Roma Drug Use HIV Risks

Marel o Del, kas kamel,
le Romes duvar
(God hits whom he chooses; the Rom gets hit twice)

An Exploration of Drug Use and HIV Risks among
the Roma of Central and Eastern Europe
Jean-Paul C. Grund, Hans Verbraeck, Paul Öfner
Project Group Roma & Drugs,
DV8 Research, Training & Development,
Rotterdam/Amsterdam, The Netherlands,
Frankfurt/M, Germany

Acknowledgements
• Funder: International Harm Reduction program,
Open Society Institute, New York.
• Conducted by: DV8 Research, Training & Development.
• We thank the board of DV8 for their intermediary efforts
and general support, and Anita van der Hulst for managing
the financial side of the project.
• We thank all our interview respondents in the Czech and
Slovak Republics, Hungary and Poland.
• Likewise, our gratitude extends to the respondents of the
Internet survey in cities across Central and Eastern Europe.
04/03/01, 12TH IHRC, New Delhi, India

J-P Grund, DV8-RTD

Acknowledgements
• We also wish to thank our three interpreters, Ruben Pellar
(CZ), Molnár Gábor (HU), Hanna Sokolowska, (PL) for
their excellent services.
• We thank Natalia Bobrova for her help with translating,
managing and analyzing the Internet-based survey.
• Josef Radimecky from the Czech Republic, Danica
Klempova and Katarína Jiresová, both from the Slovak
Republic, are thanked for providing additional data on
access to treatment of Roma drug users.

J-P Grund, DV8-RTD

Acknowledgements
• During the writing process we benefited from the
contributions of several people from all points of the
compass, who deserve our gratitude.
• These include the anonymous reviewers within the OSI
network and Sue Simon who collected these reviews;
• Dave Burrows (AU), Richard Braam (NL), Tomás
Zábranski (CZ), Andor Ürmös (HU) and Natalia Bobrova
(USA) for reviewing draft versions.


J-P Grund, DV8-RTD

Background
• Roma migrated from India in the late Middle Ages
• They are probably the first, but certainly the largest
“Ethnic Minority” in Europe.
• Roma have a Long history of being subjected to
Exploitation, Segregation and Persecution, not much
unlike the history of the Jewish People.
• After the social political changes in Central Eastern
Europe and the Newly Independent States (CEE/NIS),
Roma were hit hardest by the economic consequences
of the newly evolving free market.

J-P Grund, DV8-RTD

Background
• Long history of problem use of alcohol and solvents.
• Anecdotal Reports suggest rapid diffusion of Illicit
drugs into Roma communities in all corners of Central
Eastern Europe and the Newly Independent States.
• Almost complete lack of research.


J-P Grund, DV8-RTD

Research Questions
• Main project goal: To describe the state-of-the-art
information among experts and other key informers on
the extent and nature of injection drug use and
associated health risks among Roma in Eastern Europe.
• Resulting research questions:
– What is the extent and nature of (injecting) drug use in the
Roma communities in Eastern Europe;
– What is the extent and nature of HIV/AIDS risk behaviors
among Roma drug injectors.


J-P Grund, DV8-RTD

Research Questions
• To inform the development of pragmatic communitybased HIV prevention and treatment activities for Roma
drug users, the study also explored:
– Existing initiatives and strategies in Roma communities that
address drug use related health problems;
– The level of awareness of the hazards to community health of
an injecting drug use epidemic in Roma communities;
– The interest among Roma organizations and activists to
develop pragmatic community-based HIV prevention and drug
treatment strategies.

J-P Grund, DV8-RTD

Overview of Methodology
Explorative Pilot Study
• Literature Review
• Internet-based Survey of Experts and Key Respondents
(Treatment and HIV Prevention Providers)
• In-depth Interview Study of Key Respondents in Czech
Republic, Slovakia, Poland and Hungary
• Key Respondents: National Policy Makers, Journalists,
Representatives of Roma Self-Organizations, Treatment
and Needle Exchange Providers, and (Peer) Outreach
Workers

J-P Grund, DV8-RTD

• The Internet survey instrument was based on the
original research questions and preliminary findings.
• The survey aimed to generate a bird’s eye view of the
total region—to get an impression of the extent of drug
use; not to generate statistically analyzable data.
• Survey data were entered into Excel and presented in
table form.
• Statistical analysis was not conducted, but data was
cross-tabulated to compute approximations of addiction
rates and participation in treatment and HIV prevention.

