Sub-Saharan Africa remains the region most heavily affected by HIV. The majority of new HIV infections occur through heterosexual sex, but recent epidemiological evidence attributes an increasingly significant role to injecting and non-injecting drug use in driving many national epidemics.
Mauritius remains the only country in the region with established needle and syringe programmes. Opioid substitution therapy is also available in Mauritius and to a lesser extent in South Africa, Senegal, Kenya and most recently, Tanzania. There is potential for injecting drug use to exacerbate epidemics in countries where HIV prevalence is already high and to expand epidemics rapidly in countries that have remained relatively less affected.
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* Please refer to the table below for ranges, where these are available. The maps display midpoint averages only.
| Country/territory with reported injecting drug usea | People who inject drugsb | HIV prevalence among people who inject drugsb | Hepatitis C (anti-HCV) prevalence among people who inject drugs1 | Hepatitis B (anti-HBsAg) prevalence among people who inject drugs1 | Harm reduction responsec | |
|---|---|---|---|---|---|---|
| NSPd | OSTe | |||||
| Cote D’Ivoire | nk | nk | nk | nk | N | N |
| Dijibouti | nk | nk | nk | nk | N | N |
| Gabon | nk | nk | nk | nk | N | N |
| Ghana | nk | nk | 40.1 | nk | N | N |
| Kenya | 49,1672 | 18.32 | 51.4 (42.2–-60.6) | 6.4 | N | Y(M,O)f |
| Malawi | nk | nk | nk | nk | N(P) | N |
| Mauritius | 9,253 (5,699–-10,444)3 | 47.43 | 97.33 | 9 | Y(52)(P) | Y(16)(M,O) |
| Nigeria | nk | 4.24 | nk | nk | N | Y |
| Senegal | nk | 9.24 | nk | nk | N | Y(B,O) |
| Seychelles | 1,671 (673–, 1706)4 | 5.8g | 53.5 | 0.1 | N | N |
| Sierra Leone | nk | nk | nk | nk | nk | N |
| South Africa | 67,0005 | 19.44 | nk | nk | Y(1)(P)5 | Y(6)(M,B) |
| Uganda | nk | nk | nk | nk | N | N |
| Tanzania | 25,000-–50,00058 | 4258 | 22.2 | 3.8 | Y(1)(P) | Y(1) |
| Zambia | nk | nk | nk | nk | N | N |
nk= not known
a The countries included in the table are those which have reported injecting drug use (IDU) and/or NSP or OST according to the latest UN Reference Group systematic reviews. However, HRI data collection in 2007/08 also identified IDU reports in Angola, Benin, Burkina Faso, Cameroon, Cape Verde, Ethiopia, Gambia, Guinea, Liberia, Mali, Mozambique, Niger, Rwanda, Seychelles, Somalia, Togo, Zanzibar and Zimbabwe.
b Unless otherwise stated, data are sourced from Mathers B et al. for the Reference Group to the UN on HIV and Injecting Drug Use. (2008) Global epidemiology of injecting drug use and HIV among people who inje ct drugs: a systematic review., Lancet, 372( 9651):1733 – 1745.
c Unless otherwise stated, data on NSP and OST coverage are sourced from Mathers B, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP, Myers B, Ambekar A, & Strathdee SA for the Reference Group to the United Nations on HIV and Injecting Drug Use (2010) HIV prevention, treatment and care for people who inject drugs: A systematic review of global, regional and country level coverage., Lancet, 375(9719):1014–-28.
d The number in brackets represents the number of operational NSP sites, including fixed sites, vending machines and mobile NSPs operating from a vehicle or through outreach workers. (P) = needles and syringes reported to be available for purchase from pharmacies or other outlets, and (NP) = needles and syringes not available for purchase.
e The number in brackets represents the number of operational OST programmes, including publicly and privately funded clinics and pharmacy dispensing programmes. (M) = methadone, (B) = buprenorphine, (O) = any other form (including morphine and codeine).
f Methadone is available on a very limited basis from private clinics only.
1 Nelson PK et al (2011) Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews, Lancet, 378(9791): 571–583.
2 National AIDS & STI Control Programme-NASCOP (2012) MARPS Surveillance Report 2012: Most-At-Risk Populations. Unveiling new evidence for accelerated programming. Kenya: Ministry of Health.
3 Johnston L et al. (2011) High HIV and hepatitis C prevalence amongst injecting drug users in Mauritius: Findings from a population size estimation and respondent driven sampling survey, International Journal of Drug Policy, (22):252–258.
4 UNAIDS (2012). Global AIDS Progress Reports, http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/progressreports/2012countries/.
5 Petersen Z, Pluddemann A, van Hout MC, Dada S, Parry C & Myers B on behalf of the Secretariat to the United Nations Reference Group on Injecting Drug Use and HIV (2012) The prevalence of HIV among people who inject drugs and availability of prevention and treatment services: findings from 21 countries. A brief report. Parow: South African Medical Research Council.
6 Mathers B et al. (2008) The global epidemiology of injecting drug use and HIV among people who inject drugs: A systematic review, Lancet, 372(9651), 1733–1745.
7 Reid SR (2009) Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review, Harm Reduction Journal, 6:24.
8 Bowring A et al. (2011) Assessment of risk practices and infectious disease among drug users in Temeke district, Dar es Salaam, Tanzania. France: Medicines du Monde, Centre for Population Health, Burnet Institute.