COUNTERfit Harm Reduction Program

















There are many definitions of harm reduction. In it's most basic definition, harm reduction is a theory and a set of practices that try to reduce the harms associated with the use of illegal drugs, or prescription drugs used illegally. 

COUNTERfit believes that harm reduction has as much to do with public health as it has to do with human rights. Without addressing the rights of individuals, harm reduction is a band aid solution. We can reduce harms associated with the use of illegal drugs as much as we can; however, as long as drugs are illegal - as long as its users do not have control over their own bodies - people who use illegal drugs are vulnerable to grave harm, including abscesses, violence, overdose, infectious diseases, and death. Therefore, COUNTERfit approaches harm reduction from a public health as well as a rights perspective.


COUNTERfit believes that people who use drugs can define their realities best and design programs that are relevant to their lives. At COUNTERfit, people who use drugs are not just hired as peers. Some of the most important positions at COUNTERfit are filled by workers who are out as illegal drug users. In addition to hiring from the community, COUNTERfit employs a variety of strategies to meaningfully involve people who use drugs in all aspects of program design, development and evaluation.


HIV infection rates among people who inject drugs in Vancouver, Montreal and Ottawa arose astronomically in the early 1990s. Historically, Toronto had maintained a low HIV prevalence rate because it established needle exchange and harm reduction programs very early in the HIV/AIDS Pandemic. To maintain these low rates, the AIDS Bureau of the Ontario Ministry of Health & Long Term Care funded four new positions in Toronto in 1997. After a lengthy process that involved focus groups, interviews and investigations, a committee consisting of people who work with people who use drugs and people who use illegal drugs recommended that one of these four positions be given to South Riverdale Community Health Centre.

In November 1998 the COUNTERfit Program Coordinator was hired to work with people who use drugs. The Program Coordinator developed a Community Advisory Committee consisting of workers from partner agencies and people who used drugs and lived in the South Riverdale community. The Community Advisory Committee advised the Program Coordinator. Barely a month passed before it became apparent that SRCHC needed a harm reduction/needle exchange program (as opposed to one worker) and the COUNTERfit Harm Reduction Program was created before the end of 1998.

The AIDS Bureau’s harm reduction initiatives proved so successful, many more similar positions were funded in the following years. At just over 4%, Toronto has maintained one of the lowest HIV infection rates among people who inject drugs in the western world. At just under 2%, people who inject drugs and live in South Riverdale have the lowest rate of HIV infection in Toronto we know of.  

COUNTERfit Women’s Harm Reduction Program was funded by the AIDS Bureau in 2007 following demands by the community to develop projects specifically geared towards the needs of women who use drugs and work in the sex trade. SRCHC commissioned a Needs Assessment in 2006 and a report titled Women’s Harm Reduction & Community Safety Project rendered clear the need for a harm reduction program.  Safety of these women was one of the main factors in developing the women’s program. 


COUNTERfit serves people who use drugs and live between the Don River and Victoria Park, west to east, and Lake Ontario to Eglinton Avenue, south to north. We sometimes deliver services a few blocks outside this area provided there are no other services available.


June 3, 2004 - the Association of Ontario Community Health Centres honoured the program with the EPIC Award (Excellence in Primary Health Care Initiatives).

May 4, 2006 - Raffi Balian, the Program Coordinator, along with a number of other Canadian activists, received the National Rolleston Award on behalf of the International Harm Reduction Association and the 17th International Conference on the Reduction of Drug Related Harm. The National Rolleston Award “…is awarded to an individual or organization making an outstanding contribution to harm reduction at a national level”

2010 - the COUNTERfit Harm Reduction Program received the Jay Browne Living Legacy Award by the Ontario HIV Treatment Network (OHTN) in recognition of excellence, leadership and innovation in the field of HIV/AIDS and to advance the work of community leaders. The monetary award supported the development of the COUNTERfit Memorial for people who died because of the war on people who use drugs.

ABOUT COUNTERfit Harm Reduction Program:

COUNTERfit Harm Reduction Program (CfHRP) is a community-based, drug-user-driven project offering outreach and education services to people who use illegal drugs (PUiD) in the Riverdale area. Using a harm reduction model, the project educates PUiD on the increased vulnerability to health and social issues through education and community outreach. The AIDS Bureau of the Ontario Ministry of Health funds the program.

