Drug places and spaces of problematisation The melancholy case of a Hungarian needle exchange programme Endre Dányi Department of Sociology J.W. Goethe University, Frankfurt am Main danyi@em.uni-frankfurt.de and Róbert Csák Harm Reduction International, London, UK csakrobert@gmail.com Paper to be published in the ‘Drug places between knowledge and representations’ special issue of Drugs and Alcohol Today Last saved on 3 May 2021 Structured abstract Purpose This paper explores multiple problematisation processes through a former needle exchange programme run by Kék Pont (a nongovernmental organisation) in the 8th district of Budapest. By presenting a collage of ethnographic stories, we attempt to preserve tacit knowledges associated with the programme and thereby keep its office alive as a ‘drug place’, the operation of which was made impossible in 2014. Design/methodology/approach Drawing on the insights of Foucauldian governmentality studies and Actor-Network Theory, this paper focuses on drug use as a problem in its spatial-material settings. Based on ethnographic fieldwork, our contribution traces multiple problematisation processes and related infrastructures. Findings From the needle exchange programme’s perspective, drug use is not a singular problem but the effect of multiple problematisation processes. Although those processes are often in conflict with each other, the question is not which one is right, but how social workers manage to hold them together. It is a fragile achievement that requires years of training and ongoing negotiation with local actors. By eliminating Kék Pont’s 8th district office, the Hungarian Government did not only hinder harm reduction in the area; it had also rendered tacit knowledges associated with the needle exchange programme as a ‘drug place’ inaccessible. Originality Our paper is a melancholy intervention – an attempt to preserve tacit knowledges that had accumulated at the needle exchange programme. Our retelling of ethnographic stories about this ‘drug place’ is our way of ensuring that other drug policies remain imaginable. Key words: harm reduction; problematisation; Actor-Network Theory; Hungary; Budapest; Kék Pont; melancholy Introduction Our contribution to this special issue draws on the insights of Foucauldian governmentality studies and Actor-Network Theory (ANT), which suggest that problems are impossible to analyse ‘on their own’, independent of the social-material infrastructures associated with them (see Foucault, 1984 and Callon, 1986, respectively). Accordingly, our paper focuses on drug use as a complex, highly situated set of practices caught up in multiple problematisation processes (Bacchi, 2012; 2015; Dányi 2018; Houborg et al., 2020). These processes may include human actors involved in the development and implementation of drug policies (from medical experts through law enforcement officers to social scientists), but also a wide range of nonhuman actors, for instance run-down buildings, infectious diseases, official documents, syringes, not to mention drugs themselves (see Vitellone, 2017). In our understanding, it is particular constellations of such human and nonhuman actors that make drug use ‘problematic’. -1- In this paper, we investigate how problematisation processes work, how they relate to each other, and what political possibilities emerge in their interstices (Law et al., 2014) through the case of a former needle exchange programme in the 8th district of Budapest. By treating the programme’s office as a ‘drug place’ (Germes et al., 2021), we trace various spatial logics associated with drug-use-as-a-problem. This topological approach, central to both governmentality studies and ANT (Collier, 2009; Mol and Law, 1994; Serres and Latour, 1995), does not conceptualise space as a pre-given dimension or a neutral container of social action; rather, it is concerned with the ways in which spatial relations are established and reestablished among seemingly distant or isolated places. By doing so, it is able to show how certain problematisations become dominant over time while others are repeatedly challenged or remain marginalised. Our analysis is based on ethnographic fieldwork we conducted at the needle exchange programme’s office and its complex environment (see Rhodes, 2002). Róbert had been working there as a harm reduction worker for several years while Endre joined him as a visiting researcher in early 2014. After negotiating access to the office, in April, June and August 2014 we carried out three rounds of participant observation and analysed the media coverage of the needle exchange programme in local and national outlets. In this paper, our aim is not to faithfully reconstruct the daily operation of the programme (for arguments for detailed needle exchange ethnographies see Bourgois and Bruneau, 2000 and Page, 1997), but to highlight how it had been caught up in multiple problematisation processes. Therefore, what we present in the subsequent sections is an ethnographic collage (Clifford, 1981), in which we juxtapose three stories from the field. The first story introduces the needle exchange programme’s office as a drug place. This allows us to make multiple problematisation processes visible and, in our second story, argue that harm reduction is not so much about privileging some of those processes over others as it is about the tacit knowledge of