People Who Inject Drugs and AIDS

"The use of punitive laws against people who inject drugs and the scarcity of harm reduction services continues to expose these people to a very high risk of acquiring HIV. In 2025, only 29 of 181 countries with available data did not criminalize the possession of small amounts of drugs (18). The risk of acquiring HIV drops sharply when drug use and possession for personal use are decriminalized and when people can access effective harm reduction services (72, 73).¹⁵ This is evident in the Kingdom of the Netherlands and Switzerland, for example, where fewer than 10 people in each country acquired HIV through injecting drug use annually in 2013–2022 (75).

"Generally, however, the estimated 13.9 million [10.2 million–19.9 million] people who inject drugs around the world continue to be left behind in HIV programmes, with women who inject drugs especially neglected (76). Globally in 2024, a median of only 39% of people who inject drugs received at least two prevention services in the past three months (22 reporting countries). Women who inject drugs find it particularly difficult to access harm reduction services (76), due to stigma, genderbased violence, and generalized fear, shame and exclusion (77).

"Only two of 25 reporting countries have achieved the 2025 United Nations recommended levels of coverage for opioid agonist maintenance therapy, and only two of 32 countries have achieved the United Nations targets for needle and syringe distribution. No country has reported to have met both of these targets (Figure 3.13). Of 35 reporting countries, 13 have reached the safe injecting targets (90% using sterile equipment at last injection).¹⁶

"These harm reduction programmes are even rarer for people in prisons and other closed settings, despite ample evidence of injecting drug use in such settings. Between 2017 and 2024, nine of 133 countries reported that needle–syringe programmes in prisons were operational in the country and 28 of 132 countries reported opioid agonist maintenance therapy programmes operated in at least one prison.

"With more than three-quarters of funding for harm reduction coming from international donors, these few services are in danger of closing down— for example, PEPFAR supported opioid agonist maintenance therapy for 27,000 people in seven countries and harm reduction programmes in three countries. These programmes are highly vulnerable to donor funding cuts, since host countries often lack the political will to finance harm reduction services from national budgets."