1. Lydia H. Guterman Consultant, Open Society Institute September 25, 2008 Sofia, Bulgaria Many thanks to the Harm Reduction Coalition for partial content of this presentation. www.harmreduction.org

2. Outline What is Harm Reduction? Working Definition What are Harm Reduction’s guiding principles? What are Harm Reduction services? Why do we support the use of a Harm Reduction Model?

3. 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)

4. What is Harm Reduction? Health Safety Community HIV/AIDS Human Rights Drug Use Practical Dignity Lessen Problems WE USE HARM REDUCTION EVERY DAY!

5. What Harm Reduction is NOT Rigid Forced Top-down Abstinence-only Judgmental Moralistic Based on punishment Based on the idea that people who use drugs are bad people

6. Harm Reduction Principles Design 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.

7. Harm Reduction Principles Ensures 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.

8. 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 dependence Buprenorphine or Methadone Maintenance  Empower communities and reduce stigma Community organizing and engagement

9. What are Harm Reduction Services? Sterile Syringe Access Most effective HIV, hepatitis prevention model for IDU Does not encourage drug use No link to increased number of people using drugs Significant decrease in HIV incidence where available

10. What are Harm Reduction Services? Condom Distribution Safer sex and safer injection education HIV, hepatitis testing and counseling Access to non-coercive drug treatment services Access to medical care and counseling Overdose prevention and education Special programs for young people, women Access to services where people who use drugs are treated with respect

11. People have to stay alive long enough to change.

12. 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 Driving Only providing services to clients AFTER they stop using drugs

13. Why does OSI Support Harm Reduction? Based on human rights + dignity Practical + evidence-based Can be integrated with existing services provided Flexible Not complicated Drug use is a reality. Abstinence-only programs are not enough. Helps foster trust and understanding HARM REDUCTION SAVES LIVES!