International provision of harm reduction services is under threat from a funding crisis and lack of political will, according to a report from Harm Reduction International (HRI), the International HIV/Aids Alliance and the International Drug Policy Consortium (IDPC).
Funding has been falling ‘dangerously short’ of estimated needs for some time and is set to deteriorate further, says the document, the result of changes in donor policies and neglect on the part of national governments. The report urges international donors, UN agencies and national governments to take action, stressing that ‘there can be no “Aids-free generation” without targeted efforts with and for people who inject drugs’.
Around 40 per cent of new infections are the result of unsafe injecting practices in middle-income countries – particularly in Eastern Europe and Asia – where around three quarters of people who inject drugs live. However, changes in Global Fund funding policy ‘threaten to significantly reduce’ harm reduction allocations in these countries, says the report. Major international donors like the US and UK are also withdrawing aid from many of these countries because of their middle-income status. Of the 15 countries prioritised by UNAIDS for harm reduction programmes, only Kenya is still classed as a low-income country according to World Bank definitions.
‘Donors are retreating from these countries under the premise that they are wealthy enough to resource their own HIV responses,’ the report states. ‘Yet national governments are often unwilling to invest in services for key populations, leaving existing programmes under threat and scale-up impossible.’ It cites the example of Romania, where many programmes closed following the end of Global Fund support and where a subsequent rise in HIV transmission through unsafe injecting has been reported. ‘Underpinning many of these resource gaps lies a fundamental inhibiting factor: harm reduction services for people who inject drugs are often politically unpopular,’ it adds.
Around $2.3bn is needed next year alone to fund HIV prevention among people who inject drugs, according to UNODC estimates, but only around 7 per cent of that has been invested by international donors so far. National governments are also choosing to prioritise ‘ineffective drug law enforcement’ over harm reduction, even in countries with high drug-related HIV transmission rates, the report says. ‘Just one tenth of one year’s drug enforcement expenditure (estimated to exceed $100bn globally) would fund global HIV prevention for people who inject drugs for four years,’ says HRI.
The funding crisis for harm reduction at www.ihra.net