This information note has been compiled by Harm Reduction International (HRI) in collaboration with Rumah Cemara to support Global Fund Grant Cycle 8 processes.

• There are an estimated 34,517 people who inject drugs living in Indonesia.
• There is an estimated HIV prevalence of 39.1% among people who inject drugs.
• New HIV infections amongst people who inject drugs (HIV incidence) is 13.6%.
• The estimated prevalence of HCV among people who inject drugs it is 89.2%.

• Opioid Agonistic Therapy (OAT) coverage remained below 5% in 2025. US funding had an insignificant impact on access to OA due to integration of harm reduction services into primary care health services and government funded hospitals.
• Safe injecting practices among people who inject drugs in 2023 was 92%.
• No significant impact on core harm reduction services, such as OAT and needle and syringe programmes, was documented following the US funding cuts. However, other activities, such as outreach, awareness raising and capacity-building programmes, which are crucial to ensuring access to services for people who inject drugs, were adversely affected.
• Drug use patterns in Indonesia have witnessed a dramatic shift from opioids to methamphetamine (stimulants) and New Psychoactive Substances (NPS). 35.37% of total people who use drugs used Methamphetamine/ecstasy/amphetamine-type stimulants (ATS) in 2023.
• Despite this shift, HIV and hepatitis C risks remain and continue to require harm reduction interventions and HIV prevention measures for sexual transmission risks, such as safer smoking kits, improved access to condoms, and additional training for counsellors and healthcare workers on providing harm reduction services to stimulant users.

• Government and the Global Fund provide majority of funding for harm reduction programmes in Indonesia. The government procures OAT drugs and have integrated harm reduction services such as needles syringe programmes, HIV testing, counselling into their primary health care centers, in several provinces, funded by the government and the Global Fund; while OAT, ART and other specialised services are referred to nearby hospitals.
• The Global Fund allocated USD 1,379,481.4 for Grant Cycle 7 (GC7) and it was reduced to USD 805,464.17 after the GC7 reprioritisation process. This funding reduction affected 29 organisations in 58 cities or districts, which collectively employed 46 outreach workers supporting people who inject drugs.
• The Government allocation to harm reduction in 2023 was USD 3,583,563 and the PEPFAR allocations to harm reduction in 2024 was USD 632,500.
• Limited social contracting fund for harm reduction is reported in the province such as Bandung through pro-active advocacy led by civil society and community-led organisations.

Indonesia has integrated harm reduction services into their primary health care (PHC), in few provinces, guided by evidence, national and provincial regulations on HIV and a specific Minister of Health Regulations on Harm Reduction. However, not all PHCs have been able to deliver the integrated harm reduction services with sufficient quality and to satisfaction of people who inject drugs.

The integrated services are still high-threshold requiring mandatory registration, out-of-pocket (OOP) payment for those accessing services outside from PHC catchment areas, referrals for OAT, ART and numerous diagnostic services incurring (OOP). Nevertheless, the current integration model definitely offers pathways to sustainability as government fully funds the services.

• Sustain and scale up government funding to strengthen integration:

Indonesia government has increased health budget allocations in 2025 to USD 15 billion with strategic emphasis on achieving universal health coverage through health insurance schemes (Jaminan Kesehatan Nasional -JKN) which covered over 98% populations in 2024-2025 and significant allocations to improve health services in the region. Thus, Indonesia has a ripe context to further mobilise domestic resources on harm reduction through national and local government budgets (e.g., APBN/APBD), private sector contributions via corporate social responsibility (CSR) initiatives, and religious or community-based funding, such as zakat (charity) for harm reduction.

• Protect and resource community-led organisations:

Communities and community-led services have 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, making crucial contributions to the overall health system.

The Global Fund funding request should allocate dedicated funding to community-led organisations, including support for budget advocacy to mobilise further resource 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 resources 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 Rumah Cemara: The Impact of US Funding cuts on harm reduction in Indonesia. https://hri.global/publications/the-impact-of-us-funding-cuts-on-harm-reduction-in-indonesia/
• 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/