Barriers to harm reduction for HIV prevention

A "war on drugs" approach still prevails in many countries. Law enforcement authorities continue to criminalize the possession of needles and syringes and mount ‘crackdowns’ on people who inject drugs even when they are seeking treatment or visiting healthcare centers for clean needles and syringes or other services. Criminalization drives people who inject drugs away from health and HIV services and has a negative effect on HIV prevention and treatment outcomes. A paper provides an overview of the current state of HIV testing and counseling in Central Asia for PWID, highlighted that criminalization of drug use and discriminatory practices among government service providers restrict access of PWID to needle exchange programs and NGOs where HIV testing services are located. Based on interviews with drug users in Kazakhstan, Human Rights Watch (2007) reported that police often arrest clients of harm reduction services, confiscate drugs and syringes and extract bribes for possession of syringes/needles. Medical staff and government health care providers also often stigmatize and discriminate against PWID, which results in negative experiences and lower levels of trust in what the services can offer. A long Soviet initiated tradition of using health facilities for mandatory HIV testing without ensuring confidentiality of the test results contributes to the unattractiveness of these services to PWID.

Moreover, social stigma and discrimination associated with drug use is a barrier to place integration of services, as well as having a detrimental impact on the implementation of testing in this setting. Many advocate for stigma reduction initiatives as part of harm reduction programs.

In addition, the lack of sustainable funding in some countries constitutes one of the most significant barriers to harm reduction initiatives, forcing them to downsize or run at a much reduced rate.

Barriers such as people’s fears of discrimination, fears about getting a positive test result, and fears of social stigma need to be overcome to better implement HIV testing as a prevention program.