Documenting Disruption: Harm Reduction Research on Infectious Disease is Urgently Needed
Published in Healthcare & Nursing, Social Sciences, and Microbiology
The global landscape of infectious disease and sexual health is becoming increasingly unstable. Long‑standing gains are being unravelled, not because science has failed, but because the political and economic systems that sustain prevention are being deliberately dismantled.
Across many regions, advances in vaccination, prophylaxis and harm reduction are being reversed amid major policy shifts, rising conflict, and sharp reductions in international development funding. This is leading to a systemic, pendulous and compounding shift that will take decades to recover from.
The dissolution of the United States Agency for International Development (USAID) and the freezing of billions in US foreign assistance marked a fundamental turning point. Simultaneously, governments across Europe and G20 countries have reduced aid budgets in favour of military spending and domestic austerity.
Global health programmes have been among the earliest and hardest‑hit casualties of this fundamental shift in financing and governance. Researchers and commentators describe this period as the “great aid recession,” with profound implications for disease prevention and care.
The consequences are especially acute in Africa and across the Global South. Health systems in these regions have long operated in a delicate balance, being heavily dependent on external funding to support service delivery, research capacity, and workforce development. When funding is withdrawn abruptly, the effects are both immediate and severe.
Clinics close. Surveillance systems weaken. Health workers leave. Preventable infections resurge.
These disruptions are intensified in settings already affected by armed conflict, political violence, and mass displacement. In such contexts, short interruptions can erase decades of progress, let alone such systemic shift.
With this context, Harm Reduction Journal has launched a new Call for Papers led by Prof. Beth Meyerson MDiv, PhD (University of Arizona, Tucson, US). The collection focuses on how exogenous shocks – policy shifts, donor withdrawal, conflict – are reshaping infectious disease and sexual health across Africa and the Global South. Its aim is to document how these global decisions are translating into local consequences and what communities are doing in response.
The collection recognises that moments of disruption require methodological pluralism rather than conventional outcomes studies. Qualitative research from frontline providers is essential as it reveals how services are altered, rationed, or lost. Rapid reports from NGOs and community organisations capture impacts in real time. Policy analyses trace how decisions made by governments reshape risk on the ground.
Comparative epidemiological studies are also important. They help quantify what is being lost and where. Health‑workforce research shows how quickly capacity erodes when funding and security disappear. Together, these approaches build a clearer picture of system collapse and adaptation.
Equally important are the voices of affected communities. Narrative, artistic, and visual contributions capture the lived realities of disruption, resilience, and harm in ways that conventional methodologies cannot fully capture.
All of these forms of research serve a shared purpose to support accountability. Without timely, diverse, and context‑specific evidence, the impacts of policy decisions remain abstract. This is particularly true when formal datasets that could document these decisions no longer exist...
This collection aligns directly with SDG 3: Good Health and Well-Being, SDG 5: Gender Equality, SDG 10: Reduced Inequalities, and SDG 16: Peace, Justice and Strong Institutions. Beyond that, accountability has been a key driving force behind the development of the collection: these outcomes are neither natural nor inevitable and evidence is essential to reversing the pendulum back to progress.
Louis has been a Publisher at BMC since February 2022. He manages a fully open access portfolio of substance use and addiction journals, including Addiction Science & Clinical Practice, Harm Reduction Journal, Health & Justice and Journal of Cannabis Research.
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Harm Reduction Journal
This journal publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues, as well as rebuking the de facto criminalization of marginalized and stigmatized communities.
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The Enhanced Games: Human Enhancement, Risk, and Harm Reduction in a Post-Doping Era
Debates about performance-enhancing substances in sport have historically been framed through prohibition, anti-doping enforcement, and ideals of fairness, natural ability, and sport integrity. The proposed Enhanced Games – an international sporting event that explicitly permits the use of performance-enhancing substances – have been presented as a profound rupture in how sport, medicine, and society understand human limits, bodily risk, and enhancement. This collection asks what it means to govern, reduce harm, and protect wellbeing in a world where the use of performance-enhancement substances is increasingly visible, normalised, and commercialised.
The Enhanced Games position themselves as rejecting prohibition, reframing enhancement as positive when transparent and regulated, and describe it as technologically inevitable. In doing so, the Games propose a departure from paternalistic-type interventions in favour of autonomy and science. However, the goals of the Enhanced Games stretch far beyond the sporting arena into the supplement and pharmaceutical industries, sparking concerns regarding competing and conflicting interests. Their scale, visibility, and commercial profile have drawn significant public attention, making questions about governance, enhancement, health, fairness, and harm increasingly urgent to address.
Importantly, this collection does not advocate for or against the Enhanced Games. Instead, it aims to provide a forum for scholarly discussion of the ethical, clinical, regulatory, and social questions raised by this proposal. Given the limited empirical literature currently examining such models of openly permitted enhancement, contributions both supporting and critically challenging this idea are particularly needed. This Collection is explicitly dedicated to examining the Enhanced Games as a social, ethical, public health, and harm reduction phenomenon.
Beyond the existence of human enhancement, the Enhanced Games themselves raise urgent questions:
- Could an openly permitted and regulated model of performance enhancement reduce or mitigate harms associated with the current prohibition of enhancement drugs in sport?
