Lydia H. GutermanConsultant, Open Society Institute

September 25, 2008Sofia, Bulgaria

Many thanks to the Harm Reduction Coalition for partial content of this presentation. www.harmreduction.org

OutlineWhat is Harm Reduction?

Working DefinitionWhat 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?HealthSafety

CommunityHIV/AIDS

Human RightsDrug UsePracticalDignity

Lessen ProblemsWE USE HARM REDUCTION EVERY DAY!

What Harm Reduction is NOTRigid

ForcedTop-down

Abstinence-onlyJudgmentalMoralistic

Based on punishmentBased on the idea that people who use drugs

are bad people

Harm Reduction PrinciplesDesign and promote public health interventions that

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 PrinciplesEnsures 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 dependenceBuprenorphine or Methadone Maintenance

Empower communities and reduce stigmaCommunity organizing and engagement

What are Harm Reduction Services?

Sterile Syringe AccessMost effective HIV, hepatitis prevention model

for IDUDoes not encourage drug useNo link to increased number of people using

drugsSignificant decrease in HIV incidence where

available

What are Harm Reduction Services?

Condom DistributionSafer sex and safer injection educationHIV, hepatitis testing and counselingAccess to non-coercive drug treatment

servicesAccess to medical care and counselingOverdose prevention and educationSpecial programs for young people, womenAccess 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

Wearing a condom during sex

Reducing the amount of drugs you use each day.

Talking to your sex/ drug use partners about HIV, hepatitis

Getting tested for HIV

Forcing a person who uses 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 DrivingOnly providing services

to clients AFTER they stop using drugs

Why does OSI Support Harm Reduction?

Based on human rights + dignityPractical + evidence-basedCan be integrated with existing services

providedFlexible Not complicatedDrug use is a reality. Abstinence-only

programs are not enough.Helps foster trust and understandingHARM REDUCTION SAVES LIVES!