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The key principles of a harm reduction approach
In this video, Palani Narayanan from Global Fund speaks about some core principles of harm reduction
People have many different interpretation of what Harm Reduction is, but for these interpretations to work, a set of key principles need to be respected and adhered to. And these are being nonjudgmental. A Holistic, Person-Centered approach, putting the community at the center and heart of the response and a pragmatic evidence based response.
In many countries, drug users are seen as the scum of the society, the rubbish. Their lives apparently is not worth our attention This zero tolerance attitude is perpetuated by the war on drugs, which is being fought everywhere around the world. The trouble with this approach is that it criminalizes people who use drugs and brands them as having no moral compass, people who don’t know what is right and wrong. The result is very often people are marginalized, incarcerated, pushed to the fringes of society and sometimes even shot on the streets. The criminal justice system all too often punish people in ways that are unrelated to where that person is in the spectrum of drug use.
And there’s no evidence that is effective in treating his, his or her drug use. Likewise, compulsory drug treatment programs for someone who’s dependent on opioid opiate drugs, for example, ignores the fundamental need for the person to see that treatment is helpful rather than a punishment. If we continue to judge people. Who use drugs, depending on who’s deserving of what they get, then the harm reduction we provide will never be trusted as sincere or be as effective as it’s intended to be. To properly engage with individuals, we need to have a view that is nonjudgmental.
Harm Reduction needs to have a better understanding of the person as a whole. Things like how the person thrives socially. What do they do economically? How do they relate to their families and their surroundings? And why? And what drugs are they using? This is where the concept of the person, the drug and the environment becomes critical. Harm Reduction should not just be a set of blanket interventions for HIV and hepatitis.
A person centered approach makes us look at the type of drugs that is being consumed, how and where it is being consumed and the potential risk and the harms. Someone who’s using heroin will have a different set of harms compared to someone who is using crystal meth and again, compared to someone who’s using cocaine. This is important because imagine a woman who is using drugs will always have a set of harms and challenges that are different to a man. A young boy who is homeless in Dhaka, Bangladesh, for example, will have a very different set of experience and challenges and harms compared to a 35 year old man living in Switzerland.
So we need to recognize that each individual is different and help them choose their own treatment pathways. The person centered approach must also take into account equity, ensuring that everyone is able to access services. The services and the intervention should never be one size fits all. This holistic people centered approach also encompasses the environment, the surrounding environment. Criminalisation and stigma will only drive people further underground. This can mean that the best harm reduction provision will be disrupted and ineffective if people fear that they will be arrested or harassed for using even the harm reduction services. We need to advocate for fewer arrests of people who use drugs and advocate for better drug laws and policies.
There is a saying nothing about us without us. It is something that we should apply to all public health programs, including harm reduction. The value of community involvement in HIV programs became clear in early 1990s when people infected with HIV and their supporters marched to be heard and be involved in every aspect of HIV response. The community made it clear that for services to be effective, we need to include people with lived experiences of HIV. For harm reduction providers, it could be as simple as talking to people who use drugs about the most appropriate timing for the outreach services to take place.
That way, you don’t have outreach workers going to the outreach sites when the drug users are not there. Maybe the people who use drugs are working or are doing or assisting their family. Equally, you want to reach people who use drugs in the most remote spots, and to do that, you need to have community contacts who can take you their peers, who can open the doors for you and introduce you to the people in those remote and sometimes dangerous places. Community involvement is also important to assess the effectiveness of harm reduction services. Involving the community in feedback clearly makes practical sense in the least.
So it is really critical that we put communities at the heart of the response.
When we know what works, we need to spread the word, we share the experience and we advocate for the introduction of harm reduction wherever it’s needed. When when we started this process, there was a lot of resistance and people didn’t want to believe that harm reduction interventions could work. That asked, why are you giving needles to someone who’s injecting? Why are you giving a strong drug like methadone to someone who’s already taking heroin ? Over the years, we have gathered ample evidence to show that these are pragmatic, evidence based interventions that work. The 10 interventions that you see in the WHO guidelines are really the result of this years of evidence gathering.
These interventions successfully across geographical borders, political and social, economic divides and span cultural differences, beliefs and religions. Harm reduction works everywhere. One final word on the key principles of harm reduction, and that’s about activism. Activism runs like a living thread through all of these key harm reduction principles. It motivates us and it motivates our communities to act for themselves and or in the name of others, even to the point of civil disobedience. In the following modules, you will hear more about how activism works in lifting stigma, changing laws, gaining trust, empowering communities and showing evidence beyond any question of the effectiveness of harm reduction.
After hearing several experts describing Harm Reduction and looking into some definitions, you might be gaining an understanding that it is not so easy to capture all of what Harm Reductions stands, into one notion.
However, the concept remains very simple and is founded on very clear principles. Let’s dive into some of these principles with Palani Narayanan.
Before watching the video, take a moment to think about the previous steps and see if you can extract some of core principles that have come up before.
After watching the video, can you think of some other principles or values that define Harm Reduction?
Optional
Below, you can download a briefing paper from the Harm Reduction Coalition. It presents 8 core principles and it touches on the principles of ‘risk, set and setting’, which we will expand upon in the next topic of this course: ‘The public health dimension of drug use and harm reduction’
You can also find a link to the Harm Reduction Coalition’s website below.
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