This information note has been compiled by Harm Reduction International (HRI) in collaboration with Africa Network of People Who Use Drugs (AfricaNPUD) and Mozambique Network of People Who Use Drugs (MozPUD) to support Global Fund Grant Cycle 8 processes.

• There are an estimated 33,000 people who inject drugs in Mozambique.
• The estimated HIV prevalence among people who inject drugs is 5%, against a general population prevalence of around 11.5% among adults aged 15–49.
• The estimated prevalence of hepatitis C (HCV) among people who inject drugs is 6%.
• Mozambique has an estimated 2.4 million people living with HIV, the third highest number of any ART services reach roughly 2.1 million of them.

• There is explicit support for harm reduction in Mozambique’s national policy documents.
• National HIV prevention programme coverage for people who inject drugs stands at 6%.
• Harm reduction coverage stands at 16%.
• ART coverage for people who inject drugs living with HIV stands at only 8%.
• Drug use is criminalised in Mozambique under Law no 3/97, and the law is widely read to cover carrying paraphernalia such as needles. This drives people who inject drugs to share or hire needles rather than use steriled equipments.
• Mozambique no longer runs an active naloxone programme, having lost naloxone availability between 2022 and 2024.
• After the 2025 PEPFAR funding cuts, community workers and testing counsellors went unpaid. HIV testing became unavailable in most of the country, and enrolment of new patients stalled.
• Community workers have kept harm reduction services going on a voluntary basis, but face stigma and discrimination at health facilities, and many have had to stop their work without further suppoort.
• Modelling of these disruptions projects an extra 83,000 HIV infections (a 15% rise) and 14,000 HIV-related deaths (a 10% rise) in Mozambique by 2030 if the funding gap persists.

• In 2024, PEPFAR provided approximately USD 1,326,400 for interventions reaching people who use and inject drugs, including USD 525,000 for opioid agonist treatment (OAT/MAT).
• Across Grant Cycle 7 (GC7), the Global Fund provided USD 3,516,567, of which USD 1,046,860 went to OAT and USD 589,707 to needle and syringe programmes (NSP).
• PEPFAR funded around 8% of Mozambique’s HIV prevention programmes, one of the highest dependency levels in the region. Counting the HIV programme as a whole, the U.S. government covered an estimated 93% of costs through PEPFAR.
• The Government of Mozambique has made no dedicated domestic funding available to sustain the harm reduction interventions PEPFAR previously covered. The political instability that followed the contested October 2024 elections, together with the continuing armed conflict in Cabo Delgado, limits the government’s room to raise domestic health financing.

Integration carried out in haste, without careful planning, could further dismantle HIV prevention and harm reduction services that are already inadequate for key populations. The Global Fund country dialogues and the integration process should meet the following conditions before proceeding.

–       Secure government funding before integration: Mozambique leaned on PEPFAR for more than 81% of its HIV prevention funding, and the 2025 cuts have left harm reduction services badly exposed. The effects on HIV testing, ART initiation, viral suppression and harm reduction coverage are already documented. The government’s ability to step in and replace this funding is limited by the current political and fiscal situation. Before integration can go ahead, the government needs to make firm, enforceable domestic financing commitments for harm reduction. The Grant Cycle 8 (GC8) funding request should tie disbursements to earmarked government allocations for HIV prevention for people who use drugs, with clear checks to confirm those commitments are met.

–  Protect and resource community-led organisations: Community workers have kept harm reduction services running without pay since the PEPFAR cuts. That they have done so shows both the strength of community-led work and how precarious it now is. Facing stigma at health facilities and no institutional backing, these organisations remain the main way people who inject drugs reach services in much of the country. The Global Fund funding request should fund these organisations directly, and integration should not end up closing them. Restoring and expanding a naloxone programme, lost between 2022 and 2024, belongs among the GC8 harm reduction priorities. The GC7 commitments to bring more civil society organisations into NSP and OAT delivery should carry through and grow in GC8, and should include organisations led by people who use drugs.

–  Prioritise social contracting and human rights as core integration safeguards: The criminalisation of drug use in Mozambique under Law no 3/97, and the way the law is read to cover carrying needles and other paraphernalia, are real barriers to reaching services and need to be addressed during integration. The GC8 funding request should fund legal advocacy and human rights programming, including work to change how the law is applied where it obstructs harm reduction. The funding request should also prioritise social contracting mechanisms for community and key population organisations. These organisations need enough resources to take part in integration and to push for domestic resource mobilisation. Integration cannot end up erasing community-led service delivery.

• 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: Harm Reduction Information Note- Mozambique https://hri.global/wp-content/uploads/2025/05/Mozambique.pdf
• 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/