Harm reduction interventions for people who use drugs—such as needle and syringe programmes (NSP) and opioid substitution therapy (OST)—are cost-effective, protect against HIV and hepatitis C, and save lives. Despite the potential for these interventions to contribute to healthier communities, funding for harm reduction in low-and middle-income countries (LMICs) has flat-lined over the past decade. In 2016, US$188 million was allocated – the same amount as in 2007 and just 13% of the US$1.5 billion that UNAIDS estimates is required for an effective response in LMICs. Beneath this enormous funding shortfall are disturbing trends. International donor funding, which comprises the majority of harm reduction funding in LMICs, is declining. Donor governments are withdrawing direct funding to countries for harm reduction on the basis that it is being channelled through multilateral institutions like the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). Yet, Global Fund support for harm reduction may be decreasing, with data suggesting allocations in 2016 are 18% lower than those in 2011. Simply put, the lives of people who use drugs are being neglected.