About the Global State of Harm Reduction

In 2006, the International Harm Reduction Association (IHRA) received support from the UK Department for International Development (DFID) for a project to promote a global environment conducive to the implementation and scaling up of harm reduction interventions. The Global State of Harm Reduction represents an important part of this project.

The Global State report attempts to map harm reduction services, consolidate existing data on drug use and HIV and hepatitis C, record multilateral agency activities and document harm reduction policies and practices around the world. As such, the report provides a critical baseline though which progress can be measured in terms of the international, regional and national acceptance of harm reduction policies and interventions, and the performance of multilateral agencies.

This report, and its subsequent updates, will also identify key issues affecting harm reduction and global drug and HIV policy, such as human rights violations against people who use drugs, non-injecting drug use and instances where multilateral activities or national policies and programmes fail to meet local needs and experience.

The Global State report is designed to be an advocacy and reference tool for a wide range of audiences, including international donor organisations, multilateral and bilateral agencies, civil society and non-governmental organisations (NGOs), organisations of people who use drugs, researchers and the media.

The report will enable IHRA to engage with and work alongside a wide range of partners around the world – regional harm reduction networks, international human rights organisations and HIV and drug policy organisations – to advocate and lobby for harm reduction.

Methodology

The information in this report was gathered using existing data sources, including research papers, reports from multilateral agencies, international NGOs, civil society and harm reduction networks, as well as expert opinion from drug user organisations and those working in the harm reduction field. Within each region, IHRA enlisted support from regional harm reduction networks and researchers to gather existing data from published research.
Quantitative and qualitative indicators were developed consistent with those used in parallel data-gathering processes.a These covered drug use, HIV and hepatitis C (HCV) and the response at the policy and programming level from government, civil society and multilateral agencies.

For the purposes of the Global State, regions were largely identified using the coverage of the regional harm reduction networks. Therefore, this report examines the regions of Oceania, Asia, Eurasia (Central and Eastern Europe and Central Asia), Western Europe, Sub-Saharan Africa, Middle East and North Africa, Latin America, the Caribbean and North America. Each regional overview section was peer reviewed by the regional harm reduction networks and other experts in the field (see acknowledgements).

A database containing country-by-country information and electronic copies of sources used in the data collection process are housed at the IHRA offices in London.

Data quality

Obtaining accurate data when researching ‘hidden populations’ is notoriously difficult. Globally, surveillance and monitoring systems are improving, however the data availability in many countries remains very poor, and in these cases the experience of those gathering the data and their contacts was called upon to provide a picture of the situation.

While the data presented here represent the best estimates currently available, lack of uniformity in measures, data collection methodologies and definitions render cross-national and regional comparisons difficult.

Limitations

This report attempts to provide a global snapshot of harm reduction policies and programmes, and as such has several limitations. It does not provide an extensive evaluation of the services or policies in place, and it must be recognised that the existence of a service does not necessarily denote quality and adequate coverage to have an impact on HIV or HCV transmission. More in-depth monitoring and evaluation of services for people who inject drugs will be an important part of achieving universal access to comprehensive HIV services.

While the Global State report covers the response to HIV and HCV epidemics among people who inject drugs, the full spectrum of drug-related harms and harm reduction interventions are not documented here. Further health-related harms (for example overdose, wound botulism, tuberculosis, STIs, hepatitis A and B) as well as social and legal harms (for example violence against people who use drugs, stigma and discrimination, violation of rights) affect people who use drugs globally. The extent to which people who use drugs have access to essential social and legal support interventions, mental health and primary health care services and the full range of drug treatment services is not explored here.

Worldwide, elements of harm reduction that mitigate HIV epidemics have received most attention, largely as a result of the funding environment. In practice, this can result in a somewhat fragmented approach to harm reduction. Policies and programmes that aim to reduce other harms faced by people who use drugs form part of a comprehensive harm reduction approach and, as such, require increased consideration from the international community.

The structure of this report

Section 1 provides a global overview of harm reduction policy and programming in response to HIV and HCV epidemics among people who inject drugs.

Section 2 contains nine regional overviews – Asia, Eurasia, Western Europe, the Caribbean, Latin America, North America, Oceania, Middle East and North Africa, and Sub-Saharan Africa – which examine the harm reduction response in further depth.

Section 3 explores issues that are key to assessing the global state of harm reduction, including human rights, non-injecting drug use and civil society engagement in multilateral processes.