International Journal of Drug Policy 9 (1998) 401 – 409

Harm reduction in action: putting theory into practice

Gerry V. Stimson
The Centre for Research on Drugs and Health Beha6iour, Department of Social Science and Medicine,
Imperial College School of Medicine, 200 Seagra6e Road, London SW6 1RQ, UK

Received 1 March 1998; accepted 5 May 1998

Abstract

Harm reduction interventions have been introduced in a large and growing number of countries. Fundamental
components of harm reduction programmes are the need to raise ‘awareness’, to ‘contact’ people, to provide them
with the ‘means’ to change their behaviour, and to gain ‘endorsement’ for this work. The UK provides a case study
of public health harm reduction measures which to date appear to have successfully averted an epidemic of HIV
infection. In broad terms, the basic techniques for harm reduction projects and programmes are now known, and
there is substantial research and practical evidence to indicate their successful implementation and impact. The global
public health challenge in the next decade of harm reduction is therefore to find ways to implement harm reduction.
Many elements of good public health practice are found in harm reduction. Harm reduction can learn from public
health, and public health can learn from harm reduction. © 1998 Elsevier Science B.V. All rights reserved.

1. Harm reduction— from faith to science
This paper started life as an opening talk at the
International Conference on the Reduction of
Drug Related Harm in Paris in 1997. That confer-
ence marked nearly 10 years of harm reduction. It
was therefore a good opportunity to reflect on
developments, to assess what has been achieved,
and for participants to be rather self-congratula-
tory. That congratulation is justified, because, de-
spite all the challenges facing harm reduction, and
the times when no progress seems to be made, it is
important to recognise that there have been some
notable practical successes in reducing drug-re-
lated harm.
Harm reduction has come a long way in the last
10 years. Progress in the UK provides an apt
metaphor. In the UK, the first syringe exchange in
Liverpool in 1986 was in the Mersey Region Drug
Training and Information Centre. It was located
in a small toilet cubicle, the only spare space
within the agency. In those days, harm reduction
was very much an ‘act of faith’. Since then harm
reduction has—to risk a cliche—‘come out of the
closet’. Harm reduction projects have been imple-
mented in many places in Europe, Australasia,
South East Asia, the Newly Independent States,
and in North and South America. There is grow-
ing evidence that they have had a significant
impact on the health of drug users.

