Interventions: Harm reduction

Monograph #6 A systematic review of harm reduction [December 2005]

New Zealand Needle and Syringe Exchange Programme Review [2005]

The Centre for Harm Reduction was commissioned to review New Zealand's Needle and Syringe Exchange Programme (NSEP) in March 2002 to assess whether the NSEP is working in the most effective and efficient way possible within available resources. The report includes recommendations for action to improve the effectiveness of needle exchange services in New Zealand

Burnet Institute

Harm Reduction for IDU's in Vietnam [2005]

A situation assessment detailing the National AIDS Standing Bureau, Vietnam and the Macfarlane Burnet Centre for Medical Research project aimed at increasing institutional capacity to respond to the current HIV epidemic among injecting drug users and to develop effective, sustainable and culturally appropriate harm reduction interventions.

Burnet Institute

The Vietnamese Harm Reduction Project: Stage 2 [2005]

Report on the Stage 2 project, undertaken as a continuation of the original The Vietnamese Harm Reduction and IDU project. Stage 2 provided an opportunity to build on and expand earlier research findings and respond to some of the questions and issues raised by the former project. Findings from the former project indicated that patterns of drug use amongst the heroin users of Vietnamese ethnicity in the study differed significantly from Anglo-Australian users, typically found in the literature [Burnet Institute]

Economic Evaluation of Hepatitis C [August 2005]

The Australian Government and State and Territory Governments have committed to a variety of harm reduction, prevention and education initiatives in order to mitigate the spread of hepatitis C and other blood borne viruses. About 90% of incident cases of hepatitis C occur amongst injecting drug users (IDUs). This report is an economic evaluation of programs to control the hepatitis C epidemic [The Australian Government Department of Health and Ageing]

Needle and syringe program policy and guidelines for NSW [2005]

This document outlines the broad operational guidelines for Needle and Syringe Programs. It is intended as a framework within which Area Health Services can develop detailed operational guidelines appropriate to their own setting [NSW Department of Health, Australia]

Pointing the Way: Harm Reduction in Kyrgyz Republic [May 2005]

Unlike many countries in the former Soviet Union, Kyrgyzstan has responded to the spread of HIV infection with an aggressive plan to reduce health risks associated with drug use, including measures to protect those unable or unwilling to stop injecting drugs

International Harm Reduction Development Program

Harm reduction policies and programs for persons involved in the criminal justice system [May 2005]

Canadian Centre on Substance Abuse (CCSA), May, 2005

Protecting the Human Rights of Injecting Drug Users: The Impact of HIV and AIDS [February 2005]

Compiling statements given at the 2004 session of the UN Commission on Human Rights, this IHRD-produced volume argues that unduly strict interpretation of UN drug control treaties undermines HIV prevention efforts by discouraging countries from implementing effective, realistic, and compassionate public health policies

International Harm Reduction Development Program

Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. [2004]

Providing access to and encouraging utilization of sterile needles and syringes for IDUs is now generally considered to be a fundamental component of any comprehensive and effective HIV-prevention programme. [World Health Organization 2004]

The National HIV/AIDS Strategy 1999-2000 to 2003-2004: Changes and Challenges [2004]

Published by Commonwealth Department of Health and Aged Care

Evaluation of the Supervised Injection Site - Year One Summary [2004]

BC Centre for Excellence in HIV/AIDS, September 17, 2004

Status Paper on Prisons, Drugs and Harm Reduction [2004]

The Status Paper on Prisons, Drugs and Harm Reduction was adopted at the WHO International Meeting on Prisons and Health in De Leeuwenhorst, the Netherlands on 22 October 2004.

