Is harm reduction funding in low and middle income countries in crisis? Susie McLean, International HIV/AIDS Alliance Catherine Cook, Harm Reduction International Jamie Bridge, International Drug Policy Consortium

‘ Given the severity of the challenge, HIV prevention programming for people who inject drugs is badly under-resourced’ UNAIDS

Harm reduction – low coverage 3

Harm reduction – how much money is needed? 4

Difficult to know Government reports to UNAIDS don’t disaggregate International donors not making investment information available Differences in budget disaggregation Harm reduction – how much is being spent? 5

National governments Domestic investment in HIV is increasing BUT investment in harm reduction not reflected in this trend Priority countries: less than 5% of HIV investment Harm reduction – how much is being spent? 6

The political unpopularity of harm reduction 7

Harm reduction – dependent on international donors 8

People who inject drugs and the need for harm reduction – in middle income countries 9

Global Fund investments in harm reduction R1-R10 (2002 – 2010) 10

58 countries have received $ for harm reduction previously 41% (24) now ineligible or will receive no new $ Only 10 countries (5 MIC) are eligible for ‘incentive funding’ or funding for ‘critical enablers’ More than half MICs “over- allocated” Downward trend? Global Fund New Funding Model – bad news for harm reduction? 11

DFID bilateral funding for harm reduction - reducing dramatically Australian Government funding - unknown Dutch Government funding – maintaining their commitment PEPFAR funding – national ownership and technical support rather than programming International donor trends – away from harm reduction 12

PEPFAR spending on HIV prevention for people who use drugs in Analysis on PEPFAR spending conducted by George Washington University in 2013, commissioned by AmfAR (unpublished) 13

1. Keep the Global Fund global 14 New indicators to determine allocations –Inequalities –Willingness to pay –Policy barriers –Transitions to domestic funding Fully funded Global Fund no-one left behind

International donors -Invest where national governments won’t/can’t -Responsible exit strategies -Influence national governments UN agencies -Improve data on harm reduction need, coverage and investment 2. Invest strategically in harm reduction 15

National governments: Fund national harm reduction programmes -sustainability Address stigma related to HIV & drug use -public debate -attitudes of decision makers 3. Increase national harm reduction investment 16

National governments: -Cost effectiveness analyses. Is drug control value for money? -Estimate resource needs for HIV and harm reduction and rebalance towards health International donors: - Work together to define and commit to an international target for harm reduction investment Rebalance resources From drug control and criminalisation to health and harm reduction 17

18