 It's very good to be here, and thanks for the invitation. It is a very important national event, and I'm glad to share with you my experience and the experience of Romanian organizations. As you can see, I just came up from the video to have this presentation. So my presentation will focus, first of all, I will just introduce the organization I'm working for. And then I'll just go briefly in a history of harm reduction in Romania from its beginning until the present. And I will focus on the situation that we're facing today, which is similar to Greece, but unfortunately, we did not have the intelligence to do the right things yet. I'm very optimistic that we will be able to do this in the future. The Romanian Harm Reduction Network is a network formed by 12 organizations and 12 individual members up to now, gathering harm reduction professionals, harm reduction service providers, mainly needle exchange programs or opioid substitution treatment centers, NGOs, and private sector. We also have in the network the social department of Bucharest City Hall. The network was first created in 2002. At that time, as you'll see, there were a few harm reduction organizations in the country. And the goal was to allow organizations to share experience and to increase their quality of service. In 2006, the network was officially registered and it became an association, not just a project as it was before. But first, yeah, OK. So what do we stand for? We promote harm reduction services and facilitate the implementation of effective policies on programs targeting people who use drugs and other vulnerable groups by raising stakeholder awareness with regards to human rights in relation to drug-related issues, by promoting effective drug policies based in human rights and public health principles, by organizing public campaigns to fight stigma and discrimination, and to advocate for innovative harm reduction services such as safe consumption rooms. We're doing some research. These are two research reports we did. One is focusing on the access to clean needles and substitution treatment in Bucharest, in pharmacies, and it was done in 2010. The other one is documenting the increase in use in new novel psychoactive substances, mainly in young people and adolescents. Both of them were done with UNICEF support. And more recent studies went on analyzing the national drug policy and its costs. And also the consequences of pretrial detention over the lives of people who use drugs, what impact on their social reintegration chances and their criminal record as well. We're doing training. This is a picture from a training, and we were understanding the process of preparing a clean shot. And this is an opportunity to talk about injection, a dose, which is risks related to injection. What we are also providing as training topics is harm reduction principles, needle exchange and syringe and needles programs, and management. Over dose prevention, people who use drugs and human rights. And we also provide, produce brochures on needle exchange programs or substitution treatment. We also organize campaigns, communication campaigns. We work with media. We work with international partners. And this is part of the video we just saw prepared in collaboration and also with support of HCLU and Peter and Lisbon were in Bucharest a year ago in order to do this video. We also participate in talk shows as many times as possible and produce articles or help journalists in their efforts to document the situation. And I must say that in the last years, the media overall in Romania has improved its tone over this problem. And I would say they got to understand the complexity of the problem there. No longer talk just about junkies and about the whites and stuff like that. They started to present a more humane portrait of poor populations affected by drug use. And our most important part is advocacy because we use research, training, and communication in order to follow our agenda, which is, as I said, humane drug policies for people who use drugs and vulnerable populations in general. So our first aim is to amend the law on drugs in the sense of decriminalization of possession for personal use because this is in itself blocking the access to services for poor people. And also, it affects the private lives of people who do not necessarily develop problematic drug use. To reduce sentences for petty sellers because our legislation is not very clear. And a person who use drugs and gets two dosages for him and a friend, for example, is seen by the law as a drug dealer. And it sent us to prison as a drug dealer, not as a person who use drugs. And also, to promote alternatives to incarceration. Another part is sustainability of harm reduction services. As Fabiana said, when international donors live the country and as long as the government is not taking over the financial part of the projects, these interventions that we are operating will just be left without any support and forced to decrease their area and range. We also advocate for quality standards because this is the best way to assess the effectiveness beyond epidemiology. We also promote access to services for underage drug users. According to the current legislation, if you are under 16 years old or in the case of needles and syringes, you are not eligible for the program. So from the point of view of law, if an outreach worker provides syringes without parental consent, without asking the mother or the father of a child age 10 years, for example, who is injecting drugs, it's sort of a very unclear situation from the point of the law. OK, harm reduction started in Romania in 2000. In 1999, there was a small outreach project targeting sex workers. And with this project, the first contact with injecting drug users was made. And in 2000, there was a first needle exchange center in Bucharest in a psychiatric hospital. So at that time, nobody believed that there are so many users in Bucharest. And even the people who were operating this service were skeptical about it. But they just realized the scale of the phenomenon when, like a month later, from the first day of the beginning of the center, they had like 100 clients per day coming and getting syringes. At that time, we introduced an anonymous code because we were concerned with protecting the identity of our clients. And it's a simple code. That's, for example, it's my code. It's three letters from the first name of my mother, year of birth, my three letters from my first name, month, and the gender. And we used this code to gather information about the age of the people who were accessing the services and also to gather information about the gender distribution. So from then, we know that about 25% of the clients accessing programs are female and the rest are male. And we had also information about how many underage people we have in the system. At that time, police