Harm reduction policy in Taiwan: toward a comprehensive understanding of its making and effects

BACKGROUND: In response to the spread of HIV caused by needle sharing among injection drug users (IDUs), the Taiwan Centers for Disease Control implemented a pilot harm reduction program in 2005 that expanded nationwide in 2006. The policy led to a significant reduction in the number of HIV-positive cases among IDUs in 4 years. METHODS: This article aims to provide a critical evaluation of this harm reduction policy in Taiwan. The research leading to this article included a thorough literature review and in-depth interviews with 31 active policy participants, including people working in hospitals, the academia, non-governmental organizations, community pharmacies, the legal system, and health authorities at both the central and local levels. The collected data were analyzed on the basis of situational analysis. RESULTS: The article examines the policy success by showing how this policy was assembled and by exposing the frictions and adjustments during its formation and implementation. Inter-departmental conflicts within or without the government and the efforts to coordinate them are addressed, and the transnational dimensions of this harm reduction policy are also discussed. The article then reflects on the effects of the policy and asks where the line should be drawn between what is harm reduction and what is not. CONCLUSIONS: This case illustration reveals the complexity of understanding an assembled health policy that involves multiple participants. The article intends to render an analytic account to enable a comparison with similar policies in other countries.