holding them together and switching between them. Tacit knowledges (Polányi, 1974) associated with harm reduction, embedded and embodied in the daily practices of social workers, are hard to acquire and difficult to preserve. In many cities across the globe, like Amsterdam (Grund et al. 1991), Frankfurt am Main (Duncan et al., 2019; Kamphausen et al., 2015), Lisbon (Dányi, 2018), Manchester (Vitellone, 2017), Paris (Gomart, 2002; Jauffret-Roustide and Cailbault, 2018), and Vancouver (MacNeil and Pauly, 2011; McNeil et al., 2014), harm reduction initiatives are supported by national drug policies, whereas in others they are being actively suppressed. The latter is the case in Budapest, where the needle exchange programme’s operation in the 8th district was gradually made impossible during our fieldwork (Gyarmathy et al., 2016; Rácz et al., 2016). The third empirical story of our paper narrates the programme’s closure and discusses how its eradication fit with the Hungarian Government’s drug policy, which is one of the strictest in Europe. The concluding part of our paper discusses how we as ethnographers are being implicated in multiple problematisation processes and what we can do when confronted with deeply upsetting and saddening developments in the field. While we realise we cannot do much to change the current Hungarian Government’s drug policy, we feel we can turn our melancholy triggered by the closedown of the needle exchange programme in the 8th district into a productive force by re-telling ethnographic stories about it, preserving the tacit knowledges associated with it, and thereby keeping it alive as a drug place. This exercise in ‘melancholy politics’ (Dányi, 2020) is our way of keeping alternative imaginaries open (Benjamin, 2006; Danowski and Viveiros de Castro, 2017; Haraway, 2016; Verran, 1998) – in other words, -2- ensuring that other drug policies remain imaginable despite a lack of readily available alternatives. A local orientation point We begin our ethnographic collage with a brief description of the needle exchange programme, which had been run by a nongovernmental organisation called Kék Pont (Blue Point – a reference to blue as the colour of hope). The programme was established in 2006 and at the height of its operation was the largest of its kind in Hungary. It moved into an office at the corner of Magdolna street and Lujza street, rented from the 8th district council of Budapest, in 2012. For quite some time, the area around the programme had been considered one of the roughest parts of the city; taxis would refuse to go to nearby addresses, mostly because of drug use, illegal prostitution, and the high level of related crimes. During the time of our research, the neighbourhood began to show signs of gentrification (a renovated park here, a newly built sidewalk there), but generally it still looked like an inner-city ghetto shaped by structural inequalities: dilapidated houses, apartments without bathrooms, highly segregated communities (Ladányi, 1989; 1992; 2004). Kék Pont’s 8th district office was mostly run by sociologists and trained social workers in their 20s and 30s. It was open on weekdays between 2pm and 6pm, and on a typical day 4-5 harm reduction workers provided services for about 150-200 clients. The main service was the exchange of used needles for sterile ones (about 5 per person in 2014), but social workers also regularly offered free Hepatitis C and HIV screenings, organised counselling sessions (especially for female sex workers – see Stengel, 2020) and oversaw the use of desktop computers in the front office, where clients could check their Facebook accounts and listen to music on YouTube. Right next to the main entrance, which was normally locked during the day, there was a large blackboard that explained what behaviour was allowed and what was forbidden on the premises. Here are the two lists (in our translation): You’re allowed to: register; visit the programme once a day; take 5 syringes; exchange used syringes; [HIV, HCV] screening (1 per year); use the internet (20 mins); counselling; ask for information; drink sparkling water; come to ‘Change for Chicks’ if you are a girl :). You’re not allowed to: use the programme without registration; come more than once a day; inject in or around the programme; discuss where to buy [drugs]; buy and sell [drugs]; make phone calls; be violent; yell or shout in or around the programme. The close policing of these rules was crucial in order to keep the needle exchange programme safe as a ‘drug place’ in an otherwise tough environment. At the time of our research, the programme had about 3,500 registered clients, almost all of whom were local residents. They were mostly of Roma origin, often struggling with unemployment, family troubles, chronic illnesses, imprisonment and other difficulties – in other words, thoroughly marginalised people for whom the needle exchange programme was one of the few orientation points left in their lives. For quite a few of them, the programme was a central part of their daily survival strategy; it was a place where they could use the -3- internet, meet members of their social circle, or simply sit in peace, away from discrimination and life in the street. Social workers interacted with clients on a nickname basis: upon registration they had to fill out an intake form that asked for the first two letters of their