International donors are investing only 7% of what is needed
to provide adequate harm reduction coverage for people who inject drugs,
according to findings from a report presented on Wednesday at the 20th
International AIDS Conference (AIDS 2014) in Melbourne.
A global commitment to rebalance spending on drug control
and harm reduction is essential in order to achieve control of HIV and
hepatitis among people who inject drugs, several speakers told the conference.
Drug Commissioner, Sir Richard Branson, who joined the conference by video
link, said the global war on drugs had failed both in terms of controlling drug
trafficking and consumption and of public health outcomes, particularly in
relation to HIV and hepatitis C.
that the time has come to replace the criminalisation and punishment of drug
users with treatment and health care.
policy reform should not be seen in isolation” Sir Richard Branson said. “It
has the potential to affect change in other areas such as the world’s
chronically overcrowded penal system or of reducing the negative impact of
policing on some communities.
we’re using too much money and far too many precious resources on incarceration
when we should be spending this money on education, vocational training, and in
the case of drug users, on treatment, proper medical care and re-entry.”
The survey of harm reduction funding, carried out by Harm
Reduction International, the International Drug Policy Consortium and the
International HIV/AIDS Alliance, found that donor governments and the Global
Fund to Fight AIDS, Tuberculosis and Malaria invested US$160 million in harm
reduction programming in 2010, with little sign of subsequent growth. UNAIDS
estimates that it would cost $2.3 billion a year to provide adequate coverage
of harm reduction measures.
The core harm reduction measures include not only needle and
syringe programmes, opioid substitution therapy, and targeted education and
outreach, but also HIV testing and counselling, antiretroviral therapy, condom
programming and prevention, diagnosis and treatment of sexually transmitted
infections, viral hepatitis and tuberculosis.
Presenting the findings, Susie McLean of the International
HIV/AIDS Alliance told conference delegates that existing coverage is extremely
low. On average, just two clean needles and syringes were distributed to each
person who injects drugs each month in 2010, and only 8% of people who inject
drugs had access to opioid substitution therapy. In 71 countries, needle and
syringe programmes are not available despite reported injecting
drug use and 81 countries with reported injecting drug use do not provide opioid
Since these estimates of coverage were developed in 2010,
there has been little progress on the expansion of harm reduction, and the
survey found some evidence of a retreat by donors from funding harm reduction,
as part of a wider move away from funding health and development activities in
middle-income countries. This is despite the fact that among the 15 countries
considered the highest priority for tackling HIV in people who inject drugs,
84% of people who inject drugs reside in upper middle-income countries such as China,
Russia, Kazakhstan, Iran and Thailand.
Several major donors have taken actions that are cutting off
access to harm reduction funding in practice, even though donors endorse harm
reduction expenditure as a good investment in HIV prevention. The Global Fund
to Fight AIDS, Tuberculosis and Malaria recommends investment in evidence-based
harm reduction measures, but its new funding model has shifted resources away
from middle-income countries with the highest need for harm reduction
programming. Thailand allocated just 1% of its total HIV prevention budget to
harm reduction in 2010, highlighting the need for donor investment. A similar
pattern is evident across almost all Asian countries with a high burden of HIV
among people who inject drugs. Of the 58 countries previously eligible for harm
reduction funding, 24 are now ineligible for further support.
The United Kingdom government is also retreating from harm
reduction funding and will give no direct support to harm reduction programming
Despite a legislative ban on funding for needle and syringe
programmes, the US PEPFAR programme spent approximately US$27.7 million on harm
reduction in 2011. However, this represented only 2% of PEPFAR funding in the
countries where support was provided; in Vietnam for example, harm reduction
programming represented only 11% of expenditure despite the predominance of
injecting drug use as a mode of HIV transmission in Vietnam’s epidemic.
Susie McLean said that in order to fund harm reduction
adequately, the Global Fund needs to remain a truly global fund. Its funding
model should be reframed to take into account national policy barriers to
implementation of evidence-based measures, as well as political will to pay for
harm reduction. Similarly, international donors should continue to invest where
national governments won’t, using their influence to steer national funding
policies towards a more equitable distribution of HIV prevention funding.
National governments need to tackle the stigma associated with drug use in
order to allow a more rational debate about harm reduction spending.
Most importantly, the international community needs to ask
hard questions about the cost effectiveness of drug control policies. Drug
enforcement spending on prisons, policing, courts and probation has been
estimated to cost around US$100 billion. Even if this represents a substantial
over-estimate, there is a grave mismatch between drug control spending and harm
reduction spending, despite the fact that each form of spending is argued to achieve
the same end – minimising the harm caused by drug use.
McLean called for international donors to set a global
target for harm reduction funding, reminding the audience that ahead of the
UNGASS 2016 summit on drugs, advocates are calling for harm reduction funding
to be scaled up to reach one-tenth of the amount spent on drug control.