The state of harm reduction in North America in 2017
Guest Editor: Prof Ernest Drucker
Editors-in-Chief: Prof Nick Crofts and Dr Euan Lawson
Are we anywhere near there yet? The state of harm reduction in North America in 2017
AIDS was first seen among people who inject drugs (PWID) in the U.S., in the form of outbreaks of Pneumocystis carinii pneumonia, in 1981 [Masur et al 1981]. In 1984, the Centers for Disease Control issued strong advice to PWID to stop sharing needles and syringes [CDC 1984], but there was widespread recognition that without provision of sterile injecting equipment this advice was unachievable for many PWID. Also that year, however, the first needle and syringe programs were begun in the Netherlands, providing a model of a most effective public health intervention to stop the spread of HIV among and from PWID [NIDA 1988]. By 1993 the evidence of the effectiveness and safety of NSP in prevention of HIV transmission was more than convincing [Lurie et al 1993], but despite this NSP were not widely implemented, at a great cost [Lurie and Drucker 1997].
Some countries have wholeheartedly adopted the public health philosophy which has become known as harm reduction, and have seen prevention or control of HIV epidemics. What has happened in the ensuing three decades in achieving control of the HIV epidemic among and from PWID in North America?
This thematic series of the Harm Reduction Journal seeks to examine progress or lack thereof, and the reasons why, in the progress of harm reduction both as a philosophy and as a practical and proven effective public health intervention in North America.
The series was launched at the 25th Harm Reduction International Conference in Montréal in May 2017.
The Editors of the series declare no competing interests.
Masur, H. et al. An Outbreak of community acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction. The New England Journal Of Medicine 1981 305(24):1431-1438
Centers for Disease Control and Prevention (CDC) 'Antibodies to a Retrovirus Etiologically Associated with Acquired Immunodeficiency Syndrome (AIDS) in Populations with Increased Incidences of the Syndrome' 1984 (13 July) 33(27):377-379
National Institute on Drug Abuse. 'Needle Sharing Among Intravenous Drug Abusers: National and International perspectives' 1988
Lurie, P, Reingold, AL, Bowser, B, et al. The public health impact of needle exchange programs in the United States and abroad , Volume I . University of California. September, 1993.
Lurie P, Drucker E. An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA. Lancet 1997 (March 1) Vol 349(9052): 604-608