Estimating Coverage of Harm-Reduction Measures for Injection Drug Users in Europe

Summary

Harm-reduction approaches to prevention of drug-related infections (HIV, hepatitis B [HBV], and hepatitis C [HCV]) are becoming common practice throughout Europe (Stimson 1996; Wiessing 2000). Some countries introduced measures such as syringe exchanges during the early 1980s, while countries that initially did not provide such services rapidly introduced them in the 1990s, especially those countries that experienced the largest impact of HIV among injectors (PESESUD 1998). A preliminary overview of the existence of measures to reduce infections among injection drug users (IDUs) suggested that measures were available in most countries by the end of 1999 (Wiessing 2000). However, it is not yet clear whether prevention measures now in effect are sufficient to control the potential for new increases in infections. Quantification is necessary to assess the implementation of these prevention measures throughout Europe. This study does not attempt to measure the efficacy or effectiveness of prevention measures, which would require a more sophisticated research design based on individual infection data. As a first step in that direction, however, this paper describes basic parameters such as the provision, utilization, and coverage of HIV prevention services (Habicht et al. 1999). The concept of provision of HIV prevention services means whether the services are available. Utilization refers to whether the services are being used by the target population. Coverage refers to what portion of the target population is being reached. Thus this paper addresses the central question of whether it is possible to monitor the availability of harm-reduction measures on a European scale by developing indicators of the provision, utilization, and coverage of those services.