The role of harm reduction in controlling HIV among injecting drug users

Abstract

Injecting drug users (IDU) now account for one in 10 new HIV infections world wide. Yet it has been known since the early 1990s that HIV among IDU can be effectively, safely and cost-effectively controlled by the early and vigorous implementation of a comprehensive package of strategies known as ’harm reduction’. This concept means that decreasing drug-related harms is accorded an even higher priority than reduction of drug consumption. Strategies required involve: explicit and peer-based education about the risk of HIV from sharing injecting equipment; needle syringe programmes; drug treatment (including especially opiate substitution treatment) and community development. Many countries experiencing or threatened by an HIV epidemic among IDU have now adopted harm reduction but often implementation has been too little and too late. Although coverage is slowly improving in many countries, HIV is still spreading faster among IDU than harm reduction programmes while coverage in correctional centres lags far behind community settings. The scientific debate about harm reduction is now over. National and international support for harm reduction is growing while almost all the major UN organizations responsible for drug policy now support harm reduction. Only a small number of countries, led by the USA, are still vehemently opposed to harm reduction. Excessive reliance on drug law enforcement remains the major barrier to increased adoption of harm reduction. Sometimes zealous drug law enforcement undermines harm reduction. A more balanced approach to drug law enforcement is required with illicit drug use recognized primarily as a health and social problem.

The effectiveness of harm reduction in preventing HIV among injecting drug users

“…Moreover, evidence from recent US randomised-controlled trials indicates that behavioural interventions, including peer-driven interventions, reduce the risk of HIV and hepatitis C acquisition by encouraging safer behaviours and increasing access to health services. 33,34 Effectiveness of drug law enforcement The effectiveness, cost-effectiveness and lack of serious unintended negative consequences of harm reduction 5,35 stands in stark contrast to the relative ineffectiveness, costinfectiveness and serious unintended negative consequences of drug law enforcement. 36 Yet drug law enforcement is the mainstay of the response to illicit drugs by governments in Australia and other countries and the major beneficiary of government resources.…”

The Necessity of Enhanced Harm Reduction Programs to Prevent Blood-Borne Infections Amongst Injection Drug Users

“…People who inject drugs are at a higher risk of HIV and hepatitis C virus (HCV) transmission by sharing of injecting equipments (2)(3)(4)(5). Injecting drug users now account for one in 10 new HIV infections worldwide (6). For example, the prevalence rate of HIV/AIDS was upwards of 75% -89% among the Chinese injection drug users (3).…”

“…In response to this challenge, the prevention measurements such as harm reduction programs have been endorsed by some countries (2)(3)(4)(6)(7)(8). Harm reduction is a practical and non-judgmental set of resources and strategies to diminish the individual and community harms that caused by drug usage (3,6).…”

“…Harm reduction is a practical and non-judgmental set of resources and strategies to diminish the individual and community harms that caused by drug usage (3,6). The harm reduction priority is lessening the negative consequences of drug use, rather than to diminish or eliminate the drug use itself as well as focusing on safer practices and patterns of drug use (3,6). Indeed, these programs aimed to prevent spreading of the infections such as HIV/AIDS, hepatitis C and all blood-borne diseases, lessening the risk of drugrelated fatalities, and reducing the adverse effects of drug use (2-5, 7).…”

“…Several other studies have also showed an association between implementation of harm reduction programs and reduction in HIV incidence (2,4,(6)(7)(8). China has begun its first needle exchange programs in 2000 as a trial effort to find out an effective way for prevention of HIV/ AIDS acquisition and transmission of other blood-borne infections.…”