This information note has been compiled by Harm Reduction International (HRI) in collaboration with the South African Network of People Who Use Drug (SANPUD) to support Global Fund Grant Cycle 7 processes.

• HIV prevalence among people who inject drugs is 21% (as of 2017) which is considerably higher than among the general population
• One in every four people who injects drugs is living with HIV
• There are an estimated 82,000 people who inject drugs in the country
• The HIV prevalence amongst people in prisons is estimated to be 17.5% (as of 2020)
• The prevalence of hepatitis C (HCV) among people who inject drugs is estimated to be 43%, compared with 0.47% among the general population

• Data required to assess progress towards the 90-90-90 targets for people who inject drugs is not available
• Coverage of harm reduction services is extremely low. Less than 1% of people who inject opioids are receiving opioid substitution therapy
• 36 needles and syringes are distributed per person per year, far below the UN recommended amount of 200 for HIV prevention and 300 for HCV prevention
• The community-led monitoring study in South Africa found that the country has set unrealistically low targets for reaching people who use drugs that have resulted in the majority of people who use drugs, even those living close to harm reduction drop-in-centres, not receiving services.

• Harm reduction in South Africa is underpinned by conflicting laws and policies that hinder the effective implementation of the harm reduction programs
• South Africa adopted the 2022 High Level Political Declaration on HIV/AIDS and the 2025 Global AIDS Strategy Targets, which include the scale-up of harm reduction.
• South Africa’s National Strategic Plan for HIV, TB and STIs (2023 – 2028) includes people who use drugs as a key population and emphasises evidence-based approached to substance use.

• The South African country submission to the Global Fund in September of 2021 reported a 96% funding gap for HIV interventions for people who use drugs.
• The major harm reduction service delivery funders have been CDC/PEPFAR and the Global Fund, and the only domestic funding is from the City of Tshwane Municipality. The National Government does not fund any harm reduction services or commodities in South Africa.
• Despite the Global Fund being the largest harm reduction funder, the allocation for people who use drugs in 2022-2025 was less than 3% of the total HIV allocation for the country and only 14% of the total allocation for people who use drugs is for methadone (OST).
• There has been no consistent source of funding for community-led organisations and their advocacy initiatives across different grant cycles, leaving organisations and their work in a fragile situation.
• COSUP is a unique example of publicly financed harm reduction in South Africa. The project is supported through funding from the provincial level (City of Tshwane) and implemented by the University of Pretoria. It is the largest OST and NSP programme in South Africa.