Harm reduction

Harm reduction is a set of policies, programmes, services and actions that aim to reduce the harm to individuals, communities and society related to drugs, including HIV infection. Harm reduction is key in the prevention of HIV infection among people who inject drugs (PWIDs) and their sexual partners.

Addressing HIV associated with injecting drug use is one of the key challenges in the health sector response to HIV, especially in the east of the WHO European Region.

A comprehensive package of interventions for the prevention, treatment and care of HIV among people who inject drugs has been endorsed widely, by WHO, UNAIDS, UNODC, the UN General Assembly, the Economic and Social Council, the UN Commission on Narcotic Drugs, the UNAIDS Programme Coordinating Board, the Global Fund and PEPFAR. The comprehensive package includes:

  1. Needle and syringe programmes
  2. Opioid substitution therapy and other evidence-based drug dependence treatment
  3. HIV testing and counselling
  4. Antiretroviral therapy
  5. Prevention and treatment of sexually transmitted infections
  6. Condom programmes for people who inject drugs and their sexual partners
  7. Targeted information, education and communication for people who inject drugs and their sexual partners
  8. Prevention, vaccination, diagnosis and treatment for viral hepatitis
  9. Prevention, diagnosis and treatment of tuberculosis.

The interventions included in the comprehensive package are commonly referred to as the harm reduction approach to injecting drug use. Harm reduction in response to drug use may also encompass other interventions; those included in the comprehensive package relate in particular to HIV and other co-infections. Countries should promote scaled-up access to harm reduction services including opioid substitution therapy for PWIDs. This would also provide entry points for antiretroviral treatment.

WHO/Europe actively promotes scaling-up comprehensive harm reduction services to effectively address the HIV epidemic among PWIDs and their sexual partners. During December 2009 – June 2012, the WHO/Europe HIV/AIDS, STIs and Viral hepatitis (HSV) programme carried out a range of specific activities to scale up access to high quality harm reduction, treatment and care for people who inject drugs in the WHO European Region. The activities were carried out as part of a grant agreement between WHO/Europe and the Executive Agency for Health and Consumers (EAHC), acting under powers delegated by the European Commission (EC).