Funding the Harm Reduction Response

Stepping up the fight to end AIDS among people who use drugs

By Olga Szubert and Catherine Cook

Funding and political support for harm reduction is in crisis around the world. If we are serious about ending AIDS and combating hepatitis, we must invest in services that save lives. As governments and donors are gathering in Lyon this week for the Global Fund Replenishment, we call on them to put their money where their mouth is, and match their political commitments with financial commitments.

People who use drugs face stigma, discrimination and criminalisation on a daily basis and are among the most vulnerable to contracting blood-borne viruses. Harm reduction interventions for people who use drugs — such as needle and syringe programmes and opioid substitution therapy — are proven to be cost-effective, protect against HIV and hepatitis C, save lives and contribute to healthier communities.

However, the global provision of harm reduction interventions is critically low, with only 1 percent of people who inject drugs living in countries with high coverage. HIV infections among people who inject drugs continue to rise, accounting for over a third of all new infections in Eastern Europe and Central Asia, and the Middle East and North Africa in 2017.

Harm Reduction International research shows that in 2016, harm reduction funding in low- and middle-income countries (LMICs) was a mere 13 percent of what is required to prevent HIV among people who use drugs. Beneath this enormous funding shortfall are some disturbing trends. International donor funding, which comprises the majority of harm reduction funding in LMICs, is declining. Fewer donor governments are providing bilateral support for harm reduction; others are withdrawing support based on country-income status; and national governments are not stepping in to fund life-saving harm reduction services. This is particularly worrying for upper middle-income countries, where the majority of people who use drugs live.

This funding gap threatens the global response to AIDS and hepatitis.

It is difficult to overstate the importance of the Global Fund in ending AIDS and ensuring that people who use drugs are not left behind. The Global Fund is the largest donor for harm reduction in LMICs. It has been crucial to initiating, scaling-up and sustaining harm reduction programmes in many countries, preventing countless HIV infections and improving lives around the world.

In particular, Global Fund catalytic investment funding provides a vital lifeline for community-led and civil society advocacy for harm reduction. This is crucial in the context of donor transition, where strong, sustained advocacy with community participation is needed to drive domestic investment in high quality, human-rights based harm reduction approaches.

Last week, the United Nations General Assembly committed itself to “leave no one behind” by achieving universal health coverage and reiterated its commitment to achieving the Sustainable Development Goals, including ending AIDS and combating hepatitis, by 2030.

Millions of lives are at stake and we are relying on the Global Fund and its donors to step up the fight and to ensure that people who use drugs are able to access the health and harm reduction services they need. Unless governments commit to replenishing the Global Fund, the goal to end AIDS and combat hepatitis by 2030 will be missed, and the pledge to leave no one behind will ring hollow.

Olga Szubert and Catherine Cook work in the Sustainable Financing team at the Harm Reduction International.

Harm Reduction International

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Working to reduce drug-related harms, protect human rights, and promote lifesaving public health interventions.

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