Multilateral Agencies
UN agencies support harm reduction through financial and technical support around the world and through publishing policy and technical guidance. This page captures some of the explicit references to harm reduction from UN agencies working on drugs, health, human rights and development.
General Assembly
The UN General Assembly has endorsed harm reduction as an essential HIV prevention measure in its Declaration of Commitment on AIDS in 2001 and in the Political Declaration on AIDS in 2006.
GA Res 60/262, Political Declaration on HIV/AIDS, A/RES/60/262 (2006) Para. 22:
"Reaffirm that the prevention of HIV infection must be the mainstay of national, regional and international responses to the pandemic, and therefore commit ourselves to intensifying efforts to ensure that a wide range of prevention programmes that take account of local circumstances, ethics and cultural values is available in all countries, particularly the most affected countries, including (...) expanded access to essential commodities, including male and female condoms and sterile injecting equipment; harm-reduction efforts related to drug use; (...)"
GA Special Session on AIDS Res S-26/2, adopting the Declaration of Commitment on HIV/AIDS (2001) A/RES/S-26/2 Para. 52:
"By 2005, ensure: that a wide range of prevention programmes which take account of local circumstances, ethics and cultural values, is available in all countries, particularly the most affected countries, including (.) expanded access to essential commodities, including male and female condoms and sterile injecting equipment; harm-reduction efforts related to drug use; (.)"
Declaration on the Guiding Principles of Drug Demand Reduction, adopted by the UN General Assembly Special Session (UNGASS) in Resolution S-20/4, Measures to enhance international cooperation to counter the world drug problem (1998) A/RES/S-20/4, http://www.un.org/ga/20special/demand.htm.
Para. 8:
"The following principles shall guide the formulation of the demand reduction component of national and international drug control strategies, in accordance with the principles of the Charter of the United Nations and international law, in particular, respect for the sovereignty and territorial integrity of States; human rights and fundamental freedoms and the principles of the Universal Declaration of Human Rights; and the principle of shared responsibility:
(...)
(b) Demand reduction policies shall:
(i) Aim at preventing the use of drugs and at reducing the adverse consequences of drug abuse;
(...)"
Para. 10:
"Demand reduction programmes should cover all areas of prevention, from discouraging initial use to reducing the negative health and social consequences of drug abuse. They should embrace information, education, public awareness, early intervention, counselling, treatment, rehabilitation, relapse prevention, aftercare and social reintegration. Early help and access to services should be offered to those in need."
CND (support for General Assembly declarations which refer to harm reduction)
The Commission on Narcotic Drugs has endorsed the Declaration of Commitment and the Political Declaration on HIV/AIDS (and thereby indirectly the harm reduction words contained in them):
2008: CND Resolution 51/14
Promoting coordination and alignment of decisions between the Commission on Narcotic Drugs and the Programme Coordinating Board of the Joint United Nations Programme on HIV/AIDS http://www.unodc.org/documents/commissions/CND-Res-2000-until-present/CND-2008-Session51/CND-51-Res-2008-14e.pdf
2006: CND Resolution 49/4
Responding to the prevalence of HIV/AIDS and other blood-borne diseases among drug users http://www.unodc.org/pdf/resolutions/cnd_2006_49-4.pdf
UN System position paper
Preventing the Transmission of HIV Among Drug Abusers. A position paper of the United Nations System. Annex to the Report of 8th Session of ACC Subcommittee on Drug Control 28-29 September (2000) http://www.hivpolicy.org/Library/HPP000074.pdf
"The aim of this paper is to present a United Nations (UN) system wide position on policy and strategies to prevent the transmission of HIV among drug abusers.
