Is harm reduction funding in low and middle income countries in crisis?Susie McLean, International HIV/AIDS AllianceCatherine Cook, Harm Reduction InternationalJamie Bridge, International Drug Policy Consortium
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‘Given the severity of the challenge, HIV prevention programming for people who inject drugs is badly under-resourced’ UNAIDS 2013
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Harm reduction – low coverage
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Harm reduction – how much money is needed?
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• Difficult to know• Government reports to
UNAIDS don’t disaggregate• International donors not
making investment information available
• Differences in budget disaggregation
Harm reduction – how much is being spent?
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National governments
• Domestic investment in HIV is increasing
• BUT investment in harm reduction not reflected in this trend
• Priority countries: less than 5% of HIV investment
Harm reduction – how much is being spent?
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The political unpopularity of harm reduction
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Harm reduction – dependent on international donors
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People who inject drugs and the need for harm reduction – in middle income countries
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Global Fund investments in harm reduction R1-R10 (2002 – 2010)
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• 58 countries have received $ for harm reduction previously
• 41% (24) now ineligible or will receive no new $
• Only 10 countries (5 MIC) are eligible for ‘incentive funding’ or funding for ‘critical enablers’
• More than half MICs “over-allocated”
• Downward trend?
Global Fund New Funding Model – bad news for harm reduction?
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• DFID bilateral funding for harm reduction - reducing dramatically
• Australian Government funding - unknown
• Dutch Government funding – maintaining their commitment
• PEPFAR funding – national ownership and technical support rather than programming
International donor trends – away from harm reduction
13PEPFAR spending on HIV prevention for people who use drugs in 2011. Analysis on PEPFAR spending 2009-2012 conducted by George Washington University in 2013, commissioned by AmfAR (unpublished)
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1. Keep the Global Fund global
• New indicators to determine allocations – Inequalities– Willingness to pay– Policy barriers– Transitions to domestic
funding
• Fully funded Global Fund no-one left behind
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International donors- Invest where national
governments won’t/can’t- Responsible exit strategies- Influence national governments
UN agencies- Improve data on harm reduction
need, coverage and investment
2. Invest strategically in harm reduction
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National governments:
Fund national harm reduction programmes- sustainability
Address stigma related to HIV & drug use - public debate - attitudes of decision makers
3. Increase national harm reduction investment
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National governments:- Cost effectiveness analyses. Is
drug control value for money?- Estimate resource needs for HIV
and harm reduction and rebalance towards health
International donors:- Work together to define and commit
to an international target for harm reduction investment
Rebalance resources From drug control and criminalisation to health and harm reduction
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