J-P Grund, DV8-RTD

Table 1. Respondents of the Interview Study
Phase
Telephone Interviews
In-Depth Interviews

Hungary
13
15 (4)

Country
Czech Republic Slovakia
15
6
19 (11)
7 (2)

Poland
6
3 (1)

• Interviews were conducted in English, German,
Romanes, Czech, Hungarian and Polish.
• Interviews lasted from one hour to more than
two and a half hours.
• All interviews were recorded on mini disk.

J-P Grund, DV8-RTD

• All telephone and in-depth interviews were transcribed
verbatim into word processor files.
• After cleaning, the data was subjected to a qualitative
“Content Analysis,” guided by a formal analysis
protocol and code book.


J-P Grund, DV8-RTD

Results

Extent & Nature of Drug Use


J-P Grund, DV8-RTD

• Both the interview study and the Internet survey
found that a comprehensive view of drug use in
Roma communities is absent in all countries.
• Illicit drug use was unknown of in Roma
communities before the “Velvet Revolutions.”
– “Roma in the Czech Republic were not hard drug users.
Before the revolution there was pervitin in the Czech
republic, but Roma only sniffed toluene. After the
revolution Roma started to experiment with marihuana
and later with heroin and pervitin.”
(Baron of Ostrava Olah Roma)

J-P Grund, DV8-RTD

Start of Drug Use in Hungarian Roma Communities

• Around 1990 drugs began to trickle into the Roma
community of Budapest. So-called “party drugs”
became available in discotheques and clubs, which
were almost exclusively frequented by young
Roma.
• According to the Hungarian Vice-Minister of
Sport and Youth Affairs, the appearance of the
first Roma heroin users came as “a complete
surprise” to Hungarian policy makers.


J-P Grund, DV8-RTD

Start of Drug Use in Czech and Slovak Roma Communities

• In 1995 Czech policy makers first became aware
of the use of illicit drugs in the Roma community.
• Staff of the center for Treatment of Drug
Dependencies in Bratislava described that heroin
use started among Roma in 1989, 1990 in the Olah
Roma and Hungarian Roma communities in
Bratislava.


J-P Grund, DV8-RTD

Prevalence Estimations: Cautionary Notes

• In most CEE countries there are no reliable data
available on the overall number of drug users.
• Estimates of the number of Roma (or other minority)
drug users are particularly problematic, as
ethnicity/cultural background is not registered in
health care facilities, including drug treatment and
syringe exchange programs.


J-P Grund, DV8-RTD

Prevalence Estimations: Data from the Internet Survey
Table 2. Total Number of IDUs and Roma IDUs by City
City
Sofia
Szeged
Estonia
Vilnius
Kishineu
Novorossiisk
Pskov
Rostov Na Donu
Volgograd
Odessa
Poltava


Total IDUs

% of
Population
15-20000
1-1.5
2500
1
7000-8000
0.4-0.5
2000-3000
0.3-0.5
1416
0.2
9000
3.6
380-440
0.2
10000
1
18000
1.7
25000
2
up to 10000
3

Roma % of Total % of Roma
IDUs
No. IDUs Community
2000
10-13
2
3-400
12-16
5-7
100-200
1-3
3-10
50-60
2-3
6-10
564
40
4
No Information Available
No Information Provided
100
1
2.5
2300
13
19
500
2
2
2
>1
3

J-P Grund, DV8-RTD

Prevalence Estimations: Proxy Indicators

• 25% of Patients of the Bratislava Center for
Treatment of Drug Dependencies are Roma.
• 23% of contacts of the street-based needle exchange
program in the same city are Roma.


