID

HIV can be stopped if: • 6000 PWID are reached with clean syringes • 3000 PWID enter opiate substitution treatment • 1000 PWID enter social integration programs • Needle exchange is re-opened in prisons • HIV/ hepatitis/TB testing is made available for PWID and other vulnerable groups

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