WHO

Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation [2004]

This 62-page report documents how harsh drug policies and routine police harassment of injection drug users—the population hit hardest by AIDS in Russia—impedes their access or makes them afraid to seek basic HIV-prevention services such as syringe exchange, which is available in other countries around the world

Human Rights Watch

HRW Index No.: D1605 April 28, 2004

A review of the evidence-base for harm reduction approaches to drug use [2003]

This overview addresses both understandings of harm reduction and summarises its key principles before going on to consider the strength and nature of the evidence of the effectiveness of various forms of ‘harm reduction’ intervention. In doing so, some consideration is also given to criticisms of harm reduction that are occasionally encountered

Neil Hunt, contributions from Mike Ashton, Simon Lenton, Luke Mitcheson, Bill Nelles and Gerry Stimson

Forward Thinking on Drugs 2003

Manual for Reducing Drug Related Harm in Asia (2003) [2003]

This Manual contains the accumulated experience of over decade of attempts to change policy and implement programs to stop HIV and other harms among drug users, collected over several years from many countries in Asia

Burnet Institute

Injecting Reason: Human Rights and HIV Prevention for Injection Drug Users California: A Case Study [2003]

Government interference with sterile syringe programs is thwarting HIV prevention efforts in California

Human Rights Watch

HRW Index No.: G1502 September 9, 2003

Fanning the Flames: How Human Rights Abuses are Fueling the AIDS Epidemic in Kazakhstan [2003]

Human rights abuse against injection drug users and sex workers in Kazakhstan is fueling one of the fastest growing AIDS epidemics in the world

Human Rights Watch

HRW Index No.: D1504 June 30, 2003

Locked Doors: The Human Rights of People Living with HIV/AIDS in China [2003]

Widespread discrimination against people with HIV/AIDS is fueling the spread of the epidemic in China. This 94-page report is based on more than 30 interviews with people with HIV/AIDS, police officers, drug users, and AIDS outreach workers in Beijing, Hong Kong, and Yunnan province

Human Rights Watch

HRW Index No.: C1507 September 3, 2003

Abusing the User: Police Misconduct, Harm Reduction and HIV/AIDS in Vancouver [2003]

An anti-drug crackdown by the Vancouver Police Department has driven injection drug users away from life-saving HIV prevention services, raising fears of a new wave of HIV transmission in the city that is already home to the worst AIDS crisis in the developed world

Human Rights Watch

HRW Index No.: 1502B May 7, 2003

Reducing the harm of drugs [2003]

International law tackles harm reduction [2002]

It has emerged from a legal study published by the Pompidou Group (1), some extracts of which are given below, that harm reduction strategies can sometimes be in contradiction with the international drug control laws. Two experimental harm reduction strategies have come up against legal barriers in this way: drug testing at rave parties and the medical prescription of heroin for relapsed drug users

Professor Brice de Ruyver University of Gand, Belgium 2002

Dependent on Rights: Assessing Treatment of Drug Dependence from a Human Rights Perspective

Social attitudes toward, and criminalization of, people who use illegal drugs have apparently influenced the practice and policy of treatment for drug dependence in many countries. The already precarious human rights situation of people who use drugs is compounded by the inability of a large percentage of them to receive humane, effective, timely and affordable treatment for their addiction. 46-page PDF [Canadian HIV/AIDS Legal Network]

Sticking Points: Barriers to Access to Needle and Syringe Programs in Canada

Barriers persist that prevent people who use drugs from free access to sufficient sterile injection equipment. 47-page PDF [Canadian HIV/AIDS Legal Network]

Harm Reduction Policies and Programs for Persons of Aboriginal Descent

A 20-page document created to inform the implementation of policies and programs for reducing harm associated with substance abuse by people of aboriginal descent [CCSA/CCLAT, Canada]

International Human Rights Jurisprudence on Issues Relating to Drug Use and Harm Reduction

Commissioned by the Open Society Institute Law and Health Initiative, this research paper reviews jurisprudence from treaty-monitoring bodies of the United Nations and selected regional and national human rights courts that can be used to advocate for the human rights of people who use drugs. 24-page PDF [Open Society Institute, USA]

HIV/AIDS Prevention, Care, Treatment and Support in Prison Settings

A Framework for an Effective National Response. 50-page PDF [WHO/UNAIDS]

