Increasing access to harm reduction services across the African region: Report from the INHSU Policy Day 2025

Background

Harm reduction is a critical component of HIV, viral hepatitis, tuberculosis and overdose prevention. However, coverage across Africa remains low, geographically fragmented, and heavily dependent on external funding.

The scale-up of harm reduction services in the region continues to be constrained by punitive drug laws, limited political will, persistent misconceptions, competing policy priorities, siloed health systems, and the chronic under-resourcing of community-led networks of people who use drugs.

Recent instability in global funding — including shifts affecting the US President’s Emergency Plan for AIDS Relief (PEPFAR) — alongside broader reductions in international development assistance, has further exposed the fragility of harm reduction systems across the region. In this context, there is growing recognition of the need to embed harm reduction within broader public health agendas, strengthen regional leadership, and support context-specific models that can be sustainably scaled.

The 2025 Policy Day was convened alongside the INHSU Conference in Cape Town, South Africa, with the aim of generating concrete and actionable recommendations to advance harm reduction implementation and policy reform.

The meeting sought to:

• Strengthen understanding of progress made in advancing harm reduction across Africa
• Identify and prioritise strategies to overcome key political and operational barriers to scale-up and sustainability
• Support multisectoral collaboration, recognising that meaningful progress requires coordination between community organisations, health authorities, law enforcement, policymakers and funders
• Elevate community leadership as a central component of effective harm reduction responses
• Share case studies to enable cross-country learning and adaptation of effective, context-specific approaches

These objectives were designed to move beyond problem identification and instead focus on practical, achievable pathways to change.