IHRA Report - Three cents a day is not enough: resourcing HIV-related harm reduction on a global basis

The report – 3 Cents a Day is Not Enough: Resourcing HIV-related Harm Reduction on a Global Basis – estimates that in 2007 approximately US$160 million was invested in harm reduction in low and middle income countries, of which 90% came from international donors. The figure is almost certainly an over estimate of actual spending on harm reduction services.

To put this into context, US$160 million is similar to the amount spent on President Obama’s Inauguration events. It amounts to US$12.8 per injector per year or 3 cents a day. It falls far short of the UNAIDS estimate of the resources needed for harm reduction – at US$2.13 billion in 2009 and US$3.2 billion in 2010.

The biggest providers and funders in harm reduction commodities are probably drug users themselves. The needles and syringes and the treatment that are needed by people who inject drugs in low and middle income countries are bought mainly with their own “out of pocket” money. This is an unfair burden on a population that lacks resources and is a situation that would be unacceptable in any other medical or public health field.

This report should be read alongside that of Bradley Mathers and colleagues ('HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage', The Lancet, 375, 9719, 1014-1028). They estimate that globally only two sterile needles were available per drug user per month, that for every 100 people who inject drugs around the world only eight were receiving opioid substitution therapy and that for every 100 people who inject drugs living with HIV only four were receiving life saving anti-retroviral treatment. According to Mathers’ study, “the current global response was not sufficient to prevent, halt or turnaround the HIV epidemic among this at-risk population”.

This year, 2010, was supposed to be when universal access to HIV treatment, prevention and care was to be achieved, and the half way mark to achieving the Millennium Development Goals. We are clearly a long way from living up to that commitment.

Current spending is only a small proportion of that required and is nowhere near proportionate to need. More money is needed for harm reduction.