Deadly Denial

This 57-page PDF report found that routine police harassment and arrest – as well as the lasting effects of former Prime Minister Thaksin Shinawatra’s 2003 drug war – keeps drug users from receiving lifesaving HIV information and services that Thailand has pledged to provide [Human Rights Watch]

AIDS in South Asia: Understanding and Responding to a Heterogeneous Epidemic

A 131-page PDF report analyzing South Asia's HIV/AIDS epidemic and offering recommendations for halting its spread [World Bank, UNODC]

Return on Investment in Needle and Syringe Programs in Australia - Report

The study updates and expands a study previously undertaken by Hurley, Jolley and Kaldor which investigated the effectiveness and cost effectiveness of needle and syringe programs in relation to HIV/AIDS

The Vietnamese Injecting Drug Use & Harm Reduction Study: Stage 1

In 1995, the Centre for Harm Reduction conducted a collaborative, exploratory study, the VIDU study, as the beginning of a program of research, specifically targeting Vietnamese IDUs. The study was the first of its kind in Victoria, Australia and the first to document extremely high rates of HCV in this group

Burnet Institute

Capacity Building for IDUs India

Report on capacity building for HIV prevention among injecting drug users

Burnet Institute

Needle Exchange Provision in Scotland

A Report of the National Needle Exchange Survey [NHS - Scotland, UK]

Needle and syringe programs

Position paper - Australian National Council on Drugs

WHO Releases Report On Role In Supporting 3 By 5 Initiative

The report - which follows the release of a 2005 report that says WHO missed its 3 by 5 Initiative target - identifies future collaboration opportunities between WHO and partners and gives recommendations for the "way forward" [WHO]

Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention

WHO/UNODC/UNAIDS position paper

Evidence for Action on HIV/AIDS and Injecting Drug Use

5 Policy briefs [WHO]

The Report of the Independent Working Group on Drug Consumption Rooms

A detailed examination of whether Drug Consumption Rooms (DCRs) should be introduced in the UK [JRF, UK]

Legislating for Health and Human Rights: Model Law on Drug Use and HIV/AIDS

Many countries with injection-driven HIV/AIDS epidemics continue to emphasize criminal enforcement of drug laws over public health approaches, thereby missing or even hindering effective responses to HIV/AIDS. There is considerable evidence that numerous interventions to prevent HIV transmission and reduce other harms associated with injection drug use are feasible, effective as public health measures and cost-effective [Aidslaw, Canada]

Preventing HIV Infection among Injecting Drug Users in High Risk Countries

An Assessment of the Evidence - a free online publication authored by the Board on Global Health (BGH) and the Institute of Medicine (IOM) [National Academic Press, USA]

Monitoring Drug Policy Outcomes: The Measurement of Drug Related Harm

This latest Report from the Beckley Foundation Drug Policy Programme looks at the various attempts by governments and academic institutions to develop a methodology for assessing and measuring the level of drug related harm, in order to better understand the impact of illegal drug use on society, and of policies and programmes that aim to reduce that impact

Closed to Reason: The International Narcotic Board and HIV/AIDS

A 37-page report arguing that the International Narcotics Board hampers efforts to address the HIV epidemic among injecting drug users [Policy Pointers Worldwide]

Hepatitis C in Prisons: Evolving Toward Decency Through Adequate Medical Care and Public Health Reform

Hepatitis C in prisons is a public health crisis tied to current drug policy's emphasis on the mass incarceration of drug users. Prison policy acts as a barrier to hepatitis C care by limiting medical care for the infected, especially drug users, and by inhibiting public health measures addressing the epidemic [SSRN / University of California, Los Angeles - School of Law, USA]

How Effective is Micro Harm Reduction in Reducing Macro Harm?

