Skip to content
  • Menu
  • About

    About HRI

    HRI is a leading non-governmental organisation working to reduce the negative health, social and human rights impacts of drug use and drug policy by promoting evidence-based public health policies and practices, and human rights based approaches to drugs. Read more about HRI’s history.

    Vision and Mission

    Our vision is a world in which individuals and communities benefit from drug laws, policies and practices that promote health, dignity and human rights.


    Meet our staff at HRI


    HRI is governed by a nine person Board of Directors, elected for three-year terms of office by our membership at our Annual General Meetings. Read more about HRI governance.

    News and Announcements

    Read the latest announcements and updates from HRI.

    What is harm reduction?

    Harm reduction refers to policies, programmes and practices that aim to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop. The defining features are the focus on the prevention of harm, rather than on the prevention of drug use itself, and the focus on people who continue to use drugs.

    Harm reduction definition and principles in 11 languages

    Contact Us

    Please feel free to contact us if you have any questions or queries about our website, our work, membership or the international harm reduction conference.


    HRI benefits from the generous support of the Open Society Foundations, the European Commission, the Elton John AIDS Foundation, the MAC AIDS Fund, UNAIDS, the World Health Organization, the UN Office on Drugs and Crime, the World Bank, The Robert Carr Networks Fund and the Swiss Government.

    Harm Reduction International Awards

    HRI presents a number of awards at outr international conference to acknowledge the contributions of outstanding groups or individuals in the field.

  • Our Work

    Evidence for advocacy

    HRI produces groundbreaking research and policy analysis informing advocacy across our sector.

    Spending where it matters

    Funding for harm reduction services is dangerously short while billions are wasted on drug enforcement. HRI works to assess resourcing needs and advocates for a reinvestment in health.

    Human rights-based policy

    Human rights abuses and drug enforcement go hand in hand. HRI challenges laws, policies and practices that generate harm.

    Sector strengthening

    HRI builds advocacy coalitions and supports emerging harm reduction networks to strengthen the international harm reduction sector.

    International conference

    Harm reduction is a global movement. Our biennial gathering is the International Harm Reduction Conference, convened by HRI.

  • Global State of Harm Reduction

    Global State of Harm Reduction

    Our flagship publication is the biennial Global State of Harm Reduction report. First published in 2008, it involves a coordinated effort across practitioners, academics, advocates and activists to map global data and responses to HIV and hepatitis C epidemics related to unsafe injecting and non-injecting drug use. It is the only report to provide an independent analysis of the state of harm reduction in the world. The information collated within the report is stored and regularly updated on an interactive e-tool for researchers and advocates.

    The Global State of Harm Reduction report is supplemented by regular thematic reports and advisories on key issues and emerging challenges. Please search our Resource Library for more information or join our e-list for regular updates.

    Interactive e-tool

    Global State of Harm Reduction’ e-tool is an interactive resource containing up-to-date information on harm reduction policy and programming around the world. Users can select countries or regions and create tables for an at-a-glance guide to the current state of harm reduction worldwide.

  • International Conferences

    International Conferences

    The 24th International Harm Reduction Conference will take place in Kuala Lumpur, Malaysia, 18–21 October 2015

    Sign up for e-updates or visit the website regularly for more information.

    You can still access the 2013 conference site for an idea of what to expect.

    Conference Archive

    Explore past international harm reduction conferences dating back to 2000.

  • Resource Library

    Resource Library

    Use our extensive resource library to search for HRI, NGO and academic reports, articles and presentations, including materials from past international conferences.

    Harm Reduction Journal

    Harm Reduction Journal,, is an open access, peer-reviewed, online journal whose focus is on the prevalent patterns of psychoactive drug use, the public policies meant to control them, and the search for effective methods of reducing the adverse medical, public health, and social consequences associated with both drugs and drug policies.

  • Support Us

    Membership & Donations

    HRI is a membership based organisation with over 8,000 members worldwide. Read more about individual and organisational membership here.

