There is a well-developed drug market across Sub-Saharan Africa which, as in other parts of the world, is associated with increased criminal activities and corruption, as well as drug use, dependence and related health problems. Most alarmingly, this includes emerging injecting-related HIV and hepatitis epidemics in a region that already bears the brunt of the global HIV epidemic.
The high rates of HIV in most Sub-Saharan African countries are primarily driven by heterosexual transmission, but injecting drug use is playing an increasingly significant role in some countries such as Kenya, Tanzania, Mauritius, Mozambique and South Africa, especially among young people.
Yet there is evidence to show that HIV transmission among people who inject drugs can be avoided by adopting a package of proven HIV prevention measures. To date, only Tanzania and Kenya in East Africa, Mauritius in the Indian Ocean, Senegal in West Africa, and South Africa have started to provide key harm reduction interventions for people who use drugs – albeit in a limited way in most cases. The coverage of these interventions across the region remains incredibly poor: it has been estimated that less than 1 per cent of people who inject drugs in sub-Saharan Africa have access to NSPs and/or OST. In addition, less than 1 per cent of eligible people who inject drugs are receiving antiretroviral therapy.
This briefing paper summarises the findings of a literature review and scoping exercise commissioned by Harm Reduction International (HRI) and the International Drug Policy Consortium (IDPC) in 2012. It aims to establish the current state of drug policy and harm reduction services in four East African countries – Kenya, Ethiopia, Uganda and Tanzania. The paper analyses the barriers and opportunities for harm reduction, and provides recommendations to improve access to services in these four countries.
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