Transcript Controlling HIV among injecting drug users: current status of harm

Addictions and HIV in Sub-Saharan Africa
Experience of the Corridor Project
ICASA Satellite Symposium, Dakar
4 December 2008
J KOFFI, J OJO, L DE SOUZA, O CAPOCHICHI, H DE HARDT-KAFFILS
Abidjan-Lagos Corridor Organization
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Outline
1.
2.
3.
4.
5.
6.
7.
Introduction
Why people abuse drugs
Experience of the Corridor project
Corridor Project’s Response
Possible Barriers to interventions
What Next?
Conclusion
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INTRODUCTION
•
Around 16 million people worldwide inject drugs, with 3 million
infected with HIV
• IDU in 148 countries worldwide of which the five Corridor
Countries
•
IDUs now account for 10% of all new global HIV infections: growing
Injection drug use has resulted in the spread of AIDS in the African
nations:
– Kenya, Nigeria, South Africa and Tanzania
– IDUs in South Africa share and use same needle up to 15 times despiste risks
associated with the practice
•
Drug users have poor knowledge of HIV prevention techniques and
other HIV/AIDS treatment services
• CSWs sometimes forced to take drugs and are not able to use
condoms consistently.
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Why people abuse drugs
• Because of their work
– Truck drivers
– Sex workers
• Peer pressure
– to join in with others and belong to a ‘special’ group.
• Escape route
– problems at home and school
– outside pressures
• To relax and ‘feel good’
• Some medications, e.g. painkillers, physically
addictive
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Experience of the Corridor Project
• Length: 1022 km
• Resident population:
30.000.000 inhabitants
• Population in transit: about
47,000,000 people/year
migrate along the corridor
• The most important corridor
in West Africa (65% of West
Africa economic activity)
Sèmè
Noé
Elubo
Aflao
Hilla Kraké
Kodjoviakop
Condji Plage
é
Sanvee
Condji
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The Abidjan-Lagos Corridor Organization
(ALCO) Project
• Established in 2001 by Govts. of the 5 countries (Cote d’Ivoire,
Ghana, Togo, Benin, and Nigeria)
• Project Development Objective: To increase access to
HIV/AIDS prevention, treatment and care services for vulnerable
populations along the Abidjan-Lagos transport corridor, presently
underserved by national responses.
• Particular attention to be paid to:
• Transport sector workers
• Migrant populations
• Communities living along the corridor
• Funding: World Bank (2003-2007), Counterpart funding by
member countries, Global Fund (2007 – to date), Technical
Assistance: UNAIDS
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Why should a multi-country,
cross-border project pay attention
to drug addiction and HIV?
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The Abidjan-Lagos Corridor border areas a melting
point for activities predisposing to HIV infection
No
interventions
Targeting
IDUs
Illicit Drugs Sale
and Use
Migration &
Delays
at Borders
Hot spot for
Sex work
Risk for
HIV infection
National HIV
Prevention progs.
weak at border
Communities
High HIV
Prevalence
among Truckers
& FSWs
Sex with
Non-regular
partner
Low
Knowledge of
STI/HIV/AIDS
Low Condom
Use
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Substance Abuse among Truckers
Drug and Alcohol Consumption among Truckers
along Abidjan-Lagos Corridor
45,8
50
40
30
%
20
3,4
10
0
Average Drug Consumption
Average Alcohol
Consumption
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Drug Abuse among Truckers at
selected borders along the corridor
Drug Consumption at selective border sites
10
10
7
8
4
6
%
4
2
0
Kodjoviakope
Aflao
Hillancondji
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Substance Abuse among Female
Sex Workers along the Corridor
Substance Abuse among Female Sex Workers along the
Abidjan-Lagos Corridor
100
100
90
80
70
60
% 50
40
30
20
10
0
41
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Alcohol
Cigarette
Non-injectable
drugs
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Injectable drugs
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Commonly Abused Drugs
Class
Examples
Cannabinoids
Marijuana, hashish
Depresants
Barbiturates, benzodiazepines
Stimulants
Amphetamine, cocaine, ecstacy,
methamphetamine, Nicotine, ritalin
Opioids and Morphine
Derivatives
Codeine, Fentanyl, Heroin, Morphine, Opium
Hallucinogens
LSD, Mescaline, Psilocybin
Inhalants
Glue, paint, solvents, nitrous oxide
Other Compounds
Anabolic steroids
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The Corridor project’s response
• Recognition of addiction (IDU) as an
emerging problem
• Currently reviewing reference
document to include these behaviours
• Some border AIDS control committees
widening their interventions to include
drug abuse
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Possible barriers we envisage to
implementation of interventions
• Stigma associated with drug use
• No-man’s land between borders
• Easy availability of illicit drugs
– ‘If demand persists, it's going to find ways to get
what it wants. And if it isn't from Colombia, it's
going to be from someplace else.’
Rumsfeld, 2001
• Interventions targeting drug users not a
priority for national programs
• Lack of reliable statistics to support
advocacy
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Suggested Next Steps
• Assessment of the magnitude of drug
addiction along the corridor
• Planning and implementation of appropriate
interventions targeting IDUs and other forms
of addiction:
– Harm reduction measures including needle
exchange programs
– Peer-based education of IDUs
– Drug treatment
• Stigma and discrimination against drug
users to be tackled
• Support from partners with core competence
and comparative advantage in this area
needed by ALCO.
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CONCLUSION
•
•
•
•
HIV among injecting drug users very important in
sub-Saharan Africa as it is globally
It has been clearly identified as an emerging
problem along the Abidjan-Lagos Corridor
Based on the field assessment, what has been
reported is just a tip-of-the-iceberg
Therefore, an aggressive ownership by national
programs and other key partners is needed to nip
in the bud likely surge in new infections that may
arise from these emerging behaviours
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Acknowledgements
• Global Fund
• World Bank
• UNAIDS
• ALCO Board Chairman – Pr. B. Osotimehin
• Pr. S. EHOLIE
• RESAPSI
• SOLTHIS
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End of presentation
Thank You
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