The Lost Decade report reveals that funding for harm reduction services in low- and middle-income countries (LMICs) is in crisis; in 2016 harm reduction funding totalled just 13% of the $1.5 billion
that UNAIDS estimates is required annually to prevent HIV among people who inject drugs.

New HIV infections among people who inject drugs increased by one-third from 2011-15.

Harm reduction interventions—such as opioid substitution therapy (OST) and needle and syringe programmes (NSP)—are cost effective and well-evidenced in preventing the spread of blood-borne viruses. The lost decade: Neglect for harm reduction funding and the health crisis among people who use drugs finds that overall funding for harm reduction in LMICs—including from international donors, domestic governments and philanthropic organisations—has flat-lined since 2007. This is despite governments in 2015 setting the ambitious goal to end AIDS by 2030. Contributions from international donors (which account for two-thirds of all funding) dropped almost 25% in a decade (2007-16), while harm reduction funding allocations from the biggest international donor, the Global Fund to Fight AIDS, TB and Malaria, were almost one-fifth less in 2016 compared to 2011.

The report also found that while a small number of LMIC governments have increased domestic funding for harm reduction services—for example, Malaysia and Vietnam—there are too many cases of donor withdrawal leading to service closures. Many LMIC countries have punitive drug laws that criminalise and discriminate against people who use drugs, further hindering their access to lifesaving HIV prevention and treatment, along with other healthcare services.