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Sub-Saharran Africa - Regional Overview
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The majority of new HIV diagnoses in Sub-Saharan Africa are attributable to sexual transmission, but the influence of drug use and of drug injecting is becoming increasingly evident in many countries. Although data on drug use in the region are limited, injecting has been reported in the majority of the forty-seven Sub-Saharan states. There are indications that HIV prevalence is high among people who inject drugs. Needle and syringe sharing is common, and extremely risky practices have been reported in Tanzania and Zanzibar. As in other world regions, women who inject drugs are particularly vulnerable to HIV infection.
Responses to HIV in the region currently include little focus on people who inject drugs. Mauritius is the only country where needle and syringe programmes (NSP) are operating. Limited opioid substitution therapy (OST) is prescribed in South Africa and Mauritius. No prisoners in the region have access to either NSP nor OST. In Sub-Saharan Africa, injecting drug use could exacerbate epidemics in countries where HIV prevalence is already very high, as well as rapidly expand epidemics in countries which have so far remained relatively less affected. Experiences from Asia and Eastern Europe illustrate the importance of timely interventions to mitigate the rapid escalation of epidemics among key populations and the wider population.
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Injecting Drug Use, HIV and Hepatitis C
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The following maps and table outline the current available data on injecting drug use, as well as the prevalence of HIV and hepatitis C among injecting populations in Sub-Saharan Africa.
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The map below illustrates HIV prevalence among injecting drug users in countries of the region.
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The map below illustrates hepatitis C prevalence among injecting drug users in countries of the region.
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The following table provides the latest estimates of HIV and hepatitis C prevalence within injecting populations, as well as the estimated total number of injecting drug users in countries of the region.
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Countries/territory with reported injecting drug use
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| | Adult HIV prevalence amongst people who inject drugs**
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| Adult HCV prevalence amongst people who inject drugs***
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*Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008)
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The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
**Mathers, B. et al. Reference Group to the United Nations on HIV and injecting drug use (2008) The global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet 2008, Volume 372.
***Cook, C & Kanaef, N (2008) The Global State of Harm Reduction: Mapping the global response to drug-related HIV and hepatitis C epidemics. International Harm Reduction Association, UK
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Harm Reduction Policies
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Few countries in Sub-Saharan Africa include an explicit supportive reference to harm reduction in their national policies on HIV or drugs. This is illustrated in the map and table below.
Although policy wording is not necessarily indicative of the implementation of effective harm reduction measures in a country, it does indicate governmental commitment to tackling drug related harms and is therefore an important advocacy target.
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Countries/territory with reported injecting drug use
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| Explicit reference to harm reduction policies in official documents*
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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Harm Reduction Programmes
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Key harm reduction interventions (including needle and syringe exchange and opioid substitution therapy) are not available in the majority of countries in this region, as illustrated in the maps and table below. Where available, coverage is insufficient and there are many barriers to accessing them.
No prisoners in the region have access to either needle and syringe programmes or opioid substitution therapy.
The following table indicates which countries have a) one or more needle and syringe exchange sites operational both in and outside prisons, b) prescription of opioid substitution therapy for maintenance in and outside of prisons c) one or more drug consumption rooms in countries of the region.
A tick in this table does not indicate the scope, quality or coverage of services. Also it should be noted that in some countries, harm reduction services, NSP in particular, are NGO-driven and may be operating without government support.
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Countries/territory with reported injecting drug use
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*International Harm Reduction Association (March 2009) Harm Reduction Policy and Practice Worldwide: An overview of national support for harm reduction in policy and practice [PDF:2.59KB]
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The map below shows which countries have operational needle and syringe programmes and opioid substitution therapy programmes.
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There are currently no countries in the region with prison-based needle and syringe exchange programmes and opioid substitution therapy prescription.
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