0955-3959/98/$ - see front matter © 1998 Elsevier Science B.V. All rights reserved.
PII S0955-3959(98)00056-5
402 G.V. Stimson / International Journal of Drug Policy 9 (1998) 401–409
In this paper I will first note what I see as the
key components of harm reduction. I will then
take a case study of successful harm reduction
with respect to HIV and drug injecting. Finally I
will try to draw out some themes about public
health and harm reduction in the future.
2. Key components of harm reduction
There is a wealth of theorising and model build-
ing about the nature and practice of harm reduc-
tion, despite the fact that it was — and continues
to be—a grass roots and bottom-up social move-
ment. Different writers have tried to set out the
basic principles of harm reduction. In my modest
contribution here, I am trying to keep things
simple. I have reduced harm reduction to four key
components which I think are its essence in prac-
tice. I think that most harm reduction pro-
grammes and projects comprise these four
components, although the way they are combined
and the prominence given to each will vary from
project to project, and over time. (An overview of
types of harm reduction interventions can be
found in Rhodes and Hartnoll, 1996; Ball, 19981).
The four key components can be remembered
by the word ACME (Fig. 1) — the need to raise
awareness, to make contact with populations, to
provide the means for people to change their
behaviour, and to get endorsement for harm re-
duction measures. There are numerous ways in
which these components have been delivered in
practice, i.e. the specific techniques that have been
used.
Fig. 1. Harm reduction—intervention components.
1
As conventional in the ‘International Journal of Drug
Policy’, references have been kept to a minimum. Apologies to
the many people who have influenced me and upon whose
work I have drawn.
For example, techniques for raising ‘awareness’
about health risks include individually targeted
methods such as mass and local media campaigns
or counselling, or through community and subcul-
turally targeted strategies for facilitating changes
in social norms such as outreach and peer
education.
Harm reduction has been typified by innovative
methods for ‘contacting’ populations, by having
appropriate, attractive and accessible services, by
using outreach to the hard-to-reach, and facilitat-
ing the passing of health promotion information
through social networks. In many treatment mod-
els, failure to complete treatment entails being
dismissed from the programme. Harm reduction
emphasises the need to retain contact with people
and to offer them ongoing help, services and
advice in anticipation that they will eventually
change their behaviour. In harm reduction, ejec-
tion of unsuccessful clients would be a failure of
the programme rather than the client.
Those promoting harm reduction suggest the
importance of providing drug users with the
‘means’ to change their behaviour, through the
provision of sterile injecting equipment or the
means to de-contaminate this, such as bleach; and
condoms for safer sex. Treatment and help for
drug problems is also a means for behaviour
change. Appropriate drug treatment and mainte-
nance programmes facilitate contact with drug
users and help them change their drug use. The
most common approach has been methadone
maintenance. Maintenance programmes using
other substitute drugs (e.g. buprenorphine) have
also been tried.
And finally projects include ways of gaining
endorsement for harm reduction activities. This
includes creating alliances between target popula-
tions, local communities, social activists, social
scientists, and government. A major activity for
many projects is gaining support for harm reduc-
tion activities from the local community, other
health workers, and government.
There is an accumulation of international evi-
dence about the importance, feasibility and effec-
tiveness of different techniques for reducing drug
related harms. Much of that evidence comes from
projects designed to reduce the risks of HIV trans-
 G.V. Stimson / International Journal of Drug Policy 9 (1998) 401–409
mission. Looking back over the 10 years it is
extraordinary how much we now know about
techniques to prevent problems connected with
drug use. Harm reduction techniques work not
only in developed countries, but also in coun-
tries with very different economic and social
conditions—harm reduction activities have been
implemented, for example, in Nepal,
Bangladesh, Thailand, Manipur, and in Central
and Eastern Europe. Evidence for success has
come from practical experience of people run-
ning projects, from the accumulating interna-
tional scientific evidence about the effectiveness
of different interventions, from comparative in-
ternational studies, and from individual case
studies (see for example overviews in Stimson et
al., 1998). An earlier International Conference
on the Reduction of Drug Related Harm led to
a book called ‘Harm Reduction: from Faith to
Science’. Harm reduction in the last 10 years
has now moved from faith to science.
3. A UK case study— evidence for successful
prevention of HIV infection
There are a number of case studies which
could be selected to show governments and pol-
icy makers that harm reduction is not only a
philosophical and practical approach to drug
problems, but that it can deliver the goods.
There is now evidence for successful HIV pre-
vention in many countries — as has been demon-
strated by the WHO Multi-City Study on Drug
Injecting and HIV Infection (Stimson et al.,
1998) and many other studies.
One of the problems facing harm reduction
has been that it is difficult on grounds of ethics,
costs and time to subject it to tough scientific
scrutiny using, for example, randomised con-
trolled trials. Country and city-wide case studies
are therefore important, because they may help
us understand the interaction between national
and local policies, the interventions that are de-
veloped, how these interventions influence risk
behaviours, and in turn the history of epidemics
(Fig. 2). The task is difficult, but not insupera-
ble. It requires piecing together information
403
Fig. 2. Task of comparative HIV policy analysis.
from a wide number of sources about national
policies, the kinds of projects that were devel-
oped, risk behaviours, and the direction that the
epidemic has taken over time. It takes some
imagination—because if we argue that the
course of an epidemic has been altered by the
intervention, we have to argue what might have
happened without the intervention. This we can-
not know—but we can imagine what could
have happened by looking at the histories of
epidemics elsewhere. The question is: would
things have turned out differently, but for the
policies and interventions? (The problem is akin
the Max Weber’s attempt to argue the link be-
tween the rise of protestantism and the develop-
ment of capitalism.) The analytic task is aided
by comparisons between countries and cities
with different polices, practices, risk behaviours
