Harm Reduction and HIV

What Is Harm Reduction?

Harm reduction is a way of dealing with behavior that damages the health of the person involved and of their community. Harm reduction tries to improve individual and community health.

Much of the work on harm reduction has been in connection with drug use. This fact sheet focuses on harm reduction applied to drug use and HIV.

Some key points of harm reduction:

  • Drug use won't disappear but its harmful effects can be reduced. Harm reduction should be a goal for service organizations and governments.
  • Some drugs are safer than others. Some ways of using drugs are less harmful than others.
  • Drug users can best reduce the harm of their own drug use.
  • Abstinence is the ultimate goal. However, it is also good to reduce drug use and drug-related deaths, disease and crime.
  • The criminal justice approach should not be the only method for dealing with drug use. Combining it with a public health approach is more productive.
  • Services for drug users should be non-judgmental. They should not force people to receive services.

Harm Reduction in Action

Harm reduction related to drug use includes:

  • Teaching drug users about the risks of different drugs and their use.
  • Providing information on using drugs more safely, and reducing the harm of overdoses.
  • Providing methadone as a substitute for heroin
  • Offering education and medication to prevent or counteract a drug overdose.
  • Offering education and referral to drug treatment opportunities.
  • Permitting drug users to exchange used syringes for new ones, or buy new syringes.
  • Providing outreach services in areas where drug sales occur.
  • Treating clients as the experts on their lives; dealing with them as they are.

There is research to support several harm reduction approaches, including methadone maintenance for heroin users and needle exchange for injection drug users.

Harm Reduction and HIV

Some harm caused by drug use is related to HIV. Fact Sheet 154 has more information on drug use and HIV.

  • Sharing equipment for drug use can spread HIV infection if it contains even a tiny amount of infected blood.
  • Drug use is linked to unsafe sexual activity. This increases the spread of HIV infection.
  • It is also related to missing doses of HIV medications (poor adherence.) This can make HIV disease get worse.

Harm reduction can include:

  • Providing education about the HIV-related risks of drug use and of unsafe sexual activity. Fact Sheet 151 has information on safer sexual activity.
  • Helping drug treatment counselors incorporate harm reduction skills into their work.
  • Offering overdose prevention education and support to drug users.

Challenges to Harm Reduction

Drug use and its effects are huge challenges. They require the coordinated efforts of treatment specialists, law enforcement agents, public health professionals, corrections experts, and drug users themselves.

Harm reduction suggests that drug treatment is usually more effective than arrest and imprisonment. It also says that the best approach to drug use problems involves public health providers working with drug users rather than imposing legal punishment. Exceptions would be where drug use results in criminal activity that harms others, such as theft, violence, and driving under the influence of drugs.

Many communities combine harm reduction and law enforcement approaches to drug use. Unfortunately, many debates about drug policy put public health arguments on one side against morality and law enforcement on the other.

Is Harm Reduction Legal?

Some aspects of harm reduction are legal. Drug users can get information on methadone, on using drugs more safely, or referrals to drug treatment programs. In some states, people can purchase syringes without a prescription or obtain medications to reverse a drug overdose. People can get information on reducing the risk of HIV infection through sexual activity and can get condoms. Some countries (not the US) have set up safe injection sites for drug users. At these sites, clean syringes and medical care are available.

Many other aspects of harm reduction require changes in laws or in law enforcement procedures. For example, syringe exchange programs operate under specific exemptions to existing laws or local "emergency" legislation. Programs to permit the purchase of new syringes without a prescription, or to distribute medications to prevent overdose, also require changes in laws. These legal changes may require cooperation from local law enforcement officials.

Harm Reduction in New Mexico

In 1997, the legislature passed the Harm Reduction Act. It legalized needle exchange statewide. A bill passed in 2001 permits pharmacists to sell syringes to drug users.

These actions put New Mexico among the few states that have implemented harm reduction approaches to drug use instead of relying totally on a law enforcement approach.

The Bottom Line

Harm reduction is a public health approach to behaviors that harm individuals and their communities. Harm reduction can be applied alongside law enforcement activities.

Harm reduction focuses on improving the health of individuals and the public, more than on eliminating harmful behaviors, although that is the ultimate goal. Harm reduction principles can be applied to reducing the HIV-related risks of drug use or of unsafe sexual activity.

See the Drug Policy Alliance at www.drugpolicy.org/ for more on drug policy. For more information on laws related to syringe access, possession and disposal, see www.temple.edu/lawschool/aidspolicy/

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