HIV Community Link is committed to working from a harm reduction perspective in all our support, education, and advocacy programs. The concept of harm reduction is applicable to our work in reducing the risks of HIV and hepatitis C infection, as well as our work in preventing opioid overdose deaths, and reducing risks associated with sex work. In my role as lead for our education team and in my graduate work, I’ve had the opportunity to explore and have many engaging conversations about harm reduction with researchers, advocates, people who use drugs, and members of our diverse communities. In this blog, I invite you to learn more about harm reduction and how it is conceptualized both in theory and in practice. Do not hesitate to get in touch with any questions, and references for this content are available upon request.

Harm reduction is a concept that is applied in healthcare and social services, as well as law and policy development around the world. The term made its official debut in 1990 at the first harm reduction conference in Liverpool, but the concept’s definition continues to confuse advocates and critics alike. Despite its rapidly expanding use, there is no universal definition of harm reduction.

Generally, harm reduction refers to illegal substance use, but is also applied to alcohol, tobacco, and prescription drug use, as well as sexual practices, sex work, or other behaviors associated with risk. Some examples of the concept include needle distribution, safe consumption sites, methadone and other opioid replacement therapies, safer sex supply distribution, outreach and education approaches, law enforcement styles, alcohol and tobacco programs, and the development of drug and health policies.

According to Harm Reduction International (2017):

‘Harm Reduction’ refers to policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community.

The seven characteristics that follow describe harm reduction and do not represent any significantly outlying or uncommon viewpoints. As harm reduction has historically been associated with drug use, these attributes focus this application of the concept, but could be expanded to other risk behaviours as well.

Focus on Harms

Though it is clear that abstinence-oriented programs aim to reduce drug use, harm reduction recognizes abstinence as an ideal outcome but accepts alternatives that reduce harm. On an individual level, harm reduction could mean a change in mode of drug administration (from injecting to smoking) or in pattern/frequency of use. On a greater scale, it involves addressing health, social, and economic factors that negatively affect drug users, communities, and society as a whole. Applied to other activities, such as high-risk sexual practices, harm reduction programs are not intended to prevent the behavior but instead to help reduce the negative consequences associated with it. Harm reduction puts the focus on reducing the harms of a behaviour rather than on eliminating or reducing the behavior itself.

Participation of People Who Use Drugs

Another attribute is that of drug users as key advocates and participants in harm reduction. As an example, the Vancouver Area Network of Drug Users (VANDU) was established in 1998 when people who used drugs came together to create a drug user-run organization. The philosophy of the group includes user involvement and empowerment that strives to represent the concerns of drug users and places a high value on peer support approaches. The idea of direct user involvement is reflected in a phrase commonly used by drug user groups around the world; “Nothing About Us Without Us”. Our local group, Alberta Addicts Who Educate and Advocate Responsibly (AAWEAR), advocates for better health and leadership for drug users across our province.

Promotion of Human Rights

Harm reduction upholds the human rights of people who use drugs, including self-determination and self-preservation, and the right to be treated with dignity rather than as a criminal. In addition, given that the right to health is supported by international human rights organizations, harm reduction is a necessary health service that supports this right.

Public Health Approach

Harm reduction is deeply rooted in public health traditions around HIV/AIDS prevention and replacement treatment for opiate users. Specifically, harm reduction is closely tied to population health promotion in that it aims to prevent disease and promote health in communities and populations, and it emphasizes the significant role the social determinants of health play in the health outcomes of a population. Like any health service, harm reduction is not designed to be a standalone solution for drug-related harms but rather is part of a comprehensive continuum of services that includes prevention, education, treatment, and follow-up.

Non-judgementalism

Present but heavily debated in the literature is harm reduction’s value neutrality or non-jugdemental perspective regarding drug policy, law, morals, and long-term goals. Some harm reduction advocates avoid moral questions about drug use and drug users as well as the role of the government in preventing or interfering with drug use, while others have strongly held beliefs on these issues, which may include support for decriminalization, legalization, etc. Most people who advocate for harm reduction perceive drug use as a morally neutral behavior and have an unyielding commitment to non-judgementalism. This dedication to non-judgementalism is conveyed in the commonly used phase: “meeting the client where they are at.”

Practical and Pragmatic

When VANDU established an unsanctioned needle distribution service in Vancouver’s Downtown Eastside (DTES) in 2001, it was a practical response to the HIV epidemic occurring amongst people who inject drugs in the neighborhood. As such, harm reduction is a pragmatic and practical strategy. Harm reduction also accepts that some use of mind-altering substances is a common feature of human experience and that there may be benefits to experimenting and using drugs that should not be ignored. Recognizing that drug use will always exist, harm reduction seeks to reduce the more immediate and tangible negative effects of substance use.

Adaptive and Innovative

Harm reduction strategies are always evolving to meet the immediate and pressing needs of drug users. From the drug user’s perspective, harm reduction is flexible in that is has minimal requirements for involvement, such as low-barrier programs, and has many accessible service entry points and intervention options. Harm reduction is a holistic process requiring creativity and innovation to initiate flexible strategies to maximize options for drug users. Illustrating this, harm reduction could be re-conceptualized as a living document, where practice can adapt to accommodate a community’s dynamic needs.

Conclusion

Harm reduction is a broad concept. It’s key attributes may include: a focus on harms, the participation of people who use drugs, the promotion of human rights, a public health approach, non-judgementalism, pragmatism, and adaptability. Harm reduction is an essential concept to reduce risk-related harm, and given its widespread application, has significant potential to improve health outcomes and save lives.

HIV Community Link offers presentations on harm reduction, get in touch by sending an email to education@hivcl.org.

Blog by Dominique Denis-Lalonde BN, RN, HIV Community Link, Team Lead, Prevention and Education