ZIMBABWE is battling increased drug and substance abuse, especially among youths, which is reportedly contributing to a spike in new HIV infections. NewsDay reporter Vanessa Gonye (ND) recently interviewed the Joint United Nations Programme on HIV and Aids (UNAids) adviser (equality and rights for all), Jeremiah Manyika (JM) on the nexus between drug use and HIV and Aids in the country. Here are the excerpts:
ND: The drug abuse scourge is increasing by the day, in what way does it contribute to HIV and Aids?
JM: Drug use, especially injectable drugs associated with sharing needles, predisposes users to HIV and other blood-based viral infections including hepatitis.
In most cases, drug users fail to access HIV prevention, care and treatment services due to stigma, discrimination and the fact that they need to be completely off drugs for them to be initiated on treatment or ART (anti-retroviral treatment).
Drug users, oftentimes, feed their appetite for drugs at the expense of health seeking, thus they delay accessing HIV testing services and ART, resulting in high morbidity and mortality among the group, sadly these statistics are not easily available.
ND: In terms of numbers, please explain the impact of drug use.
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JM: World over, there are around 250 million drug users, the majority use cannabis followed by opioids, amphetamines, cocaine and heroin. About 0,22% of people aged 15-64 years inject drugs. More than 11 million people in the world inject drugs.
One in eight people using drugs are living with HIV, half of the people injecting drugs are living with hepatitis C. Of the 980 000 persons who inject drugs in Africa, over 100 000 (11,3%) are living with HIV.
Within the region, southern Africa has the highest prevalence of persons who inject drugs among the population (0,18%) and the highest prevalence of HIV among persons who inject drugs (21,9%).
Zimbabwe has no population size estimates for people who use injectable drugs (PWUIDs). However, with purposive sampling and operational data, programmes have reached out to more than 5 000 drug users in their diversity.
ND: What interventions are in place to deal with the problem?
JM: The government appointed a national co-ordinator for drug and substance use, established an inter-ministerial taskforce on drug use and conducts supportive Cabinet briefs on the drug situation.
Zimbabwe launched a national drug master plan in December 2020 with strong leaning towards harm reduction for people who use drugs. The government has adopted treatment guidelines for alcohol and substance use in Zimbabwe. The country conducted a legal and environmental assessment for key populations in 2018-19.
The Zimbabwe national HIV strategic plan also recognises the vulnerabilities of PWUIDs and prioritises interventions for this key group. Rehabilitation facilities are mostly private-owned and are expensive for the community, hence the need to be deliberate in planning for harm reduction services.
The majority of drug users often find themselves chained and isolated from the public, at mental health institutions and in the worst-case scenario, incarcerated at maximum security prisons like Chikurubi.
ND: Are drug users willing to take HIV and Aids preventive measures?
JM: Drug users are in need of healthcare services; these are human beings with health, socio-economic and educational needs. Some of them are qualified professionals including teachers, health workers, drivers, lawyers, engineers, etc, and they do require HIV services including ART.
In the situational analysis, 67,4% had tried to quit drugs, that indicates a willingness to rehabilitate and refocus life goals, hence the people who use drugs are more than willing to take up SRH [sexual and reproductive health] services including HIV, family planning, STI treatment, ART etc.
ND: What milestones have you made in addressing drug use and HIV?
JM: The Zimbabwe drug master plan is a genuine attempt to address drug use with a focus on rehabilitation.
The inter-ministerial committee on drug use also demonstrates wider stakeholder engagement and government commitment to address the issues of drug use, inclusive of harm reduction and addressing supply and demand of drugs.
Government’s appointment of a national co-ordinator who is also a special adviser on health to the Executive is a huge statement of action.
Conducting a situational analysis to describe the problem of drug use is also a very huge step towards addressing the challenges faced by drug user communities.
ND: With UNAids support, what are some of the achievements made in the Zimbabwe HIV response?
JM: Zimbabwe has achieved the 95-95-95 milestones and it is presumed that for the country to reach the remaining 5-5-5, a deliberate targeted approach to key populations including PWUIDS is key. Because of the criminalisation of drug use and possession, the populations tend to go underground to evade the police.
UNAids has supported a review of the country’s HIV programme that has brought attention to PWUIDs. The agency has also supported financially and technically the situational analysis on drug use and continues to work with the Health ministry and National Aids Council to further characterise drug use in Zimbabwe with a view to make appropriate recommendations for harm reduction with the ultimate goal of ending Aids by 2030.
ND: What are the impacts of drug use on women?
JM: Women bear the brunt of HIV infection the most as they are often carers in homes. The challenges escalate when women are also using drugs. Women drug users often do not get treatment or rehabilitation on time due to stigma.
Often, women resort to selling sex in order to get money for drugs and to support the family, including the husband or partner who could also be addicted to drugs.
Drug use affects reproductive health and women drug users may fail to conceive or they give birth to low weight babies or babies that are addicted from birth. Babies born of drug users often die before their first birthdays and that has huge psychological challenges for the mothers.
ND: How can the gains achieved by Zimbabwe to end Aids by 2030 be sustained?
JM: UNAids encourages community engagement, leadership and participation at all levels to ensure the gains are community owned and guarded. Efforts should increase to ensure that the communities are able to bring the people in need of HIV services into care.
There is need to address barriers to care inclusive of legislation, practices, beliefs and stereotyping that drive some communities away from health facilities and even go underground for fear of stigma, arrest and detention, confinement and other unknown consequences of coming out to seek HIV services including any other health service needs as required.
ND: In December, the country is hosting two events; the World Aids Day and the International Conference on Aids and STIs in Africa. What message are you going to emphasise during the two events?
JM: Given that the country has achieved the 95-95-95 targets, UNAids emphasises the need to “let communities lead” to enable the country to reach out to the remaining 5%. It is the communities that know where to find the people in need of services and the type of service required.
The community has its own ways and mechanisms of supporting each other when faced with problems. It only needs minimal resources and technical support to deliver quality and accountable health services among its members. It is, therefore, very important to foster community leadership for HIV programmes including other pandemics that affect society.
UNAids emphasises the need to ensure that 30% of HIV testing, care and treatment services must be community-led, 60% of programmes that address barriers to care are community led and 80% of HIV services for women, girls and key populations are led by women, girls and key populations for greater reach and sustainability.