Harm Reduction International (HRI) welcomes the PEPFAR Strategy Draft Overview Version 2.0 and the opportunity to input. HRI’s submission takes into account Treatment Action Group (TAG)’s recommendations on access to hepatitis C treatment. PEPFAR is the second largest funder of harm reduction programmes for people who use drugs, after the Global Fund, to which the US Government is the largest donor. As such, it is critical that the PEPFAR strategy makes a strong commitment to ensuring progress on ending AIDS among people who use drugs by 2030.

Currently, we are facing a 95% funding gap for harm reduction in LMI countries, rising new HIV infections among key populations, including among people who use drugs, ongoing stigma, discrimination, criminalisation and human rights abuses that prevent people from accessing services, alongside shrinking civil society space and political pushback. For key populations, already left far behind in the global HIV response, there has been a devastating roll-back in service access due to COVID-19 and related lockdowns. Combined with an economic downturn caused by the pandemic and uncertainty around the impact of this on donor and government investments within the HIV response, we face an unprecedented challenge to meet the 2030 goal to end AIDS. It is essential that PEPFAR’s strategy reflect the crucial work that must be prioritised in order to avoid further roll-backs and to address inequities in the HIV response for key populations to date.

Constraints on federal funding for needle and syringe programmes have severely impinged upon PEPFAR’s ability to prevent HIV among people who inject drugs to date. It is crucial that under this strategy PEPFAR’s impact on the epidemic is maximised, including through strategic investments in cost-effective, evidence-based programming for people who use drugs and the procurement and provision of sterile needles and syringes.

Our submission also calls on PEPFAR to emphasise person-centred harm reduction services, community-led service delivery and decriminalisation within their Strategy. We also endorse the intention and stress the importance of the close coordination between the PEPFAR strategy and the GAS 2021-2026 and the post-2022 Global Fund Strategy. The alignment of these interlinked processes and entities will be crucial to their collective impact.