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A write up on People Who Use Drugs and HIV/AIDs in Uganda

Uganda has continued to experience a severe generalized HIV epidemic. Recent estimates put the number of new HIV infections at 140,000 with an approximate 1.6 million people living with HIV (MoH, 2014). The 2011 Uganda AIDS Indicator Survey estimated the HIV prevalence to have increased from 6.4 to 7.3 per cent among adults (aged 15–49 years). Although the epidemic is generalized, the epidemic is in the rise among sub-populations groups referred to as most at risk population groups (MARPs) or key population groups that bear a high burden of HIV compared to other populations and are highly vulnerable  (UAC 2011; Wabwire-Mangen, Odiit, Kirungi, & Kisitu, 2009). While there has been general focus and studies on other Most At-Risk Populations in Uganda, scanty information exist among people who drug users in terms of HIV programming yet they are of national importance. Available national information through a combination of UNAIDS and UNODC data, provide estimates that HIV prevalence rate of PWID in Uganda is 11.7%, also a small-scale study of 67 sex workers who use drugs found a HIV prevalence rate of 34 per cent (IDPC Briefing Paper, HIV prevention among people who use drugs in East Africa; September 2013). Another study conducted in Kampala (Most At Risk Population (MARPS) Network in 2012-2013) highlighted HIV prevalence at 17% among injecting drug users. However little attention is being given to them and yet they may have a major contribution to the 7.3% (Uganda AIDS Indicator Survey 2011) prevalence of the total population of Uganda. The International experiences and national anecdotes suggest that the use of illicit drugs or illegal narcotic substances is a critical causative cum vulnerability factor to HIV/AIDS and the association is closely related with sharing of contaminated drug-injection equipment (e.g., needles, syringes, and cookers), multiple sexual partners, exchanging sex for money or drugs and inconsistent use of condoms among users (Choudhry, et al., 2014). Alcohol and drug use is highlighted as one of the risk factors driving the HIV epidemic in Uganda as reflected through the Modes of Transmission and Prevention Response Analysis (UNAIDS Report March 2009) though there has been limited focus on this sub-population in national programming seen through the  HIV National Strategic plans that does not include any strategies for them. The only mention of IDUs is in the National HIV Prevention Strategy (2011-2015) does not include any actions targeting people who use drugs but simply states: ‘It is globally acknowledged that IDUs and MSM play a major role in HIV transmission”. In this sense therefore, if Uganda has not included PWUDs in the national HIV Strategic Planning, indeed it’s a gap in adopting the WHO, UNODC and UNAIDS guideline on Universal Access to HIV prevention, treatment and care for drug users (2012 revision).

UHRN's SYRUS ON VOA OCT 2015 25

SYRUS the Programs Manager giving an overview of UHRN’s Programmes during an Interview with Voice Of America. http://learningenglish.voanews.com/content/heroin-and-cocaine-use-increase-in-uganda/3014915.html

It’s from the above background that Uganda Harm Reduction Network through its programming is committed to raise awareness and promote effective access to quality prevention, treatment, care and support services for people who use drugs living with and affected by HIV, TB, Hepatitis and other related health issues and lobby and advocate for a national platform for better health and policy programmes that promote good practices and supportive environment for the expansion and implementation of harm reduction programmes for people who use drugs (PWUDs) in Uganda

World Drug report 2014 shows why Entebbe Airport is origin destination for traffickers .Visit link for details:- how-big-is-ugandas-drugs-problem

THE PEOPLE LIVING WITH HIV STIGMA INDEX August 2013 UGANDA. Visit link for details:- Uganda-PLHIV-Stigma-Index-Report-2013-Final

PHYSICAL ABUSE:

Grabbing, pinching, punching, shoving, slapping, hitting, hair pulling, scratching, biting, throwing things at you; stopping you from getting medical care or forcing you to use alcohol and/or drugs.

SEXUAL ABUSE:

Forcing or attempting to force you to do any sexual act without your consent; raping or threatening to rape you (includes marital rape); treating you in a sexually humiliating manner.

ECONOMIC OR FINANCIAL ABUSE:

Making or trying to make you financially dependent by maintaining total control over financial resources; not giving you money or only giving you a very small allowance; making you account for every cent you spend; stopping you from earning money; withholding access to money.

EMOTIONAL AND PSYCHOLOGICAL ABUSE:

Undermining your sense of self-worth, e.g., constantly criticizing you, telling you that you are useless or stupid, calling you names, damaging your relationship with your children, humiliating you in public or privately; intimidating you; threatening physical harm to him/herself, to you and your children; destroying your belongings or the property; isolating you from your family and friends; harming your pets; being overly jealous and possessive; stalking you, i.e. following you or waiting for you at work or other places you frequent.

VERBAL ABUSE:

Calling you names; constantly shouting at you; swearing at you; talking to you as though you were a child or as though he/she owns you.

HARM REDUCTION:

Harm Reduction refers to policies, programmes and projects which aim to reduce the health, social and economic harms associated with the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. It is an evidence-based and cost-effective approach – bringing benefits to drug users, their families and the community. Harm reduction is a targeted approach that focuses on specific harms. It requires that politicians, policymakers, communities, researchers and frontline workers ask two questions: What specifically are the harms associated with different psychoactive drugs? And what can be done to reduce the risk of those harms occurring? People have always used drugs, engaged in drug use and will always use drugs as such there will never be a drug-free society. But harm reduction accepts that some people who use drugs are often unable or unwilling to stop, and seeks to provide care, support and resources in a non-judgmental.The most humane, compassionate and effective approach is therefore to attempt to alleviate the worst of the harms associated with drug use.

Harm reduction promotes safer use and options that help to minimize the risks from drug use and of causing harm to themselves or others, without requiring the cessation of use. It is a pragmatic approach that is based in “public health” and “human rights”. There is a large and ever growing body of evidence that demonstrates harm reduction as an effective approach for preventing drug related harms including HIV, STI/STDs, TB, Hepatitis B and C, and overdose. In addition to individual benefits, harm reduction interventions also benefit the community, for example by reducing crime.

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