- What are the strongest arguments against such an approach, and how do these concerns compare with the potential benefits claimed by proponents?
- Who bears responsibility for risk in environments where pharmacological enhancement is permitted?
- What does autonomy look like within the Enhanced Games model?
- What constitutes informed consent in high-stakes, financially sponsored performance contexts?
- Can harm reduction meaningfully coexist with elite competition and commercial sport promoted as spectacle?
- Are the vast monetary rewards offered the Enhanced Games for athletes that break ‘world records’ a coercive offer?
- Are there differences between public perceptions of the Games and the realities of athlete participation, and how might both shape decision-making among athletes and spectators?
- Are athletes vulnerable within the Enhanced Games model?
- What lessons might this model offer for broader enhancement practices beyond sport?
The Harm Reduction Journal invites interdisciplinary contributions that critically engage with the Enhanced Games, situating them within wider enhancement cultures, drug use practices, regulatory systems, and harm reduction frameworks. The legitimacy of the Enhanced Games as an alternative model for harm reduction remains an open question. Lived-living experience perspectives on enhancement and risk are specifically encouraged.
This Collection aims to provide the first dedicated harm reduction–focused scholarly examination of the Enhanced Games. The Editors seek to promote evidence-based analysis and discussion of policy, sport governance, and public health responses to emerging enhancement models.
Scope of the Special Issue
We welcome empirical, theoretical, policy, and commentary papers addressing topics including, but not limited to:
1. Enhanced Games–Embedded Research and Case Studies
Empirical papers drawing directly on the Enhanced Games, affiliated teams, athletes, or operational settings, including, where ethically appropriate and critically engaged:
- Biomedical, performance, and health monitoring data from Enhanced Games athletes
- Case studies of elite athletes using enhancement drugs within enhancement-permissive environments
- Governance, safety, and medical oversight models implemented by the Enhanced Games
- Ethical and operational challenges encountered in practice
2. Comparative Studies, Trials, and Harm Analysis
Research examining empirical evidence that may support or challenge the implementation of the Enhanced Games, including quantitative, qualitative, mixed-methods, and trial-based studies that compare:
- Enhanced Games athletes using enhancement drugs vs elite athletes operating under prohibition-based regimes
- Elite athletes using enhancement drugs vs non-athletes using similar substances
- Consumers vs non-consumers in comparable populations (e.g., fitness, strength, or aesthetic domains)
3. Commentary, Policy, and Lived-Living Experience
Analytical and reflective contributions examining:
- Ethical, legal, and public health implications of the Enhanced Games
- Athlete autonomy, consent, coercion, and commercialisation
- Lived and living experience of athletes and others who use enhancement drugs
- Perspectives from clinicians, harm reduction workers, regulators, and policymakers
- Implications for future sport governance, drug policy, and harm reduction frameworks
This Collection supports and amplifies research related to SDG 3, Good Health and Well-Being.
All submissions in this collection undergo the journal’s standard peer review process. Where necessary, Guest Editors will ensure peer-review is provided by those unaffiliated with the Enhanced Games in any way and will ensure diversity is strongly considered with regards to gender, ethnicity, geography and lived/living experience. All manuscripts authored by a Guest Editor(s) will be handled by the Editor-in-Chief. As an open access publication, this journal levies an article processing fee (APC). We recognize that many key stakeholders may not have access to such resources and are committed to supporting participation in this issue wherever resources are a barrier. For more information about what support may be available, please visit Harm Reduction Journal's Fees and Funding page, or email OAfundingpolicy@springernature.com or the Editor-in-Chief.
Publishing Model: Open Access
Deadline: Dec 16, 2026
Repairable damage: harm reduction and US policy
Recent shifts in US policy and the approach to public health have placed renewed pressure on communities that already face significant health and social challenges. Policy decisions increasingly prioritize criminalization or abstinence-based strategies over interventions that have been consistently shown to reduce harm. These choices reflect a broader trend of sidelining empirical evidence, with real-world consequences for public health.
As a result, morbidity and mortality have increased among people who use drugs, experience homelessness, or who are involved in the US criminal justice system. Rates of preventable illness and infectious disease are also rising. Rhetoric and stigma further undermine public trust and discourage engagement with health services, disproportionately affecting marginalized populations.
Harm Reduction Journal has commissioned a collection of articles to highlight how evidence-based harm reduction strategies – grounded in science, dignity and practical outcomes – can inform more effective, humane public health responses.
This Collection supports and amplifies research related to SDG 3, Good Health and Well-Being, SDG 5, Gender Equality, SDG 10, Reduced Inequalities, and SDG 16, Peace, Justice and Strong Institutions.
All submissions in this collection undergo the journal’s standard peer review process. Similarly, all manuscripts authored by a Guest Editor(s) will be handled by the Editor-in-Chief. As an open access publication, this journal levies an article processing fee (details here). We recognize that many key stakeholders may not have access to such resources and are committed to supporting participation in this issue wherever resources are a barrier. For more information about what support may be available, please visit OA funding and support, or email OAfundingpolicy@springernature.com or the Editor-in-Chief.
Publishing Model: Open Access
Deadline: Aug 18, 2026
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