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

• Estimates of the number of people who inject drugs in Zambia vary. UNAIDS reports approximately 30,0001 people who inject drugs, while a 2023 Johns Hopkins University size estimate, cited in the Global Fund GC7 funding request, found 91,137 people who inject drugs.
• The estimated HIV prevalence among people who inject drugs is 24%, compared to an adult HIV prevalence of around 11% in the general populations.
• Zambia has an estimated 1.3 million people living with HIV.

• There is an explicit support for harm reduction in Zambia’s national policy documents.
• National HIV prevention programme coverage for people who inject drugs stands at 37.7%.
• ART coverage for people who inject drugs living with HIV stands at only 4%.
• A 2021–22 biobehavioral survey across three cities found that 62% to 73% of people who inject drugs living with HIV knew their status, and viral load suppression among those on treatment ranged from 40% to 74%. These figures fall well short of the 95-95-95 targets Zambia has met in the general populations.
• Injecting narcotic and psychotropic substances is illegal under Zambian law. This pushes people who inject drugs away from services and stands as a barrier to harm reduction.
• After the 2025 PEPFAR funding cuts, 32 drop-in centres were shut down. These sites had provided HIV services to more than 20,000 people from key populations living with HIV on ART across seven of Zambia’s ten pro In the six districts of the Northern Province, HIV services have stopped entirely, as the affected implementing partner was the only provider in the region.

• In 2024, PEPFAR provided approximately USD 1,358,242 for interventions reaching people who use and inject drugs. This included USD 165,127 for opioid agonist treatment (OAT/MAT) and USD 361,614 for pre-exposure prophylaxis (PrEP).
• Across GC7, the Global Fund provided USD 402,226 for prevention of people who inject drugs and their partners, of which USD 75,258 was allocated to OAT and USD 17,059 to needle and syringe programmes (NSP).
• Donor funding covers around 92% of annual HIV-related spending in Zambia. The government raised its domestic contribution to the AIDS response from 7% in 2022 to 10% in 2024, though this still sits far below the level of need.
• However, Zambia has made no dedicated domestic funding available to sustain the harm reduction interven­tions PEPFAR previously covered.
• The total 2025 PEPFAR budget was cut by USD 367 million, and a further USD 21 million was lost under Global Fund grant reprioritisation. Together these reductions have sharply narrowed the resources available for HIV prevention and harm reduction for people who inject drugs.

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: The Government of Zambia has published its HIV Response Sustainability Roadmap 2025–2030 and raised its domestic contribution to the AIDS response. These commitments and domestic funding need to reach harm reduction programming for people who inject drugs, which so far has received no dedicated domestic funding. GC8 co-financing requirements are one route to securing government commitments for key population programming. Disbursements should be tied to earmarked domestic allocations for HIV prevention for people who use drugs, including OAT and NSP, before integration begins. The gains against the 95-95-95 targets in the general population have not reached people who inject drugs, where awareness and viral suppression stay critically low. Integrating services without funding targeted programming for this group will only widen that gap.
• Protect and resource community-led organisations: The closure of 32 drop-in centres and the collapse of HIV services in the Northern Province show what happens when harm reduction depends on a single external funder. Community-led organisations are often the main point of contact between services and people who inject drugs, and the disruption after the PEPFAR cuts fed straight through to HIV outcomes. The Global Fund funding request should set aside dedicated funding for these organisations, including support for budget advocacy, and should bring organisations led by people who use drugs into the design and delivery of programmes. Integration cannot mean closing community-led services.
• Prioritise social contracting as a core integration safeguard: The Global Fund funding request should prioritise setting up and expanding social contracting mecha­nisms for community and key population organisations, treating community systems as part of the wider health system. These organisations need enough resources to take part in the integration process and to push for domestic resource mobilisation. The Global Fund should fund budget advocacy so that social contracting mechanisms can be unlocked at national and sub-national levels. Legal barriers to harm reduction, including the criminalisation of drug injection, should be raised during integration and reflected in the human-rights module of the GC8 funding request.

• 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- Zambia. https://hri.global/wp-content/uploads/2025/05/Zambia.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/