COUNTERfit has taken a unique approach to harm reduction program delivery in that it distributes harm reduction materials using alternative hours and delivery methods to increase its success of providing effective and targeted services to people who use illegal drugs. Some of these strategies include a Nights And Weekend Mobile Service, On-Site Harm Reduction Material Distribution, Peer Support Workers (aka Harm Reduction Workers) and Community- and Service-Based Satellite Sites. These alternative approaches to program delivery have proven to reach people who use illegal drugs when they are most in need, maintain anonymity by delivering services at clients’ homes, and can effectively deal with specific issues related to drug use and cultural norms. 

Presently, COUNTERfit Harm Reduction Program is one of the busiest harm reduction/needle exchange program in Toronto that has seen significant and consistent increases in 1) the number of harm reduction materials it distributes and 2) the number of PUiD who access the service. For example, in 2012, the program distributed 269,136 sterile syringes to the drug-using community in South Riverdale, and collected 288,012 used syringes. The program collects more syringes than it distributes because our service user feel safe when we collect their used needles from their homes. During the same period, the program distributed almost 45,000 Safer Crack Stems and Stem Kits and over a quarter million condoms and lube. 

In 2012, COUNTERfit had 34,499 encounters with its service users. Almost 50,000 services were offered and 2,000 referrals made during these encounters, including referrals to nurses, physicians, housing, shelters, Opiate Substitution Therapy, Narcan training (training to deal with opiate overdose), detox and traditional and harm reduction-based treatment. During the same period, COUNTERfit meaningfully employed over 25 people who use drugs. The Program Coordinator and many COUNTERfit staff are out as people who use drugs or on Opiate Substitution Therapy.


Information Packages: These are pre-packaged articles around harm reduction, HIV, Rave (designer) drugs, Methadone Maintenance Programs, and other information. These packages are available for our service users, professionals, and students. In addition, we give out harm- and risk-reduction literature including HIV, Hepatitis A, B, and C.

Harm Reduction Materials Distribution: Beside the distribution of syringes and related paraphernalia, COUNTERfit also distributes Safer Injection Kits (small and large), Safer Stem Kits, Piercing Kits, Condom Kits, and Chase The Dragon Kits. Our kits contain condoms, tourniquets, sterilized water, cotton pellets (filters), matches, alcohol swipes, stems, screens, foils, a business card, and brochures. Other harm reduction materials include Sharps’ Containers, and personal hygiene materials.  

COUNTERfit Value Statement


COUNTERfit Harm Reduction Program offers client cards with or without a photo for those who want to register with the program. You don’t have to have a client card to receive our services or any service in our Community Health Centre.
The following programs are currently part of the Common Ground Program.
The COUNTERfit harm reduction program began in response to health and community concerns. It has proven to be one of the most effective programs in Toronto, and a model for other harm reduction efforts. Now urban health and harm reduction staff present workshops and information sessions about COUNTERfit programs and services.
Harm reduction counselors offer support and information on safer drug use, health and nutrition, relationships and personal safety, detox and methadone treatment options. As well as addressing drug, health and legal issues, outreach workers and counselors help clients secure basic needs such as housing and food.
The COUNTERfit fixed site is open between 9:00am and 5:00pm on weekdays. The fixed site is usually covered by our Harm Reduction Workers. These are people who use drugs or are on opiate substitution. We employ these experts because they can relate to the lives of their friends and acquaintances. 
Outreach workers distribute harm reduction information and materials through fixed and mobile services. Workers also provide a critical link to health and social services. Materials and services include:
COUNTERfit Mobile Program: The COUNTERfit Mobile Program operates EVERY DAY.  On weekdays, it delivers service between 6:00-12:00pm (midnight) On weekends AND holidays, you can call for harm reduction materials between noon and midnight. Services are del
Doctors, nurse practitioners, health professionals and case coordinators serve patients who have difficulty accessing health services because of homelessness, drug use and/or mental health problems. The team offers primary health care, as well as information and referrals to other community services.
TotalHYPE is a bi-monthly newsletter put together by COUNTERfit Harm Reduction Program, a program at South Riverdale Community Health Centre. TotalHYPE is dedicated to harm reduction information and other information of interest to drug users. We are strict about publishing harm reduction based information because we believe drug users are often silenced.