When funding disappears, a harm reduction programme does not simply lose a budget line.
It loses people I know by name.
It loses the peer worker who knows exactly whom to call when someone is too afraid to walk into a clinic alone. It loses the community organiser who has spent years building trust for a woman who uses drugs to finally disclose violence. It loses the support group that was never funded as “core service”, but was the only reason many people like me kept coming back.
These losses aren’t clear in a grant report, nor are they explained through data sheets.
I know this because I have lived on both sides of the harm reduction movement. I have used drugs and been criminalised. I have lived with HIV since 2002. Since 2005, I have also worked in harm reduction in Indonesia, including inside a prison and alongside women and people of diverse genders who use drugs.
For people like me, harm reduction has never been only about a service delivered within working hours. It has been about whether somebody picks up the phone. Whether someone walks with us to a health facility. Whether someone explains our rights in a language we understand, listens without judging, or helps us find a way through a crisis that no programme manual anticipated. That work is under pressure. And it is breaking.
The disruption of global aid, accelerated by the near-total American withdrawal from international aid, may be just an abstract headline for many. But, for myself and my community, it was the end of careers and support networks. It’s the reason why wait times for services became longer, or why people stopped coming at all.
According to UNAIDS, international resources for HIV programmes in low- and middle-income countries fell by 18% between 2024 and 2025. Community-led systems were among those most disrupted when international funding was withdrawn. But long before aid defunding, harm reduction was already underfunded. A 2024 briefing from Harm Reduction International (HRI) noted that global harm reduction funding only amounted to about 6% of what was actually needed. Global defunding has only worsened the situation: community surveys highlight how changing funding streams and priorities for remaining donors have pushed drug user networks underground and critically disrupted long-standing HIV care, needle and syringe programmes, and more. Women, trans people, and gender-diverse people who use drugs were, and remain, as some of the most underserved groups in this uncertain phase.
HRI and Rumah Cemara outlined the impacts of US and Global Fund aid defunding in Indonesia in a 2025 report, underscoring its impact on civil society organisations working with people who use drugs. Beyond the numbers, I live this reality on the ground. Some organisations stopped recruiting outreach and peer workers, doubling the workload of the remaining staff. Peer support groups and study clubs, that offered learning and psychosocial support, were reduced or cancelled.
While the organisations kept working on paper, their day to day was radically altered. A woman may still be able to get sterile injecting equipment or HIV medication at a health facility. But what happens when the person who used to accompany her there no longer has funding to do that work? What happens when one outreach worker has twice as many people to support, and half the time to do it? What happens when there is no money left for the meeting where women can talk about violence, sexuality, parenting, relationships, or simply how they survived the week?
Trauma doesn’t follow funding cycles
It is within this aspect that the end of long-term funding and support for organisations, and a shift towards short-term project-based funding has hit the hardest.
Projects are designed to have beginnings and endings. They need indicators of success, clear, and clear deliverables. Those things are not inherently bad. But life is not organised around grant cycles.
Trauma does not follow a workplan. Trauma does not follow funding cycles. Violence does not wait until the next round of applications. Trust takes years to build.
And people who use drugs do not become less vulnerable once a project has reached its final reporting date.
Yet community-led organisations like SPINN (Suar Perempuan Lingkar Napza Nusantara), where I work, are expected to respond to these long-term realities through short-term projects while spending more time writing proposals than working directly with people. In the end, this means civil society is trying to solve chronic issues through temporary funding.
I have seen how much harm reduction depends on labour that does not fit neatly into a budget: a peer worker calling someone late at night after an overdose to make sure they’re alive; a woman accompanying another woman to a police station to report violence, because she knows the system will not believe her alone; a support group where meetings run over time so that everyone has a chance to be heard without judgement or pathologisation.
These are not just “extras”. They are key moments of contact that keep people alive, well, and understood.
Direct support for women and lived experience
For women who use drugs, the gaps are even sharper. Women who use drugs already face the combined effects of gender stigma, drug criminalisation, violence, and exclusion from health services. women are underrepresented in treatment services, with only about one in five people receiving treatment for drug dependence being women. The UN High Commissioner for Human Rights Office has also recognised how women are exposed to heightened sexual violence, torture and coercion when arrested for drug crimes by those detaining them. Funding specifically for women, trans people, and gender-diverse people who use drugs to organise themselves remains extremely limited.
When funding disappears, the care does not disappear. It is redistributed and often absorbed by women like me.
We take on more emotional labour: more calls, more support, more secrets, more private tears so we can show up strong in public.
This is why I believe drug policy is a feminist issue.
It is also why I believe lived experience is political knowledge.
People who have lived through criminalisation understand things that cannot always be captured by programme indicators. We know which streets people are afraid to walk down, why someone may refuse a service, and how stigma changes the way a person asks for help.
But lived experience is often invited into the room only as testimony – where we retell our stories, join consultations and panels, but rarely asked to lead and design on things that will directly impact our lives.
Piling on more work
Indonesia should not simply be understood as a place waiting to receive lessons from better-funded harm reduction systems elsewhere. Global South communities have operated under constant funding precarity for decades. We have developed peer networks, informal care systems, and community leadership to navigate this environment because formal systems have repeatedly failed to reach everyone.
But our resilience should not become an excuse to continue underfunding our work. We should not be praised for “doing more with less” as a standard operating practice, with more workload critical to our survival simply piled on.
If donors want harm reduction to survive the current funding crisis, they need to think beyond individual projects.
That means supporting core organisational infrastructure. It means longer funding cycles. It means paying peer workers properly, including women and people of diverse genders who do so much of this work. It means resourcing community-led organisations not only to deliver services, but also to organise, advocate, rest, learn, and build political power.
Most importantly, it means recognising that the relationships holding harm reduction together are not incidental to the work. They are the work.
If we continue funding the project while leaving the people and relationships behind it unfunded, there will be nothing left for the project to stand on. It will not be a budget line that disappears. It will be people I know.
