Harm reduction and hepatitis C

Key points

Harm reduction is a set of practical strategies and ideas, based on human rights, social justice and public health, that aim to reduce negative consequences associated with drug use.
Harm reduction approaches are built on the belief in, and respect for, the rights of people who use drugs, and are centred on their expertise and ongoing involvement.
Hepatitis C is prevalent among people who inject drugs. Almost two-thirds of people who inject drugs in Canada have been exposed to hepatitis C.
Effective hepatitis C prevention, testing and treatment services are informed by harm reduction. These models provide compassionate, respectful, dignified and non-judgmental services to people who use drugs or who have used drugs in the past.

A harm reduction approach is central to the provision of services that support safer substance use. This page focuses on harm reduction in relation to hepatitis C and drug use.

What is harm reduction?

There is no single accepted definition for harm reduction. Harm reduction generally refers to a set of practical strategies and ideas that aim to reduce negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. It is a pragmatic approach that recognizes that people always have used drugs and always will. Harm reduction seeks to reduce social, legal and health harms associated with drug use without requiring people to reduce their drug use or abstain from using drugs, and it informs good public health policy.

Taking a harm reduction approach involves providing services for people who use drugs that are respectful, dignified, compassionate and caring. To practise harm reduction is to challenge policies, practices and behaviours that are judgmental, stigmatizing or discriminatory. Harm reduction requires the meaningful involvement of people who use drugs in programs and decisions that affect their lives.

Harm reduction programs are also supported by evidence and proven to reduce drug-related harms, including infectious disease transmission and overdose deaths. They reduce stigma around drug use and support the engagement of people who use drugs in health and social services more broadly.

How does harm reduction relate to hepatitis C?

Hepatitis C is prevalent among people who inject drugs. As such, the principles and practices of harm reduction are critical to effective hepatitis C prevention, testing and treatment.

Prevention

A harm reduction approach includes policies, practices and programs that support people who use drugs to decrease potential harm associated with substance use and facilitate safer substance use practices. Sharing equipment that has been used for injecting, smoking or snorting drugs increases the risk of hepatitis C transmission. People who use drugs can be supported to help prevent the transmission of hepatitis C through access to new equipment, education and supportive environments. Supervised consumption services, where people can use their own pre-obtained drugs, decrease the risks of overdose and criminalization.

Testing

A harm reduction approach to hepatitis C testing prioritizes the meaningful engagement of people who use drugs and ensures that testing is delivered in settings that are accessible and acceptable to the community. Currently available and simplified testing methods can be used in a variety of settings, including community centres, harm reduction organizations, mobile services and outreach.

Treatment

Changing or reducing substance use is not a requirement for hepatitis C treatment, and people who use drugs are very successful at clearing hepatitis C infections, reaching cure rates >95%. Combining harm reduction and hepatitis C care can help keep people who use drugs to engage in treatment, reduce reinfection risk and help meet other needs (e.g., linkage to care, social support, decreased isolation). Healthcare providers or support workers may explore a person’s substance use to appropriately support them through hepatitis C treatment and aftercare.

Resources for service providers