Transcript Harm Reduction overview

Lydia H. Guterman
Consultant, Open Society Institute
September 25, 2008
Sofia, Bulgaria
Many thanks to the Harm Reduction Coalition for partial content of this presentation.
www.harmreduction.org
Outline
 What is Harm Reduction?
 Working Definition
 What are Harm Reduction’s guiding
principles?
 What are Harm Reduction services?
 Why do we support the use of a Harm
Reduction Model?
What is Harm Reduction?
Harm Reduction Definitions:
 A set of practical, public health strategies designed to
reduce the negative consequences of drug use and promote
healthy individuals and communities. (HRC)
 Harm reduction is a pragmatic and humanistic approach to
diminishing the individual and social harms associated
with drug use, especially the risk of HIV infection. It seeks
to lessen the problems associated with drug use through
methodologies that safeguard the dignity, humanity and
human rights of people who use drugs. (IHRD)
What is Harm Reduction?
 Health
 Safety
 Community
 HIV/AIDS
 Human Rights
 Drug Use
 Practical
 Dignity
 Lessen Problems
WE USE HARM REDUCTION EVERY DAY!
What Harm Reduction is NOT
 Rigid
 Forced
 Top-down
 Abstinence-only
 Judgmental
 Moralistic
 Based on punishment
 Based on the idea that people who use drugs are bad
people
Harm Reduction Principles
 Design and promote public health interventions that



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minimize the harmful effects of drug use.
Drug use is a reality. Abstinence-only will not work for
everyone.
Accessible + Low Threshold Services for people who use
drugs. Abstinence is NOT a requirement for services.
Understand that drug use is complex and can include a
range of behaviors from habitual, chaotic drug use to
abstinence.
Meets people where they are in their use and in their lives.
Harm Reduction Principles
 Ensures that people who use drugs are
MEANINGFULLY involved in the planning of all
services designed for their benefit.
 Affirms that people who drugs are in charge of their
own bodies and the only ones who can decide when it
is the right time to make a change.
 Harm reduction recognizes that the realities of poverty,
class, racism, social isolation, past trauma, sex-based
discrimination and other social inequalities affect
vulnerability to, and capacity for, effectively dealing
with drug-related harm.
Goals of Harm Reduction
 Prevent disease
Sterile syringe access to prevent HIV and hepatitis
 Reduce mortality
Overdose prevention with training and naloxone
distribution; link to medical care and social services
 Treatment for drug dependence
Buprenorphine or Methadone Maintenance
 Empower communities and reduce stigma
Community organizing and engagement
What are Harm Reduction
Services?
 Sterile Syringe Access
 Most effective HIV, hepatitis prevention model for IDU
 Does not encourage drug use
 No link to increased number of people using drugs
 Significant decrease in HIV incidence where available
What are Harm Reduction
Services?
 Condom Distribution
 Safer sex and safer injection education
 HIV, hepatitis testing and counseling
 Access to non-coercive drug treatment services
 Access to medical care and counseling
 Overdose prevention and education
 Special programs for young people, women
 Access to services where people who use drugs are
treated with respect
People have to stay
alive long enough to
change.
Harm Reduction or Not?
YES
NO
 Wearing a seatbelt in the car
 Forcing a person who uses
 Wearing a condom during sex
drugs into treatment when
s/he does not want to go.
 Deciding not to use a clean
needle even though they are
available.
 Drinking and Driving
 Only providing services to
clients AFTER they stop using
drugs
 Reducing the amount of
drugs you use each day.
 Talking to your sex/ drug use
partners about HIV, hepatitis
 Getting tested for HIV
Why does OSI Support Harm
Reduction?
 Based on human rights + dignity
 Practical + evidence-based
 Can be integrated with existing services provided
 Flexible
 Not complicated
 Drug use is a reality. Abstinence-only programs are not
enough.
 Helps foster trust and understanding
 HARM REDUCTION SAVES LIVES!