International Response
Harm reduction policies or programmes have been adopted in more than half of the 158 countries and territories where injecting drug use has been reported. In 2010:
- 93 support harm reduction in policy or practice
- 79 have an explicit supportive reference to harm reduction in national policy documents
- 82 have needle and syringe exchange
- 10 have needle and syringe exchange in prisons
- 74 have opioid substitution therapy
- 39 have opioid substitution therapy in prisons
- 8 have drug consumption rooms
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Key harm reduction interventions such as needle and syringe programmes (NSP) and opioid substitution therapy (OST) are available in an increasing number of countries. However, the coverage of services is often limited, particularly in low and middle income countries. Recent estimates indicate that many countries are distributing less than one needle per person who injects drugs per year. Similarly, OST coverage is low in many Central Asian, Latin American and Sub-Saharan African countries - equating to less than one OST recipient for every 100 people who inject drugs (1). Of the countries with reported injecting drug use, seventy-six have no needle and syringe exchange services and eighty-eight have no OST provision.
Interventions must be scaled up in order to have an impact on HIV epidemics, but this will only be possible with substantially increased investment from governments and international donors. A severe lack of resources, government apathy and distrust of harm reduction, the criminalisation of drug users and harm reduction activities and poor engagement of people most affected by drugs and drug policy in the decision-making fora all act as barriers to harm reduction around the world. The work of harm reduction networks and wider civil society to advocate for harm reduction approaches, sometimes in very hostile policy and legal environments, is essential to the sustainability and scale up of this life-saving approach.
See the regional pages for more detail on the current state of harm reduction around the world.
References
