Lack of progress in harm reduction costs lives and money

By Bangyuan Wang

Bangyuan Wang is the Alliance's Senior Advisor: HIV Technical (Harm Reduction)

It was disheartening to read the key messages of the new Global State of Harm Reduction 2016 report. There has been very little progress scaling up harm reduction globally and this costs lives and money. A stronger effort is needed to push harm reduction policy and practices globally, and scale-up these life-saving interventions.

97. Malaysia 30A needle exchange outreach programme in Terengganu, Malaysia. ©International HIVAIDS Alliance

In the Global State of Harm Reduction 2016 report, Harm Reduction International updated a series of indicators that we use to measure the global progress on scaling-up harm reduction for people who inject drugs (PWID).

The report shows that, since 2014:

  • no new countries approved needle exchange programmes (NSPs)
  • only three new countries started opioid substitution therapy (OST)
  • only two new drug consumption rooms opened.

To end AIDS, we need harm reduction

The lack of progress in scaling-up harm reduction detrimentally impacts the control of HIV among people who inject drugs. We have enough evidence that harm reduction is a cost-effective way for governments to control the HIV epidemic among this key population.

In September 2015, world leaders gathered to adopt the Sustainable Development Goals (SDGs) with the agenda of leaving no one behind. The SDGs include a bold target to end AIDS by 2030. And yet we can clearly see from this new harm reduction report that PWID will be left behind as one of the key populations at risk of HIV globally.

Estimates suggest that of the 12.7 million people who inject drugs worldwide, at least 1.7 million (around 14%) are living with HIV. This HIV prevalence is 24 times higher than the rest of the global adult population. These figures are rising in Eastern Europe and Central Asia, where HIV prevalence among the general population grew by 57% between 2010 and 2015, with half of these transmissions attributed to injecting drug use.

The evidence points to political unwillingness

We know that the HIV epidemic among PWID is not only driven by stigma and discrimination, but also by criminalisation. It is due to a lack of political willingness that clear evidence, proven examples, and scientific evidence were continuously ignored and simple interventions that can save valuable lives were not scaled up. It should also be noted that a lack of political willingness for harm reduction is not limited to developing countries, but can also be observed in countries like the UK.

The cost of a lack of political willingness is human lives – overdose-related deaths increased dramatically from 2014 to 2016. It is not acceptable that simple interventions such as naloxone are still not being implemented in countries like the UK.

On 9th September, figures were released which showed that annual fatalities involving heroin in England and Wales have doubled in the past three years, to 1,201, the highest since records began in 1993.

It is not surprising that we missed the global target of halving HIV among PWID by 2015 that we committed to at the UN General Assembly in 2011. If the situation continues, we will miss our SDG target to end AIDS in 2030.

The Alliance’s work on harm reduction

The International HIV/AIDS Alliance contributed to this report, and despite the gloomy picture, the Alliance and our partners should be proud of our contribution to global harm reduction. Our harm reduction programme covers almost 300,000 PWID and their partners globally. Some of the work we are doing includes:

  • China: our colleagues from AIDS Care China were able to make naloxone distribution to PWID communities a government practice; have made the methadone treatment programme more flexible and tailored to the needs of PWID communities; and have scaled-up a community-based treatment pilot – seeing first time drug arrest diversion from compulsory detoxification to community-based treatment.
  • Ukraine: Our colleagues at the Alliance for Public Health are managing the harm reduction programme of Ukraine in difficult circumstances and have just successfully convinced the government to fund 100% of the methadone cost in the coming year.
  • Africa: our colleagues from the Kenya AIDS NGO Consortium (KANCO) are taking regional leadership in promoting harm reduction in six countries in East Africa and as a result, we will soon see some of these countries, such as Uganda, start to provide NSP and OST services to PWID communities.

In the coming years, the Alliance will continue to be the world’s largest provider of harm reduction programmes. We will continue to scale up our innovations in OST; work on harm reduction programme management information systems; and continue to develop innovative harm reduction service models that meet the needs of the PWID communities in controlling HIV transmission. We will also make greater effort to scale up our harm reduction and drug policy advocacy.