mother’s maiden name, their date of birth, the district they were from, and the drugs they were using. We will come back to this form as an important nonhuman actor in the next section; for now, we want to emphasise that in order for social workers to provide a good service they needed to know significantly more than the above-mentioned information. For example, they needed to know the personal circumstances of each client, which required months of training, the gradual development of interpersonal trust, and a great deal of empathy. Furthermore, since each harm reduction worker was at the local office of Kék Pont only a few days a week, it was important to develop a method of recording and exchanging insights, so that service quality was not dependent on who happened to be present on a given afternoon. The internal mailing list served that function remarkably well. Below is an excerpt from a typical report sent round on 27. 06. 2014 (in our translation, all nicknames have been altered): agnes71 has left her abusive husband of 18 years, who was her pimp, regularly took away her money, considered her his property and beat her, may he rot in hell. after she fled he reported agnes as missing to the police, the cops then picked her up and took her in, but then it became clear she was not missing at all but on the run, so the police report was in turn classified so that the husband wouldn’t be able to find her. she’s now enjoying her freedom, doesn’t have to prostitute herself anymore, can spend her money the way she wants to, and doesn’t do drugs that much, either. she’s homeless now, we talked about lélekpont [a homeless shelter], she’ll prolly check it out. *** subi told us she has a new guy, I asked her what had happened to the old one, she told me he had died next to her, messed up the hit, got blood poisoning. it turns out, the bloke was the father of her son (cute spiderman-loving boy with lots of school warnings, you know), she didn’t tell the kid his father was gone; he had anyway been taken away before the tragedy and now lives with foster parents. a good place, allegedly, subi told [the kid] to think about it as a holiday :( the new guy seems to be a jackpot: he’s a pimp but hasn’t asked subi to work yet. *** rico became really sad after watching a video of his loaded relatives in Vienna, flashing EUR50 bills :( Internal reports like this are complex and sensitive objects; here we would like to emphasise two aspects that were central to the needle exchange programme’s regular operation. First, social workers had to constantly relate to clients in ways that would have been difficult to translate into a standardised protocol. In effect, they had worked as ‘para-ethnographers’ (Holmes and Marcus, 2005), regularly talking to clients, trying to figure out what had been going on in their lives (personal stories, sometimes heart-breaking, which hardly anyone was -4- willing to discuss openly), and then writing short notes for future use. The purpose of such notes was not so much control and surveillance as sustained care across both personnel and a set of organisations (Mol et al., 2010). This, indeed, is the second aspect we wish to highlight here: harm reduction workers at the 8th district office of Kék Pont also played the role of mediators between clients and other entities in the area: police, social welfare officers, homeless shelters (like Lélekpont, mentioned in the report above), the local council, and so on. This was a crucial part of a distinct problematisation process – one that understood drug use as a distributed problem that involved users, but also neighbours, family members and a whole range of institutions. Making the everyday practices of drug use visible had also made it easier for everyone to relate to it as a problem that was unlikely to go away. A cogwheel in the quantification machine In the first story of our ethnographic collage, we have shown how the 8th district office of Kék Pont had been entangled in a distinct problematisation process: by making drug use visible, this drug place operated as an orientation point for clients, their neighbours and relatives, and a wide range of professionals in the area. In topological terms, it was a hub in a network of individuals and organisations, within which drug use existed as a distributed problem (see Duff, 2012; Latour, 1987; Mol, 2008). In our second story we aim to show that this ‘networked’ problematisation process, strongly dependent on qualitative data, was far from the only one at play. Let us return to the intake form we have briefly mentioned in the previous section. Initially this was a long list of nicknames and additional data on a collection of A4 sheets, which after a while was organised into a digital database. Given the sensitive nature of the needle exchange programme’s services, it was important to keep clients unidentifiable, at the same time it was also necessary to collect and securely store reliable information about them, partly to better manage internal resources and partly to feed that information into various ‘quantification machines’ beyond the office. Different data were used at different levels of monitoring drug use. At the level of Kék Pont, which had several offices in Budapest, the number of registered clients and the number of distributed syringes helped to keep track of general trends (number of clients per day, main