Addressing injecting drug use in Asia and Eastern Europe.

While the global HIV incidence dropped about 20% in the past 10 years, HIV incidences among people who inject drugs (PWID) in Asia and Europe continue to increase and to account for high proportions of new HIV infections among PWID globally. Great changes have been observed in this region, such as progressing from rejection to acceptance of harm reduction strategies in Asian countries, but no such change has occurred in Eastern European countries. China has quickly scaled up harm reduction activities nationwide, resulting in the decline of HIV incidence and HIV prevalence among PWID since 2006. However, insufficient scaling up of harm reduction programs in other countries has failed to slow down their HIV epidemics. In Eastern European countries where the spread of HIV among PWID is the most severe, only about 15% of funding for harm reduction programs are from domestic sources. Strong political and financial commitment from countries in this region is urgently needed to quickly scale up evidence-based harm reduction strategies in order to prevent the HIV epidemic from spreading rapidly from PWID to the heterosexual general population

Harm reduction

AbstractThe “Harm Reduction” session was chaired by Dr Jacques Normand, Director of the AIDS Research Program of the United States National Institute on Drug Abuse. The three presenters (and their presentation topics) were: Dr Don Des Jarlais (High coverage needle/syringe programs for people who inject drugs in low and middle income countries: a systematic review), Dr Nicholas Thomson (Harm reduction history, response, and current trends in Asia), and Dr Jih-Heng Li (Harm reduction strategies in Taiwan)

Harm Reduction

• Harm reduction is a policy philosophy aimed at minimizing negative health outcomes by embracing compassion and rejecting stigma. It is often described as “meeting people where they are.” • The core of harm reduction is acknowledging the lethality of modern drugs such as fentanyl. If you keep the person alive, you have a greater chance of getting them into long term recovery, even if that means tolerating their substance use for the moment. • Harm reduction does not mean condoning substance use, but it does mean withholding condemnation. • Tennessee already has a number of harm reduction policies in place, including increased naloxone availability, the Good Samaritan law, and syringe service programs (SSPs). These policies have already demonstrated a positive impact on overdose survivability, reduced transmission of infectious disease such as HIV, and increased entry into long term recovery. • Novel harm reduction strategies have been enacted in other parts of the United States, and are showing promising results for the fatal overdose rat

Harm Reduction

As member states of the United Nations take stock of the drug control system, a number of debates have emerged among governments about how to balance international drug laws with human rights, public health, alternatives to incarceration, and experimentation with regulation. This series intends to provide a primer on why governments must not turn a blind eye to pressing human rights and public health impacts of current drug policies.Harm reduction is based on the idea that people have the right to be safe and supported even if they are not ready or willing to abstain from illicit drug use. A harm reduction approach involves giving people who use drugs choices that can help them protect their health. For many people who use drugs, harm reduction services are the most likely entry point into health care and the most likely means of protection from life-threatening conditions. As United Nations agencies have noted, the effectiveness of harm reduction services for HIV prevention and prevention of drug-related mortality is beyond dispute. The UN General Assembly Special Session on drugs in 2016 is an opportunity to re-energize the commitment to harm reduction pledged by UN member states at the 2001 UNGASS on HIV/AIDS. Funding for proven and cost-effective harm reduction services that protect not only people who use drugs but entire communities should be a top priority. This report details how harm reduction is a central pillar of effective drug response, critical to reaching people who use drugs with services that can help protect them, their families, and their communities

Public health, human rights and the harm reduction paradigm: from risk reduction to vulnerability reduction

This paper explores the utility of expanding the harm reduction paradigm to incorporate vulnerability reduction. The thrust of harm reduction interventions to date, particularly in injection drug use, has been risk reduction. Many interventions have been designed to reduce drug-related harm by altering high-risk behaviours. Vulnerability looks behind risk. The notion of vulnerability incorporates the complex of underlying factors that promotes harmful outcomes as a result of drug use, and limits attempts to modify drug use to make harmful outcomes less likely. A conceptual framework will be introduced that looks at harm, risk and vulnerability at the three levels of individual, community and society. This paper uses illicit injection drug use as an example. This conceptual framework will be used to position human rights more centrally in the harm reduction debate. Human rights violations and infringements can contribute to drug-related harm by first creating the preconditions for risky drug use; and second, by limiting access to prevention and care. A human rights framework allows us to better understand vulnerability to drug-related harm, and provides an important advocacy tool for improved interventions. This expanded harm reduction paradigm that incorporates vulnerability and human rights allows for better development of a public health approach in harm reduction, exposes gaps in research, and allows for better development of more effective interventions

Controlled drinking, harm reduction and their roles in the response to alcohol-related problems

This article first distinguishes three meanings of the term ‘harm reduction’ in the literature on alcohol problems: a European sense in which a change in drinking is not necessarily required; an American sense which includes the controlled drinking (CD) goal of treatment; and a government policy sense in which it is seen as an alternative to whole population alcohol policies. The article then goes on to consider the roles of the CD goal and the harm reduction philosophy in response to three groups of people with alcohol problems or increased risk of such problems: the non-treatment-seeking population of hazardous and harmful drinkers; the population of socio-economically disadvantaged street drinkers or others who are thought unlikely to make radical changes in drinking behaviour; and the regular population of treatment-seeking problem drinkers. It is concluded, inter alia, that the equation of harm reduction and the CD goal in the American sense of harm reduction is confusing and may have had a detrimental effect of the practice of CD treatment. The CD goal should imply an aim of harm-free drinking

Use of harm reduction strategies in an occupational therapy life skills intervention

Thesis (M.S.)--Boston UniversityObjectives of Study: Harm reduction intervention strategies have the potential to support positive health outcomes. However, no studies have explored how these strategies can be implemented in an occupational therapy intervention. This study addresses this knowledge gap by examining harm reduction strategies that were discussed during group and individual sessions of an occupational therapist-led life skills intervention for people who have a mental illness and are or were homeless. Methods: This study is a secondary analysis of a larger study that used a longitudinal repeated measures design to implement a life skills intervention. This secondary analysis uses a mixed methods design. Qualitative methods were used for data collection and initial analysis. Quantitative methods were then used to analyze differences between settings. Results: Three major themes emerged from the data: Financial, Physical, and Psychosocial Hann Reduction. The most prevalent theme was Financial Harm Reduction. All three themes were present throughout all of the different life skills intervention modules. There was no significant difference in the themes used between settings. Limitations and Recommendations for Further Research: This study was limited to what was documented in the therapy notes. Although the notes may not include every discussion that occurred, these results suggest that harm-reduction strategies can be utilized in an occupational therapy intervention. Additional research is needed to investigate how harm reduction can be implemented in other areas of occupational therapy practice