Deciding on the implementation of the intervention strategies to prevent HIV in injecting drug abusers is one of the most urgent questions facing policy makers. Studies have demonstrated that HIV transmission among injecting drug abusers can be prevented and that the epidemic already has been slowed and even reversed in some cases. HIV prevention activities which have shown impact on HIV prevalence and risk behaviour include AIDS education, access to condoms and clean injecting equipment, counselling and drug abuse treatment"
UNAIDS
Letter from the Executive Director of UNAIDS Michel Sidibé to the Chairperson of the 52nd Session of the Commission on Narcotic Drugs Ms. Selma Ashipala-Musavyi, http://www.hrw.org/en/news/2009/02/12/letter-executive-director-unaids-chair-cnd "In considering its review of progress, the Commission may wish in particular to note the parallel commitments made by the General Assembly in its twenty-sixth special session in 2001 concerning HIV/AIDS. The Declaration of Commitment adopted by that special session referred specifically to "harm-reduction efforts related to drug use" as elements of a wide range prevention programme to reduce the spread of HIV/AIDS.This view was repeated in the 2006 Political Declaration on HIV/AIDS. It has been highly appreciated that the Commission has reaffirmed both these resolutions in its resolution 51/14 and thereby recognized explicitly the inextricable link between the issues of harms associated with drug use and efforts to combat AIDS."
"In assisting member states to fulfil the commitments made by the General Assembly in relation to harm reduction, UNAIDS, including our Cosponsors and in particular UNODC and WHO, have amassed a considerable body of strong and consistent evidence on the effectiveness of harm reduction approaches. Conversely, there is no convincing evidence of major negative consequences of such interventions (...). In other words, harm reduction provides an excellent return on public investment."
Resolution 14.2 of the 23rd Meeting of the UNAIDS Programme Coordinating Board, 1517 December 2008,
http://data.unaids.org/pub/InformationNote/2008/20081208_pcb_23_decisions_en.pdf
Para. 14.2:
"Mindful of Commission on Narcotic Drugs resolution 51/14, which calls for collaboration among Member States represented both in the Commission and on the Programme Coordinating Board towards the promotion of better coordination and alignment of the AIDS response in order to scale up towards the goal of universal access to comprehensive prevention, care, treatment and support services for people who use drugs; takes note of the upcoming UNGASS review of the World Drug Problem and requestsUNODC, as one of the UNAIDS Cosponsors, to work towards an outcome of the meeting that accurately reflects the importance of decreasing HIV transmission and co-infection in people who use drugs."
Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access (UNAIDS 2007),
http://data.unaids.org/pub/Manual/2007/jc1274-towardsuniversalaccess_en.pdf
p. 46: "Table 2.2 - Injecting drug users
"Why? (...)
Harm reduction measures such as access to sterile injection equipment; drug dependence treatment such as methadone and buprenorphine; community-based outreach; and providing HIV prevention information are among the most effective and cost-effective measures to prevent, the epidemic among injecting drug users."
"How? (...)
Promote adequate coverage of the full range of harm reduction measures - particularly sterile syringe and needle access and drug substitution treatment."
Intensifying HIV prevention, UNAIDS policy position paper. Programme Coordinating Board, Seventeenth meeting, Geneva, Switzerland, 27-29 June 2005,
http://data.unaids.org/publications/irc-pub06/jc1165-intensif_hiv-newstyle_en.pdf
P. 34: "3. Preventing transmission of HIV through injecting drug use- by developing a comprehensive, integrated and effective system of measures that consists of the full range of treatment options, (notably drug substitution treatment) and the implementation of harm reduction measures (through, among others, peer outreach to injecting drug users, and sterile needle and syringe programmes), voluntary confidential HIV counselling and testing, prevention of sexual transmission of HIV among drug users (including condoms and prevention and treatment for sexually transmitted infections), access to primary healthcare, and access to antiretroviral therapy. Such an approach must be based on promoting, protecting and respecting the human rights of drug users"
Office of the High Commissioner for Human Rights
Office of the High Commissioner for Human Rights (OHCHR) and UNAIDS - International Guidelines on HIV and Human Rights, Consolidated Version 2006
http://www.ohchr.org/Documents/Publications/HIVAIDSGuidelinesen.pdf
Guideline 4, para 21(d):
"Criminal law should not be an impediment to measures taken by States to reduce the risk of HIV transmission among injecting drug users and to provide HIV-related care and treatment for injecting drug users. Criminal law should be reviewed to consider: the authorization or legalization and promotion of needle and syringe exchange programmes; the repeal of laws criminalizing the possession, distribution and dispensing of needles and syringes."