    We rely on trusts, grants, membership fees and donations to continue our work. To make a donation or pay membership fees, please use our secure payment page.

    Or why not fundraise for us with ‘Discover Adventure’?

    Contact Us

    Harm Reduction International
    Unit 2C09 Southbank Technopark
    90 London Road
    SE1 6LN  

    Tel: +44(0) 207 717 1592
    Fax: +44 (0) 207 922 8822
    Join us on facebook at: Harm Reduction International
    Or join us on Twitter at: HRInews


    Sign up to receive email updates, report launches, harm reduction advisories and information about the forthcoming international harm reduction conference

Caribbean - Regional Overview

  • Print
  • Bookmark and Share

After Sub-Saharan Africa, the Caribbean is the region of the world most affected by HIV and AIDS. Here, the virus is predominantly sexually transmitted and injecting drug use remains rare in much of the region, with the exception of Puerto Rico. However, research has highlighted a link between non-injecting drug use and sexual HIV transmission in several Caribbean countries, with HIV prevalence estimates among crack cocaine smoking populations reaching those found among injecting populations elsewhere. Crack cocaine is widely available on most islands, due to drug transhipment routes, and its use is reported to be ‘extensive’.

The harm reduction response remains limited, with needle and syringe exchange and opioid substitution therapy only available in Puerto Rico. The predominant response in the rest of the region is characterised by abstinence-based, high-threshold services for people who use drugs. The use of illicit drugs is highly criminalised, with harsh sentencing resulting in large numbers of people who use drugs in Caribbean prisons. Despite evidence that drug use is playing a role in HIV epidemics in the region, national drug and HIV policies remain largely unlinked. However, in the past two years, there have been indications that the need for a harm reduction approach to drugs is increasingly being recognised on some Caribbean islands.

Get Adobe Flash player

This page requires Flash Player version 9.0.45 or higher.

* Please refer to the table below for ranges, where these are available. The maps display midpoint averages only.

Caribbean - Regional Overview
Country/territory with reported injecting drug usea People who inject drugsb Adult HIV prevalence amongst people who inject drugs Hepatitis C antibody (anti-HCV) prevalence among people who inject drugsc Hepatitis B surface antigen (anti-HBsAg) prevalence among people who inject drugs Harm reduction responsed
Bahamas nk nk nk nk N N
Bermuda nk nk nk nk N N
Dominican Republic nk nk nk nk N N
Haiti nk nk nk nk N N
Jamaica nk nk nk nk N N
Puerto Rico 29,130 12.9g 89%h nk Y(13) Y(6)(M)
Suriname nk nk nk nk N N

nk=not known

a In 2008 the UN Reference Group found no reports of injecting drug use for Antigua and Barbuda, Barbados, Belize, Dominica, Grenada, St Kitts and Nevis, St Lucia or St Vincent and the Grenadines.

b Unless otherwise stated, data are sourced from Mathers B et al. for the Reference Group to the UN on HIV and Injecting Drug Use (2008) Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review, Lancet, 372(9651):1733–1745.

c Nelson PK et al. (2011) Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews, Lancet, 378(9791): 571–583.

d Unless otherwise stated, data on NSP and OST coverage are sourced from Mathers B et al. for the Reference Group to the United Nations on HIV and Injecting Drug Use (2010) HIV prevention, treatment and care for people who inject drugs: A systematic review of global, regional and country level coverage, Lancet 375(9719):1014–28.

e The number in brackets represents the number of operational NSP sites, including fixed sites, vending machines and mobile NSPs operating from a vehicle or through outreach workers. (P) = needles and syringes reported to be available for purchase from pharmacies or other outlets, and (NP) = needles and syringes not available for purchase.

f The number in brackets represents the number of operational OST programmes, including publicly and privately funded clinics and pharmacy dispensing programmes. (M) = methadone, (B) = buprenorphine, (O) = any other form (including morphine and codeine).

g Estimate from 1998–2001.

h This figure is sub-national and relates to San Juan only.