The harm reduction movement has made major gains nationally and around the world. But, according to a new report by Harm Reduction International, efforts to spread harm reduction services still face major hurdles and funding shortfalls.
The Global State of Harm Reduction 2018, released December 11, is described as “the most comprehensive independent analysis to date on harm reduction policy and practice around the world.” It indexes the successes and challenges of what grew from “an idea shared by hundreds in the late 1980s and 1990s to an international movement of thousands or more,” writes Filter contributor Maia Szalavitz in a foreword.
The harm reduction movement itself is “thriving,” as Szalavitz puts it. “The power of the idea that drug policy should focus on reducing harm rather than use remains unparalleled: more and more people recognise both the racism and the futility of the war on certain drugs and those who take them.”
But the report documents some troubling developments, with a plateauing in the international reach of harm reduction services. In 2016, 90 countries provided needle and syringe services. In 2018, that number stands at 86—with Bulgaria, Laos and the Duterte-run Philippines having cut services. The report found that of the nearly 15.6 million injection drug users in the world, over half live with hepatitis C and nearly one-fifth with HIV.
Provision of some other harm reduction services rose only slightly. The number of countries providing MAT increased from 80 to 86 from 2016-2018. And safer consumption sites, a vital intervention to reduce drug-related deaths, are still a rarity: Only 11 countries, including Canada, Australia and several in Western Europe, currently have them. The total number of sanctioned sites of this kind has edged up from 90 to 117 since 2016.
“The lack of progress in implementing harm reduction measures is a major concern and stunting progress in global health,” said Katie Stone, Harm Reduction International’s public health and social policy lead, in a press release. “It is disgraceful that governments continue to ignore the evidence in favour of demonizing people who use drugs. This is a crisis in need of urgent response.”
“The prohibition of drugs, combined with the lack the capacity and effective health care coverage, means that life-saving and cost-effective harm reduction services are disregarded by health authorities in low- and middle-income countries where the burden of the drug-related health issues is the greatest,” said Ruth Dreifuss, former president of Switzerland and chair of the Global Commission on Drug Policy.
This governmental disregard translates into a severe lack of funding. Previous Harm Reduction International research found harm reduction funding in low- and middle-income countries to be at “just 13% of what is needed annually for an effective HIV response among people who inject drugs.”
Certain drugs are also flying under the radar. While US politics and media fixate on the fentanyl-related overdose crisis, amphetamine-type stimulant (ATS) use is on the rise, with 35 million ATS users worldwide. Countries are not keeping up with corresponding harm reduction interventions, like safer consumption sites, drug checking services and safer smoking kits.
For the first time, Global State added a section on ATS use and harm reduction practices to each regional chapter as a way to begin more conversations on this issue. The sparse number of promising interventions in this area has previously been outlined by Dutch harm reduction organization Mainline in a 2018 report on harm reduction for people who use stimulants.
While overall provision of harm reduction services is inadequate, the application of existing services is also unequal. For example, services remain overwhelmingly male-focused. Specific issues faced by women who use drugs include notions of feminine “purity,” gender-based violence and unsafe sex work conditions—all of which, as the report notes, contribute to the vulnerability of women using drugs. And in Cambodia and the Philippines, for example, over 90% of incarcerated women in 2016 were imprisoned for nonviolent drug-law violations.
Prisoners in general are a group whose health rights are routinely violated. Harm Reduction International notes that “up to 90% of people who inject drugs may be incarcerated at some point in their lives,” and that prisons are “high-risk environments for the transmission of blood-borne infections.” Despite this, only 10 countries provide syringe services in prisons, and only 54 provide MAT to incarcerated people.