Repressive policies that stigmatize and punish drug users have tended to exacerbate social problems rather than mitigate them. In contrast, harm reduction (HR) approaches to drug use have been shown to prevent the spread of blood-borne viruses (such as HIV, HBV, and HCV), thereby lowering morbidity and mortality rates. Over the past 15 years, many HR initiatives have been launched in the MENA region, including Lebanon. However, continued progress in HIV prevention will require more structured and comprehensive HR interventions, adjusted to the needs of local populations.