Resourcing Harm Reduction Blog Series: Frontline AIDS
Recently, FCAA released a data spotlight illustrating the intersection of HIV and people who inject drugs (PWID). Given that PWID are 22 times more likely to acquire HIV than the rest of the global population, we felt that it was important to understand where private philanthropy was supporting harm reduction programs. As we worked with partners to analyze the data, it was clear that the numbers tell only one part of the story. We wanted to dig deeper, to understand what challenges grant makers and recipients are facing in funding and implementing these programs.
As part of this important conversation, we are proud to feature the following blog from Frontline AIDS
Learn more about this blog series and other entries.
How did your organization enter into funding harm reduction work?
We started our harm reduction journey in November of 2001 when the HIV epidemic among people who inject drugs (PWID) was clearly spiking in a few key countries – such as Ukraine, Malaysia, and Vietnam – where proper harm reduction services just didn’t exist and where people were dying because they were not getting the help they needed.
Firstly, we made grants at the community level, through our Asia and Eastern Europe regional programme. The first stage was to mobilise people who use drugs (PWUD) to form community groups to voice the issues they face. We then supported these groups to engage in mapping and size estimations, and the development of outreach plans that involve PWUD at every stage of the process. This process was then documented in manuals and case studies to share with other countries in the global south such as the HIV and Drug Use: A Toolkit on Participatory Assessment and Response (PAR) to improve programme and/or policy responses to the drug-related HIV epidemic.
We developed good practice guidelines and programming standards on our work with people who use drugs to further refine our approach and strengthen the quality of our programming in this area. Our biggest breakthrough was a joint programme with the Dutch government, Community Action on Harm Reduction (CAHR), which ran from 2011 to 2015. The project involved work in seven countries where HIV rates were extremely high among PWUD – China, India, Indonesia, Kenya, Malaysia, Myanmar (starting from 2015), and Senegal (starting from 2016). CAHR used the same approach of strengthening community mobilisation, building strong evidence about need, and supporting with the technical resources to begin work. We worked closely with governments to ensure that the work was recognised, appreciated as lifesaving, and would ultimately be financed by them.
In Kenya, the Ministry of Health now funds harm reduction services with a contribution from the Global Fund to Fight AIDS, TB and Malaria. We continue to work with the government of Kenya to share good practice on harm reduction in the region.
The Frontline AIDS Integrated Harm Reduction Programme is the next iteration in the journey. Running between 2016 and 2020, this ambitious programme differentiates countries in three categories: “kick-starter” (no programming or very small scale), “accelerator” (the country has small scale programmes which need to be scaled up), and “multiplier” (programmes exist at scale, but there are major quality or inclusion gaps which need to be addressed). Each country intervention aims to start work that will, within the timeline of the investment, be picked up at scale by government or other providers.
What is one major challenge you have had to overcome in funding harm reduction work and how have you navigated that challenge?
Starting harm reduction work is often a long, political journey. We needed to accompany community groups in the long-term, with grant funding and technical support, to keep up the advocacy needed. But we also need to move quickly to bring in highly skilled technical ability, experience of working at scale, and mobilising across multiple stakeholders when the opportunities arise.
The ability to react quickly and effectively when opportunities arise or problems occur is a key part of our approach. Balancing between long-term advocacy and taking advantage of a short-term opportunity to make change is key. This has been the case in countries such as Uganda and Nigeria, where we have been central in recent positive moves towards piloting new services and agreeing policy frameworks for harm reduction.
The fact that drug use and drug users are criminalised in all the countries we work in means there is a constant threat to their safety and life. It is never easy to begin outreach work and in the earliest days of our work we heard about activists working on the frontline in Kenya who always wore sneakers so they could run away quickly when the police came around. Incarceration of PWUD and outreach workers is common. The shift in mindset from a punitive approach to a more health centric one, where PWUD are supported to manage their health needs instead of punished or put in prison, is the biggest challenge. This is why the #supportdontpunish campaign was borne from the CAHR project. Check out suppportdontpunish.org to find out more and join the campaign.
What is the most effective strategy, tool, piece of data, or resource that you have used to successfully overcome a barrier to funding harm reduction work?
One important tactic has been helping national partners to understand the concerns key funders (particularly governments) have around drug use, to see them as opportunities, and to strategically exploit them to advocate for harm reduction services. For example, in China, our partner AIDS Care China responded to government concerns about public safety around drug use as a way to engage them on the issues. It has been very successful in providing innovative models that have become embedded with, or completely run with government funding. For example, it developed a model of methadone take away services for PWUD. The Yunnan Institute of Drug Abuse has since then taken leadership of this approach and developed standard operating procedures in many of their clinics. AIDS Care China recently won a UNAIDS Innovation award for this work. Even in the most challenging contexts, there are often hooks or issues that can be leveraged to begin work.
We have also joined forces with our strategic donor, the Dutch Ministry of Foreign Affairs, on joint advocacy with other governments and policy makers. Together, we successfully pushed for PWUD as a key group named in the Guttmacher-Lancet Commission on Sexual and Reproductive Health Rights – allowing for donors funding this work to include PWUD as a key underserved group.
Are there other ways your organization has been able to take part in the response without directly funding harm reduction work?
We have played a critical role in transferring knowledge on harm reduction from one place to another. Expertise has been applied from Ukraine in West Africa; from China in Kenya; and from the Netherlands in Southern Africa. We have used our convening power to bring together key decision makers from public health, law enforcement, and communities to effect real change. And on the global stage, we play an active role in policy discussions, such as supporting community members to engage with policy makers in national and international spaces to advocate for drug policy changes.
We also partner with UNITE, a global network of Parliamentarians committed to ending HIV and infectious diseases as a global health threat, working to mobilise parliamentarians from around the world to advance harm reduction.
In addition, we have joined forces with our partners International Drug Policy Consortium (IDPC) and Human Rights International (HRI). With IDPC, we work on the “Support. Don’t punish.” campaign, drawing attention to the need to apply a health, rather than a criminalisation, lens towards people who use drugs. We also joined HRI’s “10 by 20” campaign, advocating for the reallocation of 10% of resources from law enforcement towards harm reduction by 2020.
What is your biggest success story as a funder of harm reduction work?
From the early days of mobilising communities of PWUD, the Frontline AIDS partnership now reaches over 300,000 people with harm reduction services in 15 countries. The largest programmes we have supported are in the Ukraine and India, which have had a significant impact on reducing new infections among PWUD in those countries. From the early days of supporting civil society actors to reach people, there are now mass scale, government-sponsored (in whole or part) programmes. The Ukrainian civil society organization, Alliance for Public Health, communities of people who use drugs, and the government collaborate to deliver this impressive scale of work. However, we are now at a critical juncture as the Global Fund transitions from the Ukraine and India. We need to work hard to ensure that this progress does not come under threat. We must continue to support the delivery of critical services and to support responsible transition to governments in these and other middle-income countries when the Global Fund and other donors leave.
Through our network, the knowledge from this work has been shared around the world from East Africa to East Asia. Our vision is to kick start programmes of a similar scale and ambition where they are most needed.