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

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‘Given the severity of the challenge, HIV prevention programming for people who inject drugs is badly under-resourced’ UNAIDS 2013

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Harm reduction – low coverage

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Harm reduction – how much money is needed?

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• 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?

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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?

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The political unpopularity of harm reduction

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Harm reduction – dependent on international donors

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

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

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• 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?

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• 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

13PEPFAR spending on HIV prevention for people who use drugs in 2011. Analysis on PEPFAR spending 2009-2012 conducted by George Washington University in 2013, commissioned by AmfAR (unpublished)

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1. Keep the Global Fund global

• New indicators to determine allocations – Inequalities– Willingness to pay– Policy barriers– Transitions to domestic

funding

• Fully funded Global Fund no-one left behind

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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

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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

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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

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