Harm reduction needs to be scaled-up to reduce HIV infections in sub-Saharan Africa
Scaling up the provision of opioid substitution therapy (OST) and needle syringe programmes (NSP) in new and emerging regions of sub-Saharan Africa are necessary in order to effectively respond to the growing HIV and AIDS epidemic among people who inject drugs (PWID) in these pockets. According to the newly released 2014 Global State of Harm Reduction report, the programmatic scale-up of harm reduction services in sub-Saharan Africa has slightly improved since the release of the last report in 2012. However, this programme expansion did not keep up with the growth of the HIV epidemic among PWID in the region.
Countries such as Tanzania, Uganda and Senegal have a growing number of PWID. This is partly caused by their geographic location along key transit points related to the trafficking of heroin, cocaine and other drugs, thus making drugs easily available. Although services for PWID in the sub-Saharan Africa region are often not available, some countries, including Tanzania and Kenya, are initiating small programmes to reduce harm to PWID. Whilst these programmes mark positive steps, for an effective approach, it is important that these interventions are scaled-up and adopted across countries in the region where similar patterns of drug use are emerging. A priority for the sub-Saharan region should be the initiation of research to provide a basis for policy development in the future.
In 2012, an estimated seven million adults living with HIV received antiretroviral therapy (ART) in sub-Saharan Africa. However, data on people living with HIV (PLHIV) who inject drugs, and are receiving ART in sub-Saharan Africa is limited, and often not available. Data from 2008 indicates that only 38 PWID in Kenya were receiving ART, representing less than one percent of PLHIV and injecting drugs in Kenya. This low rate of access to ART for PWID is not only significant in the sub-Saharan Africa context – globally, only four percent of PWID receive ARTs.
In other parts of the world, Malaysia, Iran and Australia have been highly successful in the implementation of NSP, making them more accessible for PWID. However, only an estimated eight percent of people worldwide can access OST. Despite the overall increase in the past two years in the number of countries providing OST and NSP, the target of the 2015 Millennium Development Goals to reduce HIV incidence among PWID by 50 percent, sits only at 10 percent. Still more needs to be done to scale-up commitment to this key vulnerable population for HIV.