Uganda’s toughest sanctions against drug users have among some of the highest levels of consumption, as well as some of the highest levels of drug user’s incarceration. Access to drugs remains as easy as it has ever been. Demand remains as strong as it ever has done. The goal of the UN to eliminate the cultivation of coca bush, cannabis and opium by 2009 has clearly not been reached and likely never will be. The production and cultivation of many drugs has increased.
The criminalization of drug users and harmful bills such as the HIV/AIDS Prevention and Control Bill, Anti Narcotic Bill, and the Anti Homosexuality Bills which are still being pursued in our 9th parliament. “The coverage gap among drug users is gravely concerning, along with the public health impact of the discrimination and human rights violations they face”. Lack of legal protections and recognition compromises the ability of drug users to access health care services for Hepatitis B and C, HIV, TB particularly; the discrimination by health care providers also prevents drug users from seeking health care or antiretroviral drugs (ARVs) to treat HIV. Some HIV-positive drug users choose to die rather than go to the hospital, due to the fear of getting arrested, humiliated, and treated as sub- human.
In Uganda “Drug use” is illegal;- Police and other law enforcement agent’s harassment has lead to a widespread of human rights violations; inhumane detention in police cells and rehabilitation centers, also lead to “drug use” going “underground” increasing the likelihood of drug users engaging in high-risk drug using behaviour that makes them vulnerable to harms such as HIV, STI/STDs, TB, Hepatitis B and C and overdose. Fear of arrest prevents them from accessing quality and comprehensive health services. The evidence supporting the idea that imprisonment of drug users reduces rates of “drug use” and reduction in “availability” is almost non-existent. Drug users are seen as “victims of abuse, violence and are perceived as a voiceless community without rights”. http://allafrica.com/stories/201301151322.html.
Lack of data; there is extremely limited information available on people who use drugs in Uganda, as for most-at-risk populations in general. As a result, this country overview is notably shorter than the others. Yet Uganda is a key country in East Africa in terms of drug policy and harm reduction.
The most common drugs used include cocaine, heroin, alcohol and cannabis. HIV prevalence amongst people who use drugs is unknown, although a small-scale study of 67 sex workers who use drugs found a HIV prevalence rate of 34 per cent. Effective interventions to prevent HIV among people who use drugs (such as NSPs and OST) do not currently exist in the country.
Uganda does not currently have a drug law, although a national drug policy has been in development since 2005. The National HIV Prevention Strategy 2011-2015 does not include the provision of harm reduction services for people who use drugs – rather it merely states: ‘It is globally acknowledged that IDU and MSM play a major role in HIV transmission. However, in Uganda we do not have sufficient information on these population groups… It will be important to keep an eye on these population groups’ Nevertheless, the Strategy does commit to ‘ongoing surveillance of risk behaviours among IDUs’.
In Uganda and Ethiopia, the lack of harm reduction services reflects a lack of political will to even acknowledge the existence of injecting drug use. If people who use drugs are not recognized as a population in need of services, they will not be mentioned in the key policy documents. This can be a major barrier to implementation. http://idpc.net/publications/2013/08/idpc-hri-briefing-paper-hiv-prevention-among-people-who-use-drugs-in-east-africa.
The studies which exist have largely approached the question from a heavily medical perspective or on the other hand, a criminal law perspective, neither of which suitably account for the complexity and multiple realities of the question of drug use in Uganda. For instance, these perspectives do not take into account questions of recreational drug use in circumstances where there is no significant danger to the health of the drug user or the public or the use of drugs as part of religious or cultural rights. More problematically, pathologizing and criminalizing drug user’s results in coercive and heavy-handed interventions which might exacerbate rather than ameliorate any problems that might exist. By failing to incorporate international best practices such as “Harm Reduction”, such ill-informed interventions may cause irreparable harms to particular communities such as injecting drug users, sex workers, youth, fisher men and other sexual minorities, and serve to further stigmatize and alienate them from public health services and care. This is already evident in provisions for mandatory testing for HIV among LGBTI, sex workers and injecting drug users under the HIV Prevention and Control Bill of 2010; http://wthrockmorton.com/2010/05/hivaidspcbillft/, See e.g. Joshua Kato ‘Uganda: Drug Abuse Behind Kampala’s High Crime Rates’at; http://allafrica.com/stories/200807170172.html, See for instance,http://www.trinityafer.com/en/index.php/news/12906-substance-abuse-youth-a-healthcare-time-bomb-uganda.
Briefly; drug users continue to experience multiple problems in Uganda and they include; housing and homelessness, low levels of educational attainment, stigma and discrimination, criminalization:- police harassment, abuse, torture and assault. Sometimes drug users are forced into detention or imprisonment without trial due to drug possession and consumption or released after a paying a huge sum of monies for securing a police bond or court bail or force them into rehabilitation centers such as Butabika National Referal Hospital, Serenity Rehabilitation Centre and Naguru teenage centre. Some drug users also experience mental and physical health problems and among them : higher rates of hepatitis B and C, HIV/AIDS, TB and physical impairments that can affect drug user’s ability to complete everyday tasks, therefore to work. Drug users in Uganda are seen as “victims of abuse, violence and are perceived as a voiceless community without rights”. It’s from the above background that Uganda Harm Reduction Network was formed to reduce the health, social and economic harms associated with drug use and develop an enabling environment for the implementation and expansion of human right interventions for drug users in Uganda.
