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Substance Abuse and HIV/AIDS in Sub-Saharan Africa

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Substance Abuse and HIV/AIDS in Sub-Saharan Africa African Journal of Drug and Alcohol Studies The African Journal of Drug & Alcohol Studies is an international scientific journal published by the African Centre for Research and Information on Substance Abuse (CRISA). The Journal publishes original research, evaluation studies, case reports, review articles and book reviews of high scholarly standards. Papers submitted for publication may address any aspect of alcohol and drug use and dependence in Africa and among people of African descent living anywhere in the world. The term “drug” in the title of the journal refers to all psychoactive substances other than alcohol. These include tobacco, cannabis, inhalants, cocaine, heroin, prescription medicines, and traditional substances used in different parts of Africa (e.g., kola nuts and khat). EDITOR-IN-CHIEF ASSOCIATE EDITORS Isidore S. Obot Neo Morojele African Centre for Research and Information Medical Research Council on Substance Abuse (CRISA) Pretoria, South Africa E-mail: [email protected] E-mail: [email protected] DEPUTY EDITORS Nazarius Mbona Tumwesigye West Africa Makerere University Olabisi A. Odejide Kampala, Uganda University of Ibadan E-mail: [email protected] Ibadan, Nigeria E-mail: [email protected] Andrew Zamani Psychiatric Hospital Southern & Central Africa Gwagwalada, Abuja, Nigeria Charles D.H. Parry E-mail: [email protected] Medical Research Council Cape Town, South Africa MANAGING EDITOR E-mail: [email protected] Akanidomo J. Ibanga, Nigeria & UK E-mail: [email protected] Eastern Africa David M. Ndetei EDITORIAL ASSISTANTS University of Nairobi Pam Cerff, Cape Town, South Africa Nairobi, Kenya Danjuma Ojei, Jos, Nigeria E-mail: [email protected] EDITORIAL ADVISORY BOARD Francophone countries Reychad Abdool, Nairobi, Kenya Baba Koumare O.A. Ayo-Yusuf, Pretoria, South Africa Hopital Point G Moruf Adelekan, Blackburn, UK Bamako, Mali Yahyah Affinih, New York, USA E-mail: [email protected] E. E. O. Alemika, Jos, Nigeria Pascal Bovet, Seychelles Rest of the world Layi Erinosho, Abuja, Nigeria James T. Gire A.J. Flisher, Cape Town, South Africa Virginia Military Institute Axel Klein, London, UK Lexington, VA, USA Hope Obianwu, Benin, Nigeria E-mail: [email protected] D. A. Pritchard, Swaziland AFRICAN JOURNAL OF DRUG & ALCOHOL STUDIES ______________________________________________________ Volume 5, Number 2, 2006 Special Issue: Substance Abuse and HIV/AIDS in Sub-Saharan Africa CONTENTS From The Editor-in-Chief.............................................................................................................. v Substance Abuse and HIV in Sub-Saharan Africa: Introduction to the Special Issue ................. 83 Richard H. Needle, Karen Kroeger, Hrishikesh Belani & Jennifer Hegle Heroin use in Kenya and Findings from A Community Based Outreach Programme o Reduce the Spread of HIV/AIDS................................................................................................. 95 Clement Deveau, Barry Levine, Susan Beckerleg The Injecting Drug use and HIV/AIDS Nexus in the Republic of Mauritius ............................ 107 Reychad Abdool, Fayzal T. Sulliman, Mohammad I. Dhannoo Drug use and HIV Infection in Nigeria: A Review of Recent Findings .................................... 117 Moruf L. Adelekan, Rahman A. Lawal HIV and Substance Abuse: The Dual Epidemics Challenging Zanzibar................................... 129 Mohammed. J. U. Dahoma, Ahmed A Salim, Reychad Abdool, Asha A. Othman, Hassan Makame, Ali S. Ali, Asha Abdalla, Said Juma, Badria Yahya, Shaka H. Shaka, Mohammed Sharif, Asha M Seha, Mahmoud Mussa, Omar M. Shauri, Lucy Nganga, and Tabitha Kibuka Risk Behaviour and HIV Among Drug Using Populations in South Africa.............................. 139 Charles D.H. Parry, Anne L. Pithey Substance Abuse, HIV Risk and HIV/AIDS in Tanzania.......................................................... 157 Sandra Timpson, Sheryl A. McCurdy, M. T. Leshabari, Gad P. Kilonzo, John Atkinson, A. Msami, Mark L. Williams Three-Country Assessment of Alcohol-HIV Related Policy and Programmematic Responses in Africa ................................................................................................................... 169 Chester N. Morris, Barry Levine, Gail Goodridge, Nkandu Luo, Jeffrey Ashley Report of First Pan African Consultation on Alcohol Policy and its Significance for the Region ............................................................................................................................ 185 Summary of the Proceedings of Meeting on ‘Alcohol, HIV Risk Behaviours and Transmission in Africa: Developing Programmemes for the United States President’s Emergency Plan for AIDS Relief (PEPFAR)’............................................................................................................ 