This harm reduction information note has been compiled by Harm Reduction International (HRI) in collaboration with Recovering Nepal, the national network of people who use drugs, to support Global Fund Grant Cycle 7 processes. It compiles key data and evidence related to HIV and people who use and inject drugs, harm reduction services and funding, as well as community advocacy priorities. It was developed for use during the Global Fund funding request development process grant making and implementation.

• The new HIV infections amongst people who inject drugs is 2.8% at the national level, while the incidence is as high as 4.9% in Bagmati province.
• New HIV infections amongst people who use drugs are highest among young people (under 25 years old) and women who inject drugs.
• Despite being a high-risk population for HIV, there are no data available for sexual partners of people who inject drugs.
• There are discrepancies on population size estimates, new positive cases and testing coverage data for people who inject drugs

• The HCV prevalence amongst people who inject drugs is 13.3% at the national level while the prevalence is 26.8% in one of the provinces (Sudurpaschim).
• The HIV co-infection prevalence is 70.3% at the national level and while the prevalence is 100% in Koshi province.
• There are discrepancies within data on Hepatitis C prevalence amongst people who inject drugs in Nepal.

• The overall coverage of HIV prevention amongst people who inject drugs is 67.8%, while coverage of individual intervention differs.
• The Needle Syringe Exchange Program coverage is 94% while Opioid Agonistic Therapy (OAT) coverage is merely 4.3%.
• The HIV testing rate is 38.2% and condom use during the last sexual intercourse stands at 67.8%
• The distribution of naloxone is available only at OAT sites
• HIV prevention coverage is consistently lower amongst younger groups and female who inject drugs.
• Currently there are no data available on viral hepatitis prevention and treatment coverage at the public domain.

• The Narcotic Drugs (Control) Act 2033 (1976) is the key guiding law to control drug use in Nepal and often contradicts the other policies based on public health and hinders expansion and effective implementation of comprehensive harm reduction programmes.
• However with consistent advocacy and with support from the international donors such as the Global Fund, the community-led organizations are implementing the OAT and needle syringe exchange programs.
• Tentatively one in five people in prison are there for drug-related offences

• The Global Fund is the largest funder for the harm reduction program in Nepal that covers all the existing OAT and needle-syringe programs, with partial support from the government.
• Out of the total 12 OAT sites, 8 sites are operating at the public hospitals and is supported through the conditional grants from government of Nepal and the Global Fund; and the remaining 4 OAT sites are operated through community-led organizations and is supported by Global Fund.
• Out of total Global Fund HIV funding from 2021-2024 the funding on the interventions (including procurement of needles and OAT medicines) targeted to people who inject drugs constituted around 18%.
• Out of total national HIV budget, in 2019-2020, less than 1% of the total budget was transferred to the provincial government for OAT Site Operations and Salary