COUNTRY TABLE. MONTENEGRO.

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1 EPIDEMIOLOGICAL DATA Indicator Data Source of data/additional notes re data Year of estimate Population National Census data 2011 Estimated number of people who inject drugs (PWID) 1282 (95%CI = N ±1.96) Comments Institute for Public Health 2012 These are the most recent estimates based on validated and adjusted counts. Estimates made for Podgorica only. 1 Total number of registered HIV cases 192 Institute for Public Health As of 01/12/2015 This figure represents the cumulative number of the registered HIV cases since the beginning of the epidemic in HIV prevalence among adults (15-49), % <0,02 UNGASS Country Progress Report The 91% of all detected HIV cases are within this age group. HIV prevalence among PWID, % 1.1% These estimates are Hepatitis C (anti-hcv) prevalence among people who inject drugs, % Hepatitis B (anti-hbsag) prevalence among people who inject drugs, % 53% 1.4% based on integrated bio-behavioral RDS survey among IDU conducted in 2014 in Podgorica and nearby municipalities. Sample size = Dr I. Bozaric, Protocol for a population sizes estimates study of injecting drug users in Montenegro, Institute for Public Health of Montenegro, Podgorica, Dr B. Mugosa, Country Report on December 1st 2015, Institute for Public Health of Montenegro, Podgorica, Available at 4 Dr Mugosa, Dr Lausevic, et. Al. Survey on HIV/AIDS risk related behavior, HIV seroprevalence among injecting drug users in Montenegro, Institute for public Health of Montenegro, Podgorica, 2014.

2 Estimated prevalence rate of tuberculosis per population 29 (13 50) WHO Country Profile Access to HIV testing, counselling and treatment What are the main barriers to HIV testing and counselling for people who use drugs in your country? How accessible is ART for people who inject drugs in your country? Please consider in your answer. a. What is the available data on ART coverage for people who inject drugs in your country? b. What are the main barriers to initiating and adhering to ART for people who inject drugs in your country? c. Are there ART and harm reduction integrated service provision centres in your country? If so, how many and where? Access to viral hepatitis testing and treatment Do country has a national viral hepatitis programme and/or policy? Are hepatitis C diagnostics available to people who use drugs? What are the main barriers to accessing these for people who use drugs? According to the country report, in people received VCT services. Out of this number only 8.7% were IDUs. VCT with rapid HIV tests is available free of charge and anonymously in 8 VCT sites established within Population Counselling Centers. 6 The key barrier for PWID is that although there are trained counselors, VCT is not integrated into the community based services for PWID, such as drop in centers and outreach sites 7. There is a universal access to ART for all citizens, including PWID 4. a) Officially, since the beginning of the epidemic in 1989, there were only 5 PWID with HIV registered, out of them 1 was on ART in But since the country does not have national estimates neither on the size of PWID population, no on HIV+ PWID, there is no reliable data on ART coverage in this group; b) ART is available for every person who has a health insurance, and there are no barriers at all. The active drug users are also eligible for ART 6 ; c) No, ART provision and harm reduction services are not integrated 5 No Yes the HCV diagnostics and treatment is available in general sense. By 2013, 98 PWID had received HCV treatment in Montenegro, and for 56 patients sustained virological response had been achieved. The Health insurance Fund covers HCV 5 Available at 6 UNGASS Country Progress Report 7 Information provided by the national expert 8 Dr. Alma Cicic, Head of department for sexually transmitted and blood born infections, IPH of MNE, Official correspondence, Podgorica, 2016.

