Harm Reduction

Recognizing that individuals may not be able to immediately change behaviors that put them at risk for HIV infection, some prevention programs have focused on ways to decrease the harm that certain behaviors may cause.

The most common example of a harm-reduction approach is needle exchange, in which injection drug users are provided with clean needles and syringes to help them reduce their risk for contracting HIV.

In this example, providers have acknowledged that although the best way for injection drug users to reduce their risk for HIV is to stop injecting drugs, this may take time, or may never occur for some. So in the meantime, providing clean needles and education about the dangers of sharing injection drug works will at least increase the chances that these clients will remain uninfected.

In some circumstances, this same principle can be applied to sexual behaviors that put individuals at risk for HIV. For example, in resource-poor areas where condoms may not always be readily available, a counselor and client could discuss strategies to reduce relative risk for STI/HIV transmission during unprotected vaginal intercourse. One such strategy is to have the man withdraw his penis from the woman’s vagina prior to ejaculation (although pre-ejaculate does contain HIV, this practice may somewhat reduce exposure). Alternately, clients may decide to reduce their number of partners. While these practices may not be considered “effective”  prevention measures, some may consider reduction of risk better than no action at all. Each woman’s situation is different and with support, she must make her own decisions as to what is feasible and safe.

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