November 2, 2022

In cooperation with the National Health Development Institute, the non-profit organization Convictus Estonia has provided harm reduction services for the past 20 years. Harm reduction services are a scientifically developed cost-effective method of engaging with people who use drugs and minimizing risks associated with drug use. 

The main goals of these services are reducing the spread of blood-borne diseases, counselling clients about less risky behaviours, and directing them to treatment. 

The smaller the number of infected people, the less the state has to pay for their treatment. The state's costs associated with diseases are considerable. For example, in 2018 the cost of HIV medicines in the state budget reached 15 million Euros a year.Additional costs of treating diseases, social assistance and other services significantly add to this. 

By the end of 2019 there were 10 079 HIV-positive people in Estonia, which means that the state spends about 71 107 345 Euros on them yearly.

In Estonia, the proportion of blood-borne infections among people who inject drugs is very high. HIV has been diagnosed in 58% of people who inject drugs, and 90% of them have hepatitis C. 

Data collected by the World Health Organization show that needle and syringe exchange programs can constrain the spread of HIV by 33–42%. In comparison to other health care and social services, the syringe exchange service has been recognized as one of the cheapest and most cost-effective public health measures. 

In 2005, 48% of people living with HIV in Estonia were people who used drugs. In the past 15 years, transmission of HIV has decreased appreciably, and the results of harm reduction measures are outstanding. While back in 2001, the incidence of HIV infection per 100 000 population was 107, today it is only 11,8. 

In the past nine years, incidence of HIV spread by people who inject drugs has fallen from 22,3% to 6,9%. This means that in just nine years, this figure has diminished by 15,4%. 

This shows that the indicators of the HIV epidemic have decreased from a critically high level to a lower one, although this does not mean that the disease is vanquished or that the risk no longer exists. Reaching the current level has been a long-term strategic effort that has required a plethora of services. 

Harm reduction services help to directly curb the spread of the HIV infection. The smaller the number of infected people, the less the state has to pay for their treatment. 

During the period from 2018 to 2021, harm reduction services have removed 1,15 million used syringes from circulation and given out 1,6 million unused syringes to people who use drugs. The need for these services has grown year by year, and they have successfully proven their worth. 

A big part of the harm reduction package is psychological counselling. For a long time, Convictus has employed psychologists and peer-to-peer counsellors with specific corresponding competences, whose contribution to making the set of harm reduction services as a whole effective has been extremely important. While it’s critical to use clean equipment when injecting drugs, this may not provide solutions to the problems that have caused people to start using drugs in the first place. Psychological counselling allows people to work through their past traumas, complexes and fears — everything that holds them back from functioning as a full member of society. Psychologists and counsellors are the ones who motivate people who use drugs to turn to rehabilitation services. Psychologists have the qualifications and the competence needed to create humane and respectful relationships with people who use drugs — relationships that make people feel appreciated and help them find the strength to change their behaviour in the desired direction. 

The work of psychologists and peer counsellors provides support to our clients and restores their belief in themselves and the notion that it is possible to function differently and thus live a socially fully-valued life. Thanks to counselling, a person who uses drugs is capable of returning to normal work and family life, which contributes to the whole society through taxes accrued from the labour market as well as the fact that yet another family has become capable of functioning normally and contributing to the society. 

Distributing equipment is a very important part of diminishing risk behaviours among people who use drugs, but this only a single initial part of the necessary set of complex services. Establishing contact and trust with clients is a critical part of this. After that, psychologists, counsellors and social workers will join in the work done with them. In this way, our clients can receive the services on different levels, focusing first on their health, then housing, employment, family relations, and eventually on functioning in the wider society. 

In the period from 2018 to 2021, the service of psychological counselling as part of harm reduction services was utilized 2213 times a year on average; the peer counselling service was used 8544 times and the social worker's service 8912 times a year on the average. The popularity of these services has grown year by year, while the behaviour of people who use drugs has become less risky, because now they have the skills, the tools and the self-confidence to choose more secure ways of diminishing or quitting drug use.