Fourteen months after the withdrawal of U.S. foreign assistance, this report examines the escalating impact of funding cuts on harm reduction and community-led services worldwide. Based on a global survey, it documents worsening financial instability, widespread service disruptions, and reduced access to HIV, hepatitis C, and overdose prevention. It also highlights how increasingly punitive policy environments are driving people who use drugs further from essential services and calls for urgent, sustained investment in community-led harm reduction.

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