Funding and political support for harm reduction is in crisis in many countries around the world. Harm reduction is evidence-based, cost effective and has a positive impact on individual and community health. While harm reduction is far broader than HIV prevention, this call to action centres on galvanising urgent action to secure a strong 6th replenishment of the Global Fund to Fight AIDS, TB and Malaria (Global Fund), in recognition of the significant impact of HIV and TB on people who use drugs. 

As advocates, activists, researchers, donors and policy makers from around the world gather in Porto, Portugal, for the 26th Harm Reduction International conference (HR19), we take this opportunity to express our concern that people who use drugs have been left behind in the fight to end AIDS by 2030. 

Harm reduction interventions for people who use drugs—such as needle and syringe programmes (NSP) and opioid substitution therapy (OST)—are proven to protect against HIV and hepatitis C, and save lives. However, the global provision of harm reduction interventions is critically low, with only 1% of people who inject drugs living in countries with high coverage. HIV infections among people who inject drugs continue to rise, accounting for over one-third of new infections in Eastern Europe and central Asia, and the Middle East and North Africa in 2017. 

Funding for harm reduction in low- and middle-income countries (LMICs) remains overwhelmingly reliant on international donors. The Global Fund is the largest donor for harm reduction, and contributed two-thirds of all donor funding in 2016. It has been crucial to initiating, scaling-up and sustaining harm reduction programmes in many countries and has prevented countless HIV infections and improved lives around the world.

In particular, Global Fund catalytic investment funding provides a vital lifeline for community-led and civil society advocacy for harm reduction. This is crucial in the context of donor transition, where strong, sustained advocacy with community participation is needed to sustain life-saving services for people who use drugs and to drive domestic investment in high quality, human-rights based harm reduction approaches. 

The Global Fund aims to raise at least US$14 billion at its 6th replenishment, which will be invested from 2020-22. We believe that more funding is required and support the call of the Global Fund Advocates Network (GFAN) for a replenishment of $18 billion. This will enable the Global Fund to step up the fight to end HIV, TB and malaria, and we urge Global Fund donors to be ambitious in their pledges. A strong and fully-funded Global Fund is vital to the harm reduction response and to delivering on government commitments to end AIDS by 2030.

1) We, the undersigned, call on governments, philanthropic donors and the private sector to step up and fully fund the Global Fund. We call on them to make ambitious pledges to ensure the US$18 billion target is reached.

2) We call on governments to put “People before politics” and ensure that people who use drugs are not left behind in the fight to end AIDS by 2030.

3) We call on the Global Fund Board to safeguard catalytic investment funds, regardless of replenishment outcome, in order to sustain life-saving services for people who inject drugs and to incentivise domestic investment in harm reduction. 

Signatories:

ACEID (Costa Rica)

AFEW International

AIDS Information and Support Center (AIDS-i Tugikeskus) (Estonia)

AIDES (France)

Aidsfonds (Netherlands)

AIDS and Rights Alliance for Southern Africa (Namibia)

Alliance for Public Health (Ukraine)

Alliance Myanmar

AntiAIDSAssociation (AAA Kyrgyzstan)

APDES – Agência Piaget para o Desenvolvimento (Portugal)

ARAS – Romanian Association Against AIDS

AS – Center for the Empowerment Youth of people who are living with HIV and AIDS (Serbia)

Asia Catalyst (USA)

Asian Network of People who Use Drugs (ANPUD) (Thailand)

Associação Psicodélica do Brasil

Association des intervenants en dépendance du Québec (Canada) 

Association Hasnouna de Soutien aux Usagers de Drogues (Morocco)

Association Margina (Bosnia and Herzegovina)

Association Guyanaise de Réduction des Risques (French Guinea)

Associazione Luca Coscioni (Italy)

Association Nationale de Réduction de Risques Maroc (Morocco)

Autamaimasa Health Foundation (Nigeria) 

Auto Support des Usagers de Drogues

CAT Cooperativa Sociale Florence (Italy)

CACTUS MONTREAL (Canada) 

Canadian Drug Policy Coalition

Canadian HIV/AIDS Legal Network

Centre on Drug Policy Evaluation (Canada)

Centre for Humane Policy (Bulgaria)

Centro de Orientación e Investigación Integral – COIN (Domnican Republic) 

CO “CF”All – Ukrainian network of People who use drugs” (VOLNA) (Ukraine)

Coalition des organismes communautaires québécois de lutte contre le sida (COCQ-SIDA) (Canada)

Coalition of Drug Users in Nepal

Coalition Plus (Worldwide)

Collectif Urgence Toxida (Mauritius) 

Correlation – European Harm Reduction Network

CRIPS (France)

COUNTERfit Harm Reduction Program (Canada)

Dianova International (Spain)

Dristi Nepal

Drug Harm Reduction Advocacy Network (Nigeria)

Drug Policy Australia

Drug Policy Network South East Europe

Estonian Network PLWHIV

Eurasian Harm Reduction Association (Lithuania)

Eurasian Key Populations Health Network (Poland)

Eurasian Network of People who Use Drugs

European African Treatment Advocates Network (UK)

FÉDÉRATION ADDICTION (France)

Fedito Bxl – Drugs & Addictions Brussels (Belgium)

FORUM DROGHE (Italy)

Frontline AIDS (UK)

Fundacja Polska Sieć Polityki Narkotykowej (Poland)

