84 Cent Eur J Public Health 2007; 15 (2): 84–86 SUMMARY Objectives: The main objective of this study was to explore how harm reduction (HR) approach and low-threshold approach are realised at low-threshold services (LTSs) in Hungary in comparison with the guidelines presented in different policy papers (European Union drugs strategies) and national regulations. Materials and methods: Hungarian LTSs were investigated: 29 organisations out of 44 (66% return rate) were reached with questionnaires and 40 LTS workers were interviewed. Results: The LTSs have difficulties reaching their target group, distributing sufficient sterile syringes and interpreting the concept of ‘low-threshold’ and HR, sometimes defining them as a transient stage to abstinence-based treatment. Conclusion: The study results suggest that Hungarian LTSs need to be re-orientated toward more emphasis on health-related issues. Key words: drug abuse, harm reduction, Hungary, low-threshold service Address for correspondence: J. Rácz, Institute for Psychology of the Hungarian Academy of Sciences, Victor Hugo utca 18-22, Budapest – 1132, Hungary. E-mail: raczj@mtapi.hu INTRODUCTION The UNAIDS (Joint United Nations Programme on HIV/ AIDS) (1), the European Union (2) as well as Hungarian drug policy documents (3) emphasize the importance of harm reduc- tion (HR) and low-threshold (LT) services for drug users. The HR approach and the services provided by low-threshold agencies (LTS) (4) contribute to the reduction of social and individual harms caused by drug abuse (5, 6). Transitional countries (state- controlled countries developing into market economy) display particular drug and HIV-related problems (7, 8). Therefore, it is quite useful to view how a transitional country makes an attempt to apply HR. The most important client population of LTSs is ‘problem drug users’. Problem of drug use (PDU) is defined as ‘injecting drug use or long duration/regular use of opiates, cocaine and/or amphetamines’ by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (9, 10). According to the Annual Reports (11, 12), the ratio of problem drug users to the general population is 2–10/1000 inhabitants in the 15–64 age group, with significant differences among countries as well as within them. The injecting drug user (IDU) prevalence is about 1–6/1000 in the same age group. According to the EMCDDA reports, the available data show that the ratio of needles (from needle and syringe programs, NSP) distributed to IDUs vary from 25 needles/IDU/year (France and Portugal) to 76 (Austria) or 162 (Czech Republic) (11, 12). According to current available data, Hungary (10 million inhabitants) has one of the lowest drug abuse prevalence rates among the EU member states (12, 13). The HIV infection ratio LOW-THRESHOLD SERVICES FOR PROBLEM DRUG USERS IN HUNGARY Katalin Melles 1 , Ferenc Márványkövi 1 , Jozsef Rácz 1,2 1 Research Institute on Drug Studies, Eötvös University, Budapest 2 Institute for Psychology, Hungarian Academy of Sciences, Budapest among IDUs was 1% in the period between 1997–2004 (14). How- ever, between 1997 and 2002, the proportion of hepatitis C (HCV) infected IDUs treated in hospitals rose from 16% to 30% (15). While in the new EU member states drug-related death increased between 1996 and 2003, Hungary is experiencing a decreasing rate with drug-related annual death figure dropping from 52 to 32 in the same period (12). The Hungarian National Drug Strategy (3) as well as other regulations (16) make a reference to the set-up of low-threshold agencies as well as HR services (17). The main objective of this study was to explore how HR approach and low- threshold method are realised at LTSs in Hungary in comparison with the guidelines to be found in different policy papers (2) and national regulations (3, 16). MATERIALS AND METHODS Sampling Procedure and Sample Description To select agencies, a directory called ‘Droginfó’ (18) that in- cludes contact details of all Hungarian LTSs was used. To obtain a representative sample, all organisations defining themselves as ‘low-threshold agencies’ were selected from the directory. Then a sub-sample was made by omitting incorrectly categorised agen- cies (abstinence-based services). Of the 62 agencies selected this way, 4 had ceased operations before the survey, 14 did not return the questionnaire as they could not interpret the questions as they turned out to be agencies providing services to target groups other than drug users. Thus the sample was reduced to 44 organisa- tions from all parts of Hungary. 29 organisations returned the questionnaire finally, which represents a 66% response rate. The