KEY HARM REDUCTION MESSAGES ON INTEGRATION FOR GRANT CYCLE 8

12 February 2026

Rushed integration is an equity risk. Sudden and dramatic funding and political shifts in global health have resulted in a push for integration as an effective pathway to UHC and financial sustainability for HIV, TB and malaria programmes. However, for key population programmes, including harm reduction, this poses serious risk. A rushed integration process without undertaking careful planning could further dismantle already inadequate HIV prevention and harm reduction services for key populations.
The foundations for meaningful integration have been weakened. Global Fund GC7 reprioritisation and US funding cuts have stripped back essential enablers of integration – human rights and gender work, community led interventions, advocacy, and efforts to secure government investment in harm reduction.
Harm reduction funding is now critically fragile. Evidence shows that the double hit of US cuts and GC7 reductions, combined with minimal to non-existent government financing, has left harm reduction programmes at breaking point. Pushing accelerated integration in this context risks deepening marginalisation and cutting people who inject drugs and other key populations off from essential, life-saving services.

Secure government funding before integration. The Global Fund 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 and harm reduction.
Protect and resource community-led organisations. The Global Fund 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.
Prioritise social contracting as a core integration safeguard. The Global Fund 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.