People who use drugs are often at increased vulnerability to a variety of harms, including blood-borne and sexually transmitted viruses such as HIV, or hepatitis B and C. The sharing of injecting equipment provides a highly effective transmission route for HIV and has resulted in the rapid expansion of the epidemic among people who inject drugs in many countries.
There are an estimated 15.9 million people that inject drugs living in 158 countries around the world, primarily in low and middle income countries. Up to 10% of all HIV infections occur through injecting drug use, meaning that globally, there may be up to 3.3 million people who inject drugs that are living with HIV. Women, young people, street-involved people, new injectors and prisoners are particularly vulnerable to HIV.
In some areas, such as much of Western Europe, as well as Australia and New Zealand, the prevalence of HIV infection among people who inject drugs remains below 5% (read more). At the other extreme, in countries such as Argentina, Brazil, Estonia, Indonesia, Kenya, Myanmar, Nepal and Thailand, the prevalence of HIV infection has reached 40% or higher among people who inject. There is also evidence of a link between non-injecting drug use, such as crack cocaine smoking, and sexual HIV transmission, in the Caribbean, the USA and Latin America.
The term ‘harm reduction’ refers to policies and programmes aimed at reducing the health, social and economic harms associated with the use of controlled substances. Harm reduction is entrenched in both public health and human rights rationales, and takes a pragmatic and non-judgemental approach to addressing the problems associated with drug use. Importantly, harm reduction involves the recognition that the overall reduction of the scale of drug markets and use is not the only, or even the most important, objective of drug policy. Individuals and communities must therefore be provided with information and tools for reducing the risks associated with drug use.
A variety of interventions fall into the category of harm reduction. These include the dissemination of information on how to reduce risks associated with drug use (often through peer-led outreach), the provision of services which increase the safety of people who use drugs such as needle and syringe exchange programmes and safer injecting facilities, and a range of drug dependence treatment options including the medical provision of substitution for opiate dependence, psychosocial interventions or mutual aid groups. Harm reduction approaches also seek to identify and advocate for changes in laws, regulations and policies that increase harms or that hinder the introduction or efficacy of harm reduction interventions and health services for people who use drugs.
It was in the 1980s that harm reduction approaches started to be adopted by communities and a number of governments in response to the growing HIV epidemics among drug using populations. Today, harm reduction is supported by ninety-three countries and territories across every continent of the world.
Despite this widespread recognition of the concept of harm reduction, the term remains controversial in certain international forums. The concept is endorsed and promoted by a number of international agencies which provide technical and financial support to governments and civil society for harm reduction initiatives across the world. This includes UNAIDS and the Human Rights Council. Within the UN Commission on Narcotic Drugs (CND), however, there is a lack of consensus on harm reduction, as the term was omitted from the new 10 Year Political Declaration on Drugs in 2009. Twenty-six states registered their objection to this by lodging a statement that the term ‘related support services’ used in the document would be interpreted by them to mean harm reduction. In March 2010, the CND refused once again to include harm reduction in its resolution on universal access to HIV services, after considerable debate. Other drug control agencies, particularly the INCB, have been – and continue to be – highly restrictive in their understanding of the term and in their interpretation of the legality of some of its practices. On the other hand, the UNODC has sought to extend the term to include law enforcement measures and, by making it too inclusive, has rendered it virtually meaningless.