Harm reduction refers to policies, programmes and practices that minimise negative health, social and legal impacts of drug use and drug laws and policies. Harm reduction approaches focus on supporting positive change without requiring that people stop using drugs.
The Global Fund notes, in its Technical Brief Harm Reduction for People Who Use Drugs that, in many countries, harm reduction and human rights programmes are still small, not scaled-up, and in a state of ‘perpetual pilot’, and reminds that the 2021 – 2026 Global AIDS Strategy has the following targets:
- 90% of people who inject drugs have access to comprehensive harm reduction services integrated with or linked to hepatitis C, HIV, and mental health services
- 50% of people who inject drugs and are opioid dependent have access to OAT
- Less than 10% of people who inject drugs or living with HIV experience stigma or discrimination
- Less than 10% of women who use drugs or living with HIV experience gender inequality/ violence
- Less than 10% of countries have punitive legal or policy environments that lead to denial or limitation of services.
To accelerate change towards meeting the above targets, the Global Fund now recognises harm reduction and human rights as ‘programme essentials’. This means that all country proposals will need to provide an update on achieving them and to identify gaps. Additionally, countries will have to decide how to address unmet programme essentials and include specific actions in their funding request. Applicants from ‘Core’ and ‘High Impact’ countries will also be asked to describe how they plan to introduce or scale up all programme essentials that are not yet fully implemented.
The top priority harm reduction interventions are:
- Needle and syringe programming (NSP)
- Opioid agonist therapy (OAT)
- Naloxone for overdose
Human Rights programme essentials are:
- HIV programmes integrate interventions to reduce human rights- and gender-related barriers to services (e.g., inclusion of legal services at harm reduction sites or inclusion at NSP programmes of services for women who use drugs in all their diversity).
- Reduction of stigma and discrimination in healthcare and other settings (e.g., community-led monitoring to document human rights violations).
- Legal literacy (know your rights) and access to justice activities (e.g., legal trainings for people who use drugs).
- Support for efforts, including community-led efforts, to reform criminal penalties for drug use, possession of harm reduction equipment/drugs for personal use, and other harmful laws and policies (e.g., community-led advocacy for legal and policy reform)
Other important changes that strengthen the support for harm reduction include
In accordance with the Global Fund notes Technical Brief Harm Reduction for People Who Use Drugs:
- Now, programmes can address needs of people who use drugs, not only of people who inject drugs. The needs of sexual partners of people who use drugs can be addressed as well. These changes give increased scope for stimulant harm reduction.
- Treatment for hepatitis B and C can be supported for people who use drugs regardless of HIV status if there is a strong epidemiological case and is part of comprehensive HIV programming, such as harm reduction.
- Community-led monitoring is emphasised, which means there is a key role for people who use and inject drugs in planning, delivery, and evaluation of services and policy change.
Additionally, the new WHO guidelines on key populations acknowledge that interventions which promote abstinence from drug use, such as rehabilitation are not effective for preventing HIV and should not be included in funding requests to the Global Fund