Question

What is harm reduction? How does it relate to HIV prevention?

Describe one harm reduction program in US and give evidence of how it has been successful in reducing HIV rates.

Answer 1

Harm Reduction

Harm reduction refers to policies, programmes and practices that aim to minimise negative health, social and legal impacts associated with drug use, drug policies and drug laws. Harm reduction is grounded in justice and human rights - it focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that they stop using drugs as a precondition of support.

How does it relate to HIV prevention?

Harm reduction strategies aim to lessen harms associated with drug use and related behaviors that increase the risk of HIV infection. Sharing needles and syringes raises the risk of blood-borne HIV transmission. Drug use is associated with risky sexual behaviors including unprotected sex and the exchange of sex for drugs or money, which are linked to an increased risk of HIV infection. Harm reduction strategies can reduce behaviors resulting in elevated risk of HIV infection among injecting and non-injecting drug users. Research has shown that many people receiving treatment for substance use disorders stop or reduce their drug use and related behaviors, including unsafe sex.

Describe one harm reduction program in US and give evidence of how it has been successful in reducing HIV rates?

Syringe exchange programs and syringe exchange research

When HIV antibody testing was first implemented in Amsterdam, the prevalence was over 30%. The city had already implemented a small syringe exchange program (also referred to as needle and syringe exchange programs, syringe service programs, syringe access programs, syringe distribution programs, needle/syringe exchange programs) the year before in an effort to reduce the transmission of hepatitis B virus (HBV) among PWID (Persons Who Inject Drugs). This exchange program was started after a large pharmacy in the central city stopped selling needles and syringes to drug users. With the discovery of the very substantial HIV/AIDS problem among PWID in the city, the Amsterdam health department rapidly expanded the exchange program, and other Dutch cities implemented programs.

While the original purpose of syringe exchange programs was to reduce transmission of blood-borne infections among PWID, programs in the USA rapidly evolved into multi-service organizations. In addition to basic syringe exchange, the programs have provided a wide range of additional health and social services to people who use drugs (and also often to community members who do not use drugs). These services include condoms, referrals to substance abuse treatment, HIV, hepatitis C virus (HCV), HBV counseling and testing, and naloxone for overdose. Of particular importance is education about overdose and the distribution of naloxone to drug users, their friends and families for reversing overdoses.

Evidence

Wodak A., Cooney A. Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. Geneva: World Health Organization; 2004. Available at: http://www.who.int/en/ (accessed 2 February 2005).

This study concuded as there is compelling evidence that increasing the availability and utilization of sterile injecting equipment by IDUs reduces HIV infection substantially. Overall, there is convincing evidence that NSPs, assessed conservatively, fulfil six of the nine Bradford Hill criteria (strength of association, replication of findings, temporal sequence, biological plausibility, coherence of the evidence and argument by analogy) and all of the five additional criteria (cost effectiveness, absence of negative consequences, feasibility of implementation, expansion and coverage, unanticipated benefits and special populations). Measured against any objective standards, the evidence to support the effectiveness of NSPs in substantially reducing HIV must be regarded as overwhelming.