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Hidden in plain sight: the need for more action on injecting drug use among under-18s

Date: 12 December 2013

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Harm Reduction International has compiled the first global data snapshot on injecting drug use and related HIV and other harms among children and young people under the age of 18.

Young people who inject drugs have specific developmental, social and environmental vulnerabilities. They are less likely to use harm reduction and treatment services and are less informed about risks and their rights. Early onset of injecting, and being a new injector, have been associated with increased risks of HIV and hepatitis C transmission, while specific groups of young people, especially those that are street involved, are at considerably higher risk. 

The legal status of being a minor, meanwhile, raises challenges for both achieving a better understanding of the situation and for the development of targeted harm reduction interventions.

Based on a detailed literature review and expert questionnaires our report, ‘Injecting drug use among under-18s: a snapshot of available data (PDF, 1 MB)’, finds that injecting among this age group represents a significant data ‘blind spot’ impeding our ability to assess service need and to estimate budgetary implications. A global population size estimate for under-18s who inject is not available, and not currently possible to obtain. National estimates are exceptionally rare and age disaggregation in HIV/AIDS reporting is poor. 

Available studies that have looked at injecting among this age group, however, provide important insights from every region and make a clear case for more action. In Nepal, for example, it is thought that one in five people who inject drugs are under 18, while in Ukraine it is estimated that over 50,000 adolescents aged 10-19 inject drugs. 

As noted in the foreword by Greg Ramm of Save the Children USA "too often younger drug users are ‘hidden in plain sight’ – we know they are there but do not know enough about their needs and risks. This cannot continue"

HRI’s report aims to help improve this situation by increasing attention to an often overlooked aspect of responses to HIV and other health harms associated with unsafe injecting; by improving our understanding of the extent of the problem internationally; and by identifying gaps and limitations in data collection in order to begin filling them. 

The report is available for download (PDF, 1 MB) and will be launched at the UNAIDS PCB thematic day on children, youth and HIV on December 19th. 

Throughout 2014 HRI will continue to focus on this issue, looking at policy and legal dilemmas relating to harm reduction services for this age group and collating examples of best practice. 

We are also working with Save the Children, the International HIV/AIDS Alliance and Youth RISE to produce a guide for harm reduction services to help prepare them for work with children and young people.