Breakthrough as Uganda announces harm reduction pilot

The Ugandan Ministry of Health has made a breakthrough decision to pilot needle and syringe programmes (NSP), led by the Uganda Harm Reduction Network (UHRN) and Community Health Alliance Uganda (CHAU).

<p>Outreach worker Isaiah from the Drug Abuse Rehabilitation And Treatment project (DARAT), a project funded by Alliance linking organisation <a href="/about/where-we-work/52-kenya-aids-ngo-consortium-kanco" title="KANCO">KANCO</a>, with injecting drug users 'Niko' and 'Omar'&nbsp;in Mombasa, Kenya.</p>
<p>Niko says, &ldquo;I have tried to stop using drugs but it was just too hard without medical help. People don&rsquo;t want to help if you are addicted; the stigma against drug users is very bad. Many people think I am wicked but I think I need treatment.</p>
<p>&ldquo;I met Isaiah, a field worker from Darat&hellip; He tested me for HIV &ndash; and I was negative.&nbsp; That&rsquo;s because I have never shared needles. With drug use it&rsquo;s easy to get HIV if you have no knowledge about how it&rsquo;s transmitted, that if you share needles you can get infected.</p>
<p>&ldquo;Most people don&rsquo;t know that and most drug users share needles. When I learned about HIV, we were only told it was transmitted through sex, but people should know you can get it through injecting drugs too. Luckily I have never shared needles and I don&rsquo;t now. I am going to make very sure I don&rsquo;t get HIV.&rdquo;</p>Drug outreach in Kenya, a country that began implementing harm reduction in 2011 © Nell Freeman for the Alliance

The NSP programme will reach 250 people who inject drugs in four districts (Kampala, Mbarara, Mbale and Gulu). The pilot is being implemented by UHRN and will run until December 2018 as part of the Ugandan Global Fund programme, with a vision to scale up to more sites in Uganda.

Advocacy breakthrough

The landmark decision was confirmed by the Ministry of Health in September. It is the result of soft and evidence-based advocacy led by Alliance Linking Organisation CHAU in partnership with UHRN, a drug user-led network that delivers peer-to-peer HIV and harm reduction services.

Wamala Twaibu, Executive Director at URHN, said: “For the past six years our strategy has been to use soft skills advocacy, targeting high level and influential persons in the Ministry of Health, and within internal affairs and law enforcement circles, to accept the concept of harm reduction in Uganda.

“With support from the Alliance’s PITCH programme [Partnership to Inspire, Transform and Connect the HIV response], we have been able to amplify the voices of people who inject drugs more effectively. Through their shared testimonies we have been able to voice out the need for needle and syringe programmes and established collaborative working relationships.

"People who use drugs have been supported to participate and organise at a grassroots level, and take part in high-level meetings and decision-making fora at district, national and global level. This has enabled us to finally secure Ministry of Health buy-in for the implementation of the needle and syringe programme in the country.”

Drug use in Uganda: building the evidence

In Uganda, between 17-20% of people who use drugs are estimated to be living with HIV; around three times more than the general population. Data collected by UHRN across 13 districts between 2013 and 2016 suggest prevalence is even higher, at 43% of injecting drug users.

Women who use drugs are disproportionately affected, with 45% of female injecting drug users in these districts estimated to be HIV positive, compared to 21% of their male counterparts.

Although national data on drug use in the country is limited, CHAU and UHRN carried out a rapid assessment and population size-estimation study between March and July 2017, key evidence which the organisations then used to advocate for harm reduction services.

Wamala added: “People who use drugs in Uganda face systematic human rights violations. They experience mass incarceration, ill treatment by police, as well as denial of essential medicines and basic healthcare services. This is driven by repressive drug laws and policies, which in turn fuels constant stigma and discrimination.

"Existing drug enforcement practices have increased the exposure of people who use drugs to drug-related harms and undermined the regional and global response to HIV, TB, viral hepatitis and other public health issues."

“If we don’t pay greater attention to people who use drugs, the concept of attaining the UNAIDS’ 90-90-90 targets will be impossible in Uganda.” - Wamala Twaibu, Executive Director at URHN

Often, people who use drugs who attempt to access services are reported by health workers to authorities for their drug use. To tackle this, the pilot will work with people from the drug user community to sensitise health workers on the rights of people who use drugs to access services. It will also establish a number of community based drop-in centres and engage in peer-led outreach to build trust between communities of people who use drugs and health service providers.

“We hope the implementation of the needle and syringe pilot is a stepping stone and a window for embracing and implementing harm reduction interventions for people who use drugs in the country, and will go a long way to reducing new HIV and hepatitis infections, overdose cases and drug-use related harms,” Wamala adds.

“If we have made a breakthrough on the needle and syringe programme why not on opiate substitution therapy as well? It will just be a matter of time, we are positive about it, and our hopes are high.”