On the eve of the 20th International AIDS Conference taking place in Melbourne, three leading HIV and drugs organisations have issued a stark warning that global funding for HIV prevention for people who inject drugs is in crisis and that achieving an 'AIDS-free generation' will be impossible without concerted action.
To coincide with the conference, Harm Reduction International, the International Drug Policy Consortium and the International HIV/AIDS Alliance are publishing a report which indicates that HIV prevention services for people who inject drugs are not being prioritised due to changing donor policies and national government neglect. This failure to invest will bring an exponential rise in HIV transmission which in turn will cause additional costs to government health sectors.
The report, The funding crisis for harm reduction: Donor retreat, government neglect and the way forward, highlights that:
- US $2.3 billion is needed in 2015 alone to fund HIV prevention among people who inject drugs, according to UNAIDS
- Only US $160 million was invested by international donors at last count - approximately seven percent of what is required
- Changes in the Global Fund to Fight AIDS, Tuberculosis and Malaria threaten to significantly reduce allocations for harm reduction
- International donors such as the UK are withdrawing aid from some of the most affected countries due to their 'middle income' status
- National governments are neglecting HIV prevention for people who inject drugs, and instead spend vast public sums on ineffective drug law enforcement
- Just one tenth of one year's drug enforcement expenditure (estimated to exceed $100 billion globally) would fund global HIV prevention for people who inject drugs for four years
The report recommends changes in international donor priorities and national spending to address the crisis.
A major focus of the report is on the Global Fund to Fight AIDS, Tuberculosis and Malaria - until now the largest funder of HIV services for people who inject drugs. According to the study, Global Fund support for these so-called 'harm reduction' programmes is at risk due to a 'new funding model' launched in 2013. Half of the 58 countries that have previously received harm reduction funding are now either ineligible for support or have not been assigned any 'new' HIV money.
"We're facing a perfect storm of donor retreat, national neglect and massive overspending on ineffective and often counterproductive drug enforcement," said Susie McLean, senior advisor on drug use and HIV at the International HIV/AIDS Alliance. "But we've identified clear ways forward. We are strong supporters of the Global Fund but it must invest strategically to end the HIV epidemic, in particular among people who use drugs. That demands changes to the new funding model.'"
Bilateral donors such as the UK are also deprioritizing middle income countries, focusing instead on those with the lowest income. However, the study shows that the majority of people who inject drugs - 75% - live in middle-income countries, and that this is the group most affected by HIV in the countries facing cuts.
"The cost effectiveness of harm reduction interventions in preventing new HIV infections is well documented," said Catherine Cook, senior research analyst at Harm Reduction International. "In many middle income countries more than two fifths of new HIV infections are among people who inject drugs. But donors are nonetheless withdrawing due to their middle income status without responsible exit strategies in place."
According to the report, in difficult financial times existing funds need to be spent more strategically. Current resources spent on drug policy should be rebalanced in favour of health and harm reduction. The costs are minimal when compared to the level of funding invested in drug law enforcement and the comparative return on investment of these strategies.
"What we're saying is that the money is available to make real progress in the response to HIV, but too often governments would rather punish people who need support," said Ann Fordham, Executive Director of the International Drug Policy Consortium which coordinates the global Support. Don't Punish campaign. "The figures are clear. A tiny fraction of what is spent on drug enforcement, even a tenth, would cover HIV prevention many times over, save lives and massively reduce future health costs in terms of HIV and hepatitis C infections averted. We must demand more accountability for how funds are spent."