The Global Fund's cancellation of Round 11 and the cost-cutting measures that followed have put harm reduction programmes in jeopardy, especially for those countries with low resources and heavy HIV and TB burdens, according to a report on the global state of harm reduction published by Harm Reduction International (HRI).
“The international financial crisis, combined with a shift in aid priorities toward low-income countries and resource constraints at the Global Fund, pose a major threat to the future and sustainability of harm reduction,” the report said.
HRI estimated that approximately $160 million was invested in HIV-related harm reduction in low- and middle-income countries in 2007, of which $136 million (90%) was from international donors. This $160 million investment was just a fraction of what UNAIDS estimated was needed to meet the basic HIV prevention needs of people who inject drugs ($2.1 billion in 2009 and $3.3 billion in 2010).
Harm reduction programmes are particularly vulnerable to global economic downturns, the report said. This is because support from government in the countries affected is rare, often because of political or social considerations, including the fact that harm reduction tends to be low on governments’ lists of priorities.
The report said that there is continuing uncertainty about the Global Fund’s new funding model (NFM) and what the NFM will mean for harm reduction programming. The authors state that the uncertainty needs to be addressed quickly to minimise the impact on existing programmes and to ensure future projects stand a chance of being implemented.
“It is unclear how financing for harm reduction will be prioritised as part of the new Global Fund funding model that is being developed,” the report notes.
Noting that the Transitional Funding Mechanism established by the Global Fund did not allow for scale-up of services or start-up of new services, the report said that this adversely affected several countries in Asia and Eastern Europe with significant HIV and injecting drug use burdens or emerging epidemics.
In addition, the report said, as a result of these restrictions, several countries that might have planned to submit grant proposals in 2012 and 2013, cannot do so until 2014.