Could 30 years of political controversy on needle exchange programmes in Sweden contribute to scaling-up harm reduction services in the world?

Author:

Karlsson Niklas1ORCID,Berglund Torsten1,Ekström Anna Mia2,Hammarberg Anders3,Tammi Tuukka4

Affiliation:

1. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; and Department of Public Health Analysis and Development, Public Health Agency of Sweden, Solna, Sweden

2. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; and Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden

3. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Sweden

4. Finnish Institute for Health and Welfare, Finland

Abstract

Aims: To end the hepatitis and AIDS epidemics in the world by 2030, countries are encouraged to scale-up harm reduction services and target people who inject drugs (PWID). Blood-borne viruses (BBV) among PWID spread via unsterile injection equipment sharing and to combat this, many countries have introduced needle and syringe exchange programmes (NEP), though not without controversy. Sweden’s long, complicated harm reduction policy transition has been deviant compared to the Nordic countries. After launch in 1986, no NEP were started in Sweden for 23 years, the reasons for which are analysed in this study. Methods: Policy documents, grey literature and research mainly published in 2000–2017 were collected and analysed using a hierarchical framework, to understand how continuous build-up of evidence, decisions and key events, over time influenced NEP development. Results: Sweden’s first NEP opened in a repressive-control drug policy era with a drug-free society goal. Despite high prevalence of BBV among PWID with recurring outbreaks, growing research and key-actor support including a NEP law, no NEP were launched. Political disagreements, fluctuating actor-coalitions, questioning of research, and a municipality veto against NEP, played critical roles. With an individual-centred perspective being brought into the drug policy domain, the manifestation of a dual drug and health policy track, a revised NEP law in 2017 and removal of the veto, Sweden would see fast expansion of new NEP. Conclusions: Lessons from the Swedish case could provide valuable insight for countries about to scale-up harm reduction services including how to circumvent costly time- and resource-intensive obstacles and processes involving ideological and individual moral dimensions.

Publisher

SAGE Publications

Subject

Health Policy,Health (social science)

Reference96 articles.

1. Legal access to needles and syringes/ needle exchange programmes versus HIV counselling and testing to prevent transmission of HIV among intravenous drug users: A comparative study of Denmark, Norway and Sweden

2. Arponen A., Brummer-Korvenkontio H., Liitsola K., Salminen M. (2008). Trust and free will as the keys to success for the low threshold service centers (LTHSC): An interdisciplinary evaluation study of the effectiveness of health promotion services for infectious disease prevention and control among injecting drug users. Publications of the National Public Health Institute B24 / 2008. Helsinki.

3. People who inject drugs remain hard-to-reach population across all HIV continuum stages in Central, Eastern and South Eastern Europe – data from Euro-guidelines in Central and Eastern Europe Network

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