Articles and publications on drug users in Uganda;
Uganda has moved from being a “transit route” for drugs from Afghanistan, Indonesia, Pakistan, West and South Africa to a “significant drug-using country”. The permanent secretary at the Ministry of Internal Affairs, Dr Steven Kagoda says most culprits involved with drugs are “Youth”. Drug users tend to be 10-60 years of age. Opiates users tend to be 25-55 years of age, cannabis users 10-45 years of age and sedatives users 20-60 years of age. The use of volatile solvents is most common among the youth, around 10-20 years old (U.N. 1991). The use of prescription drugs is common among professionals such as nurses and doctors (EFDR 1993).
Ever injected drugs for pleasure, Crane surveys finding showed that there was a lifetime history of injecting drugs among all groups. There is almost twice as much (12%) of MSM (men who have sex with men) who have used injectable drugs as compared to PSW (Partners and clients of sex workers) (7%). Also 5% of FSW (female sex workers), 2% of boda riders and 0.5% of university have ever injected drugs for pleasure. More than half (54%) of the boda riders had ever drunk alcohol, and 12 % had drunk it in the last 30 days. 16% percent ever used illegal drugs, and 2 % had ever injected drug. .http://www.uhspa.org/wpcontent/uploads/downloads/2011/06/Crane-Survey-Report-Round-1-Dec10.pdf
Drug trafficking and drug use are fast increasing in Uganda. According to Dr David Basangwa, a senior consultant psychiatrist at Butabika hospital, over 20% of the patients at the country’s main psychiatric health centre, are drug users. Statistics show that between 1995 and 2005, 2.3 million plants of cannabis were destroyed by police, who also seized 109 tonnes of heroin and 80kg of cocaine. Basangwa says families are increasingly taking their children to rehabilitation centres in Butabika hospital, seeking help. Gilberto Gerra, the Chief of drug prevention and health at the United Nations Office on Drugs and Crime, says drug abuse affects 28 million Africans, who use mainly cannabis. This is second to North America where some 32m people use and abuse drugs.http://www.observer.ug/index.php?option=com_content&task=view&id=24085&Itemid=114.
“Drugs: The deadly vice making silent rounds among students” It is suspected that the drug barons use innocent Ugandans, especially students, as couriers. These are made to swallow the drugs packaged in pellets or carry them as luggage. Indeed investigations by the Saturday Monitor show that drug use is common among students and youth. School administrators are aware of the problem, although they say they have no way of solving it. “The problem is turning out to be a very complicated phenomenon in that the students no longer take the drugs in their raw form. They are no longer taking the traditional ones,” the deputy head teacher of Kampala Secondary School, Mr Paul Bwaniki, says. He added: “You may find a student chewing and you cannot tell whether they are chewing drugs. So the ignorance of the administrators is not doing us any good.” http://www.monitor.co.ug/SpecialReports/Drugs–The-deadly-vice-making-silent-rounds-among-students/-/688342/1702222/-/4v4xr9z/-/index.html.
Drug use is described as a problem especially among marginal groups, who are unemployed (EFDR 1993). Cannabis is mainly used by street and school youth, as well as by soldiers; heroin tends to be consumed by urban and street youth; cocaine use is prevalent among high income groups; Somali refugees and town youth use khat; petrol is inhaled by street children (EFDR 1993). It is estimated that 55 per cent of sedatives users, 30 per cent of synthetic narcotic analgesic users, and 20 per cent of opiate users are women (U.N. 1991).
Uganda Harm Reduction Network (UHRN) is a youth led initiative established in 2008 under Reg.No.181733 as a national, not-for-profit NGO to champion and coordinate people who use drugs’ health (HIV/TB, Hepatitis & STI), advocacy and harm reduction programmes to respond to the drug use crisis in Uganda. The network provides a country-wide systematic and all-inclusive coordination structure for people who use and inject drugs (PWUIDs) with a growing subscriber base of over 4500 PWIDs and over 26 grassroot drug user led and serving CSOs and CBOs spread across the 40 districts in Uganda. Vision: “A Ugandan society that reorganizes and protects the health, social, economic and human rights of drug users”. Mission: “To reduce the health, social and economic harms associated with drug use to develop an enabling environment for the implementation and expansion of human right interventions for drug users in Uganda. Objectives: We work to: • Promote access to cancer screening, psychosocial support and comprehensive care (HIV, SRHR, TB, and Hepatitis B and C treatment). • Organize and equip drug users whose rights have been violated to take responsibility of their health, social, economic wellbeing and sustainability through economic empowerment trainings and functional adult literacy programmes. • Document and expose human rights violations against drug users and call for legal protection and engage in policy reforms on laws that negatively impact on drug users. • Build partnership, synergy and develop the leadership capacity of drug users to take charge of their program. • Promote the health, social economic and human rights of “drug users” in Uganda irrespective of their social, economic, academic, cultural or political background. • Promote safer sex education such as condom use, needle and syringe exchange program, comprehensive care and mechanism on how to deal with issues of overdose, trafficking and violence against drug users. • Call for an enabling environment and strengthen partnerships towards “drug users”. Core values for UHRN The driving forces that guide all actions and practices in UHRN are: • Social justice, protection and recognition in society • Love and respect for one another. • Support and care for one another • Honesty in all our undertakings • Empathy for each other as drug users • Sharing the available resources.
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