(Information also available in Standard table No. ST-10ee and structures questionnaire SQ-23)
In 2003, syringe/needle programmes in Lithuania were executed in Alytus, Druskininkai, Klaipėda, Mažeikiai, Vilnius (Vilnius Centre of Addictive Disorders, AIDS Centre). Each year, the volumes of healthcare services and the number of accessed drug users are growing, possibilities of getting a medical assistance are more widely advertised. Actions provided in the programme, such as ordering of syringes, needles and other required accessories; change of syringes and needles; distribution of condoms and spirit napkins, are carried out; mobile services are organized, used syringes and needles are utilized, etc.
Information activities under the programme are carried out as well: clients are provided with information on safer intravenous use of drugs, on drug overdosing, safer sexual intercourse, treatment opportunities, substitution treatment with methadone (STM), social and psychological assistance, driving licenses for drug addicts. Medical and social experts are provided with information on treatment of individuals addicted to drugs and assistance to such people. A number of information leaflets, reminders and other publications on STM, targeted to patients and physicians, were published. Seeking to extend close cooperation between medical and social institutions, Vilnius Centre of Addictive Disorders published the Reference Book of institutions and agencies engaged in provision of healthcare and social services to persons suffering from addiction to psychoactive substances.
Objectives of Harm Reduction Programmes
The main objective pursued on implementation of these programmes is prevention of spreading of HIV/AIDS (refer to Diagram No. 3.6.1) and other diseases among intravenous drug users and providers of sexual services, by rendering them with medical, social and legal assistance.
Programmed goals are:
1. to maintain contacts with intravenous drug users and to establish new contacts; to provide information on health improvement;
2. to carry out a permanent assessment of intravenous drug users’ needs (including providers of sexual services), particularly through direct contacts of the personnel with clients;
3. to provide an opportunity to intravenous drug users to be rendered with various services, such as changing of syringes and needles, provision of condoms, social and legal consulting, treatment with methadone, as well as detoxication and rehabilitation;
4. to publish of enlightening materials, such as folders and placards targeted to intravenous drug users (including providers of sexual services);
5. to propagate needs of intravenous drug users (including providers of sexual services) and encourage representatives of the Government and municipalities to pay their attention to such needs.
Syringe/Needle Exchange Programmes in Urban Areas of Lithuania In Vilnius (Capital of Lithuania)
Syringe and needle exchange programme has been started in Vilnius since 1997. The mobile syringe and needle change centre Blue Bus started its activities in 2001. This project is implemented by Vilnius Centre of Addictive Disorders (CAD).
Blue Bus arrives to places of maximum concentration of intravenous drug users and providers of sexual services according to the fixed schedule. A client shall be provided with syringes and needles only upon a presentation of the programme participant’s card. Syringe exchange between a client and other drug users is possible only in the case, when participant’s card of the other person (only one) is submitted. These restrictions have been introduced because of an appearance of the suspicion that sales of syringes may be arranged.
In the syringe exchange programme, 3 participants supporting the programme of treatment with methadone (STM) (social workers) and 2 professional social workers, trained by the Project Coordinator and medical professionals, provide consulting services.
Under the programme, clients are provided with appointments for consulting to a psychiatrist, a drug addiction doctor, a surgeon, a dermatologist-venereologist, a gynaecologist, for treatment at Vilnius Centre of Addictive Disorders, primary healthcare institutions, Vilnius Dermal and Venereal Diseases Centre.
In 2003, a quite new system of appointments (so called vouchers) was introduced: its principle is an appointment of an intravenous drug user or a provider of sexual services to a healthcare institution after an assessment of the health status of such person and his/her needs in getting medical assistance. Because most of clients of Blue Bus has no Medical Insurance Police, services of doctors at healthcare institutions are unavailable to them.
The programme is financed by Open Lithuanian Foundation (George Soros Fund in Lithuania) and the International Harm Reduction Development programme, Health Division of Health and Social Security Department under Vilnius Municipality; the latter should fully assume financing of Blue Bus since 2004. In 2003, support was provided by Family Health International organization as well.
Klaipėda
Klaipėda is the third town of Lithuania with the population of 196’000 and is the principal seaport of the state.
Klaipėda is situated near the border with the Kaliningrad Region of the Russian Federation, where about 3000 persons infected with HIV/AIDS reside.
Syringe and needle change is carried out at two anonymous consultation centres as well as through Outreach programmes. The first centre was established in 1997, the second – in 2001. The anonymous consultation centres are situated in different locations of the city in order to access a larger number of drug users.
The number of permanent clients (visiting the centre at least once a month) increased from 217 in 1997 to 273 in 1998 and 371 in 1999. In the first half of the year 2003, the number of new clients was 126; 7311 visits were recorded.
Spreading of HIV infection among intravenous drug users was successfully stabilized. 21 new cases of HIV were detected in Klaipėda in 2003 (in 1997 - 21 new cases of HIV, in 1998 – 29, in 1999 – 8 and in 2000 – 11 new cases). On the average, 15 clients a day visit the first centre situated in the old town and about 30 clients attend the second centre. 15-20 persons are accessed through outreach programme.
In each Centre, two persons work simultaneously: a social worker-consultant and an ex drug user. Social workers interchange their workplaces on a regular basis, because elder drug users (over 30 years old) mostly visit the centre situated in the old town, and younger drug users (14-25 years old) more frequently visit the centre situated in the new ward of the town. The latter are provided a wider spectrum of consulting and information. Social workers of both centres share their experience with each other on a regular basis. The centres operate 7 days a week.