3 Is hepatitis C treatment available to people who use drugs? What are the main barriers to hepatitis C testing and treatment for people who use drugs? treatment to PWID with HCV diagnosis based on clinical criteria, however it is available only to those who have a health insurance. 9 The other significant barrier is the fact that PWID has to be clean from drugs for 9-12 months prior to the treatment in order to be eligible for it 10. Only for those who are not using drugs for at least 9 months. Hepatitis C testing is not available within community based service providers and even though it is possible to have the test within VCT sites, it is not anonymous 8. Besides, the national treatment protocols directly influence PWID decision to postpone HCV diagnostic and treatment till the day when he/she decides to become clean 8. Is hepatitis C covered within HIV or harm reduction programmes? Only if services providers are having hepatitis C as a personal affiliation 8. Is there a hepatitis B vaccination program for people who inject drugs? Vaccination for hepatitis B is generally provided through the national vaccination programmes for the newborns. It is also available for the general population, but there is no hepatits B vaccination programs specifically designed for PWID 8. Access to TB diagnosis and treatment Is TB diagnosis and treatment available for people who use drugs? Is isoniazid preventive therapy for prevention of TB available for HIVpositive PWID? What are the main barriers to TB diagnosis and treatment for people who use drugs? Is TB covered within HIV or harm reduction programmes? Access to STI diagnosis and treatment Are there condom distribution programs for people who inject drugs and their sexual partners? Is condom distribution part of harm reduction programs? Is STI diagnosis and treatment available for people who use drugs? What are the main barriers to STI diagnosis and treatment for people who use drugs? There is a TB diagnostic and treatment program for general population, available for all, but there are no specifically designed for PWID programs 8 Data n/a. It is not part of community based service, no active TB case finding among PWID is conducted 8. No There were until 30 of June Condoms had been distributed through 2 drop-in centers and the outreach programs 11. Not specifically for PWID, only for the general population. -Prompt diagnostic and treatment of STIs is not yet included into basic health care package under the ongoing health reform. -STI screening and treatment are not integrated into the national AIDS response. 9 D Hedrich, I Jekabsone, A Pirona, at el. Prevention of infectious diseases among people who inject drugs in some Western Balkan countries. December, Information provided by the nation al expert 11 UNGASS Country Progress Report. Available at

4 Is STI covered within HIV or harm reduction prorgammes? -It is not part of the community based service - STI screening is not anonymous 12. Only provision of the information HARM REDUCTION IMPLEMENTATION Indicator Data Source of data/additional notes re data Year NSP introduced in country 2005 EMCDDA Country Profile 13 Number of NSP in country 1 Data provided by the national expert NSP Coverage Previously available data: 1549 IDU. The recent data are not available yet, but taking into consideration total close out of UNGASS Country progress report Year of estimate Comments 2015 In 2014 Montenegro reported 3 NSPs in the country (UNGASS Report), but statefunded NSP within Primary Health Center stopped service provision few years ago. And after GFATM left the country on June 30 th 2015 only 1 drop-in center continued to work. In accordance with IBBS survey conducted, in % PWID get syringes in drop-in center for IDUs, 17.9% from needle exchange programs 12 Information provided by the national expert 13 Available at

5 NSP programs throughout the country we can expect it s dramatically decreased. within Primary Health Care Centre and 8.0% through 11 outreach needle exchange programs. Governmental support to the existed NSP: please select from the list: 1) No support, 2) policy level support only, 3) partial funding, 4) full funding Partial funding is provided through the National Lottery Fund. In % of the total planed budget are covered by this fund. Ministry of Health of Montenegro, National AIDS Strategy , Action Plan , Podgorica, Year OST introduced in country In Podgorica in Primary Health Care Center In Kotor in In Berane in 2011 In Bar and Niksic in Number of OST in country 5 Primary Health Care Center 2015 Total official number is 6, but center in Pljevlja still do not have any patients Drugs used for OST Methadone buprenorphine Ministry of Health 2015 Buprenorphine was introduced in the middle of 2015, but it is still not used at national level, as doctors are afraid to proscribe it due to the absence of medical protocols. OST Coverage 367 Institute for Public Health 2015

