With opiate use documented in over half of the countries of Africa, injecting drug use reported in most of these, and linked emerging concentrated epidemics of HIV and hepatitis C infection among people who inject drugs (PWID), there is increasing attention on the incorporation of harm reduction interventions as part of national drug policy responses in African countries. The focus of interest in relation to implementing HIV and hepatitis C prevention is 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. There is a growing body of epidemiological research linking the diffusion of injecting drug use with concentrated outbreaks of HIV and hepatitis C in the region. HIV prevalence estimates among PWID in Nairobi, Kenya, for example, have ranged between 14.5% and 50%, and in Dar es Salaam, Tanzania, between 35% and 50%. While data is limited, estimates of hepatitis C prevalence among PWID in these settings appear higher still. There are few robust prevalence estimates of HIV, hepatitis C or tuberculosis among people who use drugs in West African and other Sub-Saharan African countries.
In a number of East African countries – notably Mauritius, Kenya and Tanzania – drug policies have recently been characterised by a state of adaptation, wherein multiple stakeholders – including global, international as well as local actors – have negotiated the relative merits and evidence in support of harm reduction as a measure of HIV and hepatitis C prevention. In Mauritius, the endorsement of needle and syringe programmes (NSP) and opioid substitution treatment (OST) as cornerstone HIV prevention interventions as part of national policy since 2006 has reportedly enabled these services to be considerably expanded since their introduction, including OST within prisons, to the extent that over 50% of PWID are said to be receiving OST and around 50% NSP (Republic of Mauritius, 2012). In Tanzania, NSP was introduced in 2010 and methadone-assisted drug treatment in 2011, while in Kenya, NSP was introduced in 2013, and methadone treatment in late 2014. The estimated coverage of these interventions, however, is generally below optimum. For instance, assuming the numbers of PWID in Nairobi, Kenya, range between 5031 and 10,937 (0.2–0.5% of the adult population), NSP reaches between 10% and 20% of PWID, while OST in Nairobi was reaching an estimated 400 PWID by September 2015.
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