"We need trained pharmacists, governmental and social workers to improve integrated care in HU"
The NGO INDIT Foundation, based in Pécs, is one of the few organisations, which is providing harm reduction services for people who use drugs (PWUD) in Hungary. The foundation maintains facilities providing medical care services and social support, such as the “Drug Clinic” with outpatient care or opioid substitution therapy (OST), and testing and counselling; and the so-called “Alcohology”, which provides services to people who face problems with alcohol; a drop-in centre and two low-threshold centres with social, peer and outreach services.
András Szabó is working at one of the low-threshold centres of INDIT. In this interview we asked András to tell us about the impact of social and political environment in his harm reduction work and his professional outcomes of the HA-REACT Joint Action in Hungary. András has already been working in the harm reduction field for 10 years. He says that accepting attitudes towards PWUD help to have good work relationships with his clients. His core work is counselling and testing and providing needle exchange.
Question (Q): Hungary is developing repressive political standards in the last years. What are the political and social difficulties in working with PWUD for you?
András: In my opinion, the main difficulty is the actual political situation. Most of the politicians believe that using drugs is a crime and that PWUD are criminals and not citizens who are in trouble or in possible danger, or at risk. The media is reproducing this statement and the general population mount the same opinion. It brings more difficulties into the work with and lives of this community. Some approaches by the government may harm the community. For example, if police catches a person, who is using drugs for the first time, this person is entitled to choose a legal construct called “Diversion”, which in case of recreational drug use is usually a preventive-consulting service, that they need to attend to stay out of prison. After concluding the programme, duration of which is 6 months, the police suspends the criminal prosecution for a period of two years, after which their criminal record is deleted under the condition that this person has not been arrested for drug use again. If the same person is caught again during these two years, the police arrest them and reopens the legal prosecution, which results in a court case and prison sentence and/or fine.
The central governmental administration system on drug use was recently reduced to one office. There is almost no effort to improve this situation; worse, it is aimed to reduce activities towards harm reduction services.
Q: Regarding the HA-REACT Joint Action, what activities did you participated in and how did they contributed to your work?
András: At our Foundation, we provide needle-exchange and perform rapid tests on HCV and HIV. Since our organisation is the only one in the Pécs region, which provides such services, we are happy to participate in trainings and work support programmes.
I was in the trainings on HIV and HCV rapid testing in low threshold services for PWUD (WP4). INDIT received 40 HCV rapid tests and we are monitoring the pre- and post-test counselling in cooperation with HA-REACT representatives. It would have more impact if we could maintain a regular shipment of tests.
Thanks to this project, I learned about the new HCV treatment DAA (directly acting antiviral agents), to cure HCV. Now people can be cured in 99% without side effects. It is a huge breakthrough in the HCV treatment. It was very new to me. I now see how it is important for my consultation work. Sometimes our clients are struggling with good perspectives in their lives and feel helpless; this treatment can cure people and give them a new perspective to build up their lives.
"I would strongly recommend training pharmacy staff, governmental and social workers to improve the integrated care approach, because DAA is now available for everyone who has health insurance in Hungary. Nevertheless, PWUD face policy barriers to receive the treatment while being active drug users.* That is why we need more trained professionals in this sector."
Q: Which problems do you face in your work and what impact had HA-REACT on your work?
András: The main problem was the long pause on the Joint Action in Hungary. After HA-REACT kicked off, the Hungarian government has decided to rearrange their departments and the activities could not be performed in time. Our activities were postponed. The Hungarian Joint Action partner set up a new team and we were waiting until everything was in order.
Within our trainings, I again realised how difficult the work on harm reduction services is in our country. Political and social environment greatly affects our work. We need to learn how to overcome political obstacles to improve our situation on PWUD in Hungary.
On the other hand, I met people who work in the same field and they have similar problems. I had the chance to network and meet international stakeholders. Meeting them and exchange experience add significantly to our harm reduction work.
Q: What do you think we need to focus on in the next years as the European community working on Harm Reduction?
András: At least in our country, the focus should be shifted to changing the attitude of the public and politicians on harm reduction services. Nowadays, most of the people in Hungary think that harm reduction is nothing else but helping the PWUD community to use more drugs, and it is nothing but wasting public money. They cannot see how important and useful it can be, and not only for the PWUD community but for the whole population.
Q: What should be done to reach more PWUD with rapid HIV/HCV testing and to link them to care?
András: My opinion on what to do next is to sustain our work we are doing right now. I think it is always very important to be ready for the new challenges, and get ready to handle them with new proper tools.
Note of the editor: *The current Hungarian guidelines on financing the treatment of viral hepatitis C state that in case of positive history of drug use, the combination therapy can be only initiated in case of 3-month abstinence that needs to be proved by 2 negative drug tests (Guidelines 6.10.2). https://hepreg.hu/custom/hepreg/doc/hepatitis-C_finanszprot%2020150916.pdf