The global HIV response is undergoing profound change, with community-led organisations increasingly bearing the consequences of funding cuts and shifting political priorities. Our latest report brings together findings from INPUD’s global survey, documenting the impact on harm reduction services and on the health, rights and wellbeing of people who use drugs. The findings make it clear that this is no longer solely a financial crisis. It is a crisis affecting health, human rights, dignity and lives.

Eight key messages are drawn from our findings:

1. The health, rights and dignity of people who use drugs are being pushed underground. The emergency is no longer solely a financial one. The downstream harms to the community are also quickly escalating. Today, we are observing the consequences of a year of service disruption, and the crisis is now transitioning to a state of emergency for the rights, dignity and lives of our community.
2. Significant and ongoing disruption to needle and syringe programming (NSP) is setting off our alarm bells. Low threshold access to free sterile injecting equipment provided by needle and syringe programming reduces HIV transmission among people who use drugs by approximately 50% and 76% for hepatitis C infection. Needle and syringe programming is also in many cases, the first point of contact with people who use drugs and because of this, are vital gateways to a breadth of comprehensive health and social support services. The absence of such programming increases the likelihood that community members remain entirely out of reach, allowing epidemics of HIV, HCV, and tuberculosis (TB) to spread unchecked.
3. Drug user community-led organisations/networks are confronting a critical funding gap. Community-led responses can’t exist on volunteerism and goodwill alone, they need to be funded with direct, flexible and predictable funding.
4. The triple hitter: drug user-led harm reduction organisations and networks have been the hardest hit by funding shifts and are on the brink of extinction. Our findings show consecutive funding shocks to be concentrated among the same community-led organisations. The first financial shock was the U.S. withdrawal of its foreign assistance. The second financial shock was the Global Fund’s GC7 reprioritisation process. The triple hitter has been the withdrawal and changing priorities of other donors, including bilateral government programmes, philanthropies, and UN agencies. Relatedly, community participation in decision-making processes has shown no protective effect: closure rates are similar across organisations regardless of whether communities were ‘at the table’ (19% versus 17%).
5. Spoiler alert: we know this story because we’ve been here before. Steep increases in service disruptions are giving way for burgeoning levels of stigma, low access to harm reduction supplies (likely related to the closure of NSPs) combined with higher police surveillance, harassment and punitive legal environments. Each of these occurrences signify crucial factors that drive people into hiding, away from available services and into high-risk settings for HIV transmission and other bloodborne infections. Stark increases in disrupted overdose prevention activities across the two survey periods (30% to 43% respectively) shows that we are witnessing the brewing of another perfect, but preventable, storm.
6. The connection is clear: the shifts in the funding environment are happening in tandem with increased punitive drug policy landscapes. Intensified police presence, raids on hotspots, arbitrary arrests, ICE activity, and harassment of harm-reduction workers are driving our community further underground and making it difficult for our organisations to provide the services needed. Repressions on civic space in many countries are making it a challenging operating environment for community-led organisations, outreach workers, and for the lives and safety of people who use drugs.
7. Women who use drugs are identified as the most impacted group experiencing the greatest reductions in services in addition to the category of people who inject drugs. Further research is urgently needed to better understand the extent to which women, lesbian, gay, bisexual, trans and gender diverse people who use drugs are being affected by this new funding environment, and what health responses are needed.  
8. Advocacy priorities – It is of no surprise that the growing funding gap, the sustainability risks to harm reduction and community-led service delivery, and the safety and security of people who use drugs have risen as the most prominent and urgent concerns of our community today. Financial mechanisms at global, regional and national level must urgently respond in a coordinated manner to prevent service collapse and resultant public health crisis with spiking rates of new HIV/HCV infections and preventable overdose deaths.