Different environments, different risk behaviours: Consequences of decreased coverage of needle exchange programmes in Budapest and Belgrade

By Robert Csák, Irena Molnar, Péter Sárosi, Jovana Arsenijević, Bojan Arsenijević

Our results emphasize that drug related harms are generated in a complex system with intricate connections amongst diverse, heterogeneous actors, in an ever-changing assemblage. We tried to illustrate in this paper how the diverse everyday practices of injecting, combined with the different substances available, the social context of injecting, the physical environment where the substance use occur, could shape the risk behaviours of PWID and the risks of substance use as such. The differences in the prevalence of individual risk behaviours represent the differences in injecting practises in the two communities, and these differences underline the importance of tailoring harm reduction services to the specific needs of the local PWID community. Nevertheless if we would like to implement interventions that can effectively reduce the health risks of substance use, it is necessary to consider environmental, structural factors influencing the consequences of substance use, and aim for responses that could promote an enabling environment, despite it could be hard to transform these factors into variables affecting public health indicators directly

Some of the lessons learnt from our research:

• Although the demographic characteristics of drug users were the same (mostly men in their mid-thirties, with low educational attainment, and poor labour market position), there were differences in drug use. Whilst in Belgrade most people still inject heroin, in Budapest mostly new psychoactive (cathinone-type) stimulants are injected.
• Access to sterile injecting equipment declined significantly in both cities. In Belgrade 78 percent of drug users bought their clean needles in pharmacies. In Budapest, where a few NSPs remained open, this figure was only 51 percent.
• The overwhelming majority of users share their equipment in both cities. The situation was more severe in Belgrade, where half of our sample practiced seven or more types of risky behaviour (compared to one quarter of the Budapest sample).
• Our research confirmed that injecting drug use is a community activity, shaped by the environment and by mediated drug-sharing practices amongst the same marginalised, criminalised groups. Any future interventions should consider these environmental, structural factors.
• In both cities, fewer people have access to HIV/HCV screening and counselling, vein-care products, and social services (eg. housing, employment). The closure of NSPs severely exacerbated the social isolation of their former clients: they reported significantly less access to “a place to sit for a while” or “speaking with social workers”.

The study was conducted by the Rights Reporter Foundation, in co-operation with the NGO ReGeneracija from Belgrade.