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Western Europe - Regional Overview
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Early HIV epidemics among injecting populations in the Netherlands and the United Kingdom during the 1980s prompted the beginnings of needle and syringe exchange programmes. Governments were fast to adopt harm reduction approaches and now almost every country with reported injecting drug use has key harm reduction interventions in place. The high distribution of sterile injecting equipment (over 140 needles and syringes per person per year) and good coverage of opioid substitution therapy (OST) have averted or reversed HIV epidemics in several Western European countries. Despite this, large areas within countries are not covered and stigma, discrimination, as well as limited funding remain barriers to increasing accessing these services. Several countries in this region have employed innovative harm reduction measures such as establishing drug consumption rooms, syringe vending machines, injectable OST and diamorphine (pharmaceutical heroin) prescription.
Harm reduction programmes in prisons are less widely available. Whereas many countries prescribe OST to prisoners in some institutions, the availability of sterile injecting equipment is more limited. The European Union strategy and action plan are explicitly supportive of harm reduction and many Western European countries are amongst the most vocal in support for harm reduction in international fora.
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Injecting Drug Use, HIV and Hepatitis C
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The following maps and table outline the current available data on injecting drug use, as well as the prevalence of HIV and hepatitis C among injecting populations in Western Europe.
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The map below illustrates HIV prevalence among injecting drug users in countries of the region.
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The map below illustrates hepatitis C prevalence among injecting drug users in countries of the region.
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The following table provides the latest estimates of HIV and hepatitis C prevalence within injecting populations, as well as the estimated total number of injecting drug users in countries of the region.
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Countries/territory with reported injecting drug use
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| | Adult HIV prevalence amongst people who inject drugs**
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| Adult HCV prevalence amongst people who inject drugs***
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*Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008)
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The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
**Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008) The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
***Cook, C & Kanaef, N (2008) The Global State of Harm Reduction: Mapping the global response to drug-related HIV and hepatitis C epidemics. International Harm Reduction Association, UK
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Harm Reduction Policies
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The vast majority of Western European countries have an explicit supportive reference to harm reduction in their national policies on HIV and/or drugs. These are illustrated in the map and table below.
Although policy wording is not necessarily indicative of the implementation of effective harm reduction measures in a country, it does indicate governmental commitment to tackling drug related harms and is therefore an important advocacy target.
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| Explicit reference to harm reduction policies in official documents*
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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Harm Reduction Programmes
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Key harm reduction interventions (including needle and syringe exchange and opioid substitution therapy) are available in the vast majority of countries in this region, as illustrated in the maps and table below. Coverage in some areas remains low and improvements to service opening times, as well as stigma reduction and increased investment are necessary to enable more people to access services.
Harm reduction programmes in prisons are not widely available. Whereas many countries prescribe opioid substitution therapy to prisoners, the availability of sterile injecting equipment is more limited.
The following table indicates which countries have a) one or more needle and syringe exchange sites operational both in and outside prisons, b) prescription of opioid substitution therapy for maintenance in and outside of prisons c) one or more drug consumption rooms in countries of the region.
A tick in this table does not indicate the scope, quality or coverage of services. Also it should be noted that in some countries, harm reduction services, NSP in particular, are NGO-driven and may be operating without government support.
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Countries/territory with reported injecting drug use
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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The map below shows which countries have prison-based needle and syringe exchange programmes and opioid substitution therapy prescription.
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Harm reduction programmes in prisons are not widely available. Whereas many countries prescribe opioid substitution therapy to prisoners, the availability of sterile injecting equipment is more limited.
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