Harm Reduction Focus Areas

Harm Reduction & Drug Use

Reducing Harm Through Services

Needle exchange, substitution treatment, overdose prevention, and legal support

An overwhelming body of scientific evidence supports the efficacy of needle exchange and opiate substitution treatment in reducing HIV risk. Services that the OSI International Harm Reduction Development Program (IHRD) has supported include:

• needle exchange programs across Central and Eastern Europe and the former Soviet Union;
• substitution treatment with methadone or buprenorphine in countries including Albania, Kyrgyzstan, Lithuania, and Ukraine;
• the formation of harm reduction networks in Central and Eastern Europe, Russia, and Central Asia to help programs exchange information and advocate for change;
• prison-based harm reduction programs, including needle exchange in Kyrgyzstan and Moldova;
• counseling and outreach efforts to reach drug users, their families, and friends with accurate information about HIV, hepatitis C, and overdose;
• legal services programs to help fight discrimination and prevent legal abuses; and
• trainings for police, HIV physicians, drug treatment specialists, and harm reduction program staff.

Reducing Harm Through Advocacy

Policies based on evidence rather than ideology

Harm reduction programs cannot be effective if fear of harassment, arrest or incarceration makes drug users reluctant to use them. IHRD has worked with policymakers at local, provincial, national, and international levels to:

• encourage the United Nations and national governments to support proven measures such as syringe exchange and substitution treatment at the UN Commission on Narcotic Drugs, the Human Rights Commission, the UNAIDS Programme Coordinating Board, and in national plans;
• highlight the role that incarceration and forced institutionalization play in accelerating the HIV epidemic, and the policy changes that can reduce overcrowding, disease risk, and human rights violations;
• increase funding for and political commitment to the provision of HIV prevention, treatment, and care for IDUs; and
• sponsor or co-sponsor policy dialogues, conferences, satellite sessions, and study tours to explore solutions and demonstrate lessons learned in harm reduction.

Reducing Harm Through Technical Assistance

New models of treatment for HIV and drug dependence

Support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and from bilateral and multilateral donors such as the UK’s Department for International Development (DFID), the Canadian International Development Agency (CIDA), and the World Bank has greatly increased funding available for harm reduction. The need for assistance in scaling up such services at the country level, however, remains acute. Technical assistance provided by IHRD has facilitated:

• expansion of antiretroviral treatment (ARV) in Russia, and the development of the first HIV treatment protocols that include drug users;
• integration of programs providing HIV prevention, HIV treatment, opiate substitution treatment, and care for tuberculosis in Ukraine;
• support in the preparation and implementation of Global Fund grants on harm reduction in Azerbaijan, Georgia, Moldova, Russia, Tajikistan, Thailand, and Ukraine; and
• bilateral funding of harm reduction initiatives in Central Asia, and monitoring to ensure that the money is used appropriately.

Reducing Harm Through Community Organizing

Support for drug users and people living with HIV

More than two decades of HIV have shown that “hard-to-reach” populations are often their own best advocates. Despite the importance of involving those directly affected in the formation of AIDS policy, drug users often have been excluded from even those mechanisms that are supposed to increase the participation of people living with HIV. IHRD has supported active participation of affected communities by offering:

• funding and technical support to organizations of drug users and people with HIV in 13 countries of Eastern Europe, the former Soviet Union, and Asia. Groups work on issues as varied as overdose prevention, HIV treatment advocacy, and media campaigns;
• sponsorship of participation of people who use drugs and people with HIV in international conferences as well as in regional and national conferences in Asia and the former Soviet Union;
• work with groups such as the European AIDS Treatment Group, the Global Network of People Living with HIV/AIDS (GNP+), and the Collaborative Fund for HIV Treatment Preparedness/International Treatment Preparedness Coalition on programs to increase HIV treatment literacy, ensure transparent and effective procurement of ARV, and challenge the systematic exclusion of drug users from care; and
• training and grants to support community mobilization, monitoring of the Global Fund and other HIV programs, and documentation of human rights abuses.