Veza is the first NGO in Serbia that started to work with injecting drug users. The association was created in May 2005, handing over the program led since 2002 by Medecins du Monde France. Veza staff was the first one experienced in this kind of work in the country and that introduced Harm Reduction principles. Veza is recognised by authorities, health institutions and other NGOs as the pioneer in this field. Staff is formed of six Outreach workers, six administrative Office employees and a Director.
KEY PROBLEMS IN SERBIA
Harm Reduction is a set of strategies aimed at limiting health-related and social risks connected to drug use. Harm Reduction is based on the assumption that a drug-free world does not exist. Harm Reduction is based upon this observation, pragmatic and realistic:
- it is better not to take drugs
- if someone takes drugs, it is better not to do it through injection
- if someone injects drugs, the best is to use a clean syringe and to use it only once
Harm Reduction is a global approach including prevention, health care and restored dialogue with the most marginalized. It refuses to repress drug users and prefers to turn them into partners for prevention.
Harm Reduction came into being in the eighties with the AIDS epidemic. Its initial objective was to limit viral infections (HIV, hepatitis) among intravenous drug users. The approach of the target group was possible mainly through outreach activities, that made possible to enter into contact with drug users and then to spread Harm Reduction messages.
Harm Reduction has since extended to comprehensive health care for drug users.
In Serbia, intravenous drug users (IDUs) have to face at least three key problems:
- Limited access to appropriate health care
- Civil society and health professionals in government structures do not have the expertise in Harm Reduction principles as an effective approach to health care for drug users
- Harm Reduction approach is not integrated into the public health care system
Drug addiction is considered as a serious social and health problem by the Serbian government and they recognize the important role of NGOs in addressing the problem. The government has officially voted in Serbian Parliament on February 17th, 2005, the National Strategic Plan against HIV which includes Harm Reduction (HR) principles as effective in the fight against HIV/Aids. However a specific community health approach to drug users is not yet implemented by national health authorities, only a few initiatives are developed at the moment by local NGOs, such as Veza.
No reliable data on drug users in Serbia are available. Drug users are a vulnerable group, they are stigmatized and are at high risk of HIV and hepatitis infection. There is limited access to appropriate health care for intravenous drug users (IDUs), which results from the stigma that surrounds them and the absence of expertise in Harm Reduction (HR) principles in Serbia.
Overall objectives of Veza
- To reduce the risks of communicable diseases in Serbia for drug users and overall population
- To empower civil society and health institutions regarding Harm Reduction
- To promote an open environment in Serbian society regarding issues of drug addiction and relating health risks
- To integrate Harm Reduction into the national public health care system
Main activities of Veza
- To provide a health structure for care and prevention (drop-in centre and mobile unit)
- To provide IEC (Information, Education, Communication) for target group
- To train and sensitize health professionals
- To create and operate an interactive network of HR organizations, local authorities and community-based organizations
1. To provide a health structure for care and prevention (DIC and mobile unit)
1.1 To distribute sterile material to IDUs
1.2 To implement safety measures procedures (destroying medical waste)
1.3 To ensure basic medical treatment and arrange minimum hygiene conditions for IDUs
1.4 To perform HIV and hepatitis testing in the Drop In Centre (DIC) of Veza and follow-up tests
1.5 To refer IDUs to health institutions and follow up (HIV-infected IDUs to Institute for Infectious Diseases of Belgrade, other patients to relevant health structures)
1.6 To develop psychological support to IDUs in the DIC and through referrals
2. To provide IEC for target group
2.1 To conduct an inquiry on background and practices of IDUs
2.2 To inform and educate IDUs and high risk groups on HIV, hepatitis and general health (health regulations, rights and obligations, addresses).
