People who use drugs are stigmatised, discriminated against and criminalised in almost every country in the world. Too often, this translates into a lack of political will to invest in and implement life-saving harm reduction services. The 2021 update to the key data in the Global State of Harm Reduction, found that the spread of harm reduction services continues to stall globally - a trend we have observed since 2012. 

Findings

• In 2021, the total number of countries implementing needle and syringe programmes (NSP) has increased by just one, from 86 to 87. The new country is Uganda.
• Two new countries (Uganda and Mozambique) have begun implementing opioid agonist therapy (OAT) programmes since 2020. The total number of countries implementing OAT in 2021 is 86 (up from 84 in 2020).
• There were no reports of countries ceasing implementation of NSP, OAT, peer distribution of naloxone or shutting down drug consumption rooms.
• New search strategies identified an additional 11 countries with explicit supportive references to harm reduction in national policy documents. The total number in 2021 is 98.

The findings reflect the 95% funding gap for harm reduction in low-and middle-income countries.  Rising new HIV infections among key populations, including among people who inject drugs, disruptions in HIV prevention programmes and services caused by the COVID-19 pandemic and ongoing human rights violations that prevent people from accessing services mean that we need urgent investment in harm reduction and HIV prevention. The concurrent economic downturn caused by the pandemic and shrinking donor investments in the HIV response have resulted in an unprecedented challenge in meeting the goal of ending AIDS by 2030.