Harm reduction funding is a small proportion of the Global Fund investment portfolio, but it is a lifeline for harm reduction programmes in many LMI countries. As the largest donor to harm reduction and with the loss of PEPFAR support, the role of Global Fund is more critical than ever to ensure harm reduction programmes continue and sustain the gains made so far. The reprioritisation process, while protecting funds for life-saving harm reduction services in many countries, has halted planned scale-up and led to the reprioritisation of funds from advocacy, law and policy reform and human rights programming crucial for the effectiveness and accessibility of harm reduction services.

We call on the Global Fund Board to centre those left most behind within strategic decision-making on GC8, including people who use drugs and their partners. The replenishment shortfall must not widen the funding gap for harm reduction or further decimate programmes for people who use drugs.

• Before the seismic shifts in the funding landscape in 2025, harm reduction funding in low- and middle-income countries amounted to USD 151 million – just 6% of the USD 2.7 billion needed annually by 2025 – leaving a funding gap of 94%.
• The loss of funds from the second largest donor for harm reduction – PEPFAR, and the subsequent Global Fund Grant Cycle 7 (GC7) reprioritisation process have brought harm reduction to its knees in many countries, with services closing, community programmes such as outreach and advocacy halted.
• Harm reduction is more reliant on the Global Fund than ever before, and it was already the source of 73% of all donor funding for harm reduction before 2025.
• Where in place, domestic funding protected harm reduction services in 2025, but not enough countries are investing and community programmes are not covered through domestic funding.
• To ensure access to life-saving services for people who use drugs and to retain the gains made so far, harm reduction programmes and key areas such as advocacy, community-led monitoring and legal and policy reform must be protected within Grant Cycle 8.

• The replenishment shortfall must not widen the funding gap for harm reduction or further decimate programmes for people who use drugs and their partners.
• Funding for community systems and community-led harm reduction should be prioritised. Where cuts have been severe, it is communities that have remained resilient and innovative during service chaos.
• Co-financing and strengthening domestic health financing must be prioritised in GC8, with communities at the centre, engaged from the outset with government and technical partners. Social contracting to ensure funds reach community-led and civil society organisations must be a strategic priority.
• Communities and civil society must be supported to engage in budget advocacy to mobilise domestic funding for harm reduction.
• The Global Fund must monitor their allocations and expenditure in GC8, disaggregated by key populations.