Budapest at the edge of an HIV explosion?

In Budapest's largest needle exchange center, there only remain two or three weeks' reserves of sterile needles and syringes to provide to intravenous drug users – according to NGOs dealing with low-threshold services in the Hungarian capital. Over 2000 drug users could end up without sterile supplies, in the event that the government fails to intervene. Most of these drug users live marginalized lives, in extreme poverty, and are unable to purchase clean needles from pharmacies. They will be forced to share equipment with fellow people who use drugs, posing a major threat of HIV and Hepatitis spread.

A single HIV-positive person in a drug-using community could, within months, infect a couple of hundred people, and though their sexual relations reach out to many more non-drug users. This Russian-roulette situation should be an issue for society as a whole, as much as for the people who use drugs: while HIV treatment for a single person costs around 1000 euros a month, sterile needles and syringes cost a small fraction of this amount.

The situation in Budapest is not unique: Low-threshold services are endangered throughout Hungary. Furthermore, the whole provider structure suffers from similar problems. NGO workers are being sent away, programs shut down, opening hours shortened or no new clients registered. Ultimately, the net result is that harm reduction services are less available.

The phenomenon is not new: For some years now, the problem has received less and less attention, as financial resources have dried up. The Hungarian government dismissed the national drug strategy two years ago – just a year after it was agreed in 2009. According to the official argument, the strategy gave too much attention to harm reduction, and too little to prevention. Despite the ombudsman’s strong concerns expressed back in June, and promises from the government, no new drug strategy has been agreed in the intervening two years. In the meantime, revenue budgets and grants have been significantly reduced. In addition, grants already agreed are subject to constant backlogs, which force NGOs running long-standing successful programs to the brink of collapse.

Some argue that needle and syringe exchange programs are throwing good money after bad, and that the focus should be on drug prevention and treatment, while young people should be scared away from drug use by draconian laws. Real life, however, is not that simple. Nowhere have preventative approaches and laws been developed which significantly lower the number of drug users – while so-called 'deterrence' and zero-tolerance have only made drug use more secretive and risky.

Western European countries have generally learned the lesson that the road to treatment and rehabilitation of people who inject drugs leads through low-threshold services such as needle exchange. Without it the government’s "recovery-oriented approach" mantra remains an empty slogan.

The Hungarian government now plans to set up a central needle depot; but by the time it becomes reality, the worst may already have happened – in which case, there will be a need for more than just needles: HIV and Hepatitis screening, advocacy, condoms, to name a few. Further these centers play a crucial role in those who drug user's life who decide to go on rehab.

Statistics show a reducing number of heroin users in Hungary; but at the same time the numbers of those injecting other stimulants (e.g. amphetamines and designer drugs) are constantly growing. The intravenous use of designer drugs poses several other risks, beyond the fact that the long time effects of the new substances are unknown. Users of designer drugs inject more frequently, giving rise to a greater demand for clean needles, and increasing the risk of HIV and hepatitis spread. Hepatitis C is significantly more infectious: in some districts of Budapest, eight out of ten people who use intravenous drugs are living with the virus. It is thanks to the NGOs providing low-threshold services, that the number of HIV-infected users has so far been kept low, except for Hungarian prisons, from which no reliable data is available.

Hungary has to take seriously the Romanian example. Within our eastern neighbour, until recently HIV spread was kept low, but as a consequence of reduced funds for low-threshold services, and the booming popularity of designer drugs, the number of infections among drug users is now exploding.

The needle exchange providers sent several letters to the responsible minister, Zoltán Balog, without receiving any response. Only after the publication of this article in Hungarian, with an awareness-raising video from HCLU, did the ministry call for a meeting with stakeholders. As another consequence of the media attention, a private donor donated 1000 needles in order to provide urgently-needed immediate help to Kékpont, one of the main harm reduction NGOs in Budapest.

Péter Sárosi (HCLU) / Translated from Hungarian by György Folk