characteristics of clients, kinds of drugs used, daily syringe distribution). These trends were then used to adjust service delivery, but also served as important references in local harm reduction advocacy. For example, the large proportion of clients from the 8th district was used to demonstrate that the needle exchange programme was mostly serving local residents and had not attracted people who inject drugs (PWID) from other parts of the city (the significance of this information will become clearer in the next section). In addition, there was monitoring going on at the national level. The total number of distributed syringes was communicated annually to the so-called National Focal Point, which collated that data with those coming from other parts of the country in order to assess the overall coverage of needle exchange programmes in Hungary. In their 2015 report, for example, the National Focal Point wrote: ‘In 2014 the programmes distributed a total of 460,977 sterile syringes to the clients, and the number of used syringes returned by the clients or collected was 296,716. A total of 4,442 [PWID] attended the programmes in 2014 on 41,535 occasions. 81 syringes were distributed per [person who inject drugs] in the year in question’ (Hungarian National Focal Point, 2015: 71). -5- These and similar data, collected and standardised by the National Focal Point, served as the basis of annual country reports, but they were also passed on to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) – the European Union’s agency responsible for collecting and harmonising drug use-related statistics in Europe. Together with data from 31 other countries (all EU member states, the UK, Switzerland, Norway, Turkey and Israel), the numbers from Hungary then became part of a ‘bigger picture’, which outlined what drug use looked like as a European problem (see Dányi, 2018), reaching across country borders and populations. It is impossible for us to do justice to all data flows that had originated from Kék Pont’s office in the 8th district in Budapest in just a few paragraphs. Here our aim is mainly to point out that drug use-related numbers, initially scribbled down on A4 sheets and then entered into digital databases, are not neutral representations; they do not simply capture drug use as a pre-existing problem ‘out there’. Rather, as several scholars at the intersection of Foucauldian governmentality studies and Actor-Network Theory have emphasised (Rottenburg et al., 2015; Verran, 2015), such numbers are performative. Through quantification they strengthen a problematisation process that regards social workers’ experience in a given ‘drug place’ as something that needs to be ‘scaled up’ to the level of cities, countries, and continents in order to be meaningful. This way, with the help of various indicators (see, for instance, WHO, 2012) drug use in the 8th district in Budapest becomes comparable with drug use in ‘problematic areas’ in Amsterdam, Frankfurt am Main, Lisbon, Manchester, Paris or Vancouver. But comparability comes at a price: in the process of ‘scaling up’, drug-use-as-aproblem ceases to be distributed across people and organisations; in comprehensive graphs and statistical tables it becomes located in individual users, whose habit is framed as a public health concern. This ‘scalar’ problematisation process, made possible by numbers, is at odds with the ‘networked’ problematisation process we have outlined in the previous section, and harm reduction workers know this very well. Their everyday encounters with clients, which require a set of para-ethnographic skills, are difficult to squeeze into the narrow cells of statistical tables designed elsewhere, far away from their office and its surroundings. Ongoing translation between the two processes is not only time-consuming; it also comes with considerable information loss and the reduction of complexity. And yet harm reduction workers at the needle exchange programme in the 8th district in Budapest participated in this ongoing translation willingly, meticulously filling out forms, consolidating data, making annual reports travel across cities, countries, and continents. They did so because they understood that harm reduction was less about privileging one problematisation process over others than about the art of holding those processes together and switching between them whenever it was necessary (for example, when discussing city-level public health concerns or negotiating the national harm reduction budget). An eyesore In the previous two sections we have highlighted two distinct problematisation processes associated with drug use and argued that the double task for social workers at Kék Pont had been to 1) skilfully participate in those (and possibly other) processes and 2) recognise when to switch between them in their everyday practice. This hard-gained, tacit knowledge would probably come in handy in any needle exchange programme, but it is absolutely vital in -6- settings that are hostile to harm reduction services. To emphasise this point, in the third and final part of our ethnographic collage we recount how changes in the Hungarian drug policy and local politics had gradually made the operation of Kék Pont’s 8th district office impossible, leading to the needle exchange programme’s closure in the end of August 2014. To give a sense of the political context, let us return