was very reluctant in accepting needle exchange programs or syringe needle programs because they just believed that it's a way to promote drug use and that our mandate should be to persuade people not to use drugs to stop doing drugs because drugs are bad. And it's easy that you just realize that. And next day, you just stop using. It wasn't the case. So our colleagues in that time had a lot of trouble with police officers. We're just parking their car next to the needle exchange program, waiting for people to get syringes and then harass them and stuff like that. Even the clients were reluctant because they believed that we're undercover police officers who found a smart way to attract drug users and then to arrest them. So that was the part when the programs started to develop. At that time, there were few needle exchange programs were available in three cities in Bucharest, Timishara, and Constanza. And in Constanza, the program was operated by people who use drugs. In 2004, 2006, with global fund support, we managed to scale up the services and we reached up to 5,000 people in two years. We had protocols with police and police finally accepted the existence and effectiveness of needle exchange programs. The focus in that time, because we had access to funding, so we were quite safe for two years, was on quality, on what information we provide, on how we educate people, what are their rights, where they go ask for help in case of medical problems or social situations. And it lasted until 2007 when the first part of the global fund project stopped. And we were in the risk of stopping the services. In 2007, 2010, another round of the global fund, round six, allowed organizations to continue the services and also the United Nations UNODC program allowed state institutions and one NGO to open more open substitution centers. So five new centers were opened by the National Anti-Drag Agency in this interval. Two programs in prisons providing substitution to prisoners as well as two pilot needle and syringe programs in prisons. Also, an NGO with the Infectious Disease Institute in Bucharest opened another opiated center who is still working today. It was the best part of our harm reduction history because in 2009, we reached about 9,000 people with the 1.7 million syringes with the calculated rate of 183 syringes per client. And from 2009, the services continued to go down even though the distribution of syringes sometimes went up. But on a general basis, we're in a crisis right now as we were last year when you guys came in Bucharest and we did this video. In 2008, approximately, new substances like synthetic drugs entered the market as it happened in here as well. First, they were used by people who were not close to injection. But in short time, heroin users just discovered that these drugs were way better in terms of effect and cheaper. And the best thing was that they were legal, so they were no longer facing any issues with police. And all these conditions determined an epidemic of synthetic injection in the communities of people who inject drugs in Bucharest. And just two years later, we had this increase in HIV. At that time, we organized a conference on opiate substitution treatment for the whole Balkan region and for the, sorry, sorry, sorry. Just sorry. I have another line here, which is not on my presentation. I changed some things. So at that time, we also had six NGOs providing needle in syringes, while now we just have two. Starting with 2010, our services went in the crisis because the Global Fund, the main supporter of HIV prevention services for vulnerable populations, canceled the program because Romania is a quite developed country, and we've, as you know, and it's no longer eligible under their eligibility criteria for HIV. So UNODC also ended their project in 2011. The European structural funds allowed organizations to apply just one organization in the network to manage to submit proposals that were approved, which includes needle exchange syringe programs and opiate substitution treatment. And the cost was actually to turn our colleagues in this project into bureaucrats because the European structural funding in Romania is taking the Brussels bureaucracy, adding the Romanian bureaucracy and passing all this bureaucracy to the people who are implementing the project. So in fact, instead of working with people, part of the teams were just doing papers on and on and recording personal information and data of their clients and sending them to the state because the state wanted so. In 2011, for the first time, the Infectious Diseases Institute, which is the national focal point on HIV, signaled a very high increase, actually, compared to a year before 12 cases and now 62 cases in September 2011. And that draw attention of international institutions as well, and World Health Organization, the European Center for Disease and also the European Monitoring Center for Drug and Drug Addiction. They came in Romania in 2000. Actually, I'm not sure if they came in Romania because our government did not ask for WHO to come. Anyway, in 2011, a common paper was published by ACDC and EMCDDA showing that Greece and Romania have major issues with HIV among people who use drugs. Our expectations was that the state will react immediately and do something about it. But it was not the case. There were signs of interest from the municipality of Bucharest. So the Bucharest city hall contracted one organization in the network, the Romanian Association Against AIDS, to provide syringes to drug users in Bucharest under the same condition to gather the ID information because, unfortunately, in our country, this is the only way, I imagine, because of bureaucracy and corruption. It's the only way to double check if that syringe really made it through to the beneficiary and it was not sold or something else by the professionals. So actually, the aim of gathering personal ID information was not to see how many drug users we have and who are they, but just to make sure the syringes were delivered as planned. In 2012, 2011, drug users started mobilizing and started realizing that this is a difficult situation and they have to at least say something about it because to do something about it, it was quite difficult. So on 1 December, 2012, we had the first public statement from the community of people who use drugs done by a colleague who, unfortunately, now is dead because of an overdose. Just a few months after this statement, in 2013, we organized a protest. I will show some images about it. In 2012, 2013, we noticed a general scale down of services, not necessarily in the NGO part, but also on the governmental side. If we had in 2007, 2009, we had effective needle exchange programs in prisons. Starting in 2012, they were canceled, not officially, because even now, if you ask the prison administration, if they have needle exchange programs or syringe and needle exchange programs, they will say, yes, they have. But the condition is that the prisoners have to ask for the syringes. It's by demand. And there is a problem with keeping the confidentiality, protecting the identity of the person. What happens is that if you're a prisoner and you ask for a syringe, the next night, you will have the guards looking for drugs in your room. So nobody actually asks for syringes. So from the point of view of the administration, we don't have any problem with drugs in prisons. So actually, this is the consequence of this policy. Sorry. 