How failure to tackle injection drug use harms Nigeria’s health

Harm Reduction Report says ‘political resistance’ fuels HIV, Hepatitis C and death of IDUs

By Sola Ogundipe

FAILURE of the Federal Government of Nigeria  to implement harm reduction programmes against   HIV, hepatitis C and preventable death among injection drug users, has been identified as a major factor militating against progress of the nation’s public health sector.

The Global State of Harm Reduction 2018 – the most comprehensive independent analysis to date on harm reduction policy and practice around the world – shows that Nigeria continues to be “politically resistant” to implementing needle and syringe programmes (NSP) and opioid substitution therapy (OST), despite both being evidenced to prevent the spread of blood-borne infection.

Information from the Harm

Reduction report, a major new publication from Harm Reduction International, reveals that “Nigeria contrasts sharply with other countries in  sub-Saharan Africa region that are beginning to fight public health crisis among people who use drugs.

An overview of the Report in Sub-Saharan Africa shows that Nigeria is yet to seriously adopt harm reduction interventions, even in the face of  the relatively high lifetime prevalence of use of drugs such as heroin (63 per cent) and cocaine (70 per cent)) among people who inject drugs, and unsafe practices such as the sharing and reuse of needles.

In the Report, an analysis of the  Epidemiology of HIV and viral hepatitis, and harm reduction responses in Sub-Saharan Africa, shows that the number of people who inject drugs in Nigeria is 44,515 – the burden is second only to South Africa that has 70,000 injection drug users.

In a breakdown, the  Global State of Harm Reduction 2018, establishes that in Nigeria, the HIV prevalence among people who inject drugs is 3.4 per cent; Hepatitis C (antiHCV) prevalence among people who inject drugs is 5.8 per cent, while Hepatitis B (anti-HBsAg) prevalence among people who inject drugs in the country is 6.7 per cent.

Good Health Weekly gathered that needles and syringes are sold at pharmacies, but people who inject drugs are often asked undesirable questions and worry about criminal repercussions.

“Coupled with this are the behavioural norms of needle sharing as a sign of trust or brotherhood, and new practices, such as the shared purchase of pre-loaded syringes by several people, leading to the sharing of a single syringe.”

Findings reveal that harm reduction is integral to the world’s HIV response and cannot be ignored. People who inject drugs are among the most vulnerable to contracting blood-borne viruses.

“Unless the funding landscape for harm reduction changes urgently, the goal to end AIDS by 2030 will be missed and the pledge to leave no one behind will ring hollow.

“People who use drugs are being forgotten – with dire public health and social consequences.”

As endorsed by the World Health Organisation (WHO), the United Nations Office on Drugs and Crime (UNODC), and other partners, a comprehensive package of harm reduction interventions has been scientifically demonstrated to support the prevention and spread of HIV and the reduction of other harms. Needle and syringe programmes in particular are based on strong evidence for their effectiveness in the prevention of HIV and hepatitis C, and are known to lead to a reduction in injecting risk behaviours, such as the sharing of equipment.

In the last two years, sub-Saharan Africa progressed in harm reduction policy and services in selected countries. Explicit support for harm reduction is now contained in national policy documents in 10 countries as opposed to seven in 2016, and needle and syringe programmes services are now established in eight  countries.

Nations with some opioid substitution therapy  provision have also increased since 2016. However, Nigeria is yet to operate either needle and syringe programmes or opioid substitution therapy initiative.

There continues to be discordance between levels of HIV and hepatitis C among people who inject drugs and the availability of harm reduction services in the country.

The Report highlights the  great need in the Sub-Sahara Africa region for stability of harm reduction in policy, programming and security of its funding.

Earlier in 2018, the Nigerian health minister reportedly set up a task force in 2018 to advise on implementing harm reduction in the country.

Globally, less than half of the 179 countries where injecting drug use is reported currently provide needle and syringe programme and opioid substitution therapy. New HIV infections among people who inject drugs increased by one third from 2011-15 and coverage of OST and NSP is critically low.

Harm reduction interventions for people who use drugs—such as needle and syringe programmes and opioid substitution therapy are cost-effective, protect against HIV and hepatitis C, and save lives.

Despite the potential for these interventions to contribute to healthier communities, funding for harm reduction in low- and middle-income countries  has flat-lined over the past decade.

the health crisis among people who use drugs,’ found that in 2016, US$188 million was allocated for harm reduction – the same amount as in 2007 and just 13 percent of the US$1.5 billion that UNAIDS estimates is required annually by 2020 for an effective response in LMICs.

International donor funding – which accounts for two-thirds of all harm reduction funding – fell by almost one-quarter from 2007-16.

Global Fund allocations for harm reduction appeared to decline 18 percent in 2016 compared to 2011. The Global Fund is the largest donor for harm reduction in LMICs.

PEPFAR was the second-largest donor, but contributes a fraction of its overall HIV budget and doesn’t fund procurement of needles or syringes because of a US federal ban.

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