and epidemic histories. We may be therefore be
able to learn as much from comparative na-
tional and city analyses as from the more fo-
cused evaluation of specific interventions. This
level of analysis also helps us to begin to under-
stand the circumstances under which harm re-
duction projects may be successfully
implemented.
The UK provides a useful case study that can
contribute to this comparative analysis—with
strong evidence that HIV infection among injec-
tors has been averted through public health risk
reduction measures. It will be for others to as-
sess whether a case has been made that what
was done in the UK helped avoid a major epi-
demic of HIV infection among IDUs.
404 G.V. Stimson / International Journal of Drug Policy 9 (1998) 401–409
3.1. Conditions for epidemic take-off
Let’s look at the evidence for the claim that the
UK has averted an HIV epidemic. First, it is
necessary to speculate what might have happened
in the UK—could a major epidemic of HIV
infection have occurred among drug injectors? We
have to look at the critical period when HIV first
appeared. In my view three conditions for HIV
epidemic take-off existed in the UK between 1982
and 1986 (Fig. 3).
First, there was a substantial population of
injectors. By the 1980s, in common with other
European countries, injecting had spread to most
major cities and to many sectors of the popula-
tion. In the early 1980s, diffusion of injecting was
especially apparent in deprived inner-city
populations.
Second, there was the potential for transmission
of HIV infection. Sharing needles and syringes
was the norm. There was considerable mobility
and mixing, with multiple sharing partners. Many
cities, and especially London, attracted injectors
from elsewhere in the UK and from Europe.
Indeed one of the first deaths from AIDS was of
an Italian drug user who died in Hammersmith
Hospital in London in 1985. Unprotected sexual
intercourse was the norm.
The third condition was the presence of HIV.
In Scotland HIV appeared in Edinburgh injectors
late 1982 or early 1983, with the first documented
sero-conversion in January 1983. The first AIDS
case in an injector was in the South of England in
Fig. 3. Three take-off conditions for an HIV epidemic in the
UK— 1980s.
1984. By that year HIV was present in a small
number of injectors in all health regions in Eng-
land, and Wales and Scotland. By 1985, the HIV
prevalence rate in Edinburgh was 50%.
It would appear reasonable to assume that—
given the existence of these conditions—HIV
could have spread among drug injectors through-
out the UK. One scenario would have been the
repetition of the Edinburgh HIV outbreak in
other cities. That such rapid epidemic spread has
occurred in many parts of the world lends cre-
dence to this view.
3.2. Epidemic history
What has been the history of the epidemic since
then? The overwhelming evidence is that our in-
jectors have not experienced a major problem
with AIDS and HIV infection. The cumulative
number of injecting-related AIDS cases is 520,
with a further 283 in Scotland. AIDS incidence is
about 100 cases a year. Recent statistical mod-
elling suggests that there are 2770 people currently
living with HIV infection associated with injecting
drug use (2100 in England and Wales and 670 in
Scotland). Hickman et al. (1997) estimate that
there are about 130 (CI 40–240) new HIV infec-
tions among injectors in England and Wales each
year—about 100 of these in London, that is,
about two new infections occurring each week.
We do not have good estimates of how many
injectors there are in the UK: but if we assume
conservatively that in London there might be
around 50000 and around 100000 further in Eng-
land and Wales, then the estimated annual inci-
dence rate would be in the order of 0.02 per 100
person years or less.
Recent modelling of trends in HIV incidence,
back-calculating from AIDS data, suggests a peak
of new injecting-related HIV infections in Lon-
don, and in England and Wales outside London,
between 1984 and 1986, with a substantial decline
thereafter (Fig. 4). The point at which the decline
occurs is important in terms of epidemic preven-
tion—it seems to be coincident with the introduc-
tion of HIV prevention measures. The earlier
peaking in 1984 in London could indicate early
saturation of higher risk groups, or early risk
behaviour changes by injectors.
 G.V. Stimson / International Journal of Drug Policy 9 (1998) 401–409
Fig. 4. Estimated annual incidence of HIV infections in England and Wales.
Finally we have the evidence from HIV preva-
lence surveys. Overall, in England outside of Lon-
don, the prevalence of HIV infection is around
1% or less among injectors tested by the Public
Health Laboratory Service in a large number of
drug agencies. This figure is consistent over time
and across health regions. Our studies in London
show a decline in prevalence rate from 13% in
1990 to 7% by 1993. Lower rates are found in
other studies in London (for an overview, see
Stimson et al., 1998). Overall we conclude that the
prevalence rate in London amongst chronic long-
term injectors is around 7% or less — and lower in
younger injectors. In 1996, Gillian Hunter in our
group found a prevalence rate of only 1% in a
sample of female injectors in London. In Scot-
land, studies in Glasgow have never found a
prevalence rate above 2%. Prevalence rates in
Edinburgh have now declined to 20% or less (for
reviews see Stimson, 1995; Unlinked Anonymous
Surveys Steering Group, 1996; Stimson and
Hunter, 1998).
I would now like to turn to risk behaviour. We
are currently undertaking a UK survey of syringe
exchange, and currently estimate that there are
about 450 syringe exchange and pharmacy ex-
change schemes in the UK, with a total of over
405
2000 outlets. About 25–30 million syringes are
distributed each year (Parsons and Turnbull, per-
sonal communication). There is at least one
scheme in every health district. In addition there
are pharmacy sales of syringes and needles. Most
injectors obtain their syringes from pharmacies
and syringe exchange schemes: in London about
75% of injectors obtain their syringes this way.
Very few get second-hand syringes from other
injectors. Sharing when it does occur is discrimi-
natory; injectors who share do so mostly with
sexual partners and close friends: sharing with
strangers is rare. There is a low rate of partner
mixing—in a recent study we conducted across
Central and Southern England the mean number
of sharing partners for the total sample in the last
month was just over 1.
Data indicate that before 1987 syringe sharing
was relatively high, that it declined between 1987
and 1990 coincident with the introduction of pre-
ventive interventions, and that thereafter it has
remained relatively low and stable (Stimson and
Hunter, 1996). We have, however, to be cautious
about the interpretation of risk behaviour data.
Some studies and routine information systems
have asked fairly crude questions about syringe
sharing. More recent work asking more detailed
406 G.V. Stimson / International Journal of Drug Policy 9 (1998) 401–409

