Resourcing Harm Reduction Blog Series: Harm Reduction International

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 a leading expert in financing for harm reduction: Catherine Cook of Harm Reduction International.  

Learn more about this blog series and other entries.


What are the possible reasons a donor might begin/enter into funding harm reduction work?

Donors choose to fund harm reduction because it is evidence based, cost-effective, and has been proven to reduce HIV transmission. We will not end AIDS by 2030 without a significant scale-up of harm reduction programming:

  • Evidence: There is an abundance of scientific research showing the effectiveness of harm reduction interventions in preventing HIV infection. The priority interventions for people who inject drugs – as outlined in World Health Organization, United Nations Office on Drugs and Crime, and UNAIDS technical guidance – are needle and syringe programmes and opioid substitution therapy. However, only 1% of people who inject drugs live in countries with high coverage of harm reduction interventions. Consequently, HIV infections among people who inject drugs continue to rise in many countries in the world, particularly in Eastern Europe and Central Asia, and the Middle East and North Africa. Funding for harm reduction in low- and middle-income countries falls far short of need. Harm Reducation International (HRI) research found this to reach only 13% of the $1.5 billion that UNAIDS estimate is required to cover 90% of people who inject drugs with services by 2020.
  • Value for money and cost-effectiveness Harm reduction has been demonstrated to be a high impact, “value for money” investment for donors. Harm reduction interventions are relatively inexpensive to implement and are proven to be cost-effective HIV prevention measures. HRI summarised some of this evidence in our report The Case for a Harm Reduction Decade: Progress Potential and Paradigm Shifts (p.11). It is becoming increasingly important for civil society and community advocates to be able to convey cost-effectiveness evidence when advocating for harm reduction funding.
  • Potential catalytic impact: While ultimately there is a need for national governments to be funding these programs in their countries, donor support can have a catalytic effect, demonstrating the impact of investing in harm reduction.
  • The failure of punitive approaches to drug use: Harm reduction often also involves challenging punitive approaches to drugs, which are ineffective and expensive. It also increases the risk of HIV and other health and social harms, through mass incarceration, creating barriers to accessing services,and threats to the safety of people who use drugs.

Funding for advocacy is rarely prioritised by governments, so it is overly reliant on donor funds. However, our research found that within international donor funding for harm reduction in 2016, only 8% was allocated towards advocacy, human rights, and policy reform focused activities. This poses a major challenge for the sustainable financing of harm reduction in low- and middle-income countries.

In an era of donor retreat from middle-income countries, strong advocacy for government investment in harm reduction is particularly important. Civil society and community advocates need to be able to call on governments to invest, hold them to account, and ensure mechanisms such as social contracting are in place. This enables the community and grass roots organisations to deliver services. This can, of course, be extremely challenging work. It is often carried out by those same organizations delivering services, in punitive drug policy environments with limited, or shrinking civil society space.  We need to be able to articulate the value and impact of investments in advocacy, to be able to encourage donors to support this work.

Catalytic investment funds from the Global Fund have been an important source of harm reduction advocacy funding in recent years. In anticipation of Global Fund Board discussions on the allocation methodology (determining the amount available for catalytic investments depending on the final replenishment amount), we developed a briefing paper illustrating how important these funds have been for harm reduction, with Frontline AIDS. The paper includes many examples of the difference that advocacy funding has made, through multi-country grants and strategic initiatives.

What are some tools or resources that you would recommend to funders interested in supporting harm reduction work?

Some of HRI’s work has been to build and share the evidence base for harm reduction. Our biennial Global State of Harm Reduction report tracks the provision of health and social services worldwide for people who use drugs. It has become a key resource for civil society, academics, and donors. We have also been tracking harm reduction funding for the past decade, using tools we developed to assess how much has actually been invested or allocated to harm reduction by donors and governments. Raising awareness of the funding shortfall has proven to be an important first step in advocating for this to be addressed.

Most recently, we have been working with civil society and community partners in seven countries in Asia to assess harm reduction investment and inform advocacy for domestic resourcing of harm reduction. We have also developed tools to assess drug law enforcement expenditure, illustrating the vast spending on ineffective punitive approaches. Our research shows that if just a small proportion of this spending was redirected towards harm reduction, we could end AIDS among people who inject drugs by 2030.

Are there other ways you would recommend that funders take part in the response without directly funding harm reduction (i.e. convenings, advocacy, etc.)?

Donors (or organisations like FCAA which closely connect with donors) hosting events on harm reduction can be powerful opportunities to build support for funding of harm reduction as a crucial part of the response to HIV and AIDS. For example, the Elton John AIDS Foundation (EJAF) held an event at the Harm Reduction International Conference – HR19 – in Porto, Portugal on Funding the response: increasing donor support for harm reduction. Both EJAF and ViiV Healthcare chose that event to unveil parts of their new strategies and to convey their commitment to funding harm reduction.

At this event, I was asked to talk about the role that philanthropic donors could play in addressing the funding crisis for harm reduction and I highlighted three main points:

  1. Existing donors should use their access, position, and power to call for other donors to increase their commitments to harm reduction. Only 1% of the philanthropic donor contribution to the global HIV response goes to harm reduction in low- and middle-income countries, so they are a major potential source of funds. Sharing evidence of the funding crisis – as well as the scientific, economic, and human rights case for implementing harm reduction approaches – is crucial for catalysing support. But hearing this case made by fellow donors is likely to be more powerful than hearing it from civil society. So, I called upon philanthropic donors to be loud and proud about their support for harm reduction; to communicate the impact of their investments and their reasons for prioritising this funding in a manner that speaks to the interests of investors. This could be using cost-effectiveness evidence, or perhaps speaking to donor priorities in terms of the populations they want to reach. People who use drugs are also women and girls, sex workers, transgender people, men who have sex with men, prisoners, migrants, and refugees. They all need harm reduction.
  2. Philanthropic donors could use their influence to support the Global Fund. Over 155 organisations and parliamentarians signed the HR19 call to action for a strong Global Fund replenishment and for catalytic investments to be protected. Philanthropic donors can use their influence to encourage strong pledges to the Global Fund from fellow donors. They can also call upon the Private Foundations Delegation and others on the Global Fund Board to protect and maximise the potential for harm reduction funding from the organization.
  3. Philanthropic donors should fund harm reduction advocacy. Philanthropic donors can provide an essential lifeline for civil society and networks that are the driving force of harm reduction all around the world. One of the best ways to do this is by providing core funding, which strengthens organisations and allows them to respond to unpredictable advocacy needs.