J-P Grund, DV8-RTD

Prevalence Estimations: Key Respondents

• “it is our impression that of the younger generation
Roma [in the Czech Republic] 10% is somehow touched
by the drug problem.”
(Policy Maker, Czech National Drug Commission)

• Some 25% of heroinists are Roma.”
(Chief Clinician, Drug Treatment Center, Budapest)

• In my generation and milieu, I mean, among my friends,
30% are on drugs. That includes all drugs. Personally,
I know 20 to 30 people who use hard drugs.”
(Rom respondent, working on the establishment of
Drug treatment center for Roma addicts in Budapest)

J-P Grund, DV8-RTD

Extent & Nature Drug Use
Drug Choice

• Inhalation of solvents and alcohol abuse remain
important problems in Roma communities
throughout the region.
• Solvent users are described as very young, with
starting ages even under 10.
• These youngsters reportedly switch to alcohol
during their teens, and, in many cases, end up as
alcoholics.


J-P Grund, DV8-RTD

Drug Choice

• In Slovakia and the Czech Republic, Roma drug users
reportedly mostly use heroin.
• In Budapest, speed, XTC and cannabis products are
regular features of certain nightlife spots, frequented
by Roma.
• But treatment providers contend that heroin is widely
used among Budapest Roma.
• Amphetamine is reportedly the drug of choice among
the Roma participants of the needle exchange
program in Szeged.

J-P Grund, DV8-RTD

Mode of Administration - Czech Republic
• Mode of drug administration seems to vary by area,
context of use, drug of choice and availability.

• In Prague, few Roma heroin users seem to inject. But
outside the capital, the picture becomes less clear.
• There may be a geographical difference:
– In Northern Moravia chasing is reportedly the norm.
– Northern Bohemian users may be more likely to inject.


J-P Grund, DV8-RTD

Mode of Administration - Slovak Republic

• Information from Bratislava is ambiguous. Most
of the Roma sex workers reached by the local
needle exchange program are injecting.
• But the experience of the local (methadone)
treatment program may be more significant:
“Roma started smoking heroin cigarettes. … They only
inject heroin when they are short of money. Right now
when they have money they are chasing the dragon.”
(Nurse, Center for the Treatment of Drug Dependencies, Bratislava)

J-P Grund, DV8-RTD

Mode of Administration - Hungary
• In Budapest and elsewhere in Hungary drugs such as
amphetamines and heroin seem to be used in various
ways, depending on the specific context of use.
• Drug injecting is on the rise among Budapest Roma.
– “… in the last four to five years the patterns of addiction
among Roma are shifting from the classic substances, … to
intravenous drug use.”
(Hungarian vice-minister of Sport and Youth Affairs)


J-P Grund, DV8-RTD

Results

HIV Risk Factors for Roma Drug Users


J-P Grund, DV8-RTD

Prevalence of Injecting Drug Use
• The Internet Survey suggests that injecting is the norm
in the wider CEENIS region, among Roma and nonRoma alike.
• In Hungary, Slovakia and the Czech Republic
prevalence of injecting drug use among Roma is
reportedly lower than among Non-Roma.
• In these three countries IDU prevalence among Roma
may vary from region to region and, in metropolitan
areas, perhaps from neighborhood to neighborhood.

J-P Grund, DV8-RTD

Needle Sharing
“Between Gadjé and Roma drug users [in Budapest] there
is a major difference, Gadjé injecting drug users use
their own needles, but Roma injecting drug users only
have one needle that goes around.”
“Needle sharing is not so popular in Usti, because they
know from us the risks of HIV and hepatitis.”
“[Roma IDUs in Plzen] do not accept needles. They do
not buy needles at pharmacies, but share the needles.
They share needles, but they do not understand the
risks.”
(Outreach Workers, Budapest, Usti nad Labem, Plzen)

J-P Grund, DV8-RTD

Group Drug Use
• Roma use drugs in friendship groups.
• Drugs are used as a “social lubricant.”
• Sharing drugs is a common demeanor.
– “Pervitin is used in groups. Sometimes heroin too. I know a
case of a Rom who earned a lot of money through a
marriage. He shared his heroin with his friends. Heroin
bought with prostitution money is most of the time also
shared among Roma.”
(Outreach Worker, Plzen)


J-P Grund, DV8-RTD

Sexual Risks
• Involvement in prostitution.
• Roma street prostitutes are at the bottom of the
hierarchy in the sex business.
• Taboo on condom use.
• HIV prevention campaigns are not aimed at or
attuned to Roma culture.


