Four presentations were made during this session, two less than announced.

Despite the fact that harm reduction projects and experiences are widely reported to be successful, it is still difficult to develop and implement them. All presentations made at the session tried to analyse why this is so and how can we get out of this blocked situation.

The first contribution concentrated on safe injection facilities, particularly in Canada. Legal issues were examined. Arguments against such facilities are outweighed by the expected benefits. In Canada, the law doesn’t forbid the setting of safe injection facilities. Even international treaties don’t mention them. On the legal side, it could be assumed that the obligation to respect a person’s right to health make them possible. Government should support their implementation.

Lazzarini presented a rapid policy assessment tool which helps to assess the policies adopted by countries towards harm reduction. This framework allows us to identify where the legal-structural problems are, what kind of changes in the legal system are needed. The research must also help to find solutions and to identify the legal changes which are needed.

Gustavo Hurtado presented the Argentinean Harm Reduction Project. In Argentina, IDUs are almost impossible to reach because of the very repressive policy followed by the police and prescribed by the law. One of the most efficient actions of the project is distributing information about their rights in case of arrest to youngsters using drugs. Addressing the need to change the law is also an important task of the project.

For a long time, the incidence of IDUs into the AIDS epidemic in Indonesia was ignored. But, according to the presentation of Irwanto, HIV infection through needle sharing among IDU has been increasing significantly (less than 1% of HIV cases in 1999 to over 19% in 2001). Injecting drug use seems to be increasing rapidly in Indonesia. In order to implement harm reduction measures, convincing all opinion leaders is needed (in the politics, religion, health system, and so on).

All the presentations stressed the fact that the benefits of harm reduction are well documented. But they are too often ignored by politicians. The chosen way to change is often a mix of pragmatism and advocacy. It allows small progress, step by step, which is not likely to bring the decided response the HIV epidemic in IDUs is asking for. Furthermore, there is still a certain denial in some countries about the reality and the prevalence of injecting drug use. Denial is often the main argument to not fund harm reduction projects or to not even consider them.

The discussion also put into light the negative effect of the policy of USA, which advocate a drug policy aimed at strict abstinence only, or at least present themselves as such on the international level (lots of harm reduction projects happen on a local basis in the USA). UNDCP was also criticised for its attitude condemning systematically harm reduction and substitution policies. Often, UNDCP states that harm reduction programs are not permitted by international treaties, which can be seen above all as an ideological attitude.

More networking is needed in order to have more harm reduction for injecting drug users. Sharing and publicising positive outcomes is certainly the best tool, as the evolution in Europe for the past decade shows clearly. Sound optimism is possible, even if this slow evolution will mean a lot of new HIV infections.

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team