 Good afternoon. My name is Peter Szarsian from Budapest, Hungary. Today I will tell you a story of a country that had a relatively advanced harm reduction system in the beginning of the 21st century and I will tell you how it fall back into a zero tolerance approach because of lack of financial resources, but mostly because of political populism which is unfortunately hitting my country now. So harm reduction in Hungary started in the early 90s where the first programs harm reduction programs were created and the first needle exchange program was established in 1993 and our first national drug strategy in the year 2000 approved harm reduction programs and in 2007 a social welfare law created a legal basis for the funding of these programs and in 2014 we had 31 needle and syringe programs in the country. Actually most of the drug use in my country it's a very small country with 10 million people and 2 million people living in the capital Budapest and most of the injecting drug use is concentrating in the capital in Budapest and and so the two largest needle and syringe programs provided 55% of all the needles in the country and OST coverage was quite low in Hungary and HIV and hepatitis prevalence among the injecting drug users also remained relatively low compared to for example Eastern European countries so for example hepatitis C prevalence among injecting drug users before 2011 it was not much more than 20% and oops sorry, yeah, and what happened in 2009-2010 was there was this huge shift in the drug market in Hungary so before that heroin and amphetamine dominated the illicit drug market, especially the injecting drug use and in that year new psychotic substances came to Hungary from, you know, these drugs were produced in China and India and they almost completely replaced heroin and amphetamine, which is a quite unique phenomenon in Europe There is only one country Romania according to my knowledge where this happened so like heroin almost disappeared from the market and almost all users switched to from heroin and amphetamine they switched to catenones like methadrone and other synthetic stimulants, which were easily and cheap available and and you know that also meant that the drug market is in a constant change because these substances are changing you know as soon the government is banning one substance a new substance is coming so and you know these substances have different dosage and different use and different mechanism of of effects so that meant that this changing market in and itself was a risk for for drug users and the characteristics of this new psychotic substance injectors for example is that they use or they injected much more frequently than drug users before so it's not rare that people inject 15-20 times a day and that means that sharing of injecting equipment increased and there are the the risk of infections also increased among the new psychotic substance injectors and and There is also a trend to Injects in an unsafe environment more than heroin users so that you know new psychotic substances donate cooking for example so people can use them much more easily and We had much more cases of hospitalization due to paranoia and psychosis with in a new psychotic substance users In 2010 this change in the drug market corresponded with the political change So there was a change of government in anger in 2010 and maybe some of you know that we had a quiet conservative government with Prime Minister Orban with a populistic policy and and actually the the new government rejected The drug strategy that was approved by the previous administration, which was very much pro harm reduction national drug strategy, so they rejected that and They also restricted our criminal laws so they increased punishment for drug use and drug possession and They also had a new recovery oriented approach, which is it was more like abstinence based approach so they they were rejecting the concept of harm reduction and In 2013 they adopted a new national drug strategy, which actually aimed to create a drug-free Hungary by 2020 which is a very ambitious and very stupid Goal, of course and you know just Parallel to these changes the drug budget was Was was in the decline also you see on this graph So the when you know government had this rhetorics of of course we will stop drug use and making drug-free country but at the same time they dramatically drastically cut the budget of of recovery programs and harm reduction programs and and That means that in 2011 there was a huge decline in the availability of of Needles and The services the needle and syringe services were very very underfunded So there is a professional protocol for needle and syringe programs in Hungary and that requires that That's all programs have to employ three and half staff members for each program But actually, you know the the the programs don't get enough money from the government even to pay for the salary of the Social workers working at the Nilexons program not to mention, you know buying Equipment and and all other you know related social services so that that meant like a really bad they they get into a very difficult situation and And the government created a new action plan which didn't mention harm reduction at all and As I mentioned to you the the two largest needle and syringe programs were in Budapest and there is one part of Budapest the district 8 which is a quiet, you know District where many people live in poverty and their unemployment is quite high and There are thousands of injecting drug users in that only on in that district most of these people belong to the Roman minority who are you know discriminated and who are segregated in in the Hungarian society and And that there was a new mayor of course from the ruling party of this populist conservative party and He scapegoated the local needle and syringe programs for For the problems in the districts so he said that the needle and syringe program attracts drug users to his district and He said that he accused the million syringe programs to spreading drug litter on the streets and he you know Spread fear