We Can End AIDS Among People Who Inject Drugs: the Case for a Harm Reduction Decade

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The world has come a long way in providing harm reduction services to people who use drugs. But this journey has been a slow one, and there is much further still to go. If there is to be any hope of putting a stop to the countless avoidable deaths and health-related harms of people who use drugs every year by overdose, HIV/AIDS, and viral hepatitis, there needs to be a significant scale-up of harm reduction provision the world over.

The data Harm Reduction International (HRI) has collected over the last decade for their Global State of Harm Reduction shows that there is now some level of harm reduction programming in over half of the 158 countries with documented injecting drug use. 91 countries provide for harm reduction in national policy documents, 90 have one or more needle and syringe programme, and 80 provide opioid substitution therapy. Where it is in operation, harm reduction has had a dramatic impact in improving the health and wellbeing of people who use drugs, and on protecting their human rights. Importantly, at the last count, only US$160 million was spent on harm reduction in low- and middle-income countries, just 7% of estimated need, and much of this funding is now precarious or under direct threat.

This article was first published by The Lancet Global Health Blog. You can read the original here.

While this appears to paint a dismal picture, offering little hope to those of us working to end HIV/AIDS and see a transformation of global drug policy, the amount of funding required to achieve this is hardly enormous. This is particularly clear when considered as a proportion of the $100 billion spent annually in the name of the ‘war on drugs’. HRI’s newly released report, The Case for a Harm Reduction Decade: Progress, Potential and Paradigm Shifts, models the potential impact of different levels of future harm reduction spending based on past Global State data. It shows that if as little as 7.5% of the global drug control funding were to be redirected to scaling-up harm reduction by 2020, there would be 94% fewer new HIV infections among people who inject drugs by 2030, and 93% fewer HIV-related deaths.

These are staggering figures: a tiny proportion of existing drug control funding redirected to achieve an almost total elimination of HIV/AIDS within this key population within the next 14 years.

With just weeks to go before the UN General Assembly Special Session on drugs (UNGASS), this is a rallying call for the growing numbers of civil society organisations and people who use drugs who are advocating for a political and financial commitment to health- and human rights-based responses to drug use. HRI’s ‘10 by 20’ campaign has been calling on governments to commit 10% of their drug control spend to harm reduction by 2020, and we now know just what a huge impact this would have by 2030.

Since the 1998 UNGASS, which marked the start of the misguided – and ultimately doomed – UN Decade for a world without drugs, harm reduction has proved itself to be an approach to drugs that saves lives, saves money, and helps respect, protect and fulfil the human rights of people who use drugs. If commitments can be made to the tiny shift in funding suggested by today’s report, this year’s UNGASS could mark the start of a Harm Reduction Decade, and by 2030 we could have seen HIV/AIDS all but wiped out among people who inject drugs.

The data modelling for The Case for a Harm Reduction Decade: Progress, Potential and Paradigm Shifts was undertaken by David Wilson, Professor at the Burnet Institute, an Australian, unaligned, not-for-profit, independent organisation that links medical research with public health action, recognising that solutions to many of the major global health problems require comprehensive and innovative responses. These include novel discoveries, such as the development of new vaccines and diagnostic tests, and the better use of existing best-practice health interventions. For more information visit www.burnet.edu.au