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Out of harm’s way

German support for countries reducing the harm of injecting drug use and HIV

James Boothroyd

Peer reviewers
  • Jürgen Klee, LaStrada Drogenhilfe & Prävention (first version)
  • Susanne Schardt, independent consultant (final version)

Published by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, October 2009 (this edition January 2011) / Technical supervision: Patricia Kramarz

1 Reducing Harm

A key to HIV prevention and other social benefits is reducing the harms of drug use, a major mode of HIV transmission, accounting for about 30% of all new HIV infections outside sub-Saharan Africa. Harm reduction measures include providing easy (low-threshold) access to sterile drug paraphernalia and contact centres, drug consumption rooms and clinics for medically assisted substitution therapy (with methadone or buprenorphine) and they have helped Germany, and other countries, to control outbreaks of HIV and other infectious diseases.

This report gives an up to date overview of the controversial international debate on this issue and describes projects supported by German Development Cooperation (via German International Cooperation, GIZ) in five countries that are struggling to reduce the severe personal, social and economic harms of illicit drug use and HIV.

Whilst its Commission on Narcotic Drugs pleads for a balanced approach between drug-demand reduction and supply reduction, the UN does not speak with one voice on this matter: Many countries continue to emphasize law enforcement and the criminalization of drug use, above all. This position is at odds with a major body of evidence showing that repressive measures alone are ineffective, if not counter-productive – while they do not control either supply or demand in illicit drug markets, they do tend to drive drug users underground, undermining prevention efforts. Germany has, therefore, been a leading voice amongst countries aiming to expand the role of drug-demand reduction, to recognize the importance of the harm reduction approach and to advance policies based on evidence rather than ideology.

Toolbox: Harm-reduction

The GTZ-programme, run in partnership with the Ukrainian Ministry of Health and well-established NGOs, has launched a comprehensive training course for providers of services to female drug users in Ukraine. Women who use drugs often engage in sex work and are thought to act as a bridge for HIV to the wider population.

By mid 2009, this programme had sensitized some 50 members of NGOs with good early results: for example, the Chernivtsi NGO immediately doubled the number of female IDUs receiving its services, reaching around 600 women in August 2009. GTZ-backed capacity building for services for female drug users and Oral Substitution Therapy (OST) is thus helping regional agencies to implement critical elements of Ukraine’s national strategy.

Video: The Other Choice – Opioid Substitution Therapy in Nepal

This is a documentary about opioid substitution therapy in Kathmandu, Nepal. It follows a patient who is in methadone maintenance treatment and includes interviews with various stakeholders and experts. The documentary explains why methadone is a beneficial tool for the prevention of HIV and for the treatment of drug addiction. Nepal’s main private TV channel has broadcast it on several occasions.

Director: Miraz Roshan; Production: FAITH
The Other Choice – English subtitles (15:24 Min.)


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