AIDS and Drug Misuse in the UK-10 Years on: Achievements, failings and new harm reduction opportunities

Abstract

The year 1988 saw the publication of the influential first AIDS and Drug Misuse report from the Advisory Council on the Misuse of Drugs (ACMD, 1988) in the UK. Most of the policy documents and developments of practice in the intervening years can be seen as merely following through on the recommendations from this seminal 1988 report. Ten years on, it is appropriate to take stock of the situation and to describe some of the successes, reflect on the failures, and speculate on possible new areas of development in the harm reduction field. This paper comprises four parts. Firstly, what was new about the health risk facing the broader population of drug injectors—and how did this lead lo the public health approach that was adopted to dealing with the problems of HIV amongst injecting drug misusers? Secondly, an examination is required as to how concerns about HIV transmission have brought a new focus to the work of existing treatment services, as well as being the birthright of the new services established in the wake of HIV awareness. Thirdly, the spotlight should be shone on those areas in which we have failed to respond adequately, and a consideration should be made of the reasons underlying these disappointing failures of policy and practice. Fourthly, an exploration is necessary in order to chart some of the new areas in which it may be possible for new harm reduction opportunities to be developed.