Austerity, international donor retreat and poor political support are severely limiting harm reduction responses in several European Union (EU) countries.
A report by Harm Reduction International (HRI) and the Eurasian Harm Reduction Network (EHRN) finds harm reduction funding to be “in crisis” in Bulgaria, Romania, Poland, Greece and Hungary, fuelled by low investment in harm reduction services and high or increasing rates of injecting drug use, HIV and hepatitis C.
Warning that these countries are facing “public health emergencies”, the report calls on the European Commission to create an emergency fund to fill the funding gaps left by the recent or impending withdrawal of Global Fund grants, which have not been replaced by domestic spending.
The report, Harm reduction investment in the European Union, gives a snapshot of harm reduction investment in 18 EU member states, and how austerity measures are impacting services.
Highlighting the link between economic hardship, increased drug use and HIV incidence, HRI/EHRN call on governments to redirect funds from drug enforcement to harm reduction spending, and to better protect harm reduction services from further austerity cuts.
In Greece, national investment in opioid substitution therapy (OST) halved between 2012 and 2015. This is despite the European Monitoring Centre on Drugs and Drug Addiction explicitly advising the Greek government to protect harm reduction funding from cuts. Although the Portuguese government has preserved existing harm reduction investment, it has not increased it to reflect the impact of austerity on increasing living costs, which the report finds has resulted in a streamlining of services and an overburdening of harm reduction workers.
In Bulgaria and Romania, harm reduction services are described as “crippled” following the retreat of international donors and the failure of domestic funding to plug the spending gap. In Poland, harm reduction services are found to have also decreased due to reduced funding in recent years.
Against the backdrop of reduced harm reduction services, HRI/EHRN warns that some countries may experience a rapid increase in HIV and hepatitis C among people who inject drugs due to a rise in injecting amphetamine use. In Hungary, for example, hepatitis C prevalence among people who inject psychoactive substances has doubled between 2011 and 2014, while funding for harm reduction services has reduced.
In general, the report found harm reduction funding to be better in the Western part of the EU, with Belgium, Finland, France, Germany and the Netherlands all displaying strong political will for harm reduction, enabling services to be buffered against the worst impacts of austerity.
Countries in the East such as Estonia are also displaying political support and effective services. This includes the provision of methamphetamine capsules to give people an alternative to injecting methamphetamine, recently implemented in the Czech Republic.
Stressing the importance of political support for the success of harm reduction, Marta Pinto, one of the report’s researchers, said those countries who had protected harm reduction spending show “there is a real possibility to enhance the total amount of money available for harm reduction very considerably if dialogue between funders and harm reduction projects gets improved.”
Efforts to establish current harm reduction spending levels were described as “extremely challenging” by the report’s authors. None of the 18 countries ranked highly for the transparency of their reporting, leading HRI/EHRN to call on governments to address this knowledge gap by establishing systematic monitoring of harm reduction spending.
Describing the sustainability of harm reduction services in Europe as ranging from “fairly certain to extremely insecure”, the report urges national governments to honour the commitments made at the 2016 UN General Assembly Special Session on Drugs. It also calls on the Global Fund to do more to support and encourage countries facing a withdrawal of its harm reduction funding and for the European Commission to develop a new HIV Strategy and Action Plan that has harm reduction as a key focus.