• There are an estimated 9,500 people who inject drugs living in Uganda in 2024, with the majority located in the Kampala, Wakiso, Mbale and Mbarara districts.
• There is an estimated HIV prevalence of 17% among people who inject drugs in 2024, disaggregated as 8% among men who inject drugs and 24% among women who inject drugs.
• The estimated prevalence of viral hepatitis (HCV) in the general population is 0.75% in 2024, and among people who inject drugs it is 2%.

• Opioid agonist therapy (OAT) coverage data is not available in the country, though our research shows that only one OAT clinic remains in operation.
• The US Government through PEPFAR (The US Pesidents’s Emergency Plan for AIDS) previously supported OAT and other HIV prevention services across clinics in Butabika, Kampala; Mbale, Eastern Uganda.
• The shuttered OAT clinics in Butabika Regional Referral Hospital and the Kampala Region HIV Project previously supported an estimated 800 people who inject drugs with “medication assisted therapy” under PEPFAR funding.
• The Ugandan Harm Reduction Network reported a drug overdose crisis as a stop-work orders interrupting OAT.
• Needles Syringe Programmes (NSP) in the country is provided by the Global Fund in Kampala, Wakiso, Mbale and Mbarara, and was impacted by reprioritisation and reduced capacity from absorbing the impact of the closure of PEPFAR funded services.

• PEPFAR and the Global Fund have provided most of the funding for harm reduction programmes in Uganda. The Global Fund has supported OAT, NSP, PrEP, and other HIV prevention services, while PEPFAR has focused on OAT provision.
• Uganda’s reliance on international funding and a complete absence of domestic funding led to huge impacts from the funding shifts, including increased overdose, service closures, loss of staff and increased stigma and discrimination.
• There have been some indications of domestic support to ensure continuity of OAT, as the government works to integrate services within the Ministry of Health. So far this has been limited to the deployment of healthcare workers.
• PEPFAR allocations for interventions for people who use drugs in Uganda totalled USD 235,000 for 2024, before the funding cuts.
• From the Global Fund HIV country grant, Uganda had allocated USD 905,317 for people who inject drugs and their sexual partners. Following re-prioritisation this was reduced to USD 821,173. This amounts to a 9.3% reduction, or USD 84,144. Uganda’s Grant Cycle 8 HIV allocation represents a 10.2% reduction on Grant Cycle 7.
• In December 2025, Uganda entered into a bilateral MoU with the US Government, securing funding from PEPFAR from April 2026. There is no agreement in place for this funding to be used for harm reduction programming and given the restrictive legal and policy environment in the country it is unlikely this funding will target key population groups at all.
• While the Ugandan government has promised to scale up HIV prevention and treatment in 2026, there is little evidence this will reach people who inject drugs. Performance indicators related to this include increasing HIV testing and treatment, as well as access to condoms, with no reference to harm reduction interventions, people who inject drugs, or key population groups.

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 fulfil the following factors as key pre-requisites for successful and sustained integration.

• Secure Government Funding Before Integration:

Though the Ugandan government will co-finance 15% of the upcoming Global Fund GC8 allocation, there is currently no domestic funding for harm reduction within the country. Since the funding cuts and associated disruption to OAT and other HIV prevention interventions, the government of Uganda recognizes the importance of maintaining OAT access and has facilitated service provision through deployment of healthcare workers. The government of Uganda also recognised the impact of its own low contribution to even HIV treatment medicines, describing it as “critically low”.

A devolved system of governance in Uganda, with decentralisation providing more power and opportunities to local governments. Local government is structured across 5 levels, from village, parish municipal council/ divisions, district to national which are responsible for public health delivery. This offers opportunities for provincial financing for harm reduction in the country; however currently local governments are extremely reliant on transfers from the central government to finance programmes which leaves little possibility for locally financed harm reduction. The need for domestic harm reduction financing in the country is given further legitimacy by the inclusion of people who inject drugs in the National HIV Strategic Plan 2020/21-2024/25, though this has yet to be updated. Further, the East African Community Regional Policy on Alcohol, Drugs and Substance Abuse aims to scale up harm reduction programmes in the seven East African states, including Uganda. This legitimacy and recognition of the need for domestic harm reduction funding is yet to become reality.

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.

Funding cuts and reprioritisation have reduced community systems and reduced advocacy, monitoring, outreach, training, campaigns and caused the loss of skilled human resources consistently across countries. Communities and community-led services have remained resilient, offering crucial services to mitigate the impact of service disruption. Communities bridge the gap between services and marginalised populations such as people who inject drugs, making crucial contributions to the overall health system.

While the Ugandan government has made healthcare workers available to support OAT distribution previously funded and procured by PEPFAR and the CDC, the funding cuts have had a significant impact on the community. Critical community-led roles that were previously supported under PEPFAR funding including demand creation, initial client assessment, peer engagement, and psychosocial support provided by civil society organizations were not considered in the transition and consequently lost funding support. Furthermore, the government has not provided support for the operationalization of community-based harm reduction drop-in centres. As a result, the two of the harm reduction drop-in centres were closed, and the Mobile Van Dispensing services also came to a halt following the funding shifts. These developments have significantly affected community outreach, accessibility, and continuity of harm reduction services and care for people who use and inject drugs.

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. 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.

These demands come within the context of an extremely restrictive legal and policy environment for key populations. Possession of illegal drugs is punishable under the Narcotic Drugs and Psychotropic Substances (Control) Act by 15 years in prison, or life for those judged to be involved in the supply chain, while the Anti-Homosexuality Act imposes life imprisonment or even the death penalty on the LGBTQ+ community. These policies further jeopardizing the HIV response by limiting community engagement, uptake of healthcare services, and targeting those working in community-led organisations.

• 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.

This is only feasible if the necessary changes are made to ensure a supportive legal and policy framework for community-led organisations and civil society to lead service delivery. While Ugandan policy framework allows for social contracting at national and sub-natonal levels, however the restrictive environment for civil society and community-led organisations creates a significant barrier.

• 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 UHRN: Impact of PEPFAR Funding Cuts in Harm Reduction in Uganda. https://hri.global/publications/impact-of-pepfar-funding-cuts-in-harm-reduction-in-uganda/
• 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/
• Harm Reduction International: Harm Reduction Funding Landscape Analysis Uganda. https://hri.global/publications/harm-reduction-financing-landscape-analysis-in-uganda/