Children and young people, injecting and HIV Under-18 and overlooked

1. Children and young people, injecting and HIVUnder-18 and overlooked Young People and Injecting Drug Use: Overcoming barriers to HIV Prevention and Harmonizing National Laws with the UN Convention on the Rights of the Child Romania’s story IoanaTomus Romanian Harm Reduction Network July 2012

2. Harm reduction services in Romania • 1999: first outreach program (ARAS) • 2000: first NSP drop-in center (ALIAT) • 2004 – 2010: scaling-up syringe exchange programs, with international support (GFATM, UNODC, UNICEF) • June 2010: GFATM Round 6 on HIV ends – HIV prevention services for at-risk groups face financial crisis / the access to services is reduced / NGOs call state attention on the risk of a new HIV epidemic

3. TIME Magazine, September 2010

5. People Who Inject Drugs (PWID) estimates 2011: 17,000 PWID • Syringes distributed • 2009: 2,000,000 • 2011: 900,000 Consequences: • Increase in HIV among PWID • 2010 3% • 2011 18%. • New diagnosed cases, entering the 20-24 age group. • Current situation: May 2012 – 88 new cases, of which 20 are between 15-24 years.

6. Age group distribution of new HIV/AIDS infections in IDUs, diagnosed in 2011

7. Factors that determined the increase of HIV incidence among PWID 1. Rise in consumption or “legal highs” (e.g. mephedrone), especially among young people, with an initiation age as young as 10 years 2. The rate of injection of a legal highs user can reach 20 times daily Currently, based on a estimation of the NAA the total number of “legal highs users” has reached 250,000 (mostly young people)

8. Children injecting drugs and HIV – a story from Romania How is a child defined in Romania? “a human being below the age of 18 years unless under the law applicable to the child, majorityis attained earlier” (Law 272/2004 on the rights of children). Until he/she comes of age all decisions connected to one’s life and well-being are made through a third party: the parent, legal guardian or social care services, including those concerning health. The fundamental principal of the child protection legislation is the “best interest of the child”

9. Who are the children using drugs? • Mostly from Bucharest (the capital city) • Low levels of education/literacy • Social cases (low-income families), homelessness • Major behavioural disorders, including mental health problems • Do not access health services • Children whose parents are working overseas

10. Obstacles to serving the best interest of the child • Children not allowed to use NSP without parental consent; OST is not available under 17 y.o; under-age drug users in public institutions are sent to detox units • Police are entitled to take legal measures against harm reduction service providers who work with under-18s • Lack of proper data collecting mechanisms, even between harm reduction service providers • Lack of a official legislative framework to tackle the issue of children and young people using drugs

11. The practioner’s point of view • Officially, the harm reduction services providers in Romania don’t state that they offer harm reduction services to children • Numerous conflicts with the police and other health professionals • Children and young people using drugs are often treated as “invisible” by the health system

12. Challenges of a harm reduction professional • moral barriers (“is the right decision to give syringes to a child?”) • personal stereotypes of professionals working with young ID • lack of proper communication and referral among service providers, including NGOs • lack of funding for HR services impacts on developing specific services for children and young people • lack of proper instruments (specific knowledge, practices) to create youth-friendly services (for us is mostly learning by doing, without any standardization and formal procedures) • HR services are often disconnected from the social environments most frequented by young people (online and offline)

13. Lessons learned from practice • Minimum Standards for service providers working with most-at risk adolescents (MARA): drop in centers, outreach, sex work, • Capacity assessment of the service providers targeting at-risk adolescents, • Quality evaluation of services offered for MARA and young populations (aged between 10-24 y.o., boys and girls), • Changing the current laws and regulations and introducing a referral mechanism for MARA cases in the public-private social services system, • Research on “legal drugs” use among young users (including children and adolescents), .

14. Recommendations • Standardise the way we monitor the number of children and adolescents who inject drugs internationally • “Know our epidemic” and how it differs from that of adults in order to “know our response” • Make guidance accessible, specific and relevant • Collaborate internationally to produce enabling legal and policy frameworks that respect child rights • Listen to children and adolescents who inject and demonstrate clearly how what they tell us informs our responses • Learn from existing good practice and collaborate internationally to fill the many, urgent gaps

15. Acknowledgements: Gina Apolzan,UNICEFHIV/AIDS Consultant Colleagues from Romanian Harm Reduction Network

16. Thank you for your attention!IoanaTomus itomus@rhrn.ro 004 0724 051 189