Global State of Harm Reduction - 2021 Update

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

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.

However, the Global AIDS Strategy 2021-2026 gives exceptional urgency to HIV prevention and human rights by calling on governments and donors to significantly increase investments for harm reduction, including delivery by community-led organisations, and to remove policies and laws that prevent people who use drugs from accessing health and harm reduction services. Additionally, the newly adopted Global Fund Strategy 2023 -2028 puts people and communities at the front and centre of its work.

With only nine years left to meet the Sustainable Development Goals,  we need governments and donors to step up and invest in harm reduction services and advocacy that will address inequalities driving poor health outcomes for people who use drugs.

The data presented here has been gathered over the course of 2021 from publicly available sources and in cooperation with our partners around the world. To report any inaccuracies, please contact us at office@hri.global

Country or territory World Bank Income Group (2021) Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid agonist therapy operational At least one drug consumption room Peer distriburion of naloxone OAT in at least one prison NSP in at least one prison
Asia
Afghanistan Low income
Bangladesh Lower middle income
Bhutan Lower middle income
Brunei Darussalam High income
Cambodia Lower middle income
China Upper middle income
Hong Kong High income
India Lower middle income
Indonesia Upper middle income
Japan High income
Laos Lower middle income
Macau High income
Malaysia Upper middle income
Maldives Upper middle income
Mongolia Lower middle income
Myanmar Lower middle income
Nepal Lower middle income
Pakistan Lower middle income
Philippines Lower middle income ✓*
Singapore High income
South Korea High income
Sri Lanka Lower middle income
Taiwan High income
Thailand Upper middle income
Vietnam Lower middle income
Country or territory World Bank Income Group (2021) Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid agonist therapy operational At least one drug consumption room Peer distriburion of naloxone OAT in at least one prison NSP in at least one prison
Eurasia
Albania Upper middle income
Armenia Upper middle income
Azerbaijan Upper middle income
Belarus Upper middle income
Bosnia and Herzegovina Upper middle income
Bulgaria Upper middle income
Croatia High income
Czechia High income
Estonia High income
Georgia Upper middle income
Hungary High income
Kazakhstan Upper middle income
Kosovo Upper middle income
Krygyzstan Lower middle income
Latvia High income
Lithuania High income
Moldova Lower middle income
Montenegro Upper middle income
North Macedonia Upper middle income
Poland High income
Romania High income
Russia Upper middle income
Serbia Upper middle income
Slovakia High income
Slovenia High income
Tajikistan Low income
Turkmenistan Upper middle income
Ukraine Lower middle income
Uzbekistan Lower middle income
Country or territory World Bank Income Group (2021) Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid agonist therapy operational At least one drug consumption room Peer distriburion of naloxone OAT in at least one prison NSP in at least one prison
Latin America and the Caribbean
Argentina Upper middle income
Bolivia Lower middle income
Brazil Upper middle income
Chile High income
Colombia Upper middle income
Costa Rica Upper middle income
Dominican Republic Upper middle income
Ecuador Upper middle income
El Salvador Lower middle income
Guatemala Upper middle income
Guyana Upper middle income
Haiti Low income
Honduras Lower middle income
Jamaica Upper middle income
Mexico Upper middle income
Nicaragua Lower middle income
Panama High income
Paraguay Upper middle income
Peru Upper middle income
Puerto Rico High income
Suriname Upper middle income
The Bahamas High income
Uruguay High income
Venezuela Upper middle income
Country or territory World Bank Income Group (2021) Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid agonist therapy operational At least one drug consumption room Peer distriburion of naloxone OAT in at least one prison NSP in at least one prison
Middle East and North Africa
Algeria Lower middle income
Bahrain High income
Egypt Lower middle income
Iran Upper middle income
Iraq Upper middle income
Israel High income
Jordan Upper middle income
Kuwait High income
Lebanon Upper middle income
Libya Upper middle income
Morocco Lower middle income
Oman High income
Palestine Lower middle income
Qatar High income
Saudi Arabia High income
Syria Low income
Tunisia Lower middle income ✓*
United Arab Emirates High income
Yemen Low income
Country or territory World Bank Income Group (2021) Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid agonist therapy operational At least one drug consumption room Peer distriburion of naloxone OAT in at least one prison NSP in at least one prison
North America
Canada High income
United States High income
Country or territory World Bank Income Group (2021) Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid agonist therapy operational At least one drug consumption room Peer distriburion of naloxone OAT in at least one prison NSP in at least one prison
Oceania
Australia High income
Fiji Upper middle income
Kiribati Lower middle income
Marshall Islands Upper middle income
Micronesia Lower middle income
New Zealand High income
Palau High income
Papua New Guinea Lower middle income
Samoa Upper middle income
Solomon Islands Lower middle income
Tonga Upper middle income
Vanuatu Lower middle income
Country or territory World Bank Income Group (2021) Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid agonist therapy operational At least one drug consumption room Peer distriburion of naloxone OAT in at least one prison NSP in at least one prison
Sub-Saharan Africa
Angola Lower middle income
Benin Lower middle income
Burkina Faso Low income
Burundi Low income
Cameroon Lower middle income
Cape Verde Lower middle income
Central African Republic Low income
Chad Low income
Côte d’Ivoire Lower middle income ✓*
Democratic Republic of the Congo (DRC) Low income
Djibouti Lower middle income
Ethiopia Low income
Gabon Upper middle income
Gambia Low income
Ghana Lower middle income
Guinea Low income
Kenya Lower middle income
Lesotho Lower middle income
Liberia Low income
Madagascar Low income
Malawi Low income
Mali Low income
Mauritius High income
Mozambique Low income
Niger Low income
Nigeria Lower middle income
Rwanda Low income
Senegal Lower middle income
Seychelles High income
Sierra Leone Low income ✓*
Somalia Low income
South Africa Upper middle income
Tanzania Lower middle income
Tanzania (Zanzibar) Lower middle income
Togo Low income
Uganda Low income
Zambia Lower middle income
Zimbabwe Lower middle income ✓*
Country or territory World Bank Income Group (2021) Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid agonist therapy operational At least one drug consumption room Peer distriburion of naloxone OAT in at least one prison NSP in at least one prison
Western Europe
Andorra High income nk nk nk nk nk nk
Austria High income
Belgium High income
Cyprus High income
Denmark High income
Finland High income
France High income
Germany High income
Greece High income
Iceland High income
Ireland High income
Italy High income
Luxembourg High income
Malta High income
Monaco High income nk nk nk nk nk nk
Netherlands High income
Norway High income
Portugal High income
San Marino High income nk nk nk nk nk nk
Spain High income
Sweden High income
Switzerland High income
Turkey Upper middle income
United Kingdom High income

* National Strategy expired but no new has been identified

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