With the words of the chair of our Steering Committee and the Program Director at ARAS in Romania, Alina Bocai:

“Since the end of the Global Fund Programmes on HIV in 2010, despite existing evidence on an HIV-concentrated epidemic among people who inject drugs (PWID) in Bucharest, Romania, there were minimal resources allocated to sustain HIV prevention services for PWID and no formal mechanism was developed for subcontracting the harm reduction services performed by civil society organisations. Insufficient and sporadic funding has been allocated by the Social Department of the Municipality of Bucharest and other districts’ municipalities of the capital city to NGOs. Still, the funding was rather focused on social assistance instead of health, it reached a deficient number of PWID (as the primary requirement was to have a nominal reporting system of clients based on ID copies), and it did not cover the entire costs of the harm reduction package. Central authorities such as the Ministry of Health have never funded HIV prevention services for key populations (including PWID) but has always counted on external financial aid (e.g. the Global Fund for HIV and TB grants) and NGOs as service providers in this field. In the last ten years, this resulted in variations in coverage, variations in the service package components, and, finally, many service delivery interruptions. The COVID-19 pandemic posed additional pressure on ARAS’ harm reduction services, leading to difficulties in running outreach activities and establishing direct contacts with PWID and increased programme costs caused by the COVID-19 protection equipment.

There is neither central or local government funding earmarked for HIV prevention services for key populations, including PWID, nor a funding mechanism for NGOs. Consequently, in early February, ARAS – the leading service provider in this field since 2001 with annual coverage of around 3,500 PWID – publicly announced the closure of its mobile unit service (as of 31 December 2020) due to the lack of funds. Additionally, the drop-in centre for vulnerable populations run by ARAS has also reduced its harm reduction activities for the same reason significantly. Carusel, the other service provider, is still on the market. They are reaching yet small numbers of PWID annually and currently face massive pressure from a higher number of clients. Also, syringes and needles are hardly accessible through the pharmacies’ network. 

The closure of these services has been brought to the attention of central and local authorities, national media and political leaders. National authorities came out with the same excuses we have heard for 20 years, either by blaming the small national/local budget available for health/social services or by accusing the legislation that does not explicitly provide the responsibility of the state to fund such services or the lack of an appropriate funding mechanism.”

Photo credit: Daniel Herard