Joint WHO/UNODC/UNAIDS position papers
WHO, UNAIDS & UNODC (2004) Policy Brief: Provision of sterile injecting equipment to reduce HIV transmission. Geneva, World Health Organization, 2004
http://www.who.int/hiv/pub/advocacy/en/provisionofsterileen.pdf
Background: "The provision of access to sterile injection equipment for injecting drug users and the encouragement of its use are essential components of HIV/AIDS programmes, and should be seen as a part of overall comprehensive strategies to reduce the demand for illicit drugs. (...)"
WHO, UNAIDS & UNODC (2004) Position Paper - Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention. Geneva, World Health Organization 2004 http://www.who.int/substance_abuse/publications/en/PositionPaper _English.pdf
"Substitution maintenance therapy is one of the most effective treatment options for opioid dependence. It can decrease the high cost of opioid dependence to individuals, their families and society at large by reducing heroin use, associated deaths, HIV risk behaviours and criminal activity. Substitution maintenance therapy is a critical component of community-based approaches in the management of opioid dependence and the prevention of HIV infection among injecting drug users (IDUs)."
WHO, UNAIDS & UNODC (2004) Policy Brief: Reduction of HIV Transmission in Prisons, Geneva, World Health Organization, 2004
http://www.who.int/hiv/pub/advocacy/en/transmissionprisonen.pdf
UNODC
UNODC (2008) Reducing the adverse health and social effects of drug use: A comprehensive approach, http://www.unodc.org/documents/prevention/Reducing-adverse-consequences-drug-abuse.pdf
Preface:
"'Harm reduction' is often made an unnecessarily controversial issue as if there was a contradiction between prevention and treatment on one hand and reducing the adverse health and social consequences of drug use on the other. This is a false dichotomy. They are complementary."
Recommended interventions in the UNODC discussion paper include:
"b. low-threshold pharmacological interventions (example opioid-agonists and antagonist drugs), not directly related to drug-free oriented programmes, but to immediate health protection, have to be easily accessible;"
"f. needle/syringe exchange programmes (...);"
INCB
INCB Annual Report for 1993, http://www.incb.org/pdf/e/ar/incb_report_1993_1.pdf
Para. 29:"The Board acknowledges the importance of certain aspects of "harm reduction" as a tertiary prevention strategy for demand reduction purposes. (...)"
INCB Annual Report for 2000, http://www.incb.org/incb/en/annual_report_2000.html
Para. 445:
"(...) The Board would like to reiterate that harm reduction programmes can play a part in a comprehensive drug demand reduction strategy (.)"
INCB Annual Report for 2003, http://www.incb.org/incb/en/annual_report_2003.html
Para. 221:
"(...) The Board maintains the position expressed by it already in 1987 that Governments need to adopt measures that may decrease the sharing of hypodermic needles among injecting drug abusers in order to limit the spread of HIV/AIDS. (...)"
Para. 222:
"(...) [the implementation of] drug substitution and maintenance treatment as one of the forms of medical treatment of drug addicts (...) does not constitute any breach of treaty provisions, whatever substance may be used for such treatment in line with established national sound medical practice. (...)"
WHO EURO
Resolution EUR/RC52/R9 Scaling up response the response to HIV/AIDS in the European Region of WHO (2002) http://www.euro.who.int/Governance/resolutions/2002/20021231_4
"1. URGES member states:
(...)
(e) to promote, enable and strengthen widespread introduction and expansion of evidence-based targeted interventions for vulnerable/high-risk groups, such as prevention, treatment and harm reduction programmes (e.g. expanded needle and syringe programmes, bleach and condom distribution, voluntary HIV counselling and testing, substitution drug therapy, STI diagnosis and treatment) in all affected communities, including prisons, in line with national policies;
(...)"
WHO EMRO
Resolution EM/RC52/R.5 Drug Use and Dependence (2005),
http://www.emro.who.int/rc52/media/pdf/EMRC52R5.pdf
"1. URGES member states to:
(...)
1.2 Make a wide range of approaches and interventions available to address different aspects of primary prevention, through programmes like life skills education, and different levels of care, rehabilitation and harm reduction, with major reliance on community-based mechanisms and not only hospital based services;
(...)
WHO essential medicines
World Health Organization (2007) Model List of Essential Medicines, 15th list March 2007. http://www.who.int/medicines/publications/EssMedList15.pdf
List includes methadone, buprenorphine and naloxone.