J-P Grund, DV8-RTD

Results

Access to Drug Treatment
and HIV Prevention


J-P Grund, DV8-RTD

Access to Drug Treatment and HIV Prevention
• Little has been undertaken to design appropriate drugs
and AIDS policies for Roma communities in CEENIS,
or for minority communities in general.
• Treatment and HIV prevention designed for or aimed at
Roma drug users are virtually non-existent.
• The isolated position of Roma is a large barrier to
utilization, and development of services for Roma IDUs.
• Awareness among Roma self-organizations is extremely
low. Denial is a common response. As a result,
community-based initiatives are in its infancy.

J-P Grund, DV8-RTD

• Roma IDUs have limited access to clean injection
equipment (both @ pharmacies and NEPs).
• Roma do not apply for HIV counseling and testing.
• Overall, participation of Roma in existing drug treatment
programs is negligible.
• In particular in high threshold facilities, such as
residential therapeutic communities, Roma do very
poorly.
• Notable exceptions are methadone maintenance programs
in some CEE cities attract many Roma heroin users.

J-P Grund, DV8-RTD

Table 1. Proportion of Roma patients among a random sample of “Toximans”
in treatment between 1992 and 1999 at ‘CPLDZ’ Bratislava (N = 222)
Ethnicity of Patients Roma (%)
Treatment Modality
All
25.2
Detoxification Unit:
Start
15
Successful completion*
60
Middle Term Treatment:
Start
15
Successful Completion**
17
Methadone Program
36.5
Needle Exchange Program
18

non-Roma (%)
74.8
85
63
85
24
63.5
82

*: Successfully completed 14-day detoxification
**: Successfully completed 10 weeks In-Patient Treatment

J-P Grund, DV8-RTD

Results

Drugs, Addiction and Disintegration


J-P Grund, DV8-RTD

• Drug addiction puts pressure on traditionally strong
norms of solidarity and mutual assistance.
• Increasing numbers of Roma addicts end up on the
street.
• Overdose deaths of young Roma IDUs resulted in
crises in a number of Roma communities
• According to many respondents the larger social fabric
of the Roma communities starts to show cracks.
• Fear for drug-related community disintegration and a
general feeling of insecurity are not uncommon.

J-P Grund, DV8-RTD

• Respondents associate drug addiction with the
disenfranchised status of the Roma, pointing at
discrimination, unemployment and segregation in
particular.
• From this perspective, use of drugs is said to alleviate
the agony of day-to-day life.
– “The drug is alleviating their deprivation.”
– “Heroin is for them the best thing that happened in their life.”


J-P Grund, DV8-RTD

• For an unspecified proportion of the Roma community,
the drug trade provides a pathway to economic
empowerment.
• Participation of Roma in the drug economy changes the
economical balance in their communities and threatens
traditional power structures.


J-P Grund, DV8-RTD

Results

Consequences for Human Rights


J-P Grund, DV8-RTD

• Recent police actions suggest that repressive drug
legislation introduced in the last years may stigmatize
Roma drug users in particular.
– “It is quite plausible that this new drug law is meant to,
and will be used to attack Roma”
(Representative Roma Rights Center)


J-P Grund, DV8-RTD

• The potential negative consequences of the increasing
Roma involvement in drug use and dealing for the
already questionable human rights situation of the
Roma people are potentially immense.
• Collective criminalization.
• Labeling drugs as a Roma-specific problem.
• Scapegoating Roma communities for the spread of
drugs and HIV.


