Observer’s Intervention on Youth Thematic Segment – Harm Reduction International

by Damon Barrett

Injecting drug use among adolescents has been largely overlooked in responses to HIV.

At Harm Reduction International we have undertaken the first global snapshot of available data on this issue – copies are available outside (And online at )

National population size estimates are exceptionally rare for this age group.

Under 18s are often not included behavioural surveillance. Specific research is quite rare. A lot of what is available is isolated, one off or old. In other words most countries don’t know their epidemic

This should not prevent action:

  • Early onset of injecting, and having recently begun injecting, have been associated with increased risks of HIV and hepatitis C transmission.
  • Low ages of initiation are clear across regions. In Nepal, for example,it is estimated that 20% of people who inject may be under 18.

A third of young people who inject reported starting under the age of 15 in Albania – a quarter in Romania.

In Indonesia adolescents are almost twice as likely to share needles than older counterparts. They are less likely to test for HIV

In Ukraine it has been estimated that there are just over 50,000 adolescents injecting drugs. According to data from harm reduction services, about 800 were reached last year.

And that raises the key question of knowing our responses. Adolescents who inject drugs are less likely to use or accessbasic harm reduction services. Rarely are services that do exist geared up for work with adolescents who have needs and vulnerabilities that render delivery of those services more difficult, additional to their legal status as a minor.

The existing comprehensive package on HIV and injecting drug use was not developed with adolescents in mind. So it is inadequate. And each of the nine interventions is more difficult to deliver for this age group. I don’t want to understate the complexities or sensitivities this involves. Of course it would be better if adolescents were not using drugs. But let’s remember that many are living in exceptionally difficult circumstances. Imagine a girl of 15 who is injecting drugs. She lives on the streets. She cannot go home due to abuse. Her drug use is a response to that. This is why harm reduction is so important. Even if we can guarantee that tomorrow we can help her overcome that trauma.

Even if tomorrow we can reunite her with her mother and even if tomorrow we can help her stop using drugs, today she is going to inject multiple times, and each occasion could expose her to serious harm including HIV.

So what are we going to do?And how many like her are there? I leave you with that challenge and look forward to more attention to this issue.

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