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Harm reduction and AIDS Foundation East-West (AFEW)

Harm reduction is a pragmatic, non-judgmental approach to improve the health and living conditions of

drug users. It recognizes that many people, including injecting drug users, are unwilling or unable to

stop using drugs. Harm reduction looks at drug use in context. It identifies the harms caused directly by

drugs and those caused by the circumstances of use, then offers the means and information needed to

reduce these harms. Harm reduction helps drug users make the changes that they are ready for, whether

by offering them clean syringes to prevent the spread of HIV and other illnesses, teaching them how to

prevent overdose, or helping them enter drug treatment.

Syringe exchange is the cornerstone of harm reduction. By making clean syringes and other injecting

equipment easily available and educating drug users about the importance of safer injection methods,

programs can reduce the frequency of syringe sharing and other high-risk practices. There are many

studies from around the world that demonstrate the effectiveness of syringe exchange in preventing

HIV. For example, one study compared HIV prevalence in 103 cities in 24 countries and found that

HIV prevalence declined by a mean annual 18.6% for 36 cities with syringe exchanges, compared to an

8.1% increase in HIV prevalence in 67 cities without syringe exchanges.

Other common features of harm reduction programs include:

Outreach to places where drug users gather in order to establish contact and distribute materials

Counseling to help understand and reduce risks and improve psychological well-being

Support groups for people dealing with similar issues

Referrals to help with health and social problems not addressed by harm reduction programs

Legal aid to help regain lost documents and challenge rights violations such as police abuse

Overdose prevention and response education and distribution of naloxone, which reverses opiate

overdoses

Humanitarian assistance such as food or shelter, which are often a drug user’s most pressing needs

Substitution treatment with methadone or buprenorphine to reduce cravings for drugs and reduce illicit

drug use and its associated harms. While few harm reduction programs themselves offer substitution

treatment, most have strong links to substitution treatment programs.

Harm reduction as an HIV prevention and treatment support method for IDUs is supported and

promoted by organizations such as the World Health Organization, UNAIDS and the Council of

Europe. The HIV epidemic in Eastern Europe and Central Asia is fuelled by injecting drug use and

harm reduction has always been an essential part of AFEW’s work. AFEW provides technical and

informational support to harm reduction projects that implement activities according to international

standards and in accordance with local laws and regulations. When harm reduction strategies are not

yet approved at the national level, AFEW advocates for their acceptance by providing scientific

information and expert advice to government agencies and non-governmental organizations working in

the field of HIV prevention.

In Russia, Central Asia and Belarus, AFEW has introduced client management networks with social

bureaus and trained governmental and non-governmental service providers to offer psychological,

medical and social services for injecting drug users, sex workers, ex-prisoners, people living with HIV

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and other vulnerable populations. AFEW also runs harm reduction-oriented educational programs for

prisoners and prison staff.

In Central Asia, AFEW's ACCESS Project reduces HIV and TB among injecting drug users, sex

workers, prisoners and people living with HIV. Activities focus on evidence-based planning, client

management and regional and national working groups.

For more information about AFEW’s work, please visit www.afew.org.

Further reading:

European Monitoring Centre for Drugs and Drug Addiction, 2010. Harm reduction: evidence, impacts

and challenges. http://www.emcdda.europa.eu/publications/monographs/harm-reduction

World Health Organization, 2004. Effectiveness of sterile needle and syringe programming in reducing

HIV/AIDS among injecting drug users. Evidence for action technical papers.

www.who.int/hiv/pub/idu/pubidu/en/

World Health Organization, United Nations Officer on Drugs and Crime, Joint United Nations

Programme on HIV/AIDS (UNAIDS), 2004. Joint Position Statement: Substitution maintenance

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

www.unodc.org/docs/treatment/Brochure_E.pdf