6 Governmental support to the existed OST: please select from the list: 1) No support, 2) policy level support only, 3) partial funding, 4) full funding Is distribution of targeted informational and educational materials for people who inject drugs and their sexual partners included into harm reduction prorgammes? Is there a community outreach programs for people who inject drugs? Full funding Ministry of Health 2015 Yes Ministry of Health 2015 yes Information provided by the national expert 2015 Since only one drop in center in Podgorica continues to work. PWID are involved as a peer support workers. What have been the major developments in NSP and OST implementation in your country since early 2014? Please consider the following in your answer: a. Which territories have seen an increase/decrease in the coverage of NSPs? What have been the reasons behind the change? b. What are the main barriers for accessing NSPs for people who use drugs? c. Which territories have seen an increase/decrease in the coverage of OSTs? What have been the reasons behind the change? What are the main barriers for accessing OSTs for people who use drugs? d. Have there been changes to the way in which harm reduction is delivered and who delivers it in your country? (e.g. the state, NGOs with or without state support, government and NGOs, international implementing agencies, etc.). e. Have barriers to accessing services increased or lessened? If so, what are the barriers and have these changes affected any groups in particular, for example women, or under 18s? a) Till June 30 th the outreach harm reduction programs have been implemented at the national level. After June 30 th 2015, only one NSP continued to work. NSP within primary Health Care Centers stopped few years before. b) There are not enough NSP to reach all PWID who are in need of services. The one remaining NSP in the capital city is operating at the minimum scale due to lack of funds. And it s working hours are not convenient to the clients. National level outreach work currently does not exist at all. After the GFATM left the country, Government did not fulfill the obligations to fund NSP. c) In late 2014 and several times in 2015 some methadone maintenance centers (Kotor, Bar) have experienced shortage of methadone. This influenced patients in prisons as well, as methadone is transported from local MMT centers to the national prison. Also, as 1/3 of total Montenegrin population lives in Podgorica, there are waiting lists for initiation of MMT. There are approximately 200,000 inhabitants in Podgorica with the

7 estimated number of 1292 PWID, but MMT s capacity is 50 clients maximum. There is no national coordinating body for MMT and with the current level of funding it s not feasible to increase the MMT coverage. d) Currently only NGO delivers NSP at very limited scale e) The barriers in accessing the services have increased. First of all, there became fewer services to access. One remaining NSP is not capable to cover all PWID who are in need of HIV prevention services and with the existing funding this work can t be expended. It is forbidden by law to provide Harm Reduction services to minors. In addition, gaps in the normative basis on Harm Reduction still criminalizes service providers. Although it was planned to develop the missing bylaws 5 years ago, they are still not in place. 15 PRISONS Indicator Data Source of data/additional notes re Year of estimate Comments data NSP availability in prisons (Yes/No) No Primary Health Care 2015 OST availability in prisons (Yes/No) Yes Primary Health Care 2015 Only if the inmate has been on maintenance therapy prior to incarceration If OST is available in prisons, can it be initiated No Primary Health Care 2015 within prison for those haven't previously received it? (Yes/No) If ART is available in prisons? (Yes/No) Yes Primary Health Care 2015 Are condoms available in prisons (Yes/No) No Primary Health Care Information provided by the national expert

8 Is TB screening and treatment available in prisons? Are there any TB prevention programs in prisons? N/A 2015 OVERDOSE RESPONSE Indicator Data Source of data/additional notes re data Year of estimate Do country has an overdose prevention No Ministry of Health 2015 programmme (Yes/No) Are there operating naloxone peer-distribution No Ministry of Health 2015 programmes (Yes/No). If so, how many and where? Coverage of naloxone peer-distribution 0 Ministry of Health 2015 programmes Comments If no overdose prevention programmes are in place, what are the main barriers to these being introduced? If no naloxone peer-distribution programmes are in place, what are the main barriers to these programmes being introduced? Lack of funds, experience and knowledge among professional and no political will. 16 Lack of funds, experience, knowledge among professionals, etc 12. HARM REDUCTION FOR STIMULANT AND NEW DRUGS (DESOMORPHINE, BATH SALTS AND SPICES ) USE Please describe stimulant and new drugs use and related harms in your N/A country? Please consider in your answer: a. Whether there is any available data on stimulant use and harms in your country? b. Whether there is any available data on new drugs use and harms in your country? What is the harm reduction response to stimulant and new drugs use in N/A 16 Information provided by the national expert