2008, we had 52 cases in prisons. And 2013, we have 321 cases in prisons. And about 250, something like that, it's people who use drugs out of these 300 people. But according to the prison administration, it's former drug users. It's very important. It's no longer people who are currently using drugs. It's former. This graph shows how the epidemic started developing. In blue, you have the syringe distribution, which was quite changing over the years. On yellow, you have the emergency cases due to synthetic use, synthetic stimulants, and also synthetic cannabinoids. So there was a peak in 2010. And then the government immediately, after public pressure, of course, criminalized 44 substances. And in 2011, they managed to find legal methods to shut down the shops, which were quite a lot in Romania, I must say. And then you have HIV in red. From 2012 to 2013, it looks like it decreases a bit. But we're talking only about new cases. The formula of the epidemic is novel psychoactive substances. Mainly, I'm actually exclusively synthetic stimulants with an increased number of injection per day per client without syringes. It results HIV. Because people were shutting like three to five times per day. But when they turned to NPS, they started using like 20 to 50 syringes in one period of time. And in conditions when it was absolutely impossible to be aware of the risks. Because apparently, on synthetic stimulants, you lose this skill. 2013, we organized a protest on 26th of June as part of the Support Don't Punish campaign, which is a global campaign which aims to draw attention on people who use drugs and the negative effects of the current drug policy system, which is prohibition, we have to say. The protest was organized in front of three ministries, the Ministry of Health, the Ministry of the Interior, and the Ministry of Labor. And we asked for services, continuation, for removing the ID information from the records, and for more comprehensive services for people who use drugs. The protest gathered about six organizations in the network, professionals and people who use drugs as well. OK, this is what we are facing. Sorry, sorry, sorry. This is the formula of the epidemic I told you about. And this is the protest we're organized. And this is the current situation where we're talking about cumulative cases. From 2008, we have in 2014 716 cases until September 2014. So we are still waiting for the government to do something about it, or to hope that international donors will come back in the country and will allow us to continue what we started. We're not alone. We are supported by people all over Europe. That's part of a message campaign organized. Like just a few months ago, to show that international activists are on our side in our fight for funding and for people's lives. This is a group of activists. In the happening we organized in 2013 in front of the Ministry of Health. And they say that stopping the needle exchange programs is the fastest HIV transmission route. That actually was our point. We have the capacity. We have the know-how. We just need the funding to stop this epidemic. And even though it's cheaper compared to any kind of other interventions such as antiretroviral treatment, still apparently there is no funding for it. So the challenge is in controlling the epidemic. When money from the state were available in small amounts, the biggest issue was to procure syringes. And our public procurement system forced us to get the cheapest offer. So the cheapest offer was procured. And the clients of the needle exchange programs rejected the syringes because of their very, very bad quality of the needle, first of all. Overall harm reduction scaled back following the closure of international projects and decreased access to HIV testing and treatment for people who inject drugs. Because a year ago, if I'm not wrong, the access to treatment is no longer universal in Romania. You have to have papers. You have to pay your medical insurance. Otherwise, you don't get or not everybody gets to receive the treatment, which is a pity, because we had this very good practice for years and years. And it stopped right in the moment when people who inject drugs got affected by HIV. Oh. I will just end with a few conclusions. The first conclusion is that harm reduction is developing constantly, but very slowly in Romania. And with some ups and downs, but we are sure that we will continue. And it's impossible to stop after so many years of successful interventions. The harm reduction interventions in Romania are depending on international donors. And the biggest challenge is to secure the funding from national or local budgets. It is cheaper to prevent than to treat. This is just a slogan. State authorities are prioritizing health problems depending on their scale and the type of affected population. Therefore, people who inject drugs, sex worker, Roma minorities, or other vulnerable populations will always be by the end of the list, not because they are difficult or expensive problems, but because there are not so many. And the focus of the government is to cover bigger problems. And as our health system is not the best, we have a lot more other issues to take care of before HIV, unfortunately. And we realized that it took us some years to understand this. HIV gets public attention because it scares people. That's why HIV does not have anything to do with that. And it will get even more public attention because now in our communities with injecting drug users affected by HIV, TB is spreading. And the difference between TB and HIV is that you can get TB by air. So that will be another moment for our population to understand that if we do nothing now, it may be too late to do anything in the future. State representatives invoke the economic crisis to excuse their lack of reaction. In fact, it's not the economic concern. It's the lack of political power of marginalized population. And this is where we have to react. Even though publicly recognized the reality of HIV and it's spread across various marginalized groups, the problem is overpassed by the health and social issues covering broader populations. And also social problems like unemployment, for example, which is like a bigger threat in the country. All right, so that was my presentation. And...