Over the last decade, the Global Fund has played a unique and indispensable role in responding to the HIV epidemic among people who use drugs in Eastern Europe and Central Asia (EECA). From 2002 to 2009, it approved $263 million for harm reduction in EECA alone—more than all other international sources combined.  The Global Fund made important investments in capacity building and advocacy efforts by civil society, but this work is far from complete; more, not fewer, funds are needed to build harm reduction capacity and political support, critical components in establishing sustainability. EECA, which is home to a fast-growing HIV epidemic concentrated among people who inject drugs (PWID), has already been affected and in the near future will be hit particularly hard by the recent Global Fund changes – please see Quitting While Not Ahead for details.  The Global Fund’s decisions to reduce funding availability based on country income level ignores the fact that income is not the determining factor for the availability of HIV services for PWID; rather, the decisive factor is political will.  This is the wrong time for the Global Fund to reduce support for the HIV response in EECA, stepping away from sustainability and advocacy efforts on behalf of harm reduction. The need to protect harm reduction services from ideologically driven attacks and laws that directly or indirectly criminalize people who inject drugs makes it imperative to do more and better on critical enablers of harm reduction in the region.

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