2.3 To organize prevention actions in nightclubs and during festive events (festivals, techno parties)
3. To train and sensitize health/social/police professionals
3.1 To open a training centre on HR
3.2 To organize information and training for health professionals and students in medicine/pharmacy
3.3 To organize information and training for professions potentially connected to HR: psychologists, pharmacists, social workers
3.4 To inform and train on HR other NGOs working in HR or connected to HR field of activities (AIDS)
3.5 To create a website
4. To create and operate an interactive network of HR organizations, local authorities and community-based organizations
4.1 To establish and lead a National Harm Reduction Network (NHRN) of NGOs, Veza being the initiator, contact organization, coordinator and facilitator of this network
4.2 To connect the national network to regional existing networks (South Eastern Europe HR network)
4.3 To standardize HR practices, amongst NGOs and on local and national government levels
4.4. To ensure through the national and regional networks advocacy to authorities on HR
4.5 To lead through the network public awareness raising activities for prevention purposes, to reduce discrimination against IDUs and ensure their integration into the public health care system.
Results achieved
Overview of NGO Veza HR Needle exchange program 2005/2008
| 2005 | 2006 | 2007 | 2008 | |
| Duration of the program (months) | 12 | 12 | 12 | 12 |
| Budget | 257 024 € | 165 584 € | 152 560 € | 149 713 € + material |
| Number of beneficiaries in the field | 239 | 164 | 397 | 373 |
| Number of visits in the field | 1 826 | 1 493 | 1 650 | 1 513 |
| Number of beneficiaries in Drop In center | 396 | 562 | 817 | 776 |
| Number of visits in Drop In center | 2 645 | 4 174 | 4 686 | 6 177 |
| Distributed syringes | 105 457 | 119 703 | 119 331 | 129 005 |
| Returned syringes | 66 490 | 86 261 | 49 148 | 54 314 |
| Ratio (dist./ret.) | 63% | 72% | 42% | 42% |
In addition a study on the drug users attending the program (consumption habits, drug use and injection history, especially socio-professional aspects) was conducted for the first time between August 2004 and October 2005. and updated ever since.
The results of this questionnaire and the relative comments are presented below:
Drug use:
It has been observed in the past few years that the first product intake among the youngest drug user groups also tends to coincide with the first injection. This does not, however, correlate with learning by peers. On the contrary, young people are often isolated.
In light of the number of people treated within the program at least once a year, they are part of the more vulnerable populations. This includes the Roma people, where younger generations often start shooting up at around age of 12.
Heroin consumption is most common, although parallel and combined consumption is also widespread. The use of speed-ball (mixture of opiates and stimulants) is relatively prevalent, with either cocaine or speed, depending on the users financial resources.
Health problems:
Concerning the individuals medical status, it should be noted that about half of the individuals tested for hepatitis C were infected. Certain users bringing their experience to the program explain that they had never shared their injection equipment but only the cooker (spoon) used for making the drug preparation. This shows that users (even those who have been using drugs for a long time) have no knowledge of hepatitis C transmission. Close and individual involvement is therefore necessary to bring about changes in this area.
About a quarter of the drug users do not know their HIV or HCV status. Access to testing must be facilitated and made more accessible in Serbia through proximity actions in collaboration with health establishments.
A little more than half of them suffer from venous problems. We see them every day in the program, including abscess problems and growing numbers of program beneficiaries injecting themselves in the groin.
For the most part, secondary health problems accompany drug intake. They reflect the degrading general condition of the users health, in conjunction with other symptoms that may also be found in the general population (asthma, depression).
A high number of users report to have no updated health insurance card. In practice, this means that they have no access to possible care, except in cases of extreme emergency, although even then physicians can refuse to treat them. The social aspect of the work started within the program must therefore be emphasized in order to help these individuals in their attempts to reintegrate the society and gain access to health care.
NGO Veza internal structure:
- 27 registered member civil society
- 13 paid staff
- 1-yearly meeting by assembly
- 1-yearly meeting by administrative board
- Every 4th assembly meeting votes / election
- Control board is voted by assembly
- Administrative board decided who is president only civil society member
- President has only a representation function
- Executive director is assigned for signing/ decision making
