In advance of the Global Fund’s Seventh Replenishment Conference, to be hosted by President Biden in New York on 19 September 2022, Harm Reduction International, the International Network of People who use Drugs (INPUD) and the Eurasian Harm Reduction Association (EHRA) called for donors to be proactive in protecting harm reduction within all replenishment scenarios, in implementation of the Global Fund Strategy 2023-2028 and during the NFM4 cycle.

Our recommendations centre on the following five areas:

1. Harm reduction funding must be protected from any replenishment shortfall
2. Catalytic investments for harm reduction and key populations must continue regardless of replenishment outcome
3. Funding for community-led responses must be prioritised within NFM4, both for harm reduction and pandemic preparedness and responses
4. Funding for efforts to increase domestic investment in harm reduction, and broader key population programming must be increased
5. Funding for harm reduction in crisis must be protected and prioritised

The protection and scale-up of harm reduction programmes in low- and middle-income countries requires a fully funded Global Fund. An underfunded Global Fund will result in service closures, a reversal of gains made in HIV prevention among people who use drugs and ultimately, lives lost.

Harm reduction investment from international donors and governments in low and middle-income (LMI) countries totalled US$131 million in 2019 – just 5% of the US$2.7 billion UNAIDS estimates is required annually by 2025 for an effective HIV response among people who inject drugs.