This report examines the implications of the reduction and termination of United States (US) funding for harm reduction programmes in Indonesia, which are mainly channelled through USAID and the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund).

Harm Reduction International and Rumah Cemara jointly convened the study with financial support from Elton John AIDS Foundation.

The Global Fund has implemented a 9.3% funding reduction for each principal recipient from the reprioritisation process in funding cycle 7 as the result of the US funding cut, which affected principle recipients, the Country Coordinating Mechanism and civil society groups. The initial reduction proposed was 15%, as reported by Indonesia AIDS Coaltions, but this was later revised to 9.3% through the reprioritisation process. Principle recipients required sub-recipients and sub-sub-recipients to also adjust their budgets by 9.3%.

As as part of Global Fund budget adjustments, several CSOs that employ outreach workers and peer supporters cancelled their recruitment processes for new staff. Consequently, the ratio of outreach/peer support workers to clients has grown larger, increasing workloads and affecting the quality of the support provided. Although there is no data on the percentage decrease in funding specifically for harm reduction , the funding reduction affected 29 organisations in 58 cities or districts, which between them had 46 outreach workers supporting people who inject drugs.

The harm reduction services in Indonesia have been integrated into the primary health services the government provides. These services are funded through the national and local government budgets (APBN and APBD, respectively) and other funding sources, such as international donor agencies, bilateral and multilateral funding. The study found that the integration cushioned against the US funding shocks to harm reduction, though the impacts are felt by different stakeholders, harm reduction service delivery organisations and clients accessing the services.

The termination and reduction of US funding did not immediately cut off clients’ access to healthcare services, but it did reduce the availability and opportunities for services previously supported by those programmes. For example, peer support groups and study clubs which provide learning spaces and psychosocial support for members, have been reduced. In interviews, people supported by harm reduction programmes reported still being able to access needles syringe programmes and opioid agonistic therapy at designated Puskesmas. A local government interviewee also stated that harm reduction services have not been disrupted because they are funded by national and regional budgets.

The US financing decision will still have significant long-term impacts, especially for civil society organisations (CSOs) that work directly with people who use drugs and other key populations. This is because, until now, outreach, peer assistance and community education have been wholly supported by international funding, including from the US.

The impacts experienced by people who use drugs include reduced opportunities to learn and build self-awareness, while reduced mentoring and outreach activities mean clients are less able to access services and support. Families and partners of people who use drugs have experienced similar impacts.

The visible impacts for US fund grantee organisations included staff layoffs, loss of credibility due to sudden programme closures, weakened institutional capacity due to team reductions, changes in work methods, disruption to organisations’ long-term missions, strategic disruption and resource restructuring.

Harm reduction programmes are not only directed at ‘key populations’ in HIV and TB responses, such as people who use drugs, but also reach linked communities, including partners, families, social networks and the wider public. Many programmes also include mentoring for health centres and other stakeholders, such as by providing guidance to health workers to strengthen HIV testing and treatment services. This means the impact of funding cuts is not only felt by the groups being directly supported by programmes, but also by other communities that have not yet been identified or do not have adequate access to healthcare services yet are also vulnerable to HIV and TB.

This report highlights some potential strategies for the government, CSOs and communities to deploy to sustain and strengthen harm reduction funding. These include:

•  Mobilising domestic resources through national and local government budgets (e.g., APBN/APBD), private sector contributions via corporate social responsibility (CSR) initiatives, and religious or community-based funding, such as zakat (charity). Utilisation of funds from CSR and religious sources is very possible, especially to fund support and rehabilitation activities as well as economic strengthening.
• Expanding international cooperation and networks beyond the US to support capacity- building and knowledge sharing.
• Reinforcing collaboration between the government, CSOs and communities to ensure outreach, accompaniment and public education efforts continue.

Sustainable funding mechanisms are crucial for maintaining Indonesia’s progress toward national harm reduction and public health targets. Stronger domestic financing, supported by diversified international collaboration, will be key to ensuring the long-term resilience of harm reduction efforts.