Harm Reduction

Harm reduction describes any policy or action designed to lessen damage caused by a potentially dangerous behavior; equivalent terms include harm minimization, risk reduction, and risk management. In relation to HIV/AIDS, these mostly describe measures that lessen a person's risk of contracting HIV, either through injecting drug use or through sexual contact.

The concept of harm reduction was formulated in 1972 in The Netherlands to influence Dutch policy on drug-related problems. The tenets of harm reduction were refined over time into a policy known as "normalization," now the foundation for drug policy in The Netherlands. Central to normalization is the observation that drugs have been a part of human society for centuries, and thus, their use should be managed rather than prohibited.

Normalization encourages drug users to target realistic health goals, set by the users themselves. Abstinence is only one option. The focus is on reducing the harm taking place -- by developing safer alternatives, such as methadone, perhaps by controlling dosages and the quality of drugs, or by addressing the circumstances in which drugs are used. In the case of HIV transmission, harm reduction means providing access to clean needles, education about how to inject more safely, and information about other health-promoting measures.

Harm reduction stands in contrast to positions such as deterrence, abstinence, or the "war on drugs." The latter views, most notably promoted in the United States, reject any and all illegal drug use, even while tolerating legal drugs such as alcohol and nicotine. In terms of HIV/AIDS, the abstinence mentality has blocked needle-exchange programs, and the threat of legal sanction against drug users has prevented many from seeking the help they need.

There is growing evidence that harm reduction in the form of normalization is effective both in preventing and treating drug abuse and in preventing new HIV infections among injecting drug users. However, the ideological differences between normalization and deterrence have caused much controversy over the use of harm reduction as a primary strategy. There has not been evidence, as detractors claim, that harm-reduction strategies lead to the spread of drug use and addiction.

Since the late 1980s, there has been growing support, particularly in Europe, for applying the idea of harm reduction to the prevention of HIV transmission through sexual contact. Consistent with the tenets of normalization, supporters argue that the focus of early prevention efforts ignored the degree to which various sexual acts were a "normal" part of people's lives. Officials tried to stop transmission by eliminating all risk behavior, in the same way that deterrence seeks to eliminate all drug use.

Harm reduction suggests that prevention focus on informing people of the risks of the various practices and on promoting sexual activities that are least likely to transmit HIV. The goal of stopping all risky sexual activity would be abandoned as unrealistic. Further, harm reduction would not stigmatize those who practice higher-risk sex, recognizing that sexual behavior is the result of various complex situational, cultural, social, and personal factors.

Related Entries

Abstinence; Condoms; Dental Dams; Drug Outreach Projects; Injecting Drug Use; Injecting Drug Use, Subculture of; Interventions; Monogamy; Needle Exchange Programs; Universal Precautions

Key Words

abstinence, deterrence, harm minimization, harm reduction, normalization, risk management, risk reduction

Further Reading

Davies, P., et al., "On Relapse: Recidivism or Rational Response?" in AIDS: Rights, Risks and Reason, edited by P. Aggleton, et al., London and Washington, D.C., 1992.

Englesman, E. L., "Dutch Policy on the Management of Drug-Related Problems," British Journal of Addiction 84 (1989), pp. 211-218.

Odets, Walt, "AIDS Education and Harm Reduction and Gay Men: Psychological Approaches for the 21st Century," AIDS and Public Policy Journal 9 (1994), pp. 3-15.

Van de Wijngaart, Frank Govert, "Competing Perspectives on Drug Use," in Competing Perspectives on Drug Use: The Dutch Experience, Amsterdam, The Netherlands: Swets & Zeitlinger, 1991.

The Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic, Raymond A. Smith, Editor. Copyright © 1998, Raymond A. Smith. Carried by permission of Fitzroy Dearborn Publishers.

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