Most injecting drug use is both illegal and socially driven underground. A whole body of research exists which shows that punitive or coercive attempts to try to `stamp out' drug use don't succeed. What's worse is that they drive drug use even further underground and make HIV prevention services inaccessible to the majority of drug users.

If our primary aim is the reduction of HIV transmission and the provision of quality services to drug users with HIV or AIDS, then it is essential to adopt an approach that recognises the difficulties of accessing drug users and the dangers of alienating them.

It is important to begin with advice and with services that drug users will themselves value. It is important to give minimum necessary advice about risk and harm reduction rather than maximal advice requiring drug users to make total changes to their lives in a short space of time, as this will alienate clients and drive them away from services.

Harm reduction focuses on giving advice about;

• not sharing injecting equipment.
• cleaning injecting equipment for those situations where there is no option but sharing.
• safer sex.
• using all drugs via all methods.
• the wider health context of safer injecting.
• preventing and dealing with an overdose.
• referral to accessible services.
• implementing harm reduction techniques in the real world. 

If users are looking for services to help them give up drug use then clearly it is important to provide speedy and reliable referrals to these and to ensure that they are as user–friendly as possible.

The Harm Reduction approach has been implemented for all drug users. Following the death of Leah Betts in 1995 and other high-profile ecstasy deaths organisations such as the Dance International Network and other user groups have been established to give advice to clubbers about taking all drugs safely. Traditionally drug services in the UK were set up for primarily heroin- using clients; however, in recent years services have been developed to meet the changing face of drug use within the UK.

Services are now established for clients who use cocaine / crack primarily, as well as other non- opiate drug users, such as Ecstasy and other so called ‘recreational drugs’, who in the past were not able to access support (Stark et al. 1999). 

Safer sex

It should be remembered that all drug users are also sexually active and may, like the rest of the population, be heterosexual, gay, bisexual or lesbian. People under the influence of any substances, including alcohol, may engage in more risky behaviour, including engaging in unsafe sex. Due to the potential prevalence of HIV infection among injecting drug users they are also likely to be particularly at risk from HIV through unsafe sex and this issue should not be overlooked.