Marketing harm reduction: a historical narrative of the International Harm Reduction Development Program☆

The International Harm Reduction Development Program (IHRD) was established to develop syringe exchange, methadone maintenance and peer outreach for HIV prevention and health promotion among drug users in Central and Eastern Europe, the Former Soviet Union and Central Asia. This narrative describes the process of program development, since establishment in 1995, through interviews with the three program directors, focusing on the identification of development strategies and obstacles to successful implementation. The goal of IHRD was to establish independent organizations capable of beginning further initiatives in their own and other regions. Few projects were funded in the first 3 years, as IHRD focused on developing a dialogue and network of harm reduction providers. Since 1998, the number of projects funded expanded greatly. It is not possible to evaluate the impact on drug users’ health, but evidence exists to suggest that IHRD played a substantial role in establishing harm reduction as a viable intervention, in attracting other agencies to support harm reduction and in improving the lives of project participants. Although IHRD was originally scheduled to close at the end of 2001, it was granted 3 years of continued operation and continues to expand the number and breadth of programs it funds.