Harm reduction, human rights and public health

Despite vigorous efforts on the part of the international community, and an unprecedented level of research across an enormous variety of fields, HIV/AIDS has become the most severe infectious disease epidemic of modern times. HIV spread is either accelerating or remains stable at unacceptably high levels. Despite a relatively long list of prevention tools with good evidence for efficacy in HIV prevention, this domain has been marked by many failures and only a few successes by a tragic and ongoing history of inability to implement the tools available to control HIV spread. HIV spreads through sexual and reproductive behaviors and by blood and blood-products exposures, including sharing of injection equipment among drug users. The history of other sexually transmitted diseases suggests that most societies have been challenged in dealing pragmatically with diseases spread by sexual behavior. Intravenous drug users (IDUs) remain one of the most vulnerable groups for HIV infection. Prevention strategies for HIV infection can be divided into two main groups: harm-reduction strategies and a protective vaccine against HIV infection. And while it is important to include IDUs as study participants for HIV vaccine trials, harm-reduction strategies are currently the only proven way of preventing HIV infection. The immediate goal of harm-reduction strategies is not to reduce the use of drugs; instead it is to reduce the associated risk of HIV infection with drug use. Incarcerated populations remain among the most vulnerable for HIV infection worldwide because the burden of infectious disease in entrants to the penal system is significantly higher than in the general population, and in prison there is a heightened risk environment.