Hepatitis C: An In-Depth Guide
Harm reduction is…
“…policies, programmes and projects that aim to reduce the health, social and economic harms associated with the use of psychoactive substances. It is an evidence-based and cost-effective approach – bringing benefits to the individual, community and society.” ("What is Harm Reduction?" - IHRA)
“…a set of practical strategies that reduce the negative consequences of drug use.” (www.harmreduction.org)
“… strategies and interventions based on public health and human rights aimed at the reduction of negative consequences of drug use, including transmissions of infection, mortality and others. This includes HIV, hepatitis B and C, STIs, overdoses and other negative consequences of drug use." (www.harm-reduction.org)
Harm reduction principles and activities were developed to improve the health of people who use drugs. The model recognizes the many reasons why people use drugs and that some people cannot or may not wish to discontinue using. In this context, harm reduction aims to limit possible negative impacts of drug use, including the spread of infectious diseases, such as hepatitis C. Research has shown it to be an effective intervention in this regard and useful in preventing the spread of hepatitis C and other infections like HIV. When it comes to infectious diseases like hepatitis C, harm reduction aims to reduce the risk of blood-to-blood contact. (See How Hep C transmission happens for a summary of situations where blood-to-blood contact may occur.)
Below are some examples of harm reduction programs and the risks they reduce:
- Needle exchange and crack-kit distribution programs reduce the spread of blood-borne diseases by facilitating the use of new equipment and taking used equipment off the streets.
- Safer-injection sites and safer-consumption facilities reduce the number of overdoses and infections. Currently the only designated site in Canada is in Vancouver.
- Methadone maintenance programs reduce the negative impacts of opiate addiction.
- Education on safer injection and vein care empowers people who inject to reduce infections and disease.
- Testing or analyzing pills for purity can provide information to help reduce drug interactions and overdoses.
- Early warning systems and drug warnings at needle exchange programs that provide users with information on changes in how potent drugs are and what they are cut with reduce the chances of overdose, poisoning and infection.
- Education on the signs of overdose and access to naloxone (Narcan) prevent death from opiate overdose.
Programs and policies also use harm reduction to reduce risks involved with other activities. For example:
- condom distribution to reduce the spread of sexually transmitted infections
- indoor smoking ban to reduce the impact of second-hand smoke
- tattooing & piercing kits to reduce the spread of blood-borne diseases and infections
- designated driving and public transit to reduce alcohol-related car accidents
- speed limits and seatbelts to reduce deaths from car accidents
- adding filters to cigarettes to reduce the number of toxins that enter the lungs
The key principles of harm reduction are:
The harm reduction model acknowledges that people who use substances have a right to be treated with the same amount of respect as anyone else. Judgment leads to the isolation of individuals and communities, discourages people from accessing care and intensifies the harms associated with substance use. Harm reduction provides services in a manner that is not coercive or stigmatizing and uses neutral language to describe behaviours and choices.
Harm reduction interventions identify small, matter-of-fact steps that people can take to reduce harm from drug use, listed from safest to least safe. These steps are on different continuums. For example, injection can come with different levels of risk depending on if a person shares or reuses drug-use equipment:
Harm reduction meets people “where they're at” in terms of ability and willingness to alter behaviours. In doing so, it recognizes changing behaviour as a cooperative process and a process that differs from one person to the next. Two roles of harm reduction service providers are to help people identify their options and to build their ability to adopt and maintain certain activities.
This principle recognizes a need for a holistic approach to harm reduction. The presence or absence of environmental factors such as social support, steady income and shelter in a person’s life can make harm reduction practices easier or harder to sustain. While it is difficult for one organization to provide assistance around all of these issues, harm reduction programs can be an entry point for linking individuals with other social and health services.
"Nothing about us without us"
Across Canada and around the world there is a growing movement toward greater and more meaningful involvement of people who use drugs in policies and programs related to drug use, hepatitis C and HIV. Not only do people who use drugs have the right to be involved in decisions that affect them, they also offer a body of knowledge and experience that can impact the effectiveness of programs. Ways for people who use drugs to be involved at the community level include acting as decision makers, experts, implementers and contributors. The pyramid below (adapted from "Nothing About Us Without Us" Greater, Meaningful Involvement of People Who Use Illegal Drugs: A Public Health, Ethical, and Human Rights Imperative. Toronto: Canadian HIV/AIDS Legal Network, 2008.) shows how the level of meaningful involvement varies with different roles.