In the early 1980s, a radical departure from the conventional abstinence-oriented approach took place when it was appreciated that 'the spread of HIV is a greater danger to individual and public health than drug misuse'. (23> A harm-reduction philosophy is centred on the belief that it is possible to exert a powerful impact upon morbidity and mortality without necessarily insisting upon abstinence. A hierarchy of aims begins with attempts to make contact with as many problem drug users as possible in order to provide access to clean needles and syringes, advice about safer sex and injecting, basic health care, and help with housing, child care, or legal issues. Then, for some people but not all, a move away from street drugs on to a prescribed oral substitute may be feasible, possibly followed by detoxification and rehabilitation.
Whether through success of this strategy or just good fortune, a serious HIV epidemic among injectors similar to that experienced in the United States and some European countries has not materialized in the United Kingdom. Unfortunately, the same cannot be said about hepatitis C, which is becoming rampant.
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