As the Harm Reduction International Conference (HR25) in Bogotá, Colombia, ended on April 30, delegates could reflect on some reasons for optimism, as well as severe challenges and uncertainty facing the global movement.
The event took place weeks after the host nation—where the government is pursuing reform—had achieved a significant international victory, with positive implications for future global drug policy.
In March—at the 68th session of the Commission on Narcotic Drugs in Vienna, Austria—Colombia proposed a resolution calling for an independent, external review of drug treaties. The resolution passed with 30 affirmative votes, 18 abstentions and three rejections—from Argentina, Russia and the United States.
The resulting review will conclude with a series of policy recommendations made by 19 interdisciplinary experts evaluating the effectiveness of current UN drug policy, which underpins worldwide prohibition.
“This is a sign that the global debate on drugs has gone into a new phase. A phase that values accountability more than silence, and progress more than inertia,” said Laura Gil, ambassador-at-large for Colombia’s Global Drug Policy, in her plenary speech at HR25.
Gil’s work focuses on gender equity, environmental justice and human rights. Her work in Vienna was applauded throughout the conference as a step toward what delegates described as “evidence-based, people-centered drug policy reform”—and an example of strong leadership from the Global South.
“We have seen there is a crop of leaders who are coming from the Global South.”
“It is time for the people who use drugs to take leadership,” Ahmed Said told Filter at the conference. Said, from Kenya, represents the African Network of People who Use Drugs (AfricaNPUD) and identifies as a person who uses drugs himself.
“We have seen there is a crop of leaders who are coming from the Global South, and we also have a crop of leaders from the Global North who come from the community of people who use drugs and really complement the effort,” he said.
Yet at the same time, in many places, “exclusionary ideologies are gaining ground,” as Shaun Shelly, executive director of HR25 organizer Harm Reduction International, noted at the conference.
One element of the threat this poses, felt directly by many of those present, concerns funding for harm reduction work.
Large harm reduction projects in the Global South are often internationally funded. The Trump administration’s decimation of the US Agency for International Development (USAID) has already impacted access to HIV services in countries like South Africa.
“We’ve been hit hard, and currently America and South Africa aren’t seeing eye-to-eye,” Klaas Melusi Mtshweni, of the South African Network for People who Use Drugs, told Filter. He expects the worst is yet to come, with ramifications far into the future when “research has been unfunded by the US in South Africa.”
“USAID was providing about 17 percent of the HIV response in South Africa and mostly covering rural areas, covering doctors and some facilities,” Mtshweni explained. Since the US cuts, “We’ve lost about 23,000 staff members that were seeing clients. Some clinics have closed. But the most hit are the NGOs, the organizations on the ground that are mobilizing communities, that are doing … testing, tracing. We have about 150 organizations that have closed.”
Funding often goes to larger organizations that do not “understand how that community operates, and are not able to meet that community’s needs in an effective way.”
Lack of financial support is a ubiquitous problem for community-led organizations, in particular—something that often reflects the choices made by those awarding scarce funding.
Sex worker activist Claire Macon, who is the overdose prevention center manager for Project Weber/Renew in Rhode Island, told Filter that small organizations created and led by people with lived experience often struggle to access the same financial support as larger organizations. She spoke of small organizations being overlooked because funding “is going to a ‘rescue’ organization that is not from that community.”
Claire Macon (right) with Julianna Brown, MD, of Decrim305 and Idea Exchange. The two presented collaboratively on sex worker-led harm reduction.
When funding is allocated to harm reduction, Macon continued, it often goes to larger organizations that are not created by the people most impacted, and which do not “understand how that community operates, and are not able to meet that community’s needs in an effective way.”
“We are not taken into account when public policies are being built.”
The need to support initiatives led by people with lived experience, with the awareness they bring to intersecting needs, was a central message throughout HR25—including centering Indigenous-led initiatives.
“We are not taken into account when public policies are being built,” said Luz Mery Panche Chocué, an Indigenous leader from Colombia’s Amazonian territory of Caquetá, in her plenary speech. Saying that Indigenous communities have begun to work their way into participating in policy spaces, she continued that, “if we are going to talk about experts, then really the experts in the care of the Amazon rainforest are the native peoples [translated from Spanish].”
Luz Mery Panche Chocué giving her speech at HR25
“When we talk about peace and justice in relation to drug policy,” said Dandara Rudsan of the Black Initiative for a New Drug Policy in Brazil (pictured top), in her plenary address, “we must directly face the truth that it will not be possible to achieve a state of peace and justice without guaranteeing the right to land, without agrarian reform, and without the direct participation of traditional communities and peoples in the development of policies [translated from Portuguese].”
“It’s time now [for people who use drugs] to be presented as partners in the field of harm reduction,” Said told Filter. “If you present us as partners, you attract possibility, you attract resources. If you represent us like a patient, you attract punishment and you attract vulnerability, and you attract the stereotyping part of it.”
“People who use drugs are no longer sick people,” he emphasized. “They are just partners. They are just equal leaders that can lead. They can lead the movement. They can work with other stakeholders with different expertise.”
All photographs by Anna Wilcox