ID: HR19-912

Presenting author: Robert Csák

Presenting author biography:

Robert Csák is a sociologist, His field of research is the structural factors influencing the risks of substance use. Besides His academic activities He worked in needle exchange programmes, did street outreach, HIV/HepC testing and counselling. He is a member of the board of the Hungarian HarmReduction Association.

Consequences of closing needle and syringe programs in Budapest and Belgrade

Robert Csák, Jovana Arsenijević, Péter Sárosi, Irena Molnar, Bojan Arsenijević

Background:
In 2014 the two largest needle and syringe programs (NSP) have closed down in Budapest due to politically driven decisions. In 2015 three out of four NSPs were closed in Serbia, after the Global Fund grants ended, the national government did not ensure domestic funding. In both capitals thousands of injecting drug users were left without access to harm reduction services. The objective of the study was to assess the consequences.

Method
Survey among PWIDs was conducted in Budapest (N=100) and Belgrade (N=138), from February to July 2018, using Respondent Driven Sampling method.The main outcome measures were injecting patterns, access to services and risk behaviours.

Results:
While 22% have not injected in the past month in Budapest, virtually everyone injected in Belgrade. There was a substantial difference in the substance: in Belgrade 94% injected opiates, in Budapest 91% injected new psychoactive substances. There was a significant decrease in access to harm reduction services in both cities. Risk behaviours are prevalent in both cities, the average number of reuse of one syringe is higher in Belgrade, in Budapest respondents share equipment with more PWID. One in ten have never been tested to HIV or HepC, almost two thirds were tested more than 6 months ago.

Discussion:
Both cities has a serious risk environment, however differences exist. In Budapest smoking became prevalent among the former clients of the NEP – service providers in Budapest started to hand out foils as they cannot provide enough syringes, while in Belgrade that is not the case, namely due to extremely poor quality of opioids. The decrease in access to services was worse in Belgrade with a few NSPs still operating in Budapest. These differences underline the importance of tailoring harm reduction services to the specific needs of the local PWID community.