Bénéficiaire souffrant de la tuberculose. © William Daniels

Harm reduction

For almost 30 years, Doctors of the World has been working with at risk populations, particularly people who use drugs and sex workers, on harm reduction projects (HR). It is one of our key battles. The objective is to minimise harm linked to the use of psychoactive substances and sexual practices, by providing a medical, psychosocial and community response.

Understanding harm reduction

The first needle exchange programmes, mobile services for sex workers, access to opiate substitution treatments, drugs analysis and education in injection-related risks: these are a few examples of pilot projects set up since 1986 by Doctors of the World in France. Today, the Harm Reduction approach is recognised worldwide as the most effective way of reducing the transmission of HIV in these most at risk groups.

Stigmatised groups

This is why Doctors of the World makes it a priority to make Harm Reduction services accessible to these people. So many people who are largely excluded from the health system because of who they are or what they do. This is why they are more vulnerable and at risk than others: not because the virus is different or is transmitted differently, but because their social and legal status set them apart from prevention and treatment programmes. This is what makes them more exposed than others to the risk of infection with Aids and hepatitis viruses. Sometimes, their social relegation goes as far as imprisonment, torture or even death.

Harm reduction depends on the non- judgement of the other.


A comprehensive approach

Thus Harm Reduction is a comprehensive approach based on the understanding of risks. They are looked at globally in terms of health, social and economic consequences and take account of the impact of the disease on individuals, communities and society as a whole. Such a definition requires not only public health actions but also advocacy to bring about changes to the political and legal environment in which these people live.

Participative practices

Harm reduction claims to be pragmatic and humane; it is based on being non-judgemental of others and accepting the different practices and ways of life of other people. Over and above their relevance in terms of public health, our harm reduction programmes aim to contribute to the development of a community response. In other words, they are concerned with capacity building and empowerment, through the active involvement of beneficiary groups, both to set out the health response and to combat the stigmatisation and exclusion to which they are subjected. We support the creation of self-help groups to strengthen civil society and the acknowledgement of expertise born of experience. This is how HR activities, can enable social change through a community response.

Innovative and radical projects

Our harm reduction programmes were initially developed in France, then spread around the world from 1997. Today we are present in Asia, in Eastern Europe and in Africa, providing a holistic approach to Harm Reduction, mainly to people who use drugs but also to sex workers as well as sexual and gender minorities.
Thus, Doctors of the World is a global key player in Harm reduction, leveraging its expertise to develop quality practical solutions but also to build the capacity of national stakeholders to play an active role in the spread of the HR message.

Our battles

Doctors of the World promotes an approach to HR based on scientific factors which have also demonstrated added value in terms of cost and efficiency. The United Nations define 9 areas of intervention in the field of prevention and treatment of HIV amongst people who use drugs. We propose a framework for broader multidisciplinary intervention, based on 12 approaches.


Beyond a health based response, Doctors of the World draws up its battle lines around 4 political approaches:

  1. Advocacy for access to testing and treatment of viral hepatitis. This especially important approach was developed 3 years ago.
  2. Promotion of the concept and practices of HR in Africa where care and treatment for drug users is virtually non-existent (less than 1% of them receive health services which are appropriate to their situation). 
  3. Evolution of the direction and practices of HR around the world. HR is still much too focused on prevention of HIV linked to injection. It should be looked at more generally, going beyond the technical framework of national and international agencies.
  4. Reform of laws and national regulations as well as international policies on criminalisation, repression or control which sanction the practices and ways of life of these people, in favour of an approach based on public health and human rights.

fight Hepatitis C

Hepatitis C (HCV) is classed as a “silent epidemic” because despite the scale and severity of the infection, the subject is rarely discussed, and above all, is little known. It is because in low and middle income countries, many drug users who we encountered in the context of our HR  programmes were infected and had no access to treatment, that since 2011, we have been we been conducting vigorous advocacy on hepatitis C.

Prise de traitement contre l'hépatite C en Georgie
Prise de traitement contre l'hépatite C en Georgie
Inaccessible treatment

To this day, there is no vaccine against hepatitis C, but new treatments can cure in 12 to 24 weeks. However, the vast majority of patients who need this treatment cannot obtain it. One of the main challenges is their price and the fact that very few resources are currently dedicated to the treatment of hepatitis in countries with low and middle incomes.
Pharmaceutical companies hold patents which grant them monopolies on the marketing of treatments which the laboratories abuse, imposing exorbitant prices. Even in countries where generic medicines could be marketed, the absence of national programmes and available resources for hepatitis care delay the registration and marketing of generics.

A global struggle

In July 2012, Doctors of the World was behind the creation of a global coalition against hepatitis C, which runs a network and develops advocacy tools.
The coalition’s website is designed as an open and inclusive space to promote the sharing of information, strategies and advocacy tools nationally, regionally and internationally. Our advocacy activity resulted in better leadership of the World Health Organisation for the fight against viral hepatitis. Doctors of the World is part of a civil society working group with the WHO and takes part in the development of guidelines and defining the sectoral strategy on viral hepatitis.

Peer work in Harm Reduction Programs

In a few decades, peer work has become an effective and recognized model of intervention. It is now at the heart of our harm reduction programs, especially for HIV and HCV. However, funding, safety guarantees and the implementation of this approach on a large scale are still far from being commensurate with this recognition. Yet the expertise and commitment of peer workers allows them to access marginalized communities and thus to carry out outreach activities of unparalleled effectiveness.


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