The social context of injection drug use and harm reduction programmes in sub-Saharan Africa

Abstract

Sub-Saharan Africa has a documented significant burden of heroin and cocaine injection, and HIV transmission. But the region is behind in the implementation and scaling up of harm reduction measures such as syringe exchange programmes and opiate substitution therapy, due to political preference for the control of drug supply through legal prohibition. Though the policy environment is changing and small-scale programmes are emerging in some countries, large-scale programmes needed to stem HIV epidemic among people who inject drugs are bedevilled by social, cultural and political barriers. For example, current models of harm reduction are problematic in sub-Saharan Africa because they elevate the individual and his or her rights above the society and its needs, and they focus on behavioural changes and do not take into account the social factors that predispose people to drug harms. There is need to align harm reduction programmes with the realities of local contexts in order to guarantee local acceptance as well as increase the potentials for sustainability.

Keywords: Harm reduction, public health, drug policy, sub-Saharan Africa