Each month, IHRA selects a recently published journal article, study or resource which is of particular significance for harm reduction. These are featured in the IHRA e-newsletters, and on the website and, wherever possible, are made freely available to download. The articles are chosen for their capacity to advance the scientific basis of harm reduction, and their potential value for harm reduction advocates, policy makers, practitioners and researchers. If you would like to recommend an Article of the Month, please contact IHRA.
|
February 2008 Article of the Month
|
Van Den Berg C, Smit C, Van Brussel G, Coutinho R, Prins M (2007) Full Participation in Harm Reduction Programmes is Associated with Decreased Risk for Human Immunodeficiency Virus and Hepatitis C Virus: Evidence from the Amsterdam Cohort Studies among Drug Users. Addiction, 102(9), 1454–1462.
|
This research, published in a recent issue of Addiction, is from an open, large-scale, and prospective voluntary cohort study and seems to indicate that “full participation” in harm reduction programmes is associated with a reduction in the risk of HIV and hepatitis C (HCV) infection. The study sample was 714 “ever-injected” drug users at risk for HIV and/or HCV in Amsterdam, the Netherlands. The study explored five levels of harm reduction and, interestingly, no statistically significant effects were found for needle exchange programmes or methadone programmes alone. However, “full harm reduction” (defined as 60mg or more of daily methadone treatment in the past six months and either no injecting drug use in the past six months, or injecting drug use in the past six months and “always” utilisation of needle exchanges) was associated with significant reductions in risks – “not only on injecting but also on sexual risk behaviour”.
This paper supports the implementation of a broad range of harm reduction interventions in order to have the required impact on drug-related harms. This is important, as many countries and regions have had an over-reliance on individual interventions (such as needle exchange). A comprehensive package of harm reduction includes the exchange of a full range of paraphernalia (not just needles and syringes), the provision of (ideally peer-led) safer drug use advice and information, outreach services and advice, a range of opiate substitution treatment programmes, counselling, condom distribution, and overdose prevention education.
Although this research is based on self-reported behaviour, only two harm reduction interventions (albeit it the “two most important components” according to the authors – needle exchange and methadone) and a very restrictive definition of “full” participation (only using needles from a needle exchange in the last six months), the findings are very encouraging for the on-going advocacy efforts towards a conducive global environment for harm reduction. The authors conclude that their research “is most important for countries with recent and sometimes explosive outbreaks of HIV and/or HCV among [drug users], as in the former Soviet Union and Asia. To provide needles and syringes only or methadone only will not be sufficient to curb the rapid spread of these and other blood-borne infections… It is essential to offer a comprehensive programme in which both measures are combined”.
|
Click here to view the full, Open Access Article courtesy of Blackwell Synergy
|