Funders Concerned About AIDS (USA)

GAKNI (Indonesia Drug Policy Advocacy Movement)

GAT – Grupo de Ativistas em Tratamentos (Portugal)

Geneva Platform on Human Rights, Health and Psychoactive Substances (Switzerland)

Global Fund Advocates Network (Worldwide)

Global Network of People living with HIV (GNP+) (Netherlands)

Hablemos Bolivia

Hacia una vida digna para todas las personas, ReverdeSer Colectivo A.C. (Mexico)

Harm Reduction Afghanistan

Harm Reduction Alliance of Ghana

Harm Reduction Coalition (USA)

Harm Reduction Focus Nigeria

Harm Reduction International (UK)

Health Institution of Nahdlatul Ulama (Indonesia)

Healthy Options Project Skopje (North Macedonia)

Hero’s Health Community Support Initiative (Nigeria)

HIPS, Washington D.C (HIPS)

Hope and Trust (Ukraine)

India HIV/AIDS Alliance

Indonesian Drug Policy Reform

Indonesian Harm Reduction Network

Instituto para el Desarrollo Humano (Bolivia)

Instituto RIA (Mexico)

Interagency Coalition on AIDS and Development (Canada)

Intercambios (Puerto Rico)

Intercambios Asociación Civil (Argentina)

International Doctors for Healthier Drug Policies (UK)

International Drug Policy Consortium (UK)

International Network of People who use Drugs (UK)

International Treatment Preparedness Coalition (ITPC)

KALYANI SOCIAL WELFARE AND RESEARCH ORGANIZATION (India)

KANCO (Kenya)

Karitas Sani Madani Foundation (Indonesia)

Labyrinth (Kosovo)

Mainline (Netherlands) 

Médecins du Monde (Worldwide)

Ministry of Health and Sports (Myanmar)

Ministry of Home Affairs (Myanmar)

MPact Global Action for Gay Men’s Health & Rights (USA)

Myanmar Pyidaungsu Hluttaw Office

New Nicotine Alliance (Sweden)

NGO “Club Eney” (Ukraine)

ONG Dimension Humaine (Togo)

ONG Secours Social (Cote d’Ivoire)

Organisation for Social Services and Health Development (Ethiopia)

Paediatric-Adolescent Treatment Africa (South Africa)

Paroles Atour de la Santé (Cote d’Ivoire)

Prévention Information et Lutte contre le Sida (Mauritius)

PREKURSOR Foundation for Social Policy (Poland) 

Public association “supporting people living with HIV” Kuat “. (Kazakhstan)

Public Health International Consulting Center (France)

Rafique Research and Educational Society Lodhran Punjab (Pakistan) 

Recovering Nepal

Release (UK)

Responsabilite Espoir Vie Solidarite (REVS PLUS) (Burkina Faso)

RIOD (Red Iberoamericana de ONG que trabajan en Drogas y Adicciones) (Spain)

RN Women, National Network of WWUD Nepal

Rumah Cemara (Indonesia)

Science for Democracy (Belgium)

Steps Organisation (Greece)

Stigma Foundation Indonesia

South Riverdale Community Health Centre (Canada)

STOPAIDS (UK)

StoptheDrugWar.org (USA)

Support foundation “RIGRA” (Lithuania) 

TEDA Malindi MAT Clinic (Kenya)

The Daniel Carl Torsch Foundation (USA)

The Health Center Hope for Life (OÜ Tervisekeskus Elulootus) (Estonia)

The Kirby Institute for Infection and Immunity (Australia)

The Stockholm Drug Users’ Union (Sweden) 

Timok Youth Center (Serbia)

Transform Drug Policy Foundation (UK)

Treatment Action Group (USA)

Ukrainian Network of People who Use Drugs

Ukrainian Network of Women who Use Drugs

UNION CONTRE LA CO-INFECTION VIH/HEPATITES/TUBERCULOSE (Cote d’Ivoire) 

Union for Improved Services, Communication and Education for people who use drugs (Ireland) 

UNITE Global Network of Parliamentarians to End HIV/AIDS, Viral Hepatitis and Other Infectious Diseases (Worldwide)

Voices of Community Leadership and Action (Kenya)

WABHARM Foundation (Ghana)

WABHARSS Foundation (Nigeria)

Women and Harm Reduction International Network (Worldwide)

Yayasan Kesehatan Bali (Indonesia)

Yayasan sadar hati (Indonesia)

YouthAid-Liberia (YAL)

Youth Awake for Better Society (Nigeria)

Youth Rise (Worldwide)

Zimbabwe Civil Liberties and Drug Network

Ricardo Baptista Leite, MP (Portugal)

Gisela Scalia, MP (Argentina)

Cate Faehrmann, MP (Australia)

Danielle Obono, MP (France)

Jean Spiri, MP (France)

Rudolf Henke, MP (Germany)

Nova Riyanti Yusuf, MP (Indonesia)

Yeo Fozié, MP (Cote D’Ivoire)

Esther Passaris, MP (Kenya)

Dovile Sakaliene, MP (Lithuania)

Aung Khin, MP (Myanmar)

Saimone Macuine, MP (Mozambique)

Oscar Mukasa, MP (Tanzania)

Serhiy Kiral, MP (Ukraine)

Svitlana Zalishchuk, MP (Ukraine)