Despite the limited data on the continent’s addicts who inject drugs, new research shows that this practice is growing in East Africa and is associated with concentrated outbreaks of HIV and hepatitis C.

This is according to a 2016 report in the International Journal of Drug Policy.

It says that after Mauritius, the first African countries to adopt and implement policies to reduce the harm done by needle-injected drugs were Tanzania and Kenya.

But it notes that Mauritius is still the only country in the region to have introduced these policies into national legislation, despite the use of injectable drugs being reported in “28 African countries, with increasing evidence of linked HIV epidemics”.

An estimated 13% of the 12.7 million people who inject drugs globally are HIV infected and higher rates of injecting drug users in a community is typically followed by “an exponential increase in HIV transmission”, according to the 2015 United Nations World Drug Report.

This week the UN General Assembly is holding a special session about the “war on drugs” at their New York headquarters. Members are discussing whether the policy approach to narcotic drugs should change as punitive measures have aided dangerous black markets around the world. 

Many global bodies are advocating for a more public-health centred approach to international drug policy focusing on “prevention of drug use and reduction of vulnerability and risk; treatment and care of people with drug use disorders” and “prevention and management of the harms related to drug use”, according to the World Health Organisation, which is participating in the session.

Harm Reduction International, a global organisation affiliated to the UN, says that countries are increasingly implementing initiatives to “reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop”, instead of punitive methods that often prevent users from going to health services.

Methadone therapy and needle exchanges
Over the past decade, the “commitment of the top political leadership to harm reduction” in Mauritius has “led to a major paradigm shift in policy”, particularly for drug users in prisons, according to the report.

Between 2009 and 2013, the HIV prevalence among Mauritian prisoners who inject drugs more than halved – from 40% to 18.5%.

“To date, of an estimate of 10 000 [people who inject drugs] in the country, 5 570 are receiving [opioid substitution therapy] and 2 300 are receiving [needle exchange] services, thus giving a harm reduction coverage of 78%,” notes the report.

Only seven other sub-Saharan African nations have at least one needle exchange or substitution therapy programme: Kenya, Madagascar, Nigeria, the Seychelles, South Africa, Tanzania and Zanzibar.

Chris Beyrer, president of the International Aids Society, says that Tanzania was the first to implement opioid substitution therapy where addicts are given methadone that mimics the effects of their injectable drugs but allows them to function.

He notes that Kenya “has done extremely well with introducing needle exchange programmes”.

According to a 2013 study published in the Journal of the Association of Nurses in Aids Care, “HIV transmission through blood exposure is up to 100 times higher than from sexual contact” – sharing needles exponentially increases one’s risk of contracting the virus.

“Syringe exchange programmes not only help to prevent users contracting infections like HIV, but they also keep dirty and dangerous equipment off playgrounds and streets – so everybody benefits,” says Beyrer.

Preventing new HIV infections
According to the 2016 report, needle exchange programmes introduced in Kenya’s capital city of Nairobi in 2013 reach up to 20% of the estimated 10 000 injecting drug users. As of 2015, opioid substitution treatment is available to 400 of the city’s users, about 15% of whom are HIV positive.

The research notes that if there is a 60% “reduction in the unmet need” of these two interventions combined with access to HIV medication, 30% of new HIV infections could be avoided.

Harm reduction policies on the continent focus particularly on preventing HIV and hepatitis C infection, “contextualised by longer-standing and broader concerns linked to indicators of growing drug markets, especially of heroin in the East African countries of Kenya and Tanzania”, notes the report.

Beyrer says the Kenyan government rejected the idea of helping illicit drug users only a few years ago, but that the perception has changed significantly – largely a result of civil society’s involvement.

Tanzania started introducing harm reduction services in 2011, according to Beyrer, but the country has only limited programmes. “These are usually restricted to the largest commercial city Dar es Salaam, so those in outlying areas are largely not being reached,” he says.

He says that Tanzania’s context is especially interesting because it was largely the advocacy from drug users themselves that “raised the harm reduction profile” and “overcame the initial resistance from stakeholders in government”.

Through the organisation Tanzanian Network of People Who Use Drugs – a public campaign in communities and on social media platforms – he says “people are surprisingly aware about the risks and solutions available, compared to elsewhere on the continent”.

But negative attitudes among police and health workers, which he terms “addictaphobia”, remain a barrier to these services around the world.

“Drug users live on the edge of society where people want to do things to them and not with them. Our experience is that if you reach out to drug users and provide services to them in a safe and nonjudgmental way, they are very eager and willing participants.”

The perception that drug users don’t care about their health “is just not true”, says Beyrer. “If they are given access to safer approaches, they will take them and they will use them. Starting with healthcare providers, humane treatment can make a world of difference.”

drug abuseharm reductioninjecting drug users