Catherine Cook is the Sustainable Financing Lead at Harm Reduction International. She has 17 years of professional experience in harm reduction, HIV and policy research. She has developed a portfolio of ground breaking research and policy analysis on financing for harm reduction, including the tracking of investment.

Understanding the current state of funding for harm reduction for people who use drugs is crucial to ensuring sustainable funding. Funding has historically been within the context of HIV. People who inject drugs are 15 times more likely to acquire HIV compared to the general population, rising to 88 times more likely in the Middle East and North Africa and 46 times more likely in Latin America.

Harm Reduction International has monitored the state of harm reduction funding in low- and middle-income countries since 2007. This research focused on funding from 2020 to 2023. Funding data for international donors was collected through structured email requests and follow-up calls. National funding data was identified through online data sources and a literature review.

The research found that funding for an effective HIV response for people who inject drugs in low- and middle-income countries totalled US$151 million in 2022 – just 6% of the US$2.7 billion needed annually by 2025, a similar level to 2019. Harm reduction funding was only 0.7% of total HIV funding in 2022. The overall HIV funding gap was 29% compared to 94% for harm reduction. The number of donors providing harm reduction funding has reduced over time increasing reliance on the Global Fund and PEPFAR. The number of countries investing in their own harm reduction responses and the amount invested have fallen since 2019. Funding for community-led organisations remains limited despite global targets . Key funders of advocacy and legal and policy reform have reduced support.

The funding gap for harm reduction remains vast. Existing international donor support comes within the context of the HIV response and may be increasingly precarious in the face of shrinking overseas development assistance. Governments should divest for punitive drug policies and invest in health and harm reduction for people who use drugs.