IDU ISSUES IN AFRICA

Drug use in Africa: a brief report

Gregg Gonsalves, AIDS and Rights Alliance for Southern Africa

AIDS in Africa is primarily thought of as a heterosexually transmitted epidemic. While this assumption is true, other risk behaviors for HIV transmission have been largely overlooked on the continent, whether it is unprotected sex between men or substance use, including injection and non-injection drug use. This short article will focus on the latter and try to offer a brief summary of what is known about substance use and HIV/AIDS in Africa, south of the Sahara desert. [1]

Only recently has there been significant interest in substance use and HIV/AIDS in sub-Saharan Africa, with the first reports on the subject coming from the United Nations Office on Drugs and Crime (UNODC) in 1999, almost two decades after the beginnings of the AIDS epidemic in 1981. What is clear from that report from UNODC and subsequent studies is that drug use does exist on the continent.

In particular, Africa is a way-station along trafficking routes for many drugs to North America and Europe, including home-grown African marijuana, cocaine from South America and heroin from Central and Southeast Asia. The drug trade has thus brought cocaine and heroin to the continent and as these products are transported across Africa to their ultimate destination in large markets in the developed world, domestic markets for these drugs have also been established.

Heroin use on the continent has been described in Kenya, Mauritius, Tanzania, and South Africa, as has a shift in the types of heroin available (from the less refined “brown sugar” to the more refined “white” heroin) and shift in drug using practices, from non-injection to injection, though the patterns of drug use vary from country to country, and from province to province in countries themselves. Marijuana use is widespread in South Africa and use has also been documented in Nigeria, Mauritius and Kenya. In South Africa, in particular, there are a wide variety of drugs available, from heroin and marijuana as previously described, but many other substances are widely used including crack cocaine; methamphetamine and other stimulants; and Mandrax, a combination of methaqualone and antihistamines, often known as Quaaludes, the original brand name of methaqualone now banned in the United States. The use of methamphetamine in South Africa has reached large proportions with over 50% of new admissions for drug treatment among young people, particularly in Cape Town, due to the drug. The true extent of drug use in other countries in sub-Saharan Africa is not well-documented at all, and further research is likely to turn up distinct patterns of drug use throughout the region.

The extent of injection drug use on the continent is also not well-known, but injection of heroin has been documented in Kenya, Nigeria, Mauritius, Tanzania and South Africa. Alarmingly, sharing of injection equipment is common-in Kenya approximately 39% of drug users reported sharing needles and there are reports of sharing of needles, cookers, filters, rinse water, and/or injection solution in Nigeria, Tanzania, Mauritius and South Africa.

The data on HIV infection among drug users is varied. In Mauritius, the entire HIV epidemic has largely shifted to an IDU-based phenomenon, with over 90% of cases of HIV infection now reported to be in IDUs. In Kenya, 31.2% of IDUs tested for HIV in a small cohort in Mombasa were HIV-positive. In cohorts in Zanzibar, Tanzania and South Africa rates of HIV infection were reported at 26.2%, 27% (men) and 58% (women), and 28%, respectively.

The association between HIV infection and non-injection drug use in sub-Saharan Africa is unclear, though methamphetamine and cocaine use have been linked with unsafe sexual behavior in other settings. Alcohol use in Africa, particularly in Eastern and Southern Africa, represents the highest consumption per drinker in the world and hazardous drinking practices in the region, such as binge drinking or frequent drunkenness, are only second in prevalence to Eastern Europe.

Despite the reports of injection and non-injection drug use in Sub-Saharan Africa, evidence based HIV prevention and substance use treatment services, particularly syringe exchange programmes, opiate substitution therapy, and targeted HIV prevention programmes for drug users are unavailable in the region, except in Mauritius, where pilot syringe exchange and methadone maintenance therapy programmes have been recently initiated.

While more research needs to be done to investigate the breadth and depth of substance use in sub-Saharan Africa, the existing data should be sufficient to spur national governments to take action to institute up-to-date, evidence based substance use treatment programmes and HIV prevention efforts for drug users throughout the region.

Reference:
1. This article is exclusively derived from data in: Richard H. Needle, Karen Kroeger, Hrishikesh Belani & Jennifer Hegle, Substance Abuse and HIV in Sub-Saharan Africa: Introduction To The Special Issue, African Journal of Drug & Alcohol Studies, 5(2), 2006, pp. 83-94; reports from the Alcohol and Drug Abuse Research Unit of the Medical Research Council in South Africa and; personal communications with Prévention, Information et Lutte contre le SIDA (PILS), ARASA’s partner organization in Mauritius.

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Antiretroviral Treatment For Injecting Drug Users

IDU ISSUES IN AFRICA

Drug use in Africa: a brief report