9 your country? If little is in place, what are the major barriers to the development of a response? FUNDING Indicator Data Source of data/additional notes re data Year of estimate Comments Harm Reduction Spending for IDUs(US$) This figure is for 98,974 UNDP 2015 harm reduction services within NGO sector and represents 68.3% of the overall national budget for harm reduction spending Harm Reduction Spending for IDUs per capita (US$) 0.17 UNAIDS/GARPR New GARPR is under development right now, new data is going to be available soon. Harm Reduction Spending for IDUs from Domestic Sources (%) 0 0 UNDP 2015 Harm Reduction Spending for IDUs from International Sources (%) 100% UNDP 2015 Until 30 of June After that NSP was not funded. Share of Harm Reduction Spending for IDUs in the total HIV/AIDS Prevention Spending from domestic sources (%) 0% UNDP 2015 Share of Harm Reduction Spending for IDUs in the total HIV/AIDS Prevention Spending from international sources (%) 100% Until 30 of June After that NSP was not

10 funded. Harm reduction and drug policy 1. What are the major developments in terms of drug policy at the national level? In 2011, drug usage became only administrative offence (big step towards decriminalization of drug use), as well as a possession of small amounts of drugs for personal use 17. But the country still doesn t have normative basis to regulate harm reduction services and which would protect HR service providers from criminalization and pressure from the law-enforcement authorities. 2. Which national policies/strategies explicitly mention harm reduction within them? Please consider in your answer: a. Drug policies/strategies: National Strategic Response to Drugs National Strategy for prevention of abuse of Psychoactive Substances Law on prevention of abuse of Psychoactive Substances (2011). b. HIV/AIDS policies/strategies: National AIDS Strategy , National AIDS Strategy National AIDS Strategy c. Hepatitis policies/strategies N/A Please provide details on each: links to documents, when it was introduced to the policy, particularly note whether it has been since Possession of drugs for personal use Personal drug use is not sanctioned by the Penal code of Criminal/administrative offence Threshold/substance Fines Other penalties/ alternative punishment Administrative Not specified 30 up to 2000 euro If person commit criminal act under drug influence, can be sent by Year of decriminalization Criminal Act: Enabling of drug abuse 18 %20Strategy%20of%20MNE%20for%20Prevention%20of%20Drug%20Abuse% pdf %3A%2F%2Fwww.unicef.org%2Fceecis%2FNational_HIV_AIDS_Startegy_2010_to_2014_(Montenegro).pdf&usg=AFQjCNFDd6749DZlIhAs7QREnBH4S7BdLw&si g2=3nmvsvywtmdsyx6spqa4dw

11 Montenegro, nor is drug possession for personal consumption. 21 Court to Obligatory treatment of drug addiction (it is a part of criminal sanction and is summed in total prison time) Civil Society, Advocacy and Drug User Community Involvement 3. Number of PWUD community initiative groups or organizations. There is only one PWUD community initiative group (LINK), functioning in What have been the major developments of PWUD community initiative groups or organizations? Advocacy efforts in 2015 Harm reduction works. Fund it in Montenegro 5. Is resourcing a major priority for harm reduction advocacy in the country. If so, what kinds of activities are civil society and PWUD community involved in? Yes. Resourcing is the biggest priority for harm reduction in the country. Primarily PWUD community is involved in advocacy and lobbing, especially within the government and the Parliament. 21 EMCDDA Country Overview available at