History was made last week in Lyon, when governments, philanthropic donors and the private sector pledged US$14 billion for the Sixth Global Fund Replenishment, more than any other global health institution has ever raised. Harm Reduction International, Eurasian Harm Reduction Association, International Network of People Who Use Drugs and the India HIV/AIDS Alliance congratulate the Government of France, the Global Fund to Fight HIV, Tuberculosis and Malaria (Global Fund) and the broad network of health advocates, academics and policy makers on this tremendous success.

Recognising that a strong and fully-funded Global Fund is vital to the harm reduction response, over 150 organisations and parliamentarians around the world signed on to the Call to Action on harm reduction funding earlier this year.

However, US$14 billion was the minimum amount required for the Sixth Replenishment and will not be enough to meet 2030 targets. The Global Fund also assumes a very ambitious 48% increase in domestic resources from low- and middle-income governments between 2021-2023.¹ Yet, most governments have not prioritised harm reduction in their spending to date, even where the epidemic is concentrated among people who use drugs.

A seismic change is needed if we are serious about achieving Sustainable Development Goals and ending AIDS and combating viral hepatitis among people who use drugs by 2030. Much more is needed to address the funding and political crisis for harm reduction around the world.

We need international donors (including bilateral donors, philanthropic and private foundations) to increase harm reduction funding in line with epidemiological need and not withdraw or reduce funds without adequate transition plans in place. Country income status does not predict investment in harm reduction and governments tend not to prioritise the needs and rights of criminalised and highly stigmatised groups such as people who use drugs.

We need increased political will. The harm reduction crisis we are in isn’t because of a lack of evidence, or a lack of money. It is a result of international and national drug policies which have been shaped by deeply moralistic views, and policies which have prioritised punitive measures over the health and human rights of people who use drugs.

As a matter of principle and public health, national governments must invest in their own harm reduction responses, ensuring that they can contract community-led and civil society organisations to provide people-centred, quality services. They must include harm reduction in Universal Health Coverage driven national health benefit packages. And in accordance with UNAIDS recommendation, they must undertake a rebalancing of investments in drug control to ensure sufficient funding for harm reduction and HIV services.

None of this can be achieved without strong community-led and civil society advocacy on the national and regional level. Donors must invest in networks of people who use drugs and harm reduction advocates. This is crucial to drive domestic investment in high quality, human-rights based harm reduction approaches and is thus necessary to end AIDS and combat hepatitis among people who use drugs.

^{1 Joint Statement by GFAN, GFAN Asia-Pacific, GFAN Africa, Communities Delegation, Developing Country NGO Delegation, Developed Country NGO Delegation, Lyon, 11 October 2019}

Signatories:

Harm Reduction International (HRI) is a leading NGO dedicated to reducing the negative health, social and legal impacts of drug use and drug policy. We promote the rights of people who use drugs and their communities through research and advocacy to help achieve a world where drug policies and laws contribute to healthier, safer societies.

Eurasian Harm Reduction Association (EHRA) is a non-for-profit public membership-based organization uniting harm reduction activists and organisations from Central and Eastern Europe and Central Asia (CEECA) for the creation in CEECA region of favourable environment for sustainable harm reduction programs and decent lives of people who use drugs.

The International Network of People who Use Drugs (INPUD) is a global peer-based organisation that seeks to promote the health and defend the rights of people who use drugs.

India HIV/AIDS Alliance mission is to support community action to prevent HIV infection, meet the challenges of AIDS, and build healthier communities.