Prevention for a
Stronger Nation
Harm Reduction Model

Darcy is an Aboriginal two-spirited man living with HIV/AIDS. For the past five years he has been employed with the Two-Spirited People of the First Nations, an organization which focuses on HIV/AIDS education, prevention, care, treatment and support.

Darcy presented findings and recommendations from Joining the Circle: An Aboriginal Harm Reduction Model, a study done by the Canadian Aboriginal AIDS Network (CAAN). The study surveyed 126 Aboriginal injection drug users (IDUs) to identify the issues, barriers and struggles around involved in an Aboriginal IDU as it relates to the transmission of HIV/AIDS. The respondents generally shared the same characteristics, among them: poverty, having been raised in a home with alcohol abuse and violence and having been incarcerated at one time or another.

The issues:

+ Aboriginal injection drug users (IDUs) are the fastest growing group of new HIV cases in Canada.
+ Due to colonization, poverty and racism, Aboriginal people are over-represented in the injection drug use population. An unfortunate aspect of injection drug use is that the use of needles places people at an increased risk of HIV infection.
+ As many as 79 per cent of Aboriginal IDUs visit their home reserves and may share needles or have unprotected sex while there.
+ HIV awareness remains very low on many reserves. Condom distribution and needle exchange programs are virtually non-existent.
+ Approximately 87 per cent of Aboriginal drug users have been in prison, often for drug-related charges. Drug use and needle sharing is a fact of life in prison, but there is no program for providing clean needles so users can protect themselves while incarcerated.

In responding to these issues, programs must be developed that reduce the risk of HIV infection to Aboriginal IDUs and prevent further transmission in the larger community. A harm reduction approach must be taken.

What is Harm Reduction?

There has been a long debate about the use of cocaine, heroin and other drugs. One side of the debate has argued that all drugs of this nature should be illegal and that society should use all of its resources to prevent illegal drug use. The other side has argued that drugs should be decriminalized. They argue that the criminalization of drugs has created a dangerous underground control of drugs and that any war against drugs is futile. In 1990, medical experts from around the world developed the harm reduction approach which is a pragmatic, middle-of-the-road perspective on drug use, which focuses on reducing the harm caused by drugs as opposed to abstinence and legalization. Many experts now agree that preventing the spread of HIV is more important than warring against drug use.
Typical harm reduction models involve: condom distribution, needle exchange programss and methadone maintenance programs.

Harm Reduction Philosophy:

+Should be value neutral. Drug use is drug use. No judgement should be made on drug use and no judgement should be made on the drug user.
We need to focus on the problem: the risk of HIV and reducing that risk for IDUs.
+The irrelevance of abstinence. The goal is reducing harm from drug use, not reducing the actual drug use.
+The user's role. The key is respecting IDUs and recognizing their ability and their right to make their own choices.
+Community involvement. Individuals and the community should be involved in the development and implementation of harm reduction models. Programs should be flexible, wholistic and relate to the person's whole relationship with drug use, not just the symptoms. Drug use is a symptom and not the problem. The problems are racism, poverty and colonization.

Conclusions and Recommendations

Phase one of this study has identified the problem of HIV and Aboriginal injection drug use. It also included an identification of the barriers to implementing a harm reduction program in Aboriginal communities across Canada. It is recommended that a second phase provide more specific information about how to link up with regional health authorities, acquire needles, establish methadone programs, and secure funding for community-based harm reduction programs.

It is recommended that the three main components of an Aboriginal community harm reduction program be condom distribution, needle exchange and methadone maintenance treatment. It is highly recommended that abstinence not be the focus of these programs. Culture is important and should be part of the program and needs to be determined at the local level. It is recommended that the issues of confidentiality be overcome, where necessary, through the use of outside nurses and off-site record keeping.

The program must be non-judgmental, pragmatic, flexible and recognize the IDUs' ability to make their own informed decisions. Speakers who have been through street life and IDU will be important in the selling of the program to each community.

copyright © 1998 NIICHRO