14 July 2026

Harm Reduction Information Note- Tanzania

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Epidemiological Data

  • There are an estimated 30,000 people who inject drugs in Tanzania.
  • The estimated HIV prevalence among people who inject drugs is 14%, compared to 3.5% among the general population.
  • The regions Njombe, Iringa, Mbeya face the highest HIV prevalence in the country.
  • Tanzania has an estimated 1.8 million people living with HIV.
  • The estimated prevalence of hepatitis c among people who inject drugs is 23.1%, compared to 0.15% among the general population.
  • The estimated prevalence of hepatitis b among people who inject drugs is 6.9%, compared to 2.8% among the general population.

HIV prevention and harm reduction programmes after recent funding shifts

  • There is an explicit support for harm reduction in Tanzania’s national policy documents.
  • There are 9 needle and syringe programme locations, and 18 opioid agonist treatment (OAT/MAT) locations offering methadone.
  • OAT/MAT is also available in at least one prison, though NSP remains unavailable in prisons and other closed settings.
  • Services are primarily available in mainland Tanzania, with only one OAT/MAT clinic being available on the island archipelago of Zanzibar.
  • OAT/MAT coverage stands at 25.6% across 10 regions, with services expanding into the Kilimanjaro and Shinyanga regions under the Global Fund Grant Cycle 7 (GC7).
  • NSP coverage stands at 19.4% across 10 regions, with services expanding into Morogoro, Dodoma, Tanga, Arusha, Mwanza, Kilimanjaro, Shinyanga and Mbeya regions under the Global Fund GC7.
  • Following the recent funding shifts nearly 1.2 million Tanzanians lost access to free antiretroviral (ARV) medication.

Harm Reduction Financing

  • PEPFAR supported OAT/MAT with approximately USD483,700, out of a total of USD707,300 allocated for people who inject drugs, in 2024.
  • The Global Fund supported OAT/MAT with approximately USD1.8 million, and NSP with approximately USD1.2 million in 2025, or a total of USD3.7 million and USD2.9 million across GC7.
  • Following Global Fund GC7 reprioritisation, the allocation for the prevention package for people who use drugs and their partners actually increased by USD1,464,974 or 17.6%.
  • Following the loss of PEPFAR funding, the Ministry of Health pledged to reallocate part of its budget to maintain ARV supply.
  • No domestic funding has been made available in Tanzania to sustain harm reduction interventions previously funded by PEPFAR.

Recommendations for integration of harm reduction into the broader health system

A rushed integration process without undertaking careful planning could further dismantle already inadequate HIV prevention and harm reduction services for key populations. Thus, the Global Fund country dialogues and integration process for prevention and harm reduction programmes should fulfill the following factors as key pre-requisites for successful and sustained integration.

  • Secure government funding before integration

The Government of Tanzania must begin to meaningfully fund HIV prevention and harm reduction programming before any progress can be seen towards integration within public health systems. Predictions from the Global Fund GC7 show that domestic contributions in 2026 were planned to only amount to 5% of the identified need across the whole HIV response, and GC8 allocations show this must amount to at least 15% in GC8. The government has expressed willingness to step in and support ARV gaps since PEPFAR funding cuts, but it is not clear if budget allocations are in place to facilitate this.

The Global Fund funding request process should obtain concrete government commitments and financing for key populations and harm reduction programmes before initiating integration. Co-financing policies should include strict, enforceable conditions such as tying disbursements to earmarked government allocations for HIV prevention programmes for people who use drugs including 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 mitigate the equity risks of integration and to ensure community-led service delivery is not interrupted. Previous proposals under GC7 committed to increasing involvement of CSOs by almost double for both NSP and OAT/MAT interventions – this increase must be sustained and expanded in GC8 and must include community-led organisations.

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

Below are some resources specific to integration and harm reduction. Some are already listed under the reference section.

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