The syringe/needle change programme was financed by Environment Protection Fund of Klaipėda Municipality and Open Lithuanian Foundation. Since 2000, the syringe/needle change programme is fully financed by Health Foundation of Klaipėda Municipality.
Before starting an implementation of the syringe/needle change programme, a meeting with police officers had been arranged in order to inform them on intended activities. It was agreed that a drug user bearing a programme participant’s card should not be punished for disposal of a syringe.
Druskininkai
The syringe/needle change programme in Druskininkai is executed by the non-governmental organization Išsilaisvinimas (Liberation).
Druskininkai is a resort town near the borders with Belarus and Poland. Its population amounts to app.
26’000. General social situation of the town is complicated: the level of unemployment here is one of the highest in Lithuania. In Druskininkai, the number of persons using drugs is high in comparison with its population (refer to Diagram 3.6.1)
According to the data of the Primary HealthCare Centre and police, there are 50 registered drug users. At present, 12 persons infected with HIV are registered.
Syringe/needle change centre operates at the premises of Druskininkai Primary HealthCare Centre and STM Programme is being executed here. Tests on narcotic substances and HIV are carried out here as well;
clients may be appointed to primary healthcare institutions, social agencies, etc. Thanks to it, 12 HIV cases among drug users had been disclosed and most of the infected are continuing the treatment of dependence at present. The programme helped to stop a further spreading of HIV infection among all registered users.
Alytus
The syringe/needle change programme is executed at the premises of Red Cross Alytus Committee, the Room Pasitikėjimas (Confidence).
The centre operates on business days. Two doctor’s assistants, one doctor and one nurse-assistant are engaged at the centre. Once a week, a drug addiction doctor provides consulting services to clients.
Employees of the centre also visit known places of drug selling and change syringes there. After HIV outburst at Alytus Prison, the project employees also trained drug users in places of drug selling on making drug injections safer.
Within the first half of the year 2003, 66 new drug users visited the centre. 14 840 syringes were distributed within the first half of the year 2003 (refer to Table)
Financing for the programme had been allotted by the Ministry of Social Security and Labour of the Republic of Lithuania as well as Red Cross of Norway and Germany. Salaries of the programme employees and maintenance of the premises are financed by Alytus Municipality.
Mažeikiai
The population of Mažeikiai is 49’000. In the town, 82 drug users are registered. First 7 cases of HIV were registered in 2001. 18 cases of HIV were diagnosed in 2003 among intravenous drug users, 1 case of HIV – in 2003.
Within the first year of operation (since June 2002), 198 contacts were made, including 18 contacts made through the permanent network, 63 – through outreach programme and 117 – through a secondary change.
Visaginas
Visaginas is the town with the population of 30’000 in the northeast of Lithuania. The town is situated near the border with Latvia and Belarus, a considerable part of the population is Russian speaking, so the language barrier deteriorates their opportunities of getting a job. Complicated social situation of the population is getting worse because of the unclear future of the Ignalina Power Plant - the principal employer in the town. All these social and economical causes have predetermined spreading of drug use in Visaginas.
According to the data of Visaginas Mental Health Centre, 160 intravenous drug users are registered in the town. The number of registered drug users per 100’000 residents in Visaginas remains the highest in the state (refer to Diagram 3.6.1). 1 HIV case is registered in Visaginas. In 2001, the programme became available to 208 clients. Because of the lack of funds, the programme had been terminated for several times and a part of clients was lost during the said breaks, so their number decreased (62 clients in 2002 and 73 clients in 2003). The number of changed syringes decreased as well.
The programme was financed from Open Lithuanian Foundation.
Assessment of Syringe/Needle Change Programmes
Vilnius Centre of Addictive Disorders assessed the efficiency of the programmes by development monthly reports and observance of alternation of the number of new contacts, consultation services provided, and syringes and needles distributed. Assessment of the impact and behaviour is carried out using special questionnaires, seeking to clear up the needs of the clients directly through outreach employees. In Klaipėda Centre of Addictive Disorders, an assessment of the programmes is carried out by accumulation and evaluation of the statistical data of the programme, as well as the epidemiological data and changes in towns. In other towns, the executed programmes had not been assessed. No independent experts carried out an assessment. No commissions, recommendations and standards to ensure the efficiency of the programmes are provided.
Table 3.6.1 Number of Distributed Syringes/Needles in Lithuanian Cities in 2002 and 2003
Town Number of Distributed Syringes /Needles
Annual Coefficient of Syringe/Needle Change
2002 2003 2002 2003
Alytus 59 523 29 770 99% 87%
Druskininkai 8 902 4 300 65% 65%
Klaipėda 84 920 102 551 95% 95%
Mažeikiai 1 403 1 774 30% 86%
Vilnius (AIDS Centre) 89 800 20 971 70% 75%
Vilnius (CAD) 122 474 144 376 80% 81%
Diagram 3.6.1
Prevalence of HIV/AIDS and Intravenous Drug Used (IDU) in Lithuanian Urban Areas
321,3
255,1
331,47
197,35
533,33
192,31
2,8 3,33
101,53
51,02 46,15
22,66 0
100 200 300 400 500 600
Vilnius Klaipėda Alytus Mažeikiai Visaginas Druskininkai
City
IDU 100 000 inh.
HIV/AIDS 100 000 inh.
NOTES: 1. The Diagram presents the towns with highest levels of drug use and HIV/AIDS prevalence and only those where syringe/needle change programmes are implemented;
2. Alytus is an increased risk zone, because HIV outbursts (299 cases of HIV in 2002 and 15 new HIV cases in 2003) were stated in Alytus Prison.
8. Social Correlates and Consequesnces