Harm reduction history, response, and current trends in Asia

Human immunodeficiency virus (HIV) epidemics in Asia have been initially driven through injection drug use and the use of shared needles and syringes. Molecular epidemiological work has shown that where there is heroin trafficking and use, there is also HIV. Given the often strict enforcement of national antinarcotic laws, harm reduction responses to HIV infections driven by injection drug use have been historically slow. As it became clear that preventing HIV meant embracing harm reduction, many countries in the region have adopted harm reduction as part of their national acquired immunodeficiency syndrome (AIDS) strategy and increasingly as part of their national drug strategy. Initial successes have proven that harm reduction, as it pertains to HIV among injection drug users (IDUs), can and does work in Asia. These initial successes have led to more comprehensive scale-up of other essential components of HIV prevention among IDUs, including increased availability of opiate substitution programs. Still, multiple challenges remain because overall coverage of services in the region remains poor. Changes in the availability and patterns of use of drugs, including the exponential increase in the use of amphetamine-type stimulants, are providing ongoing challenges to both the law enforcement and public health sectors. This paper reflects on the history of harm reduction in Asia and the shifting trends forcing policy makers to adapt and expand harm reduction strategies to include an ever widening approach to criminal justice, policing, public health, and human rights.