AIDS/HIV: Acquired Immune Deficiency Syndrome

This critique will attempt to argue for and against Buning in 1993. ‘If a person is not willing to give up his or her drug use then we should help them in causing less harm to himself or others’. Because this statement is ambiguous and is applicable to all drugs, the critique will focus on IDU heroin users and the concept of harm reduction. Because of its complexity will be split into four pillars. The first will deliver an overview of the history of harm reduction. Then the paper will apply philosophical frameworks to the idea of choice, and free will in considering harm reduction using John Stewart Mills and Jeremy Bentham.

In analysing harm reduction as an evidenced based intervention the paper will consider two prison studies in Europe, researched by Nelles (2000). In support of abstinence in terms of crime control and not health the, paper will focus on Philip Bean and the Criminal Justice System, and will attempt to demonstrate harm reductions limitations. In 1977, the concept of harm reduction emerged. Mulder a leading social psychiatrist from Amsterdam decided to look at drug use from a public health perspective and rethink his own profession. His guiding philosophy was ‘people change themselves. As opposed to psychotherapy. Buning (1992:197).

What was unique with Mulder was his humanitarian approach to drug users. He was not solely interested in reducing his patient’s drug consumption; on the contrary, he was driven by the quest for finding ways for drug users to consume drugs safely. As a result harm reduction was born. Buning: (1992:198). In the first instance, using the Amsterdam model saw a stabilisation of hepatitis through needle exchanges. This intervention enabled heroin users to exchange used needles for sterile ones. It could be argued because of the intervention has arguably resulted in Amsterdam having an aging heroin using population, which is diminishing in numbers.

Harm reduction presently has no international meaning to the term, because it has adapted over time, thus can be interpreted in many ways. Some would argue the ‘just deserts’ model is more effective because harm reduction is best implemented by incarcerating drug users. On the other hand, some would perceive harm reduction as a way of engaging with marginalized groups, and promoting health awareness. Riley et al (1999).

Present day the components of harm reduction using Mulders interpretation include HIV/AIDS interventions, which allow the set up of needle exchanges for IDU’s to access education on how to inject safely and facilitate other services which include housing, education and health services. Because this intervention is holistic, it advises users with alternatives to illegal drugs, which include methadone maintenance, detoxification programmes, counselling, and therapy. In addition, drugs education delivery is in a non-judgemental fashion. If drug users do not want to stop taking drugs but may want to use less, then harm reduction in practice will accept this statement and will advice accordingly.

This can include relaying messages about possible contaminated drugs, which may result in overdose, because quality is not assured. Harm reduction also invents ways to reduce the amount of drugs taken in a day, by assisting users to spread drug use over a period. The goal is to advise users not to ‘binge’ on drugs i.e. vast quantities of drugs in short periods followed by 4-5 days of abstinence. Harm reduction is also concerned and advises about the risks of poly drug use, for example alcohol and heroin. In addition, it also investigates and evaluates new research on the effects of drugs and, tries where possible to reform international drugs policies.

However Harm reduction is not just restricted to needle exchanges, certain components promote basic rudiments of education. For example eating a meal before drinking, protecting the stomach from harm caused by alcohol. The objective of harm reduction is educating the individual (actor), which will cause less harm to the community (the stage). “The true champion of harm reduction is not necessarily anti-drugs nor necessarily pro-drugs. He or she expresses support, opposition or indifference to a proposed public or personal approach or a proposed legal or social response solely on the basis of the extent to which it increases or decreases the amount of harm consequent upon the drug in question…

Thus the champion of harm reduction is neither for nor against increased civil rights for drug users; neither for or against increased availability of drug substitution or drug free programmes; neither for or against the legalization or decriminalisation of drug use; neither for or against diversions from the criminal justice system-except insofar as one or other of these choices influence the nature and extent of harms consequent upon use.” (Strang, 1993: 3-4)

Strangs sentiments lead the, the author to interpret harm reduction as a way of reducing the avoidable risks to the drug user and the wider population and accept pragmatism In contrast using the just deserts model rejects this ideal, which allows drug users to make informed choices, which are unlawful, and treatment providers to deliver safe ways of experiencing drugs. The apparent flaw in this ideal is its ultimate aim, in terms of government policy. Because of this some harm reduction strategies have ultimate goals of achieving abstinence, from drugs. However the foundations of harm reduction recognises some drug users are not prepared to give up drugs. Buning (1993:1). Said “If a person is not willing to give up his or her drug use, we should assist them in reducing harm to himself and others”.

Buning would suggest true champions of harm reduction would allow drug users to access services, which are willing to work in a non-judgmental fashion. He realises we no longer live in times where we fear both divine and secular judgement, however in its place we live in an era where morality is prescribed to the concept of drug taking even though one time this was lawful. Buning would argue prescribing moral codes to drug users is unhealthy because if users are made to feel inapt and are judged by their actions they may not access services and cause harm to themselves by sharing needles, passing on BBV, causing harm to others. What emerges with the concept of harm reduction being considered a contempory drugs policy is should drug users have the choice in making decisions for themselves, surrounding their drug use, as this is their free will or should we coerce drug users into treatment and force abstinence as this protects society.

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Originating with the desire to prevent the spread of HIV through injection drug use, harm reduction emerged as an intervention for alcohol problems. Classic examples of harm reduction programs include syringe exchange programs, safe user sites for heroin use, and …

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