to the corner of Magdolna street and Lujza street, more precisely to the blackboard near the main entrance of Kék Pont’s office that had explained what behaviour was acceptable on the premises and what wasn’t. Underneath the blackboard there were a couple of pages from a brochure taped to the wall explaining how the legislation on drug use changed in Hungary after the current government came to power in 2010. Images of fingerprints, barbed wires, grilled windows and handcuffs made it clear to even those who could not or did not want to read the text: after a period of relatively liberal regulation in the 1990s and early 2000s, the consumption of illegal substances (in addition to their production and distribution) had once again become a severely punishable crime. This legislation, which required the modification of the Penal Code in 2013, went hand-in-hand with Hungary’s new drug strategy – an official document that defined the government’s drug policy for the period between 2013 and 2020. Unlike the drug strategy before 2010, which had enjoyed a wide support of policy experts both in Hungary and abroad (Trimbos Instituut, 2006), the drug strategy of 2013 was a largely political statement: reminiscent of the rhetoric of the ‘War on Drugs’ in the U.S., it aimed at turning Hungary into a drug-free country by 2020, and wanted to achieve that through stronger criminalisation. Criminalisation, as proposed by the drug strategy of 2013, stands in stark contrast with both ‘networked’ and ‘scalar’ problematisation processes outlined above. Similar to public health models, it locates drug-use-as-a-problem in individuals, but instead of seeing their addiction as an illness, it perceives drug use as a series of illegal acts. A consequence of this approach is not simply that drug users themselves become direct targets of law enforcement; harm reduction services also become suspect for allegedly facilitating (or even encouraging) unlawful behaviour. This is, at least, what happened to the needle exchange programme in the 8th district of Budapest. The first unnerving signs appeared in late 2013, when the local council rejected Kék Pont’s annual report and accused the organisation of attracting drug users from other districts and proliferating ‘drug use-related litter’ in the area. This accusation was not backed up by any evidence, but it served as an excuse for the local council to cancel its formal cooperation with Kék Pont and significantly increase the 8th district office’s rent. Furthermore, the 8th district’s mayor, who at the time was Director of Communication of the governing Fidesz party, began a massive negative campaign against the needle exchange programme, framing harm reduction workers affiliated with the programme as the main opponents of the neighbourhood’s regeneration. Whether the mayor’s negative campaign had anything to do with the upcoming municipal election in the fall of 2014 is difficult to tell; what was clear by early 2014 is that Kék Pont’s operation in the 8th district was getting both financially and politically cumbersome (Sárosi, 2013). Around the same time the tension between Kék Pont and the local council began to grow, the drug scene in the 8th district was going through a radical transformation. Heroin and amphetamine had been gradually replaced by new psychoactive substances (NPS) in the local drug market. The needle exchange programme’s clients transitioned to injecting NPSs (Csák et al., 2013; Rácz et al., 2015), which had more serious health consequences than traditional substances (Szily and Bitter, 2013) and their regular use required significantly more needles than that of heroin. Instead of increasing the number of used syringes clients could exchange -7- for sterile ones, however, Kék Pont had to actually decrease it if it wanted to survive financially. The organisation spent the first half of 2014 trying to convince its main funder, the Ministry of Human Resources, to augment their annual budget, but their request fell on deaf ears. Under such circumstances, Kék Pont had no other option than to close down its 8th district office. The last months were like watching a car crash in slow motion. The needle exchange programme in Budapest was a place where people who inject drugs had been treated with dignity and respect. Therefore, all social workers at Kék Pont knew very well the closure of the 8th district office would be disastrous for the community (as it has been elsewhere in Eastern Europe and North America – see Csák et al., 2019; MacNeil and Pauly, 2010; Rhodes et al., 2003). Still, there was nothing they could do about it. The clients were hoping the shutdown would be called off last minute, but when they realised the end was inevitable, they slowly disappeared from sight. In principle, they could have registered at a needle exchange programme in another district, but as we have argued earlier, ‘networked problematisation’ is a thoroughly local affair: no user wants to venture out to an unknown part of town on a regular basis. And, as far as ‘scalar problematisation’ is concerned, the mayor’s campaign against harm reduction services seemed to pay off, insofar as in the official statistics the number of exchanged needles, registered clients, and people with Hepatitis C in the 8th district dramatically dropped by 2015. What the drop meant, however, was not that drug-use-as-a-problem had finally