Why HIV prevention efforts may falter without sustainable harm reduction funding

By

Pharm. Melody Okereke

For more than two decades, the global fight against HIV has recorded remarkable progress. Millions of people now have access to life-saving antiretroviral treatment. New prevention tools such as pre-exposure prophylaxis (PrEP), improved testing services and viral load monitoring have transformed HIV care and helped reduce new infections in many countries.

Yet beneath these achievements lies a growing challenge that receives far less attention: the sustainability of funding for harm reduction programmes.

Harm reduction refers to a range of services designed to reduce the health risks associated with drug use. These include needle and syringe programmes, opioid substitution therapy, overdose prevention services and peer-led community outreach. Such interventions have been proven to reduce HIV transmission and improve access to healthcare among vulnerable populations.

Despite their importance, many harm reduction programmes in low- and middle-income countries remain heavily dependent on international donors and development partners. In many cases, they operate outside national health financing systems, making them vulnerable to funding cuts, donor transitions and shifting global priorities.

The consequences are often felt at the community level.

When funding becomes uncertain, outreach activities may be scaled down, peer educators may be unable to continue their work and support services may become inconsistent. For populations already facing stigma, discrimination and barriers to healthcare, even temporary disruptions can have lasting effects.

Unlike one-time interventions, harm reduction programmes rely on continuous engagement. Trust is built gradually through repeated contact between community workers and vulnerable groups. When these relationships are interrupted, service uptake often declines, referral systems weaken and opportunities for HIV prevention may be lost.

This challenge is becoming increasingly important as patterns of drug use continue to evolve.

Across many countries, including parts of Africa, younger people are being exposed to more complex drug-use environments shaped by synthetic substances, informal drug markets, economic hardship and social influences amplified through digital platforms. Public health responses must adapt to these changing realities, but financing mechanisms often remain tied to short-term projects and donor funding cycles.

As a result, many community-based organisations spend significant time seeking grants and meeting donor requirements instead of investing in long-term programme development, workforce training and service innovation.

This situation is particularly concerning because community-led organisations remain among the most effective actors in HIV prevention. Their close connection to local communities enables them to reach people who may be reluctant to seek care through conventional health facilities. In many settings, peer educators and outreach workers serve as the critical bridge between vulnerable populations and formal healthcare services.

Yet these organisations often operate with limited financial security.

Another obstacle is the political sensitivity surrounding harm reduction in many countries. Drug use remains heavily criminalised and highly stigmatised, making governments reluctant to allocate domestic resources to interventions that may be misunderstood or viewed as controversial.

The result is a dependency on external funding for services that are essential to public health.

This arrangement is difficult to sustain in the long term. No health programme can achieve lasting stability when financing depends largely on external partners while implementation responsibilities rest with local organisations and communities.

Over time, the effects become evident through workforce burnout, inconsistent service coverage, weakened monitoring systems and reduced continuity of care.

Scientific innovation alone cannot solve these challenges. Advances in HIV treatment and prevention are important, but they cannot fully compensate for weak community delivery systems. Even the most effective biomedical tools require strong, accessible and trusted programmes to reach the people who need them most.

The future success of HIV prevention efforts will depend not only on new technologies and medicines but also on the strength of the systems that support their delivery.

For this reason, health experts are increasingly calling for greater integration of harm reduction services into national health systems. Sustainable domestic financing, stronger support for community-led organisations and long-term planning are essential to maintaining progress against HIV.

The evidence supporting harm reduction has existed for decades. What remains uncertain is whether financing systems will evolve quickly enough to protect these services and ensure they remain available to the populations that depend on them.

As countries work towards ending HIV as a public health threat, strengthening the financial foundations of harm reduction programmes may prove just as important as the next scientific breakthrough.

• Melody Okereke is a pharmacist and implementation science researcher with expertise in HIV programming, harm reduction and health policy analysis.