Harm reduction policies : a study of global efficacy

This thesis discusses harm reduction as a philosophy born within specific cultural values and structures, and as one method of responding to the problem of drug use. Harm reduction is a philosophy that aims to reduce the harms associated with injection drug use, through practices such as syringe service programs (SSPs), medication assisted therapy (MAT), and safe injection facilities, among others. These practices are implemented in order to reduce the risk of disease transmission through shared needles and to provide services for people who continue to inject drugs, rather than requiring abstinence. As this thesis explores, the acceptability of harm reduction is highly reliant on the specific context of a community; historical, political, social, and cultural factors influence how and why harm reduction practices can be implemented. Through semi- structured interviews with harm reduction workers in three locations – rural Washington state, U.S., the industrial city of Togliatti, Russia, and the border cities of Tijuana and Mexicali, Mexico – I found that context must guide harm reduction practices. Finally, this thesis places harm reduction within the larger picture of global health initiatives, using a postcolonial and biosocial lens to improve future global harm reduction initiatives.