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Injection drug use has long been a driving factor in the HIV/AIDS epidemic in Eastern Europe and Central Asia. But now, there are signs it's a growing problem in sub-Saharan Africa, as well.
The Washington-based Center for Strategic and International Studies, CSIS, sent a team to Kenya and Tanzania to study the relationship between injection drugs and HIV/AIDS.
"Globally, we know that it is quite a serious problem. And we know that one in every three new infections is attributable to injecting drug use. We know that in Eastern Europe, Central Asia, the former Soviet Union, it continues to be the major driver of the epidemic there. What we're seeing happen on a parallel track is that in many countries, where the new HIV incidence is starting to stabilize and level off, that the proportion of IDU-related infections is continuing to increase," said CSIS team member Lisa Carty, who co-wrote a report on the problem. Carty is deputy director at the Global Health Policy Center at CSIS.
"I think the whole question of injecting drug use and HIV prevention has been one that's really been under resourced and not really paid adequate attention to, either from a policy or a programmatic point of view," she said.
The report said, "While it's clear the number of people injecting drugs is large and growing, the kind of epidemiological data needed for planning and implementing effective prevention and treatment programs remain uncertain." Epidemiology is the who, what, when, where, why and how of the matter.
"White" heroin became readily available in East Africa starting in the late 1990s, resulting in an increase in HIV infections through drug use.
Carty said, "It relates to drug trafficking routes coming out of South Asia and the fact that those routes have actually expanded and, you know, a lot of the sort of coastal cities of East Africa - Mombasa and Zanzibar and Dar es Salaam - have become more and more an entry point for drug trafficking out of the South Asia region in through Africa and then very often up through Europe and on to the United States."
Getting high, getting infected
Dr. Phil Nieberg, senior associate with the Global Health Policy Center, is co-author of the CSIS report. He said the sharing of syringes by drug addicts is a very easy way to transmit HIV. Far easier than sexual transmission.
"The reason is that usually with needle sharing there's blood left in the syringe or in the needle. So, basically, the second person to use the needle is getting an injection of someone else's blood that has a lot of virus in it," he said.
Women bear the brunt
And, as is the case in many sectors of the HIV/AIDS epidemic, women have it worse than men.
"Women who are drug users have a much higher HIV risk than men who are drug users. So that one reason for that is that many women, who inject drugs, turn to sex as a way of raising money to buy drugs. So there's an overlap between sex work and drug use," he said.
Women then face the triple stigma and discrimination threat of being HIV positive, a sex worker and a drug addict.
"Even men who inject drugs stigmatize women who inject drugs, saying you shouldn't be doing this. I shouldn't do it either, but I'm a man, but you have responsibilities and family support," he said.
In an effort to avoid law enforcement, injection drug users go underground or hide. But that only takes them further from care and treatment. It's a similar situation for sexworkers and men having sex with men.
Both Nieberg and Carty said there are no easy answers for dealing with HIV positive drug users. But they said treating addiction as a disease instead of a crime could allow more addicts to seek help.
Counseling, needle exchange programs, the use of the heroin substitute methadone could all be part of the plan. Changes in U.S. policy made last year now allow more flexibility in foreign aid programs to deal with such issues