Harm Reduction News: Innovations in Service and Advocacy

In country after country, when politicians, healthcare professionals, and advocates first respond to the crisis of drug use, they often hew to a narrow, abstinence-only approach—whether in terms of treatment, education, or public policy. Likewise, their initial response to AIDS is typically to segregate people with HIV through campaigns of isolation. The use of harsh approaches to drug use and HIV has been repeated throughout Central and Eastern Europe and the former Soviet Union.

When these approaches fail the people that they were designed to help, the result is often systematic discrimination and countless avoidable deaths. These tragedies demand new responses: crafting direct-service programs to meet the specific needs of drug users and people with HIV, empowering these communities to shape their own advocacy messages, curbing human rights abuses by forming partnerships with law enforcement officials, and pressing for legislative reform.

Fortunately, alternative approaches to drug use are now a reality across the region. In medicine, a shift has begun in the thinking of some narcologists, who are moving away from a strictly medical understanding of drug use to one that takes into account social and environmental factors. Support groups exist where none did before. Drug users are no longer automatically separated from family and community for lengthy “treatment.” Some clinics are piloting comprehensive services to drug users—from clean injection equipment to methadone—all offered in a single location.

New approaches are being launched on the advocacy front as well. Drug users with HIV are making advances in the fight for equal access to antiretrovirals by disproving arguments that they are incapable of treatment adherence. Campaigns have been launched in Russia and Tajikistan to decriminalize personal possession in order to halt the flow of drug users into the prison system—where they are at high risk of contracting HIV, TB, and hepatitis—and to reverse drug users’ reluctance to access lifesaving services for fear of being arrested.

This issue of Harm Reduction News highlights innovative models that challenge inadequate national responses to rising drug use and HIV infections. Profiles include a drop-in club for sex workers in Slovakia—located in a subway passage, where it’s most accessible to clients—and an AIDS protest movement in Russia that garnered positive media attention and invitations for collaboration from local officials. In some instances, the models themselves are new, such as a project in Iran that offers methadone maintenance, needle exchange, hot showers, and haircuts all at the same site; in other cases, approaches developed elsewhere are being boldly adopted for the first time in a new country, such as the embrace of harm reduction by a network of people with HIV in Ukraine.

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