What is Harm Reduction?
According to the International Harm Reduction Association, harm reduction  refers to policies, programmes and projects which aim to reduce the health, social and economic harms associated with the use of psychoactive substances. It is a safe, evidence-based and cost-effective approach that leads to benefits for people who use drugs as well as the wider community.
Harm reduction is also about preventing HIV transmission as well a other blood-borne infections. Harm reduction is about saving lives. As long as people continue to spread HIV through drug injecting and unsafe sex, harm reduction will be needed. The term harm reduction refers to various strategies and approaches for reducing the physical and social harms associated with risk behaviour. Harm reduction among injecting drug users (IDUs) can take many forms (abstinence, education programmes, counseling, drug substitution, needle exchange, etc). Harm reduction can be applied to use of legal drugs and other areas where complete abstinence from risk behaviour is an unrealistic goal in a short timespan. Harm reduction is about making dangerous behaviours and situations less dangerous.
Criminalisation of drug use and the people who use drugs leads to major negative including:
 transmission of blood borne diseases such as HIV/AIDS and Hepatitis B and C overdose various medical and psychological conditions the social costs of widespread drug use such as crime and other anti-social activities economic costs of treating people infected with HIV/AIDS legal costs of imprisoning drug users the denial of basic health care and other social services | |
Harm reduction acknowledges that some people will continue to use drugs and that drug use will therefore remain part of our societies. Studies and research continue to demonstrate that few will achieve absolute sustained abstinence from drugs. The alternative, harm reduction, aims to keep drug users alive, healthy and productive until drug treatment works or until they grow out of drug use. Most importantly, harm reduction aims to involve and empower people who use drugs in decisions and programmes that affect their lives and livelihoods. As such, such strategies always emphasise dignity and human rights for all members of society, including people who use drugs.
Principles of harm reduction
1. Harm reduction first and foremost means involving people who use drugs in a meaningful way in all programme and policy decisions that will impact their lives. Meaningful involvement starts with community consultation and needs assessments conducted in the context of mutual respect and equal partnerships. This further implies appropriate remuneration and compensation for the efforts of people who use drugs; and recognition of contributions, time and energy invested. Developed out of the GIPA framework (greater involvement of people living with HIV/AIDS), people who use drugs and their representatives call for “NOTHING ABOUT US WITHOUT US!”
2. Harm reduction places emphasis on immediate, feasible goals over vague, long-term ideals, such as that of a drug-free society. The rapid, potentially explosive spread of HIV should therefore be prioritised and such prevention activities are best initiated before HIV prevalence among people who use drugs is greater than five percent. Otherwise, achieving abstinence will remain very difficult and other programmes like vocational education and social rehabilitation will be much less effective.
3. A hierarchy based on health risks can be established to avoid HIV transmission as a consequence of drug use and its legal prohibition:
Stop or never start using drugs
If you use drugs, do not inject
If you inject, use sterile equipment and do not share
needles, syringes, spoons, water, drugs
If you need to re-use equipment, clean and use your own
If you must share, clean or disinfect before using | | |
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TDN members undergoing a training of trainers. | |
4. Harm reduction is NOT an alternative to supply and demand reduction but rather seeks to complement these approaches. In contrast, the focus of harm reduction is on public health rather than law enforcement. Research suggests that to ensure the health and well being of people who use drugs, harm reduction interventions must be couched in a comprehensive package of health and social care services. In particular, to prevent the transmission of blood-borne infections, multiple interventions are required, such as:
- Information sharing
- Drug treatment and pharmacotherapy (substitution)
- Outreach and peer education
- Needle and syringe exchange programme (NSEP)
- HIV voluntary counseling and testing
- Primary health care
- Advocacy to remove barriers to safe injecting
- Targeting marginalised groups (prisoners, women, ethnic groups)
5. Current and recovering drug users are central in designing, promoting, delivering and evaluating health care and HIV prevention services they need. Harm reduction meets them where they are, and involves them in policy-making and advocacy. It considers what, according to their opinion, will work for them, and accepts, encourages and nurtures any improvements they may be capable of making.
6. Harm reduction is an evidence based approach. Scientific data has been accumulating to support harm reduction programmes and projects. The evidence indicates that harm reduction is effective in reducing the rate of transmission for blood-borne infections, mortality rates, social and economic costs related to drug use, all the while being cost-effective and safe. No studies have shown an increase in drug use with regards to harm reduction programmes. See the evidence here.
References
McVinney, Don. Utopian dream fueling explosion of HIV cases. Interview by David Pratt for Body Positive. 2003.
Risks are a part of life. European AIDS Treatment News, May 2004.
The Centre for Harm Reduction (CHR), Burnet Institute. Understanding Harm Reduction Fact Sheet.
The Centre for Harm Reduction (CHR), Burnet Institute and Asian Harm Reduction Network (AHRN). Manual for Reducing Drug Related Harm in Asia, 2003
All audio clips on this page collected from Radio Singapore International (2005) Perspective. Interviews with Melanie Yip (RSI), Dr. Kim (WHO), Mr. Tanguay (AHRN) and Dr. Palan (WHO). Tor read the full interview, visit http://www.rsi.sg/english/perspective/view/20051231212456/1/.html.
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