Substance use, HIV infection and the harm reduction approach in sub-Saharan Africa

Abstract

Available data from the sub-Saharan Africa (SSA) region indicates the use of alcohol, cannabis, psychotropic substances, khat, organic solvents, heroin and cocaine. Alcohol and cannabis use is reported in almost all countries, khat is used mainly in the East African sub-region, while the abuse of methaqualone is a major concern in South and East African sub-regions. An increase in the use of heroin and cocaine is reported in many countries such as Nigeria, Côte D'Ivoire, Ghana, Kenya, South Africa and Mauritius. Injecting of heroin and cocaine is a growing problem in a few countries, although no causal link has been established between this practice and the AIDS epidemic in the continent. Educational and public awareness campaigns form the bedrock of preventative programs. Treatment of addicts takes place mainly in psychiatric and general hospitals but non-governmental organizations, and alternative care givers now play an increasing role. Factors that may militate against the adoption of the harm reduction (HR) approach include lack of scientific evidence linking HIV to injecting drug use, costs, inadequate social welfare and health care systems, unfavorable legal systems, low prioritization and the current moralistic views on substance use. Nonetheless, there exists a unique opportunity in SSA countries to complement and strengthen the currently practised demand reduction (DR) approach with the pragmatic principles of the HR approach, with the key aim of discouraging transition from non-injecting to injecting pattern of substance use.