Harm reduction strategies aim to lessen harms associated with drug use and related behaviors that increase the risk of HIV infection. Sharing needles and syringes raises the risk of blood-borne HIV transmission. Drug use is associated with risky sexual behaviors including unprotected sex and the exchange of sex for drugs or money, which are linked to an increased risk of HIV infection.
Harm reduction strategies can reduce behaviors resulting in elevated risk of HIV infection among injecting and non-injecting drug users. Research has shown that many people receiving treatment for substance use disorders stop or reduce their drug use and related behaviors, including unsafe sex.
Research also has shown that for people who inject drugs, medication-assisted treatment (MAT) can reduce risky behaviors, helping to prevent HIV infection. For example, findings from the NIAID-supported HPTN 058 trial suggested that use of the MAT buprenorphine/naloxone reduces risks related to HIV transmission.
Needle exchange programs contribute to decreased needle sharing and more hygienic injection practices. Numerous studies have indicated that such programs effectively reduce the number of new HIV infections. For example, according to findings from an NIH-funded study published in late 2015, the average monthly rate of new HIV infections among drug users in Washington, D.C., dropped by approximately 70 percent after the city implemented a needle exchange program in 2008.
However, preventing HIV transmission among people who use drugs remains an urgent public health issue. NIH is working to develop interventions that reduce the risk of drug use-associated and sexual transmission of HIV among injecting and non-injecting drug users. NIH also supports development of interventions designed to overcome structural and community-level barriers to accepting and implementing effective HIV prevention strategies.