In Romania, the first harm reduction programs appeared in the context of an imminent HIV epidemic among heroin users, through injection. So, the first initiatives were developed in order to attract injecting drug users to specialized medical and social services through needle exchange. In 1999, Romanian Association Against AIDS (ARAS) started in Bucharest the first HIV prevention program among sex workers, a program which also contacted drug users and provided them sterile syringes. In parallel, Alliance for the Fight Against Alcoholism and Drug Abuse (ALIAT) opened a fixed needle exchange service, which became the first permanent system specifically created to help these people.

In Romania harm reduction services can't cover all drug users that face many other challenges such as limited access to social and medical services and police violence.

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