questions, and investigating a range of sharing ventions appear to have helped us avoid the ma-
practices (both direct sharing of needles and sy- jor spread of HIV infection that has been
ringes and indirect sharing of injecting parapher- observed in many cities and countries throughout
nalia), is getting higher reports of sharing. We do the world.
not know whether this suggests an increase in risk
behaviour, or that it was not measured well in the
4.1. What helped make the UK response possible?
past by ourselves and others. Nevertheless, the
number of sharing partners is low — indicating
People working in harm reduction in the UK
low opportunity for transmission. In low preva-
had it fairly easy in the first few years—at least in
lence situations, the rate of partner mixing may be
comparison with their colleagues in many other
more important than the frequency of sharing.
countries. Harm reduction gained ready accep-
A word of warning is in order: HCV prevalence
tance at many levels in British society. There were
rates are high, as they are in some other countries
no major political or community objections, and
which like the UK have low HIV rates (e.g.
no major legal obstacles. My colleagues in the
Australia). On the face of it this might argue
UK might disagree—but, for example, people
against the hypothesis that HIV has been pre-
distributing needles and syringes have not been
vented by behaviour change. However, the expla-
arrested, as they have in the USA. That harm
nation may possibly be found in the different
reductionists have had it easy is indicated in the
epidemic history of HCV in relation to behaviour
fact that there is no national harm reduction
change (it is possible that the prevalence of HCV
association or formal network, and that harm
was high before the introduction of risk reduc-
reduction conferences and meetings are rare. This
tion); the higher infectiousness of people with
is not to suggest that there were not battles to be
HCV; and the higher viral transmissibility of
fought at a national or local level—rather that it
HCV compared with HIV. Urgent work needs to
has not been as hard in the UK as in other places.
be conducted to answer these questions.
(There are now indications that the situation is
We have not observed major changes with re-
changing—but that has to be the topic of another
gard to sexual behaviour: condom use is low with
paper.)
regular partners, higher with casual partners and
What facilitated the harm reduction response in
highest for injectors who are commercial sex
the UK was, firstly, a ‘supportive IDU/AIDS
workers with respect of paying partners. Tim
policy’ (Fig. 5). The key policy document, pro-
Rhodes and Alan Quirk have pointed out that
duced by the AIDS and Drug Misuse Working
whilst there is a norm of not sharing injecting
Group of the Advisory Council on the Misuse of
equipment, there is still a norm of unprotected
Drugs, formulated the problem in the following
sex. However, although condom use is low, it is
terms: there was—in the mid-1980s—a substan-
high in comparison with injectors in many devel-
tial number of current injectors who were unable
oping countries.

