Temitope Salami is the Project Coordinator and Researcher in the Public Health and Social Policy team, working primarily on the Global State of Harm Reduction 2022 report. Prior to joining HRI, he served as a Research and Support Officer at Migrant Action, an organisation based in Leeds, United Kingdom (UK)

Background:
Since 2008, the Global State of Harm Reduction report has mapped the global harm reduction (HR) response, covering a range of health and social services for people who inject drugs. The biennial report has become a key publication for researchers, policymakers, UN agencies and advocates, mapping HR implementation globally.
Methods:
Data was gathered using an online expert survey with closed and open questions between April and September 2022. Researchers invited stakeholders from HR organisations, academic institutions and networks of people who use drugs to respond. Survey data was supplemented by a review of academic and grey literature. Researchers familiar with the regions analysed data to identify developments in policy and implementation. Regional chapters were reviewed by regional experts including representatives of regional networks of people who use drugs.
Results:
There were 193 survey responses from 87 countries across nine regions (Asia, Eastern and Southern Africa, Eurasia, Latin America and the Caribbean (LAC), Middle East and North Africa (MENA), North America, Oceania, West and Central Africa, and Western Europe). For the first time since 2014, the number of countries implementing key HR services increased. Compared with 2020, five additional countries implemented needle and syringe programmes; four new countries opened drug consumption rooms; and three countries introduced opioid agonist therapy. However, coverage and scale of HR services remain limited and access in unequal within and between regions.
Discussion
HR services were disrupted by the COVID-19 pandemic and other humanitarian crises. Nevertheless, community and civil society organisations adapted service delivery to ensure continued accessibility of HR services. Despite some progress, the HR response remains inadequate, particularly for women, LGBTQ+ people, and Black, Brown and Indigenous people. Funding falls short of need in low and middle income countries and fundamental changes are required to fill the resourcing gap left by donor retreat.