Unlike in Russia or Ukraine, where HIV epidemics have been largely driven by policies that effectively pressure drug users into sharing injecting equipment, HIV had been virtually nonexistent among users of injection drugs in Hungary over the past two decades. This situation is now starting to change, and Hungary may follow the examples of Greece and Romania, where we have seen major outbreaks of HIV among drug users in recent years. The Hungarian Center for Epidemiology confirms that a number of new injection-related HIV transmissions have been registered this year. We have good reason to believe that a major HIV epidemic is inevitable if the government doesn't take immediate action to scale up harm reduction programs. Unfortunately, there is no political will to do so; on the contrary, the largest program providing safe and sterile needles and syringes has announced that it will soon shut down because of its desperate financial situation and political attacks orchestrated by the local mayor.
This needle and syringe program has been operated by the Blue Point Drug Counseling and Outpatient Center NGO in the 8th district of Budapest since 2006. This neighborhood has the highest concentration of drug users in the country - the majority of them unemployed, homeless and facing systematic discrimination as members of the Roma community. Use of injection drugs is on the rise in Hungary, with the number of Blue Point’s clients increasing by 80 percent during 2011 alone. The program serves almost 3,000 clients, and provides almost 40 percent of all the sterile needles distributed among drug users in Hungary.
HIV is but one of the concerns at Blue Point. The prevalence of hepatitis-C has always been very high among their clientele, now infecting over 70 percent. Dubbed the “silent killer” by epidemiologists, hepatitis-C is not as interesting to the public as HIV (even if it is equally dangerous), causing it to be overlooked by decision makers. This oversight, recent changes in the drug market and government obstruction to needle exchange have combined to create a fertile environment for a rapid and widespread outbreak of HIV among Hungarian drug users.
Drugreporter has been warning the government and the public for several years about the danger of blood-borne infections. From 2009 onwards, we witnessed an unprecedented rise in the use of injection for "legal highs" (mephedrone-like substances) among marginalized drug users in Budapest. These new psychoactive substances are injected much more frequently than opiates - as often as 10-15 times a day. This has led to a growing demand for sterile syringes and needles. Unfortunately, this growing demand has been met by an inadequate supply. Despite a brief period of scaling up in the early 2000s, the availability and accessibility of harm reduction services has remained very low, and the situation deteriorated during the first term of the Orban government.
While the United States and many other countries are contemplating drug policy reform, Hungary has declared a new war on drugs. The Criminal Code was amended last July to provide for increased punishments for the simple possession of illicit drugs. The new national anti-drug strategy, adopted last year, subordinates harm reduction to abstinence-only treatment options, and aims to create a drug-free Hungary by 2020 (it is rumored that it was the prime minister himself who insisted on the inclusion of this unrealistic goal).
Due to dramatic budget cuts in 2012, Blue Point, like other needle exchange programs, had to dismiss staff members and reduce opening hours and needle provisions. In addition, the local mayor and his team accused the program of “attracting drug users to the district,” and blamed them for drug litter on the streets. The contract between the NGO and the district council was terminated in November 2013, and they were excluded from the local drug coordination committee. In January, local politicians organized a street protest to shut down the program.
Blue Point announced in June that, due to the hostile political climate and lack of financial resources, they would have to close down the program in September, unless the national government provided an emergency grant. The Ministry of Human Resources rejected their appeal, saying that they have no extrabudgetary funds for a needle exchange program. NGOs are unimpressed by the “no money” argument. They point out that last year the government gave 13,000,000 forints (55,000 USD) to the mayor of the 8th district to fight drug litter on the streets – so why is it impossible to raise the same amount for needle exchange? Not to mention the billions of forints the government spends on arresting and prosecuting drug users every year.
Blue Point argues that the annual budget required to operate its needle exchange program at the current level is approximately 135,000 USD. Medical treatment for a single hepatitis-C or HIV patient can cost thousands of dollars a year - not to mention possible loss of life - so if needle exchange prevents even just a few cases, it has already covered its costs. If the government fails to see that harm reduction is a good investment for the whole of society, it is taxpayers who will have to pay the price.
The closure of Blue Point’s needle and syringe program may have serious consequences for other service providers as well: smaller programs will be unable to cope with thousands of new clients coming from the 8th district, making the whole system liable to collapse. The only thing that figures to gain from such political shortsightedness is the HIV epidemic itself.