UNAIDS has been a leader within the UN system when it comes to engaging communities and civil society, advocating for decriminalisation, promoting community-led programming, collecting disaggregated data, and centering human rights. The work of UNAIDS is more critical than ever to ensure harm reduction programmes continue and sustain the gains made so far. The UN80 process and proposed sunsetting of UNAIDS leaves this up for negotiation and threatens the future of the HIV response.

We call on the Programme Coordination Board, in particular Member States and the PCB Bureau, to centre those left most behind, including people who use drugs, in the restructuring process.

• Harm reduction in low- and middle-income countries is fighting for survival. The US funding cuts in 2025 led to service closures, curtailment, and loss of essential peer workers in many countries.
• Advocacy capacity and community leadership is suffering. The funding crisis hit community-led organisations and so-called “non-life saving activities” the hardest, reducing communities’ capacity to advocate at a time when it is more necessary than ever.
• Harm reduction expertise across the UN is disappearing. UNAIDS, WHO, and UNODC have all faced significant financial cuts this year, including to human resources, resulting in a distinct loss of harm reduction experience and allyship. Harm reduction and people who use drugs must find an adequately resourced home within the UN system.
• A responsible, planned transition must ensure that the mandates, and funding, related to harm reduction and people who use drugs find an adequately resourced home within a UN agency that can demonstrate supports for, and commitment to, harm reduction from the top-down and the necessary capacity and will to do this lifesaving work.
• Communities remain resilient. Despite loss of funding, communities have reacted to the emerging crisis to fill the gaps left by services reducing capacity or ceasing altogether. The success of the HIV response has always been inseparable from the strength of community-led action.
• New HIV infections are increasing. As predicted by UNAIDS modelling, we are already seeing the epidemiological impact of the funding crisis. The sharp rise in numbers of people living with HIV in Fiji should be a wakeup call for governments on what can happen when harm reduction is not in place.

• Community-led organisations and civil society must be meaningfully involved in all stages of UN restructuring.
• Comprehensive planning for a responsible transition away from UNAIDS must be put in place, especially for mandates related to harm reduction and people who use drugs – something that is simply not possible within the UN Secretary General’s proposed timeframe for sunsetting in 2026.
• Funding and support for community systems and community-led harm reduction should be prioritised. Where cuts have been severe, it is communities that have remained resilient and innovative during service chaos.
• Strengthening domestic health financing must be prioritised to maintain continuity of harm reduction services, with communities at the centre, engaged from the outset with government and technical partners. Social contracting must be utilised to ensure funds reach community-led and civil society organisations must be a strategic priority.
• Meaningful engagement with communities and civil society must be maintained beyond the lifespan of UNAIDS, and should be non-negotiable regardless of which UN entity takes on responsibility for the harm reduction mandate.
• UNAIDS data collection mechanisms must be maintained and continued beyond the lifespan of the joint programme.