4. Historical conditions for HIV prevention in the

UK

I am arguing here (and have done so in more

detail elsewhere) that there is a plausible link
between HIV and drugs policy, the HIV preven-
tion interventions which were introduced, the re-
duction in risk behaviour and the lack of major
spread of HIV infection among people who inject
drugs (Stimson, 1995, 1996). Public health inter- Fig. 5. Features of successful intervention in the UK.
 G.V. Stimson / International Journal of Drug Policy 9 (1998) 401–409
or unwilling to stop injecting; they might eventu-
ally wish to stop injecting, but in the meantime
they provided a large population in which HIV
infection could spread; the public health priority
was therefore to contact that population, and help
them reduce their risk of HIV infection.
The report prioritised HIV over drug prob-
lems —HIV was seen as a greater threat to public
and individual health than drug misuse. The re-
port argued for the need to work with continuing
injectors—implicitly this was harm reduction —
although this term does not figure in the report.
Policy does not come from thin air: the report
of the Advisory Council helped to coalesce ideas
and practices which had been developed by oth-
ers. The first syringe exchange was in Peterbor-
ough, and the first pharmacy exchange at Boots
the Chemists in Sheffield. In Liverpool — which
led the rest of the country — the ideas for HIV
prevention came directly out of public health
thinking through the work and influence of John
Ashton and Howard Seymour. By 1987, there was
enormous interest in HIV prevention at a grass
roots level in drugs agencies throughout the UK.
By the time the ACMD report was published in
1988, risk reduction was already common in drug
agencies. There was a growing development of
syringe distribution and exchange, an expansion
of methadone treatment, and of outreach to less
accessible populations.
There was also a ‘supportive context and dis-
course’ at the policy and political level. By 1985
AIDS policy was handled as a liberal consensual
issue. By 1986 the UK entered what Virginia
Berridge called a period of ‘war time emergency’
(Berridge, 1996). AIDS was officially a high-level
national issue. It was feared that the UK faced an
HIV epidemic in all sectors of society. This was a
historical moment, which facilitated co-operation
and policy consensus and helped weaken the po-
tential influence of populist fears. Some newspa-
pers tried to stigmatise people with HIV infection
and AIDS, but this did not dominate. The gov-
ernment embarked on a campaign to persuade
and educate. Virginia Berridge has argued that
AIDS revived a ‘welfare state ethos’ which else-
where was on the way out in Britain in the 1980s.
An alliance developed between civil servants, pub-
lic health medicine, AIDS activists and politicians.
407
Politicians indeed were well aware of the out-
breaks of HIV infection among injectors in Edin-
burgh, in many other European cities and in
North America. Injectors were seen as a bridge
for HIV infection into the general population.
This was the climate in which potentially unac-
ceptable approaches to dealing with drugs could
emerge. Syringe exchange became acceptable. (In
this brief history I do not wish to deny that there
were considerable difficulties and uncertainties
about these approaches in government.)
AIDS prevention became a ‘social movement
—an example of ‘single-issue’ politics that devel-
oped in the 1980s and early 1990s—in a context
of the disruption of, and decline in, party political
activism at a local level, as a result of the Conser-
vative government’s attack on trade unions and
local government. A feature of successful public
health interventions is that they become public
issues around which a social movement is devel-
oped—but that is the subject of another debate.
Other features were ‘financial resources’—it
goes without saying that this is a requirement,
and ‘infrastructures’ —the rapidity of the response
was facilitated by having a structure of commu-
nity level drug and information agencies in most
cities. These agencies were staffed by nurses and
social workers, and there was little medical domi-
nance. These workers avidly grasped HIV as a
key issue.
Others have argued that successful HIV preven-
tion requires an alliance with drug injectors, to
give them a voice. However, the UK at that time
did not have significant drug user groups, and
drug injectors were not drawn formally into the
policy-making and intervention development.
However, in my view the community level agen-
cies fulfilled the function of user groups—by act-
ing as advocates for their clients.
The next feature was that a ‘discourse on harm
reduction’ was not uncommon in the response to
drugs problems in the UK. Many people who
attend the International Conference on the Re-
duction of Drug Related Harm know that ideas
about reducing harm in the UK can be traced
from the 1920s, with the prescribing of narcotic
drugs to opiate addicts. This practice was legit-
imised in the report from Lord Rolleston, whose
408 G.V. Stimson / International Journal of Drug Policy 9 (1998) 401–409
name has been taken by the conference — in the
