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In their recent review, O'Keefe et al. (2017) describe the ways in which people who inject drugs (PWID) in low- and middle-income countries (LMICs) are confronted with particular challenges compared to PWID in upper-middle-income countries, including the increased risk of HIV and hepatitis C, greater stigma and discrimination, and greater interaction with the justice system.1 To help manage the HIV burden among PWID and to help strengthen the public health responses to injecting drug use, LMICs have relied on substantial funding from international donors (PEPFAR, World Bank, DFID, and Global Fund). However, as the economies of LMICs have progressed,many donors have begun to withdraw funding for HIV prevention and harm reduction initiatives.