The Global Fund to Fight AIDS, Tuberculosis and Malaria's investments in harm reduction through the rounds-based funding model (2002-2014).
BACKGROUND
Harm reduction is an evidence-based, effective response to HIV transmission and other harms faced by people who inject drugs, and is explicitly supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria. In spite of this, people who inject drugs continue to have poor and inequitable access to these services and face widespread stigma and discrimination. In 2013, the Global Fund launched a new funding model-signalling the end of the previous rounds-based model that had operated since its founding in 2002. This study updates previous analyses to assess Global Fund investments in harm reduction interventions for the duration of the rounds-based model, from 2002 to 2014.


METHODS
Global Fund HIV and TB/HIV grant documents from 2002 to 2014 were reviewed to identify grants that contained activities for people who inject drugs. Data were collected from detailed grant budgets, and relevant budget lines were recorded and analysed to determine the resources allocated to different interventions that were specifically targeted at people who inject drugs.


RESULTS
151 grants for 58 countries, plus one regional proposal, contained activities targeting people who inject drugs-for a total investment of US$ 620 million. Two-thirds of this budgeted amount was for interventions in the "comprehensive package" defined by the United Nations. 91% of the identified amount was for Eastern Europe and Asia.


CONCLUSIONS
This study represents an updated, comprehensive assessment of Global Fund investments in harm reduction from its founding (2002) until the start of the new funding model (2014). It also highlights the overall shortfall of harm reduction funding, with the estimated global need being US$ 2.3 billion for harm reduction in 2015 alone. Using this baseline, the Global Fund must carefully monitor its new funding model and ensure that investments in harm reduction are maintained or scaled-up. There are widespread concerns regarding the withdrawal from middle-income countries where harm reduction remains essential and unfunded through other sources: for example, 15% of the identified investments were for countries which are now ineligible for Global Fund support.
International Drug Policy Consortium, United Kingdom. Electronic address: jbridge@idpc.net.
Jamie
J
Bridge
King's College London, United Kingdom.
Benjamin M
BM
Hunter
International Network of People Who Use Drugs, United Kingdom.
Eliot
E
Albers
Harm Reduction International, United Kingdom.
Catherine
C
Cook
The Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland.
Mauro
M
Guarinieri
CHIP, Rigshospitalet, University of Copenhagen, Denmark.
Jeffrey V
JV
Lazarus
amfAR, The Foundation for AIDS Research, United States.
Jack
J
MacAllister
International HIV/AIDS Alliance, United Kingdom.
Susie
S
McLean
Open Society Foundations, United States.
Daniel
D
Wolfe
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control*; D005381:Financing, Organized / Q000191:economics*; D014943:Global Health / Q000191:economics; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D040261:Harm Reduction; D006801:Humans; D007391:International Cooperation; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D018803:Models, Economic; D040841:Resource Allocation / Q000191:economics; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control*
HIV; Harm reduction; Investment tracking; People who inject drugs; The Global Fund