been solved in the area; it had simply become invisible, and all tacit knowledge accumulated at Kék Pont’s 8th district office had become largely useless or inaccessible. Conclusion: a melancholy intervention In this paper, we have presented an ethnographic collage of three stories organised around a needle exchange programme in the 8th district of Budapest. Following a topological approach borrowed from governmentality studies and Actor-Network Theory, in our first story we have introduced the programme’s office as a drug place and then shown how it was caught up in ‘networked’ and ‘scalar’ problematisation processes associated with drug use. In our second story, we have argued that in social workers’ everyday practices harm reduction is less about privileging one of those processes over others than about knowing how and when to switch between them. This – mostly tacit – knowledge should have helped social workers and volunteers at Kék Pont carefully navigate between clients and the relevant ministry, but as we have recounted in the third story, a radical change in the Hungarian Government’s drug policy in 2013 turned harm reduction into a suspicious approach in the eyes of local and national decision makers. The latter wanted to solve drug-use-as-a-problem by making it disappear – from streets and statistical tables alike – and so the needle exchange programme in the 8th district was gradually suffocated. Anyone who knew what its closure would mean for the clients, but also for the rest of the residents, was deeply saddened and upset by this (Sárosi, 2014). Still, there was nothing they could do about it. There was nothing we could do about it, either. Or was there? After years of working at the needle exchange programme, and months of doing fieldwork together, in the end of August 2014 a sense of melancholy overcame us. In political theory, melancholy is often associated with apathy or inaction (see Brown, 1999), as if the possibility of a bright future was a required condition for politics to take place. But in ethnography this is not necessarily the case. As we have argued elsewhere (Dányi, 2020), a Hungarian understanding of melancholy -8- is closely tied to the notion of resistance: it is a collective sentiment (rather than an individual condition), which suggests that in the face of pointless, wide-ranging destruction it is possible to keep alternative imaginaries open by closely revisiting them. This understanding strongly resonates with insights from literary studies (Benjamin, 2006), science and technology studies (Haraway, 2016), and postcolonial theory (Danowski and Viveiros de Castro, 2017; Verran, 1998), where the political effects of ethnographic storytelling have been taken more seriously than in the mainstream of social sciences. In this regard, our paper has not (only) been a detailed description of ‘networked’ and ‘scalar’ problematisation processes associated with drug use, but (also) a deliberate intervention triggered by the closure of the needle exchange programme in the 8th district. It has been an exercise in ‘melancholy politics’, aimed less at transforming the drug policy of the current Hungarian Government than at ensuring that different drug policies remain imaginable despite a lack of readily available alternatives. Our ethnographic collage was centred around tacit knowledges associated with Kék Pont’s 8th district office that have become difficult or impossible to access otherwise. By weaving them into our stories we have tried to preserve them, and thereby keep the office alive as a drug place. Whether we have succeeded is yet to be seen; all we know is that as long as these stories circulate and resonate with experiences elsewhere, the programme’s erasure cannot be complete. Acknowledgements The research upon which our paper is based would not have been possible without the generous help and support of various individuals and organisations. 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WHO, UNODC, UNAIDS Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users – 2012 Revision. WHO Document Production Services, Geneva, Switzerland. https://apps.who.int/iris/bitstream/handle/10665/77969/9789241504379_eng.pdf [accessed 23 March 2021] Biographies Endre Dányi is a sociologist with a deep interest in the discursive-material conditions of democratic politics. His current research focuses on political practices that emerge in the blind spots of parliamentary settings. He is bringing together a number of such practices in his habilitation at the Goethe University (Frankfurt am Main), provisionally titled Melancholy Democracy. Endre is also co-founder and co-editor of Mattering Press – an Open Access book publisher specialised in Science and Technology Studies. Róbert Csák is a sociologist currently working as a research analyst with the Public Health and Social Policy team at Harm Reduction International. Prior to joining HRI, his research focused on substance use in rural and marginalised communities in Hungary. Róbert holds a PhD in Health Science from the Semmelweis University (Budapest) – his research had examined how structural factors affect risk-taking behaviours of people who use drugs in the context of the changing injecting drug use scene in Budapest. Róbert has worked in needle exchange programmes, done community outreach, HIV and HCV testing and counselling for over ten years. - 13 -