Study and knowledge-sharing visit to Bern

Study and knowledge-sharing visit to Bern

On November 14th-17th, delegations from Balti, Chisinau (Moldova), Odesa (Ukraine) and Sofia (Bulgaria) conducted a study and knowledge-sharing visit to Bern (Switzerland) to learn about the experience and best practices in building successful and sustainable city models of responses to HIV in key populations. The group of 23 people included representatives of “Fast-Track TB/HIV responses for key populations in EECA cities” project implementing NGOs, partner NGOs, AIDS and TB services, City Health Departments, Members of City Councils, the police and representatives of the key populations.

In the late 1980s and 1990s, a major spike in heroin-related HIV cases occurred in Switzerland. More young people were using heroin, and there was an increase in overdose deaths and heroin-related crime. Large open drug scenes in Swiss cities attracted thousands of drug users daily. A rather repressive and prohibitionist drug policy was unable to cope with these challenges. Health professionals managed to persuade the authorities that continuing with a criminalising, police-based approach would not resolve the problem. Instead, a harm-reduction approach to public health programmes was developed, which included such methods as needle-exchange programs, safe injection rooms and treatment of dependency. Switzerland developed drug policy based on four pillars—policing, prevention of drug use, treatment of drug use, and harm reduction. In 1986, the first safe consumption room in the world was opened in Bern, and in 1994 Switzerland became the pioneer of the ‘heroin clinic’, a safe environment where drug users go to be prescribed and inject pure heroin, as opposed to methadone. In order to cope with the increasing number of heroin users, methadone programs were expanded. More than 17,000 heroin users out of estimated 20,000-22,000 people who inject drugs were included in those programs which previously were very strict. These events were accompanied by thousands of articles in newspapers to promote drug liberalization. Each article started with a sentence like “The drug war has failed” or “Law enforcement criminalizes sick people.” Pictures of people injecting heroin, needles and syringes or joints, were part of the message to habituate the public on drug paraphernalia. The continuous media campaign had a big impact on prevention and therapy. Over the last 30 years, the four-pillar drug policy has led to significant changes in HIV epidemic and drug-related crimes, proving its success.

During the study visit to Bern, licit, CONTACT, the city of Bern and other partners contributed their expertise in establishing a pragmatic and coherent drug policy on national, county and city levels; in innovative harm reduction interventions on HIV, HCV, night life, substitution, safe injection rooms, social enterprises, housing and cooperation with the police for more security in the public space; in the role in designing municipal and county funding and cooperation approaches to support harm reduction, HIV, TB and viral hepatitis interventions.

The delegations had an extensive agenda: the participants visited harm reduction NGOs, counselling centre for sex workers, work integration programs, clinic for addiction and substitution treatment, the Ministry of Health, Bern regional prison where condom, syringe distribution, and OST are available, a pharmacy where PWID have access to OST, a safe injection room, where people can consume drugs, and have access to other services including shower, laundry, healthy and tasty food, and counselling.

The study visit ended with a meeting with the Mayor of Bern, Alec von Graffenried, who stated that only cooperation between the Municipality, the police and NGOs could lead to such successes in response to the HIV/TB epidemic as in Bern.

Summarizing the study visit, the Mayor of Odesa Gennadiy Truhanov said: “We need to change the mentality and philosophy of our people. We will definitely use Bern experience and the changes that were made within the last 30 years with drug use and HIV to change the situation in Odesa for the better. Unfortunately, today we treat people who use drugs as criminals, but we should treat them as sick and addicted people”. Inspired by the Bern drug policy experience, the Mayor Truhanov promised to open a safe consumption room in Odesa that will become the first one in the EECA region.

The Mayor of Balti, Ihor Sheremet thanked the Mayor of Bern Alec von Graffenried for the fantastic drug programs that have been implemented in the city, and stated that implementing them in Balti will be much easier because Balti needs only to ‘copy and paste’ the 30-year experience of Bern. Mr Sheremet promised to share with the Mayor of Bern an action plan to open a safe consumption room in Balti.

Irena Dimitrova from Sofia Municipality in her speech emphasized that the delegation from Sofia during the study visit was really impressed with the scope and the level of services offered to the members of key populations in Bern and said that she hopes that upon her return to Sofia she will be able to ensure that the services for drug users are more patient-centered. She also hopes that Bulgaria will be able to achieve the same level of cooperation between the municipality, the law enforcers and the NGOs as in Bern.

“Fast-Track TB/HIV responses for key populations in EECA cities” project will further support the cities in implementing their ambitious plans during 2018-2019.

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