States must effectively use their maximum available resources to fulfill human rights, including the right to health. Insufficient or misallocation of public expenditure that hinders the enjoyment of rights constitute a breach of this obligation. Access to essential medicines is a core component of the right to health. The World Health Organization (WHO) has recognised methadone and buprenorphine, as well as naloxone, as essential medicines, reflecting their proven effectiveness in reducing overdose, HIV and hepatitis transmission, and other negative consequences that might arise from drug use.

Countries spend over USD 100 billion in drug law enforcement globally every year. In contrast, only USD 151 million was allocated to harm reduction, a proven cost-effective life-saving measures, in low- and middle-income countries (LMICs) in 2022, just 6% of the estimated USD 2.7 billion needed annually, leaving a staggering 94% funding gap. That year, harm reduction programmes accounted for only 0.7% of total HIV funding, even though people who inject drugs accounted for 8% of new HIV infections globally.

Harm reduction has long been reliant on a small number of international donors, being vulnerable to shifting donor priorities and threatening sustainability of lifesaving services. Harm Reduction funding rose slightly between 2022 and 2025, likely reflecting increased prominence in global commitments and international HIV prevention guidelines. However, the suspension of US President’s Emergency Plan for AIDS relief (PEPFAR) in 2025, and subsequent cuts to funding, have significantly impacted harm reduction and access to essential medicines for people who use drugs in LMICs.

PEPFAR was the second largest donor in LMICs and the primary donor to the Global Fund. Stop-work orders and subsequent cuts had a negative impact on the availability of services in many countries, such as in Ethiopia, Kenya, Nigeria, Tajikistan, and Tanzania. South Africa, which bears the world’s largest HIV epidemic, already had limited access to harm reduction services before 2025 funding cuts. Following the U.S. stop-work order in January 2025, nearly 40 US-supported programmes ended, resulting in the loss of over 8,000 frontline HIV workers and collapsing of prevention and harm reduction services. Access to OAT in prison was closed, disrupting the continuity of care for people in detention, and an estimated 166,354 individuals from key populations lost HIV prevention and treatment access. In Tshwane and Ehlanzeni, facilities shut down or scaled back operations, leaving over 5,000 people who use or inject drugs without access to OAT, NSPs, HIV testing, and other essential life-saving services.

A recent modelling study found that one year of disrupted access to harm reduction due to the US funding cuts could result in 9,467 new HIV infections and 13,202 new HCV infections among people who inject drugs in just 9 countries.

In addition to the impact on bilaterally funded programmes, the US funding cuts had major implications for harm reduction supported by the Global Fund. Due to reduced funding, approved Global Fund grant allocations for 2023-2025 were reprioritised, leading to a reduction of harm reduction allocations of $12.83 million across 24 heavily reliant countries. Additionally, reductions in funding for advocacy, human rights and legal and policy reform, crucial enabling activities for harm reduction, were also reduced. As total funds available to the Global Fund have reduced, further reductions in harm reduction support are expected.

Where harm reduction is funded by domestic budgets this protected services from donor turbulence in 2025, and it is needed more than ever to sustain the gains achieved so far. In South Africa, the municipally-funded harm reduction programme became a safety net for thousands of clients who would otherwise have been left without medication or sterile injecting equipment. Similarly, in Indonesia the integration of harm reduction services into primary health care centres and hospitals, funded by the government ensured uninterrupted service delivery. But too few governments are significantly investing, and where they are, this is also fragile in the face of political shifts.

Sudden and dramatic funding and political shifts in global health have driven calls to integrate HIV, tuberculosis (TB) and malaria into national health systems such as primary health cares and universal health coverage. HRI’s research cautioned that rushed integrations, without securing sustainable domestic funding, careful planning, and involvement of communities can further weaken the already limited and inadequate HIV prevention and harm reduction services.

However, there are positive experiences to draw upon, illustrating that careful planning, inclusive of communities and broader stakeholders, high-level government commitment and viable financing could lead to better integrated services accepted by people who inject drugs.

We encourage the OHCHR to recommend Member States to:

1. Decriminalise drug use and drug possession and promote evidence-based and health and human-rights centred alternatives to incarceration;
2. Divest from punitive drug control, and invest in evidence-based harm reduction programmes -beyond HIV prevention and treatment- ensuring the availability of funding for peer-led and community-led harm reduction initiatives, research, and innovation;
3. Maintain and scale up comprehensive harm reduction services and ensure equitable, voluntary and non-discriminatory access, including in prisons and other closed settings.
4. Publish dissagregated data on harm reduction access, essential medicines, health outcomes and resource allocation to strengthen transparency and accountability