Moving from a project to programmatic response: scaling up harm reduction in Asia

Area of Science:

• Public Health
• Epidemiology
• Social Sciences

Background:

• HIV epidemics among people who inject drugs (PWID) in Asia emerged in the early-mid 1990s.
• Initial responses included small-scale needle syringe programs and community care.
• Significant scaling up of harm reduction has occurred despite limited resources and challenging policy environments.

Purpose of the Study:

• To analyze the scale-up of harm reduction programs for PWID in Asia.
• To identify factors contributing to successful scale-up.
• To explore challenges and implications for future service delivery.

Main Methods:

• Review of program-based approaches and national HIV/AIDS strategies.
• Analysis of the role of civil society and client-focused approaches.
• Examination of capacity-building models for ongoing scale-up.

Main Results:

• Program-based approaches and integration into national strategies, often donor-aided, have driven scale-up.
• Transition from project-based to program-based approaches has had mixed impacts.
• Protecting civil society involvement and client focus is vital during transitions.

Conclusions:

• Harm reduction scale-up in Asia is attributed to program-based strategies and integration into national plans.
• Sustained scale-up requires careful management of transitions to protect civil society engagement and client-centeredness.
• Resolving conflicts between drug policy, human rights, and public health is essential to expand services to all in need.