in the population that your children will jump into its needles and and And actually that you know that drug litter Issue was dominating the discourse on needle and syringe programs Even if there was not a single documented case when anyone was injured by needles But there was a many many documented case of getting infected by sharing needles. So The this mayor organized the demonstration in front of the needle and syringe program with some, you know misled local residents and And actually they he started the smear campaign against the new exchange program and in 2014 it had to shut down the program and Just shortly after that the other big needle and syringe programs also shut down in in another part of town because From that program you all the clients from that program moved to the other part of the city and the mayor there also said You know that oh we can't take that and and he just closed the the other program. So that means that more than 50% of Hungarian needle provision just stopped from one week to another in in Hungary and and So that that was a declining access to needles you can see in that graph that the distribution was like declining very sharply and You know that WHO recommends to have at least 200 clean needles per dark users per year while now in Hungary there is a There is like approximately 30 30 needles per person per year and at the same time the clients who visit Needle exchange programs are the number of clients are it's going up. So there are there is a more need for needles But less supply of needles So the consequence of this situation is a growing hepatitis C epidemic in Hungary So According to the National Center of Epidermal Geodata The prevalence of HHCV among injecting drug users rose from 34 percent to 60 percent in three years And you know when hep C is going up that's always a sign of a new HIV epidemic. So we are now pretty much afraid that Like in Romania and other countries we are facing a new HIV epidemic among injecting drug users The problem is that we were you know trying to convince the local and national government about you know to we have to fail to respond to this threat and There were many you know debates and there was even a political debate in the television It's for the televised debate where I was debating a government politician and why I mentioned it that You know sometimes scientific evidence is not enough to Support harm reduction because I was citing data of the National Epidemiological Center and the government politicians said that I don't believe your data I don't trust your data because that is collected through needle and syringe programs. So that I don't trust the needle and syringe program So that's why your data is not reliable So I don't care that so Even if we have the data in Hungary and you know hard facts, but but you know this this debate is so much emotional and We when we realize that we created the campaign because we realized that the key is to convince the local people You know who who are manipulated by the local mayor and we had an advocacy campaign that is called the room in the 8th campaign and the aim was to address local neighborhoods, you know people who live there and and actually We created messages which convinced this try to convince people that harm reduction is good for them It's not only good for drug users, but it's good for the the people who live around And live with drug users so that you know people who use drugs are part of the community and so we Like created the campaign movie And we were going to the streets and collecting signatures We had a campaign website so dude did it online offline different methods had some meetings with the local community we also get some money to have you know city lights advertisements on on the street and Actually even the ombudsman for civil liberties supported our campaign by stating that Harm reduction is beneficial for the whole society and it's it does not only About you know protecting the right to health, but it's also protecting the right to healthy environment, which is Very important when you try to convince people who are not drug users, but who are who live in areas where are affected by drug use so unfortunately Still you know we have this populist government and Unfortunately still the Netherlands finish programs are closed in Hungary What why the story is interesting is that Hungary is a case where the problem is not Mostly it's not the lack of financial resources or at least you know The government does not provide adequate resources, but that's not because they don't have the resources But it's purely an ideological Opposition to the idea of harm reduction and this is happening in the middle of the European Union you know where the European Union has a drug strategy that is Pro harm reduction and the Hungarian government even signed that but still they Don't really implement that so that shows that you know There is a limit of this international multilateral agreements and recommendations when it comes to implementation of these programs at the local level and Even if even if you know there is a the government does not say that We want to shut down needle and syringe programs But there is no political leadership in the in the national level and the local governments can stop harm reduction programs without any you know We not any support from the national government so there is no leadership for for that in Hungary and And I think it's also important to mention or it's a lesson learned is that harm reduction does not exist, you know Isolated from the larger political environment. So when for example in Hungary a civil society scapegoated and and We have now a law Discussed by the Hungarian Parliament that requires us NGOs receiving international funding to register as foreign agents and That that is exported from Russia and You know our government is saying that we are foreign agents And we are spreading, you know Some ideology coming from the West and we are not Part of the Hungarian nation and in this environment. It's really difficult to do any kind of advocacy. So Yeah, and yeah, thank you