MacCoun (1996) distinguishes between micro and macro harm reduction and notes that reducing micro harm (harm per unit of use) may or may not reduce macro (aggregate) harm depending on its effect on use. We present a simple model that relates micro and macro harm through five parameters: price, quantity, elasticity of demand, elasticity of supply, and the social cost of drug use. Parameterizing the relationship for the US cocaine market in 1992 suggests that about 75% of the apparent benefit of reducing micro harm experienced by users would be offset by increases in use. This suggests that reducing micro harm experienced by users has merit but that reducing the costs drugs impose on non-users may merit greater attention, since reducing those costs carries no risk of being offset by increases in use

Jonathan P. Caulkins

Carnegie Mellon, Heinz School

HIV/AIDS and Drug Misuse in Russia: Harm Reduction Programmes and the Russian Legal System

Professor Butler’s report breaks new ground in the HIV/AIDS prevention literature by reviewing harm reduction initiatives and programmes in the context of Russian and international law.

International Family Health

Prison Needle Exchange

Lessons from a Comprehensive Review of International Evidence and Experience 109-page PDF [Canadian HIV/AIDS Legal Network]

Ukraine: Anti-AIDS Efforts Undermined by Rights Abuses

The 84-page report, “Rhetoric and Risk: Human Rights Abuses Impeding Ukraine’s Fight Against HIV/AIDS,” documents how draconian drug laws and routine police abuse of injection drug users – the population hardest hit by HIV/AIDS in Ukraine – keep them from receiving lifesaving HIV information and services that the government has pledged to provide [Human Rights watch, USA]

Prescribing heroin: what is the evidence?

Until recently, the UK was the only country in the world that allowed doctors to prescribe heroin for the treatment of opiate dependence. The Government wants heroin prescribing to increase and to be made available to all those who have a clinical need for it. This report, by Gerry Stimson and Nicky Metrebian from the Centre for Research on Drugs and Health Behaviour at Imperial College, looks at the reasons for international interest in prescribing heroin. It critically examines the research, clinical, political and practical challenges to expanding heroin prescribing in the UK

Gerry V. Stimson and Nicky Metrebian

Joseph Rowntree Foundation (ISBN 1 85935 082 8)

Key documents on HIV prevention and care for Injecting Drug Users

The (Australian) National Drug and Alcohol Research Centre has recently assessed the top 50 papers on harm reduction and HIV. Eighteen topics were covered [International Harm Reduction Association]

Declaration of Commitment on HIV/AIDS

Declaration of Commitment on HIV/AIDS and Political Declaration on HIV/AIDS: focus on progress over the past 12 months - Report of the Secretary-Genera. 23-page PDF l [United Nations]

Dependent on Rights: Assessing Treatment of Drug Dependence from a Human Rights Perspective

Social attitudes toward, and criminalization of, people who use illegal drugs have apparently influenced the practice and policy of treatment for drug dependence in many countries. The already precarious human rights situation of people who use drugs is compounded by the inability of a large percentage of them to receive humane, effective, timely and affordable treatment for their addiction. 46-page PDF [Canadian HIV/AIDS Legal Network]

HIV/AIDS in prisons in Central and Eastern Europe and the former Soviet Union

This info sheet reviews what is known about HIV/AIDS and hepatitis C in prisons, with a focus on Central and Eastern Europe and the former Soviet Union. (28-page PDF) [Aidslaw, Canada]

Ukraine: Anti-AIDS Efforts Undermined by Rights Abuses

The 84-page report, “Rhetoric and Risk: Human Rights Abuses Impeding Ukraine’s Fight Against HIV/AIDS,” documents how draconian drug laws and routine police abuse of injection drug users – the population hardest hit by HIV/AIDS in Ukraine – keep them from receiving lifesaving HIV information and services that the government has pledged to provide [Human Rights watch, USA]

“Unlocking Potential: Making Prisons Safe for Everyone”

Report of the 8th European Conference of Drug and HIV/AIDS Services in Prison 149-page PDF [ENDIPP, Europe]

Declaration of Commitment on HIV/AIDS

Declaration of Commitment on HIV/AIDS and Political Declaration on HIV/AIDS: focus on progress over the past 12 months - Report of the Secretary-Genera. 23-page PDF l [United Nations]

Harm reduction approaches to injecting drug use

[WHO]