Out of harm’s way - German support for countries reducing the harm of injecting drug use and HIV

Writer James Boothroyd
Technical supervision: Patricia Kramarz
Peer-reviewed by Jürgen Klee (LaStrada Drogenhilfe & Prävention) - [first version] and Susanne Schardt, independent consultant [final version]
Published by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, October 2009 (this edition January 2011)
Published in the German HIV Practice Collection

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Short version - English (4 pp. 959 kB)
Long version - English (28 pp. 2.0 MB)
Проект «Уменьшение вероятности причинения ущерба»
Short version - Rusky (8 pp, 795 kB)
Long Version - Rusky (36 pp. 1.9 MB) (New)

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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.