How to end AIDS by 2030 for people who inject drugs: modelling the impact of redirecting resources from drug law enforcement to health and harm reduction

David P. Wilson, Sherrie L. Kelly, Xiao F. Yap, Cliff C. Kerr, Robyn M. Stuart, Rick Lines, Catherine Cook

Background:
Funding for harm reduction is critically low in many parts of the world. Harm reduction international’s ’10 by 20’ campaign calls for a redirection of funding from drug law enforcement, arguing that just 10% (by 2020) of the estimated USD 100 billion spent annually on drug control would meet the global need for harm reduction.

Methods:
The Optima HIV model was applied to model HIV epidemics among people who inject drugs (PWID) in six different world regions, using HIV prevalence and PWID population data for every country. The regional models were then aggregated to produce a global model of HIV among PWID. The regional models and aggregate model were used to project epidemiological trends associated with continuation of the status quo compared with shifts in intervention coverage related to changes in assumed funding available for harm reduction. Harm reduction interventions included were NSP, OST and ART.

Results:
A redirection of just 2.5% (USD 2.66 billion) of the global resources spent on punitive control measures against people who use drugs could bring harm reduction to medium coverage levels as defined by UN guidance. This could result in a 78% reduction in new HIV infections among PWID by 2030 and a 65% drop in HIV-related deaths. Investments of 7.5% of global drug control spending would have even greater potential and could secure high levels of harm reduction coverage in all countries. By 2030 this would result in reductions of up to 95% in both new HIV infections and HIV-related deaths among PWID.

Conclusion:
Sustainable harm reduction funding requires support from national governments but this does not require new funds, rather a reallocation of existing resources from ineffective and often harmful approaches to proven, cost-effective interventions. Small shifts in the allocation of existing resources could virtually eliminate HIV among PWID by 2030.