HIV in Canada: A primer for service providers


Harm Reduction Programs

Key Points

  • The consistent and correct use of certain harm reduction interventions (needle and syringe programs, opioid agonist therapy and safe consumption services) are highly effective strategies to reduce the risk of HIV and hepatitis C.

One highly effective harm reduction approach is needle and syringe programs (NSP). These programs provide new injecting equipment to people who use drugs. New needles and injecting equipment need to be used every time a person uses drugs in order to be highly effective. If a person uses all new equipment every time they use drugs they cannot acquire or pass HIV through drug use. These programs typically offer other services such as information, counselling and referrals. NSPs operate most commonly out of fixed sites; however, needle and syringe distribution also happens through mobile sites, pharmacies, vending machines and during outreach. Evidence reviews have found that the use of NSPs by people who inject drugs is associated with significant reductions in injecting risk behaviours and reduced HIV and hepatitis C transmission rates. NSPs are thought to be more effective when combined with an array of harm reduction approaches, such as educational interventions and opioid agonist therapy (OAT).

OAT is another highly effective strategy and involves the use of prescription medications to reduce drug cravings and prevent withdrawal symptoms for people who want to reduce or eliminate their use of illicit opiates. The most common medications used for OAT are methadone and buprenorphine. These drugs do not create the same euphoric or high feeling that a person would get from injecting, snorting or swallowing illicit opiates. The drugs used in OAT have consistently been shown to help reduce or eliminate injection drug use, related injection risk behaviours and HIV and hepatitis C infection rates among people who inject drugs. Less commonly, hydromorphone or diamorphine (prescription heroin) can be used as OAT for long-term drug users who have been unsuccessful with methadone or buprenorphine. They have been shown to lower illicit drug use and needle sharing, which lowers HIV and hepatitis C risk.

Supervised consumption services (SCS) are another effective harm reduction approach. These programs provide supervised areas where people who use drugs can use pre-obtained drugs in a clean and safe environment. SCSs have been shown to attract people who are at increased risk of HIV infection, and they can be important settings for delivering harm reduction education, distributing injection-related equipment and providing referrals to addiction treatment programs. Several studies have shown that SCSs are associated with reductions in injecting risk behaviours such as needle/syringe sharing, which can lead to reductions in HIV and hepatitis C transmission. When people who use drugs participate in less borrowing and lending of used needles, there is less opportunity for HIV and hepatitis C transmission to occur. Research has found that SCS use is also associated with other safer drug use practices such as less public and outdoor injection, less needle reuse, and safe disposal of used injecting equipment.

Coverage of harm reduction services must be high, including in rural and remote communities, to have an impact on reducing HIV and hepatitis C transmission among people who inject drugs. For example, NSPs that do not distribute enough equipment or do not reach enough people who inject drugs are less likely than other programs with better coverage and reach to have an impact on transmission rates. Little is known about coverage in Canada because of insufficient data. However, we do know that HIV prevalence and incidence vary across the country, suggesting that some programs may have better reach and coverage than others.

Despite the proven effectiveness of multiple harm reduction interventions, many of these have not been effectively scaled-up for people who inject drugs.


Harm reduction in action: Supervised consumption services and overdose prevention sitesPrevention in Focus

HIV prevention for people who inject drugs: New biomedical approaches and time-honoured strategies - Prevention in Focus

Supervised consumption sites: status of applications ­– Health Canada

Best Practices for Canadian Harm Reduction Programs


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