form of the ‘Rolleston Award’ — to express the
ideals of harm reduction. It would be naı̈ve to
suggest that there has been a single, continuous
view on drug problems in the UK, or that harm
reduction has dominated. However, the possibility
has been there to talk about drugs and respond to
them in this way.
Two other things were important. First, that we
did not put all the effort into one type of interven-
tion. Some are more important than others — es-
pecially access to syringes — but it is equally
significant that single solutions were not pur-
sued —there was a beneficial ‘complementary and
synergism’ between interventions (which, again,
makes analysis of impact at a national level as
important as the impact of specific interventions).
And finally, what is extremely important is that
the interventions occurred ‘early’ in the epidemic.
It may be that the UK was fortunate. With the
evidence for rapid spread of HIV infection in
many communities around the world, early inter-
vention must mean having preventive activities in
place as soon as is possible, i.e. wherever there are
people who are injecting drugs.
5. Harm reduction in the next decade: from faith
to science to action
Finally, let us turn away from this case study to
broader issues in the future of harm reduction.
What are the prospects as we enter the second
decade of harm reduction?
Drug injecting and HIV infection continue to
be global issues. The number of countries report-
ing drug injection is now 121, and the number
reporting injecting related HIV infection is now
82 (Adelekan and Stimson, 1997). In the next
decade particularly vulnerable areas will be parts
of China, India, countries in South East Asia
which have largely avoided these problems to
date, sub-Saharan Africa, parts of South America,
and central and eastern Europe.
Evaluations of specific harm reduction interven-
tions help us to understand what works in HIV
prevention. There is always more work to do on
fine-tuning interventions and in adapting them to
Fig. 6. Harm reduction — the next decade.
local circumstances, but in broad terms, I think
that we know what works (Fig. 6). The issue
ahead is not so much knowing what to do, but of
persuading others what needs to be done. In the
next decade of harm reduction, the task of per-
suading others that action is needed will be helped
by the growing evidence for success.
Case studies of national responses, of the sort I
have presented here raise some very difficult issues
regarding the successful implementation of harm
reduction in other places. Were the circumstances
in the UK fortuitous—in that harm reduction
fitted into the mood of the time? Did the UK
response occur in a particular set of historical
circumstances? These questions are important,
both for the future of harm reduction in the UK
and other countries with harm reduction, and for
its introduction elsewhere.
This suggests to me that our task is then not
only of knowing which harm reduction techniques
to use, but what determines whether they will be
acceptable and will work. In looking in a compar-
ative way at different national responses we can
potentially understand the conditions which have
to be created to make harm reduction acceptable
and successful.
The national level of analysis also raises some
difficult issues for intervention research. Most
methods are designed to assess the impact of
specific interventions. Little work has been con-
ducted on assessing the impact of policies and the
whole package of interventions that might—or
might not—be available. We need to develop
methods that are suitable for international com-
parative studies to address the questions raised
here about whether policies and interventions
have an impact on the overall course of an epi-
demic within a country.
Finally, harm reduction was born in a crisis.
The time is now right to move from crisis to
mainstreaming harm reduction within public
 G.V. Stimson / International Journal of Drug Policy 9 (1998) 401–409
health. These points are well made by Andrew
Ball (Ball, 1998) who elegantly shows how harm
reduction follows the basic tenets for public
health and health promotion as set out in the
‘Declaration of Alma-Ata on Primary Health
Care’, the ‘Global Strategy for Health for All by
the Year 2000’, and ‘The Ottawa Charter on
Health Promotion’. Drug use should not be han-
dled as a unique issue, but as one of the many
harms in a population that can be reduced by
public health interventions. Indeed harm reduc-
tion for drugs can be held up as ‘model’ for public
health more generally. Many elements of good
public health practice, as set out in these WHO
documents—such as building healthy public pol-
icy, creating supportive environments, strengthen-
ing community action, developing personal skills,
re-orienting health services — are found in harm
reduction. Harm reduction can learn from public
health, and public health can learn from harm
reduction.
Acknowledgements
I am grateful for critical comments from Gill
Hunter, Matt Hickman, Jim Parsons and Paul
Turnbull. The Centre for Research on Drugs and
Health Behaviour is core-funded by the North
Thames Regional Office of the NHS Executive.
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