ONDCP Bulletin


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National Drug Control Strategy


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Preventing HIV Transmission


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This volume addresses the interface of two major national problems: the epidemic of HIV-AIDS and the widespread use of illegal injection drugs. Should communities have the option of giving drug users sterile needles or bleach for cleaning needs in order to reduce the spread of HIV? Does needle distribution worsen the drug problem, as opponents of such programs argue? Do they reduce the spread of other serious diseases, such as hepatitis? Do they result in more used needles being carelessly discarded in the community? The panel takes a critical look at the available data on needle exchange and bleach distribution programs, reaches conclusions about their efficacy, and offers concrete recommendations for public policy to reduce the spread of HIV/AIDS. The book includes current knowledge about the epidemiologies of HIV/AIDS and injection drug use; characteristics of needle exchange and bleach distribution programs and views on those programs from diverse community groups; and a discussion of laws designed to control possession of needles, their impact on needle sharing among injection drug users, and their implications for needle exchange programs.




User Accountability


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Harm Reduction


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Harm reduction programs accept the reality of drug use while attempting to reduce its harmful consequences to individuals and society. This term, coined about 15 years ago in the U.K., has become a policy paradigm increasingly explored throughout most of the industrialized world. An example of a harm reduction program is the widely accepted substitution of methadone for the more "harmful" heroin. Programs that divert drug-involved offenders into treatment are another example of the operationalization of harm reduction policies. In these 10 original chapters, international contributors discuss the philosophical basis and history of harm reduction policies and examine their outcome. They also cover controversial topics related to harm reduction, especially conflicts between the public health system where most programs are located, and a worldwide criminal justice system that further marginalizes drug users. Included in this book are descriptions of programs in the United States, the United Kingdom, Canada, Brazil, the Netherlands, Switzerland, and Australia. The editors provide the context with a substantive introductory chapter focusing on the nature of harm reduction. The first part contains five chapters presenting the American perspectives on harm reduction; Part II includes five chapters presenting international perspectives from countries with particularly innovative harm reduction programs and policies.