Is harm reduction funding in low and middle income countries in crisis?

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

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

3. Harm reduction – low coverage

4. Harm reduction – how much money is needed?

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

6. Harm reduction – how much is being spent? 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

7. The political unpopularity of harm reduction

8. Harm reduction – dependent on international donors

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

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

11. Global Fund New Funding Model – bad news for harm reduction? • 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?

12. International donor trends – away from harm reduction • 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

13. PEPFAR 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 Analysis on PEPFAR spending 2009-2012 conducted by George Washington University in 2013, commissioned by AmfAR (unpublished)

14. 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

15. 2. Invest strategically in harm reduction 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

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

17. Rebalance resources From drug control and criminalisation to health and harm reduction 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

18. www.ihra.net http://supportdontpunish.org