How does it work?
By cutting back from shooting to smoking before she quit completely, Kim was choosing the harm reduction (HR) route. HR originally referred to needle-exchange centers’ efforts to halt the spread of disease and infection by offering clean needles to injection-drug users and encouraging safer habits among them. Proponents call it a more realistic public-health approach than an all-out “war on drugs.” “Needle exchange is often the first time someone is able to approach social services or a human outside their circle of users,” notes Alan Clear, executive director of the Harm Reduction Coalition. Opponents argue that HR promotes drug use, and they’re against using public funds for needle-exchange centers or laws allowing pharmacies to sell syringes over the counter. Basic points for HIVers who shoot up:
- use a clean, new needle every time
- don’t share needles, even among people who are positive
- don’t skip your HIV meds—and try to let your doctor know you’re shooting up

Is HR just for IV-drug users?
No—it comprises any effort to reduce the risk of death or damage while doing any drug, or while having sex (see “Recovery Rooms” ). Some HR tips for non-injection drug use:
- set limits for how much, how long or how often you’ll use
- drink plenty of water—or try cran- berry juice, a great detoxifier
- try to eat, especially fruits and vegetables, protein and whole grains
- if you’re snorting drugs, protect your nose by inhaling a saline solution or just clean, warm water
- if you’re on HIV meds, don’t forget to take them. If you’re using away from home, take along the doses you’ll need

What if HR doesn’t work for me?
If you’re sharing needles or exceeding your limits, you may be unable to control your use and should consider recovery. Don’t be too hard on yourself, though. Like Kim Hall, many users wanted to quit long before they actually did, and relapse is often part of the recovery process.