This report and briefing compiles evidence of the impact of the multi-country grant Harm Reduction Advocacy in Asia (HRAsia), funded by the Global Fund’s Catalytic Investments between 2017- 2020. They highlight a number of ways in which multi-country grants for harm reduction play a crucial role in augmenting the potential of country-led programming within Global Fund country grants, for example:

• HRAsia supports community-led strategic advocacy, which is poorly funded in general and rarely prioritized by Country Coordinating Mechanisms in country proposals.
• The Global Fund multi-country grant provides a trusted context for governments to engage in discussions on decriminalization and its potential to reduce vulnerability to HIV and remove service access barriers, as well as the opportunity it provides for redirecting funds towards cost-effective harm reduction services that support the health and well-being of communities.
• HRAsia’s community-led approach complements harm reduction programming in countries by directly addressing gender, human rights and stigma-related barriers to service access.
• The community systems strengthened through HRAsia are proving to be driving forces of resilience in the face of the crisis caused by COVID-19.

In the Asia Pacific region, people who use drugs accounted for 17% of new HIV cases in 2019. People in Asia who inject drugs – around four million in total – are more likely to be living with HIV than any other key population in the region, with HIV prevalence at about 13.5%.

As part of the Sustainable Development Goals (SDGs) and the 2016 Political Declaration on HIV and AIDS, countries have committed to ending AIDS, eliminating hepatitis C (HCV), and attaining universal health coverage by 2030. Harm reduction programming is essential for countries to achieve these goals.

Despite the overwhelming evidence and consensus in international guidance that harm reduction is effective, cost-effective and essential for preventing and treating HIV among people who use drugs, governments continue to underfund health programming for people who use drugs while investing enormous resources into punitive measures. Strong civil society and community-led advocacy is crucial to ensuring access to high quality, human rights-based harm reduction, and to reaching UNAIDS’ 90-90-90 targets3 for people who use drugs.

Harm Reduction Advocacy in Asia, or HRAsia, is a Global Fund multi-country grant that has provided funding and technical support for advocacy in Cambodia, India, Indonesia, Nepal, the Philippines, Thailand and Vietnam. The programme focused on removing legal barriers, community systems strengthening and the gathering and use of strategic information for advocacy. It has helped to change hearts and minds, and ultimately policies and practices related to drug use and harm reduction. Communities of people who use drugs have become more meaningfully involved in advocacy and service provision.

Key highlights among HRAsia’s advocacy achievements include:

• HIV and health policy reform. In Cambodia, HRAsia contributed to the development of standard operating procedures on needle and syringe programmes (NSP), HCV and overdose, which are due to be adopted by the Ministry of Health by the end of 2020. In Nepal, the programme contributed to the development of a national protocol for HCV prevention and treatment, which was approved by the Ministry of Health in October 2020.
• Expanded and sustained funding for harm reduction. Community-led advocacy for the scale-up of harm reduction programming in Nepal resulted in the largest ever funding allocation for harm reduction in Nepal within a Global Fund country proposal.
• In Indonesia and Thailand, HRAsia-supported research led to dialogue between civil society, communities and decision makers on possible redirection of state funds from punitive measures to harm reduction. In Indonesia, it was found that the government allocates around US$400,000 to harm reduction (mostly clinical services, including opioid agonist therapy) while it spends up to US$250 million annually on punitive drug control measures. Similar research in Thailand showed that the government invested 7,550 times the amount invested in harm reduction to drug law enforcement activities.
• Drug policy reform. In Vietnam, HRAsia advocacy led to a draft drug law that raised debates among policy makers around drug dependence as a health issue.
• In all countries, law enforcement have gained a greater understanding of harm reduction, helping to reduce stigma. In Vietnam, over 7,000 police officers were trained on the health and rights of people who use drugs. In pilot sites in Cambodia and Vietnam, police have begun to refer people who use drugs to community treatment programmes rather than arresting them.
• Stigma has been reduced and new alliances formed between harm reduction advocates and opinion leaders, decision makers and faith leaders. In India and Thailand, religious leaders were engaged and made public statements based on their scriptures in favour of harm reduction and humane drug policy. Faith-based groups also participated in the annual Support, Don’t Punish campaign day, with community actions drawing attention to the need for humane drug policy.
• Communities of people who use drugs have become driving forces of resilience during the COVID-19 crisis. In India, forums of people who use drugs utilised their newly created links with faith based communities to enlist their support for securing food rations for people who use drugs. In both India and Nepal, advocacy by HRAsia partners contributed to revisions of national opioid agonist therapy (OAT) guidelines to provide for take-home doses, a policy change which allowed people to continue receiving OAT during lockdowns.