191 FROM THE EDITOR-IN-CHIEF This special issue of the African Journal of Drug and Alcohol Studies is devoted to the theme of substance use and HIV/AIDS in Africa. Though substance abuse, especially injecting drug use, has long been associated with HIV infection in western countries and is today the driving force behind the rapid spread of infections in some low and middle income countries, not much is known about the role of alcohol and drug use in the African HIV/AIDS epidemic. The papers in this issue of the journal are a first coordinated attempt to address this gap in our understanding of the direct and indirect links between substance use and HIV infection based on research conducted in seven countries – Kenya, Mauritius, Nigeria, Rwanda, South Africa, Tanzania and Zambia. This is the second time a full issue of this journal has been devoted to a topic of significant contemporary relevance. The first was the immediate past issue (Volume 5, Number 1) which focused on alcohol policy in Africa at a time when many countries in the region are experiencing rapid increases in per capita consumption of alcohol and in alcohol-related problems. A special issue of this or any other journal provides a forum for concentrated attention on any topic of current interest, but we hope that this effort will also serve as a catalyst for more work on this important topic. The publication of these thematic issues of the journal has been made possible by a grant from the IOGT-NTO, Sweden, through a collaborative arrangement with the journal Nordic Studies on Alcohol and Drugs (NAT). We are grateful to the IOGT-NTO and NAT for this support and that of the Alcohol and Drug Research Group of the Medical Research Council (MRC), Cape Town, South Africa. In response to the Council of Science Editors’ call for a Global Theme Issue on Poverty and Human Development we are planning a special issue on “Substance abuse, poverty and human development in Africa” for publication in October 2007. More than 100 other scholarly journals across the world have signed on to this initiative and we are happy to be part of it. We hope you will submit a paper for publication in this special issue. Established researchers are also encouraged to suggest topics deserving of special attention and to serve as guest editors for future special issues. The journal continues to seek high quality submissions from researchers working on any aspect of psychoactive substance use and abuse with a focus on Africa and Africans in the diaspora. We are happy with the response to our new look and the overall quality of the journal and look forward to greater support and encouragement from you and your organization. I. S. Obot Editor-in-chief E-mail: [email protected] African Journal of Drug & Alcohol Studies, 5(2), 2006 Copyright © 2006, CRISA Publications SUBSTANCE ABUSE AND HIV IN SUB-SAHARAN AFRICA: INTRODUCTION TO THE SPECIAL ISSUE Richard H. Needle, Karen Kroeger, Hrishikesh Belani & Jennifer Hegle Centers for Disease Control and Prevention, Atlanta, GA INTRODUCTION Crime (UNODC) formerly named the United Nations Office for Drug Control This special issue of the African Journal of and Crime Prevention (UNODCCP). The Drug and Alcohol Studies (AJDAS) is UNODC report “The Drug Nexus in Africa” devoted to describing the current status of documented trends in drug production, the HIV/AIDS epidemic among substance trafficking to and through sub-Saharan users in sub-Saharan Africa. Included in Africa, and the consumption of cannabis, this issue are papers that address two heroin, cocaine, and other drugs, important and overlapping public health suggesting that illicit drug use in sub- concerns: drug use and HIV, and alcohol Saharan Africa is not a “minor” concern use linked to high-risk sexual practices and as was often assumed (UNODDCP, HIV transmission, both within the sub- 1999). Following the publication of the Saharan Africa context. Sub-Saharan UNODC report on drugs in Africa in Africa remains the “global epicentre” of 1999, a series of meetings, starting in the HIV/AIDS epidemic. The region 2000, was convened to review HIV in contains only 10% of the world’s drug-using populations in sub-Saharan population but carries more than 60% of Africa. The link between drug use and the global HIV/AIDS burden. In 2005, an HIV was formally discussed at the Third estimated 24.5 million people were living Annual Meeting of the Global Research with HIV/AIDS in the region, 2.7 million Network for the Primary Prevention of persons were newly infected with the HIV/AIDS in Drug-Using Populations, virus, and 930,000 died of AIDS Durban (NIDA 2000). In 2001, the (UNAIDS, 2006). In addition to facing the UNODC and
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