The city Ljubljana as a destination has for a while been on my list of places I want to visit. Finally, in August 2014, I got the opportunity to visit this wonderful town located in central Slovenia, between the Alps and the Mediteranian. The spirit of Ljubljana attracts many traveling street artists, tourists, pairs in love and young people. Ljubljana is the home of many Macedonian who have come to work here, hoping for a better life. The beautiful restaurants and cafeteria at the very river Ljubljanchica are always ready to receive the tourists with fine coffee and traditional food, and if you want to admire the wonderful view over Ljubljana and the Alps, then you must climb up the Middle Ages fortress.
Despite all the beauties offered by the city itself, like in most of the world, Ljubljana isn’t all perfect. There are people there as well who show that society has failed to build mechanisms to accept all its individuals. In the central parts of the city, and on Preshern’s square, you can notice people living on the margins of society. Among other things, Slovenia, as well as other newly independent countries after the dissolution of Yugoslavia in the 1990s, has faced increase in the use of drugs and the need for introduction of harm reduction programs. Exactly this was the reasons for my study visit. As an activist of the association “Opcija” Ohrid I had the privilege to be a guest of the association of citizens “Stigma” which carries out harm reduction programs in Ljubljana and in few other cities in the area.
“Stigma” was founded in 1991. During all these years, it has gone through many turbulent and critical periods, but still it has never stopped work. Of the total number of registered clients using drugs, 75% are male, and 25% are female, with an average age of 35-50 years. The association works with families, partners and relatives of its clients, but only if they themselves express the wish to be informed and counseled about any issues regarding the use of drugs. As a team they were well equipped. All members are full-time employees, and with health and retirement insurance. The team is created of a total of 16 people, some of them are social workers, and some are outreach workers from the target community. “Stigma” also engages secondary outreach workers – volunteers who get incentives for transport and food.
As a state with a more pragmatic approach to resolving social questions, “Stigma” activities are financed by: the Ministry of labor and social policy, the Ministry of health, the Local self-government of the city Ljubljana, and the local self-governments of other cities. Members of “Stigma” are satisfied by the cooperation with all state institutions who demonstrate openness for their requirements and recommendations. In regards to the police, they have no problems, and during the year they have 2-3 meetings with the police in order to exchange information, experience and to coordinate each other regarding the appearance of new drop-in places and if any new drug has appeared in Slovenia. The trust and protection of clients’ identites is a key issue for “Stigma”.
The first day of my visit, together with Borut, the president of “Stigma”, we visited the daily center of “Stigma” located in the very center of the city, right next to the river Ljubljanchica, and which premises were owned by the municipality, and are rented out to the association for a very low price. I had the opportunity there to meet the outreach worker Bozho and several of their clients who were present at the moment. It’s a daily center where needle exchange happens (needles and syringes), condoms, educational material, counseling by a social worker, information on dependence problems, HIV/AIDS, hepatitis, safe injection, free use of computers and informal cooperation, part for refreshment (coffee and juice). From time to time, they organize creative workshops: painting, photography and the likes. This daily center is rather visited. During the day, services are used by more than 50 different clients because it is a approachable location for people comming from other towns, as well. The other daily center, which is larger and located off the city center, also had administrative offices in addition to the services already mentioned. The social worker most often has a counseling therapist role, but also provides information about issuing documents for health and social insurance and personal identification, has regular outreach activities and visits other towns as well. Educations cover topics interesting to clients themselves. The counseling therapy which can be received in the Daily center itself, may also be given over a free phone number and over e-mail. There is also a group of users who schedule regular meetings and talk about different topics – similar to self help groups.
“Stigma” has its own vehicle for outreach work. The vehicle is used to visit clients in seven other nearby towns, and services provided are the same as in daily centers. Here they exchange: injecting equipment, condoms, alcohol wet wipes, sterile gauze and they talk, i.e counsel the clients.
The second day, together with Bojana and Bozho we went on outreach in a nearby area known as “Behind the walls”. It is an abandoned space, with tall walls which used to be used by the Slovenian Army. The municipality gave the permission to use it as a “free zone”. “Behind the walls” is divided in two parts, one where young people organize parties, and the other is a place of gathering for: drug users, alcoholics, drug dealers, sex workers and homeless people. The police does not perform any control of the area. At the moment we visited it, there were around 40 drug dependent people “Behind the walls”. We talked with some of them. They shared their experiences and problems and wanted to know how this issue is treated back in Macedonia.
Upon the initiative of our hosts, we also visited the Methadone centre within the Healthcare center – Ljubljana. In addition to methadone, they also give Buprenorphine, Suboxone and Substitol. Only the doctor and the neuropsychiatrist can decide on the type of substitute a drug user can use, because some of them have serious side effects (for example with Substitol). There is no waiting list for drug treatment, and the minimum age threshold is 35. Minor drug dependent persons first consult a psychiatrist, and are then referred to a Detox center. Social service is quite professionally organized, and coordinated with other units, when it comes to minor children.
That same day we also visited the Shelter center for women who use drugs and victims of family violence, stabilized on varying substitution treatments, and for sex workers. The shelter center was founded in 2010 and is the only one of this kind in the city. It is comprised of social workers and has only one male member who represents a positive example of communication with women, for conversations and counseling. Clients at the center can live there for a year at most. They can cook, exercise, visit individual and group counseling therapy, to learn to develop social skills, to better their life quality, to recognize and deal with violence, they can read, do some handicrafts like jewelry, and they have their own garden where they produce their fruit and vegetables. Activities are financed by the Ministry of labor and social policy and the local self-government of Ljubljana. They receive donations from different organizations and citizens, and clients who are on social welfare, donate 30% of these finances to the shelter center. The center cooperates with the Women’s prison in Ljubljana where they distribute condoms, provide consultative meetings and counseling in different topics. During my visit, the center sheltered nine women – victims of long-term violence. Through the study visit in “Stigma” I had the opportunity to closely see the work of the center and how they respond to the needs of the community. In none of their daily centers there is no needle exchange, not nurse, psychologist or lawyer services offered. These services are provided by other organizations cooperating with “Stigma”. There are also no regular HIV and HCV testing, but this is done once a year in cooperation with their health care center, for free and anonymously.
The imperfection of Slovene drug policies
Still, despite the good cooperation with state institutions, experiences show that it is also not easy to implement harm reduction policies in Slovenia. At the beginning, “Stigma” as an organization, carried our frequent visits to the Men’s prison in Ljubljana, but after a while those visitations were reduced because the Prison Administration though that they, as an organization, planned to make drastic changes which did not respond to the conditions in the prison. That’s why these visits were cut down to 1-2 annually, in the form of group or individual educations, depending on the needs of imprisoned drug users.
In Slovenia, just like in Macedonia, there is a real need for working with children who use drugs, but there are no specific programs for treatment of this group. The state simply says nothing about the problem. Minors are usually directed to the Social work center.
Although at first sight similar, “Opcija” and “Stigma”, both harm reduction organizations, this visit was a great experience for me as a social worker. I learnt about their manner of work, and the team of professionals who have traced the road to these programs in a country such as Slovenia, which functions according to all laws and regulations, and organization with long term experience and reputation in its country and among its clients.
The author is an activist social worker in the NGO Opcija – Ohrid (operating a harm reduction program and sex workers support program); a local coordinator of the field testing and counseling for HIV/AIDS and mobile gynecological ambulance in Ohrid and Struga; educator for tuberculosis; secretary of the Local Youth Counsil – Ohrid Municipality; article of the counceling group of citizens – Prevention Unit within MOI – Ohrid.