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Harm reduction is a philosophy of public health, intended to be a progressive alternative to the prohibition of certain potentially dangerous lifestyle choices in society.
The central idea of harm reduction is the recognition that some people always have and always will engage in behaviours which carry risks, such as casual sex, sex work, and drug use. The main objective of harm reduction is to mitigate the potential dangers and health risks associated with the risky behaviours themselves. Another objective of harm reduction is to reduce harm associated with, or caused by, the legal circumstances under which the behaviours are carried out (for example, prohibition of certain acts or substances can help create a black market where illicit trade flourishes).
Harm reduction initiatives range from widely accepted ideas, such as designated driver campaigns, to more controversial initiatives, like the provision of condoms in public schools, needle exchange programs or supervised injection sites for intravenous drug users, drug legalization, and heroin maintenance programs.
Harm reductionists contend that no one should be denied services, such as health care or social security, merely because they take certain risks or exhibit certain behaviours that are illegal or are generally disapproved of by society as a whole. Further, harm reduction seeks to take a social justice stance in response to behaviours such as the use of illicit drugs or prostitution, as opposed to criminalising and prosecuting these behaviours. Often, harm reduction advocates hold the view that prohibition of drugs is discriminatory, ineffective and counter-productive. Among other arguments, they point out that the burden placed on the public health system and society as a whole from cannabis use and other illegal drugs are relatively low. They also contend that the substances are still widely used, despite extremely expensive attempts to enforce laws criminalizing them, and that the prohibition has the effect of criminalizing and marginalizing otherwise law-abiding drug user.
Critics of harm reduction contend that it appears to condone and even facilitate behaviours that are dangerous, socially destabilizing or considered immoral. For these reasons, harm reduction has been very controversial in the United States, where it has met more resistance than in Europe, Canada, Australia and New Zealand. In the United States, debate about harm reduction is very polarized. Advocates are often characterized as "pro-drug". Opponents of harm reduction are often criticised for ignoring the realities and circumstances of addictions, disregarding scientific evidence, marginalizing the basic human rights of affected persons, and responding from a position of "moral panic".
There is a third group that advocates an approach which is sometimes referred to as gradualism. Gradualism advocates are of the opinion that harm reduction programs are sometimes rooted in pessimism about the ability of addicts to stop their addictive behaviors and represent the "soft bigotry of low expectations." They are unlikely to categorize interventions as "good" or "bad". Rather, they tend to be more concerned that programs should urge clients toward abstinence when windows of opportunity open.
