Substance use and abuse are important factors in the spread of HIV; alcohol and other drugs can lower a person’s inhibitions and create risk factors for transmission. (Reuters)

Drug users run the risk of HIV transmissions

Ina Skosana
More harm reduction policies and programmes will help reduce dangers of practices such as sharing dirty needles and ‘flashblooding’.

An increase in the use of injected drugs, such as heroin, is putting drug users at risk of contracting HIV and other communicable diseases in sub-Saharan Africa.

New patterns of injected drug use in sub-Saharan Africa call for an increase in preventative efforts among this population which is at risk of HIV infection, according to a report by the United Kingdom-based nongovernmental organisation, Harm Reduction International (HRI).

The Centres for Disease Control and Prevention in the United States states that "substance use and abuse are important factors in the spread of HIV. Alcohol and other drugs can lower a person’s inhibitions and create risk factors for HIV transmission."

HRI said in its Global State of Harm Reduction report, released on Tuesday, that although injected drug use has been documented in more than 150 countries, it is difficult to establish an accurate number for people who inject drugs. Globally, this form of drug consumption is estimated to be between 8.9-million and 22.4-million people. The number of people in this population group and living with HIV ranges from 900 000 to 4.8-million.

Harm reduction policies
The organisation, which advocates for the "prevention of harm [from drug use] rather than on the prevention of drug use itself", estimates that HIV prevalence among people who inject drugs in Tanzania is 33.9%, 16.7% in Uganda, 9.1% in Senegal and 19% in South Africa.

A small number of sub-Saharan African countries have taken up harm reduction policies. Kenya and Tanzania, for example, have increased the number of places that provide drug users with clean needles and syringes. The aim of these needle syringe programmes is to prevent HIV or hepatitis C infection through the use of dirty needles. 

Tanzania has also scaled up opioid substitution therapy services – the medical procedure of replacing illegal opioid with a longer-acting opioid [a group of substances that resemble morphine].

The World Health Organisation says both these methods are effective in reducing HIV infection and HIV risk behaviour among drug users who inject themselves.

Practice of flashblood
Although awareness programmes are planned in three South Africa cities – Pretoria, Cape Town and Durban – there is only one needle-syringe programme site in the country. The Cape Town initiative focuses on men who have sex with men who inject drugs.

The HRI report states that more of these services are needed – especially in light of the increase in high-risk practices such as flashblood, where one user draws blood back into the syringe after injecting heroin and then passes the syringe on to a peer, who injects the blood.

The report also highlights the surge in availability of illegal drugs in countries such as Tanzania that are along "key transit points for the trafficking of heroin, cocaine and other drugs".

The HRI said the provision of harm reduction services in sub-Saharan Africa has been marginal and "has not grown in proportion to the HIV epidemic among people who inject drugs".

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drug useHIV infections