Example of Good Practice in Drug Dependencies approaching Roma Community from Bratislava Lubomir OKRUHLICA, Zuzana BUSOVA Bratislava, Slovakia “Transnational good practices and experiences exchange on drug dependencies within the Roma Community” Budapest, 29th and 30th October 2004

Demography- Statistics Slovak Republic ,379,455 inhabitants in 2001 Roma population (1,7%)....89,920 Roma people...officially...320,00 Romas unofficially

Demography- Statistics Life expectancy - males: in general Slovak population years in Roma community years (less 12 years) Life expectancy - females: in general Slovak population years in Roma community years (less 8 years)

Living conditions Mostly rural settlements with overcrowded dwellings; absent innoxious potable water; sewage system cesspits for waste water; accumulating solid quickly decaying communal waste; no adequate access road.

Health risk factors Lower level of education; low personal hygiene standard resulting e.g. in hepatitis A; low communal hygiene standard; unhealthy boarding habits, improper nutrition; increased rate of taking alcohol and tobacco products; growing drug addiction resulting in higher risk of HIV infection and B and/or C hepatitis.

Concrete measures 1.) Simultaneous improvement in the sectors of employment, education and housing; 2.) improve access to health care; 3.) enhancing public health awareness; 4.) increase the rates of vaccination; 5.) organize health centers in Roma communities;

Concrete measures 6.) education> on personal hygiene > avoidance of toxic substances > sexual behavior, reproductive health > drug use

Drugs in Roma community Tobacco and alcohol is commonly used; especially there is a high rate of smoking up to 100%; cigarettes are very popular among many Roma children ; sniffing of inhalants by youngsters mostly in poor rural Roma settlements;

Drugs in Roma community opiates - heroin is the most prevalent of illicit drug in Roma community; and illicit use of non-prescribed sedatives (such Rohypnol) is quite common; less cannabis and stimulants; differences between rural and city population in drug consumption.

Drugs in Roma community More self-medication - less experimental drug usage; due to high stress in poor living conditions; smuggling as the way of living.

Drugs in Roma community Access to assistance resources for drug dependents is different in the capital city and different in rural areas. Extended Roma families - children copying parents behavior, - problem to find drug, tobacco and alcohol-free environment in many Roma households.

Examples from our practice 1. ’OPRE ROMA!’ - drug prevention (2000); 2. ‘Roma anti-drug forum’ - drug education (2003); 3. Approaches in drug treatment to Roma clients/patients.

’OPRE ROMA!’ Goals: - to extend the Program on public health to the Roma community with special targeting on prevention of HIV/AIDS, hepatitis A,B, C and on prevention of psychoactive substance abuse; - to improve degree of co-operation of health care workers with NGOs with priority given to Roma ethnic;

’OPRE ROMA!’ - to educate the key persons from Roma community on health issues; - harm reduction caused by drug use (e.g. HVB vaccination); - counseling for Roma families with drug problems.

‘Roma anti-drug forum’ Goals: - motivating and the involvement of the members of Roma community in Bratislava into drug prevention activities; - education of Roma community on negative health and social consequences of psychoactive substance use; - harm reduction; - facilitation of overcoming the resistance of Romas to use specialized health services for drug users; - family counseling.

Approaches in drug treatment At the Centre for Treatment of Drug Dependencies in Bratislava: non-judgmental approache without prejudices to the minority; expressing empathy and respect to their civic rights; co-operation with the elders from local Roma community;

Approaches in drug treatment sensitivity to and taking into account different cultural aspects; fair and equal access to all health care treatment services; not special, selected, ethnically targeted treatment programs for Romas (!)

Strategy for Create more optimal for implementing the health projects locally and in co-ordination. Carry out a research of health status of inhabitants of Roma settlements. Improve co-ordination of programs focused on health status and provision of health care services to Roma. During the following five years it is necessary to increase the percentage of vaccination in Roma settlements up to 95%.

Strategy for Extension of networks of health care assistance for Roma settlements. Support and extended network of health care assistance, who are expected to provide health care mainly to children and mothers, even through fieldwork.

Strategy for Aims could be: - to improve and facilitate doctor-patient relationship; - to increase the accessibility of health services for Romas; - to increase the efficiency of preventive and curative services; - to increase the level of health education for Romas; - mobilizing Roma families in taking part in vaccination; - facilitating access for Roma women to family planning. All these should include specific issues on drugs, alcohol and tobacco consumption.

Suggestion from our experience Education of majority population on prejudices against Roma people. Education of majority population on racism and racial discrimination issues - human rights. Education majority population on Roma cultural issues.

Thank you for your attention!