The human cost of policy shifts: The fallout of US foreign aid cuts on harm reduction programming and people who use drugs
7 April 2025
The impact of US foreign aid cuts on the health and well-being of people who use drugs has been massive and monumental. The International Network of People who Use Drugs (INPUD) is conducting a rapid assessment to understand the depth and breadth of this impact. Over the course of 5 days, INPUD received 76 responses to its online survey evaluating the real-time consequences of these new US policy directives on the lives of people who use drugs and their service providers. Preliminary findings highlight:
- The severity of funding cuts have “cut harm reduction services at the knees”, gutting the organisational capacity of community-led service provision, forcing service disruptions, closures and mass lay-offs of harm reduction’s essential workforce (i.e., peer educators, outreach personnel, clinic staff).
- Evidence-based harm reduction models are at-risk: Harm reduction is founded on strong peer-led front-line service delivery, such as outreach, peer education, and community leadership and engagement. Without peer-driven harm reduction services, the entire harm reduction model and its systemic infrastructure is placed at significant risk.
- Sustainability is bleak for rights-based harm reduction models that have proven effective in the fight against HIV and hepatitis C: The collapse of harm reduction services will have direct human impact, meaning a return to raging HIV, hepatitis C and overdose epidemics among people who use drugs globally.
The following recommendations are based on INPUD’s preliminary findings presented below:
- Alternative pooled funding mechanisms must be urgently established by global partners to prevent service collapse and resultant spiking rates of new HIV/HCV infections, and preventable overdose deaths.
- National governments must step up to support harm reduction services previously reliant on U.S. funding, including equitable access to opioid agonist treatment (OAT) and social contracting arrangements that prioritise community-led responses.
- International and multilateral organizations must prioritize emergency resource allocation to affected programs and key populations, including for people who use drugs.
- Advocacy efforts must be intensified to restore funding and highlight the long-term public health consequences of these directives.