J-P Grund, DV8-RTD

Conclusions
• Drug Use among the Roma may well develop into
Europe’s largest minority drug problem.
• Roma drug users are at increased risk for HIV and
other blood-borne infections.
• Through secondary sexual transmission, the entire
Roma community is at high risk as well.
• Treatment and Prevention is absent or inappropriate.
• Involvement in drug use and trafficking may seriously
aggravate the already feeble human rights situation of
the Roma.

J-P Grund, DV8-RTD

Recommendations
Education & Policy Advocacy
• Roma Leadership: Break the Silence!
– The potentially disastrous impact of the “Twin Epidemic” is
grossly underestimated by the majority of Roma leadership.

• UNAIDS: Support community-based interventions!
– Drugs And HIV among the Roma People is positioned at the
junction of many UN, sometimes conflicting interests.
– Establish a special working group to promote HIV prevention
among Roma and other minority drug users.

• the European Union: Insist on Civil Rights!
– Promote the wellbeing and civil rights of Roma communities
in aspirant member states, including the development of
pragmatic drug treatment and HIV prevention.

J-P Grund, DV8-RTD

Recommendations
Research
• Establishment of a “Roma Community Research
Working Group” (RCRWG)
– Development of a Roma-guided research capacity could
potentially overcome many anticipated barriers to researching
drug use and the associated harms in Roma communities.
– It would facilitate the investigation of drug use patterns and
HIV risk behaviors from within the community.
– Rapid assessment methodologies, as developed by the WHO,
could be applied by trained “community field workers.”


J-P Grund, DV8-RTD

Recommendations
Drug treatment and HIV prevention services for Roma users
• Establishment of drug treatment and HIV prevention
must be positioned within a wider context of community
development.
• Thus, Roma (users) must be involved in developing
appropriate services for Roma drug users, such as:
– Community-based low-threshold drug treatment (e.g. MMT)
– Peer-based HIV prevention strategies: secondary exchange
– Abstinence-only treatment is not in the interest of Roma

• While some traditional Roma leaders advocated coercive
approaches, these should be not be encouraged

J-P Grund, DV8-RTD

Epilogue
"Everyone has the right to a standard of living adequate for the
health and well being of himself and of his family, including
medical care and the right to security in the event of sickness
or disability."
Universal Declaration of Human Rights (Article 25.1)

“Since 1989 the Roma community is increasingly facing longterm unemployment. Since 1989 there has been a steady
increase in drug use. The social problems among parts of the
Roma community helped the spread of the drug epidemic.”
JUDr. Vincent Danihel
Slovak Government Office for Minorities


J-P Grund, DV8-RTD

References
• Presentation:
Jean-Paul C. Grund, Paul J. Öfner, Hans T. Verbraeck: Marel o Del, kas
kamel, le Romes duvar. (God hits whom he chooses; the Rom gets hit twice.):
An Exploration of Drug Use and HIV Risks among the Roma of Central and
Eastern Europe. Presented at the Twelfth International Conference on the
Reduction of Drug Related Harm, Delhi, India, April 2001

• Full Report:
Jean-Paul C. Grund, Paul J. Öfner, Hans T. Verbraeck: Marel o Del, kas
kamel, le Romes duvar. (God hits whom he chooses; the Rom gets hit twice.):
An Exploration of Drug Use and HIV Risks among the Roma of Central and
Eastern Europe. Final Research Report to the International Harm Reduction
Development Program, Open Society Institute, New York. AmsterdamRotterdam-Frankfurt/M: DV8Research, Training & Development, 2000.

J-P Grund, DV8-RTD

Contact Information
• Jean-Paul C. Grund, Hans Verbraeck, Paul Öfner
Project Group Roma & Drugs,
DV8 Research, Training & Development,
Elkenbachstrasse 8,
60316 Frankfurt/M,
Germany
• Address requests for copies or further information to:
jpgrund@cs.com


J-P Grund, DV8-RTD

Roma Drug Use HIV Risks

Recommended

Recommended

More Related Content

Similar to Roma Drug Use HIV Risks

Similar to Roma Drug Use HIV Risks (20)

More from Jean-Paul Grund

More from Jean-Paul Grund (16)

Recently uploaded

Recently uploaded (20)

Roma Drug Use HIV Risks