This information note has been compiled by Harm Reduction International (HRI) in collaboration with The Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN) to support Global Fund Grant Cycle 8 processes in Kenya.

• There are an estimated 27,056 people who inject drugs living in Kenya, with the majority living in Nairobi, Kilifi, Kwale, Mombasa, Lamu and Kisumu.
• There is an estimated HIV prevalence of 11.3% among people who inject drugs.
• The estimated prevalence of HCV in the general population is 6.31%, and among people who inject drugs it is 20%.

• Opioid Agonistic Therapy (OAT) coverage was 14% in 2024. However, methadone services have been disrupted due to the US funding impact which is likely to have reduced the coverage. The outreach programmes capacity was reduced by 50% by June 2025, with low numbers of people started OAT and increased loss to follow up reported.
• PEPFAR had supported at least 11 of the 15 OAT clinics, mainly with human resource, including many other drop-in centres. Many of these OAT clinics are experiencing service disruptions due to stop-work directives, leading to inadequate psychosocial support, particularly a shortage of counsellors, and resulting in loss to follow up.
• PEPFAR supported services in four counties: Mombasa, Kilifi, Nairobi and Kisumu. The main drop-in-centre ceased operating by the end of 2025 in Kisumu, with two drop-in centres closed down in Nairobi. Kisumu also experienced reduced NSP coverage due to limited operations, reduced distribution shifts, and fewer community outreach events. Mombasa experienced severe stock-outs of clinic commodities, such as naloxone, and the expiry of the methadone measure license; including increase in overdose rates have been reported.

• PEPFAR and the Global Fund have provided most of the funding for harm reduction programmes in Kenya. While the Global Fund has supported needle and syringe programmes and drop-in centres, PEPFAR support has primarily covered OAT programmes.
• Kenya’s harm reduction financing faced a double blow from US funding cuts and subsequent Global Fund Grant Cycle 7 reprioritisation, without any viable domestic funding.
• PEPFAR allocations for all interventions for people who use drugs in Kenya amounted to USD1,162,700 in 2024 with USD 403,200 for OAT programmes. Following the cuts, PEPFAR support for these programmes has not been reinstated.
• From the Global Fund, Kenya was allocated USD 12.35 million for the prevention package for people who inject drugs and their partners before Grant Cycle 7 re-prioritisation. This amount has dropped to USD 10 million post-re-prioritisation, losing around USD 2.4 million. Compared with Grant Cycle 7, Kenya’s overall HIV allocation is 18.2% reduced.
• There are no allocations from domestic budgets for harm reduction in Kenya, but a small number of county governments offer human resource support for the OAT centres and drop-in centres.

A rushed integration process without undertaking careful planning could further dismantle already inadequate HIV prevention and harm reduction services for key populations. Thus, the Global Fund country dialogues and integration process for prevention and harm reduction programmes should fulfill the following factors as key pre-requisites for successful and sustained integration.

• Secure government funding before integration:

The Government of Kenya has the opportunity to correct its policy on harm reduction and to ensure policy supports the domestic funding allocation through Harm Reduction Bill 2025 and existence of the Caucus of Harm Reduction and Drug Policy reform. Similarly, government agencies have expressed willingness to explore domestic resources for harm reduction, though as yet there have been no formal budgetary commitments.

Devolved County Governments in Kenya offer opportunities for county financing for harm reduction. Different counties have absorbed harm reduction related human resources and commodities to fill the gap left in the absence of PEPFAR funding, which should be leveraged to institutionalise such integration. With efforts from KELIN, the county government in Kwale has collaborated towards the establishment of a County level Technical Working Group for engagement during the county budgeting and public participation cycle.The Global Fund funding request process should obtain concrete government commitments and financing for key populations and harm reduction programmes before initiating integration. Co-financing policies should include strict, enforceable conditions such as tying disbursements to earmarked government allocations for HIV prevention programmes and harm reduction.

• Protect and resource community-led organisations:

Communities and community-led services remained resilient, offering crucial services to mitigate the impact of service disruption after US funding cuts. Communities bridge the gap between services and marginalised populations such as people who inject drugs, contributing to the overall health system. The Global Fund funding request should allocate dedicated funding to community-led organisations, including support for budget advocacy to mitigate the equity risks of integration and to ensure community-led service delivery is not interrupted. Community-led and civil society organisations must have sufficient resources to meaningfully engage throughout the integration process and to drive domestic resource mobilisation. Integration must not equate to the closure of community-led services.

• Prioritise social contracting as a core integration safeguard:

The Global Fund funding request should prioritise establishing and expanding social contracting mechanisms for community and key population organisations, recognising community systems as a critical component of the wider health system. Community-led and civil society organisations must be engaged meaningfully throughout this process and the Global Fund should allocate resources to budget advocacy to unlock social contracting grants at national, provincial and county levels.

Useful resource on integration and harm reduction

• Harm Reduction International: Key Messages on Harm Reduction and Integration for Grant Cycle 8. https://hri.global/publications/key-harm-reduction-messages-on-integration-for-grant-cycle-8/
• Harm Reduction International and KELIN: The Impact of US Funding cuts and reduced financing on harm reduction. https://hri.global/publications/the-impact-of-us-funding-cuts-and-reduced-financing-on-harm-reduction-in-kenya/
• The Global Fund: Grant Cycle 8- Enabling Impact: Strengthening Sustainability. https://resources.theglobalfund.org/media/fptatfhe/cr_gc8-enabling-guidance-sustainability_presentation_en.pdf
• International Network of People Who Use Drugs: Integration Without Erasure: Brief to the Global Fund https://inpud.net/integration-without-erasure/
• Global Black Gay Men Connect: Global Fund Grant Cycle 8 Strategic Overview- Kenya https://gbgmc.org/wp-content/uploads/2026/04/GC8-Strategic-overview-Kenya.docx.pdf