Harm reduction forms an integral component of HIV and drug policy and programmes within most Western European countries. Almost every country with reported injecting drug use has key harm reduction interventions in place. Several countries also include drug consumption rooms, syringe vending machines and the prescription of injectable OST and pharmaceutical heroin among their harm reduction interventions. However, there remains much variation in harm reduction coverage. Some countries, such as Cyprus and Greece, currently reach low proportions of injecting populations with sterile injecting equipment and opioid substitution therapy. Even within countries with long established services, large areas are not covered and constraints on funding pose barriers to increasing access to these services. Furthermore, other drug-related health harms, such as viral hepatitis and overdose, remain leading causes of death among people who inject drugs.
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 current European Union drug 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.
* Please refer to the table below for ranges, where these are available. The maps display midpoint averages only.
|Country/territory with reported injecting drug use||People who inject drugsa||HIV prevalence amongst people who inject drugsb||Hepatitis C antibody (anti-HCV) prevalence among people who inject drugsc||Hepatitis B surface antigen (anti-HBsAg) prevalence among people who inject drugsd||Harm reduction response|
|NSP1 e||OST2 f||DCRg|
|Belgium||5,125 (3377–7829)||3.4–6 (s)||28.1–80j (s)||0–2.8 (s)||Y(69)(P)||Y(B,H,M)||N|
467 (418–539)3 i
|Denmark||12,754 (10,066–16,821)j||2.1f||52.5||1.3ggk 4||Y(135)l||Y(B,H,M)||N|
|France||122,000m||5.1–8f (s)||41.7j (s)||4.8 (3.4–6.2)n 4||Y(532)(P)||Y(19,484)(B,M,O)||N|
|Germany||94,250 (78,000–110,500)3||3.4h||75o||7.2 (6–8.4)p 4||Y(250)||Y(2,786-6,626)(B,H,M)||Y (27)|
|Ireland||6289 (4694–7884)s||5.8v||74.6 (72.3–76.9)3t||0h 4||Y(32)(P)||Y(332)(B,M,O)||N|
|Italy||326,000o||11.5||58.5||5.1 (0.9–9.3)u 4||Y||Y(B,M,O)||N|
|Luxembourg||1485 (1253–1919)g||2.4||71.8–90.7v||3.9 v||Y(8)||Y(B,M,O)||Y(1)|
|Netherlands||2390 (2336–2444)3 w||0j (s)||47.6–67.4 (s)||1–13 (s)||Y(175)5(P)||Y(B,H,M)||Y(40)|
|Norway||10,238 (8810–12,480)3||2.4||69.9||0j (s)||Y(29)rr(P)||Y(B,M)||Y(1)|
|Portugal||10,950–21,900 3 dd||4.9–17.2||36.5–83.1||2–3.4||Y(1620)(P)||Y(B,M)||N|
|Spain||83,972x||32.3||79.6 (73.3–85.9) 4 g||3.6 (1.8–5.3)gg||Y(2274)(P)||Y(497-2,229)(B,H,M)||Y(7)|
|Switzerland||31,653 (24,907–38,399)||1.4||78.3gg z4||4gg||Y(101)(P)||Y(B,H,M,O)||Y(7)|
|United Kingdom||133,112 (126,852–143,278)3 bb||0–4.3j (s)||26.1–61.2||8.9 (0–17.8)cc 4||Y(1,523)(P)||Y(B,H,M,O)||N|
nk = not known
(s) = sub-national data
a 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 injectinga drug use and HIV among people who inject drugs: a systematic review, Lancet, 372(9651):1733–1745.
b Unless otherwise stated, data are sourced from European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) (2012) Statistical Bulletin 2012: Table INF-1. Prevalence of HIV infection among injecting drug users in the EU countries, Croatia, Turkey and Norway, 2010 or most recent year available, http://www.emcdda.europa.eu/stats12#display:/stats12/inftab1.
c Unless otherwise stated, data are sourced from EMCDDA (2012) Table INF-2. Prevalence of HCV antibody among injecting drug users in the EU countries, Croatia, Turkey and Norway, 2010 or most recent year available, http://www.emcdda.europa.eu/stats12#display:/stats12/inftab2.
d Unless otherwise stated, data are sourced from EMCDDA (2012) Table INF-3. Prevalence of markers for HBV infection among injecting drug users in the EU countries, Croatia, Turkey and Norway, 2010 or most recent year available, http://www.emcdda.europa.eu/stats12#display:/stats12/inftab3.
e The number in brackets represents the number of operational NSP sites, including fixed sites, vending machines, pharmacy-based NSP sites 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, (BN) = buprenorphine-naloxone combination, (H) = heroin-assisted therapy, (O) = any other form (including morphine and codeine).
g DCR = drug consumption room.
h Year of estimate: 2000
j Year of estimate: 2006
k Year of estimate: 2007.
l Year of estimate: 2003.
m Year of estimate: 1999.
n Year of estimate: 1992–1995.
o Year of estimate 2004.
p Year of estimate: 1992–1994.
r Year of estimate: 1990–1993.
s Year of estimate: 1996.
u Year of estimate: 1990–91 and 1992–93.
v Year of estimate 2005.
x Year of estimate: 1998.
y Year of estimate: 1999–2001, 2003.
z Year of estimate: 2002.
bb Year of estimate: 2004–2010.
cc Year of estimate: 1996–2000.
dd According to the 2009 WHO, UNODC, UNAIDS target-setting guide, <100 syringes distributed per person who injects drugs per year is considered low coverage; 100–200 is medium coverage, and >200 is high coverage.
ee Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, UK.
ff Based on estimates derived from EMCDDA regional divisions, which may be different than those of HRI in this report. For more information, please see www.emcdda.europe.eu.
gg The two strategies included a ‘combined model’ where all services are provided within a central location by a multi-disciplinary team, and a ‘collaborative’ model, characterised as client-centred and informal, which involves collaboration of service providers and outreach teams to deliver treatment in a location convenient to the client.
1 EMCDDA (2012) Statistical Bulletin 2012: Table HSR-4. Needle and syringe programmes (NSPs) Part (i). Year of introduction of needle and syringe programmes (NSPs), types of programmes available in 2010 and number of sites, http://www.emcdda.europa.eu/stats12#display:/stats12/hsrtab4a Accessed 17 July 2012.
2 Mathers B et al. (2010) HIV prevention, treatment, and care services for people who inject drugs: A systematic review of global, regional, and national coverage, Lancet, 375 (9719) 1014–28.
3 EMCDDA (2012) Statistical Bulletin: Table PDU-102. Prevalence of problem drug use at national level, http://www.emcdda.europa.eu/stats12#display:/stats12/pdutab102 Accessed 17 July 2012.
4 Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D & Degenhardt L (2011) Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews, Lancet, 378(9791): 571–583.