Drug User Issues

UHRN Press Release  0n 15th Apr 2016: The addiction to drugs is a health concern, not a genuine instance of injustice. The criminalization of a public health issue has created huge and complex obstacles for people motivated to eliminate their drug dependence to seek or obtain necessary health care and support.  When public health options are made available, studies have reported dramatic declines in drug dependence, mortality and overdose. If we want to encourage people to seek treatment, we need to assure them that they will not face prison for doing so.

UHRN firmly believes that there must be a stronger focus on the health needs and human rights of all people who use drugs, especially those who inject. There is a serious gap in service provision in Uganda for PWUD where no attention is given to those who need drug dependence treatment services. We as UHRN we are well aware in Uganda there is no treatment centers for people who use drugs, like cocaine, heroin and other opioids. Growing evidence indicates that drug treatment and counseling programs are far more effective in reducing drug addiction and abuse than is incarceration. Treatment like methadone, nalexone that can save her life is still illegal in Uganda and anyone being in possession of those drugs in the later is criminalized if not authorized by the government. Such Medically Assisted Therapy (MAT) is a treatment for persons who are addicted to heroin using prescribed medication. Such kind of treatment is prohibited in Uganda.

The current Antinarcotic law is a blow to public health; the Narcotics Law penalizes possession of illicit drugs with 10 to 25 years in prison. Trafficking—which encompasses everything from small sales to international export—is punishable with a life sentence. Even those who never come across an illicit substance can find themselves ensnared. The law goes so far as to levy a five-year prison sentence for failure to disclose prior prescriptions for narcotic drugs or psychotropic substances (including those held for pets and farm animals) when receiving a new prescription. Punitive laws like this push people who use drugs especially those who inject to higher risks of HIV, Hepatitis and other blood pathogen transmission away from accessing prevention information, health and social services that are vital to managing drug dependence, preventing transmission of HIV, and supporting people to live full and productive lives.  By further criminalizing drug use, this law pushes PWUD into the shadows. PWUD are afraid to talk and afraid to seek much-needed medical help because the government has now definitively positioned drug use as a justice issue, rather than a health issue.” The Police action will frighten people who use drugs from accessing the available health services in case they want to withdraw from drug use.

As drug use in Uganda is on the rise, we as Uganda Harm Reduction Network we advocate for a responsive treatment which encompasses the 9 harm reduction interventions which Uganda as a country has not embraced. UHRN has been advocating for inclusion of harm reduction interventions in polices and guidelines as per World Health Organization guidelines. We therefore call upon the government of Uganda not to criminalize drug users seeking health services but rather offer treatment support and non-coercive rehabilitation. For More information visit the link: UHRN Press Release

Uganda Drug User Situation.

Uganda has weak data on drug users and extremely limited information available on people who use drugs in Uganda, as for most-at-risk populations in general. 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 in Uganda, although the Country (combination of UNAIDS and UNODC data provided) 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; Alcohol and drug use was highlighted as one of the risk factors driving the HIV epidemic in Uganda’s (HIV Modes of Transmission and Prevention Response Analysis (UNAIDS Report March 2009). 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.

Uganda does not currently have a drug law and effective interventions to prevent HIV among people who use drugs (such as NSPs and OST) do not currently exist in the country, 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 IDUs and MSM play a major role in HIV transmission. Nevertheless, the Strategy does commit to ‘ongoing surveillance of risk behaviors among IDUs’. The lack of harm reduction services in Uganda 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.

The link between substance abuse and sex work is hard to pinpoint though there are a variety of factors that are common to both including homelessness, unstable family lives, socio-economic deprivation, disrupted schooling, poor local authority care and a lack of confidence and self-esteem issues. Individuals who fall into both categories are particularly vulnerable to HIV. Uganda has moved from being a “transit route” for drugs from Afghanistan, Indonesia, Nigeria, 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”. Young people who inject drugs; A report by the UNAIDS Inter-Agency Task Team on HIV and Young People found an estimated 70 percent of the world’s drug users are under 25, and at least half in urban areas start injecting in their teens. 42 Of these young people, 3 percent are living with HIV. 43 Young people are also likely to show more high-risk behavior such as sharing needles or getting needles from unofficial places. Rita 19 years “The Needles and syringes we use when [injecting] drugs are very expensive. For this reason… we don’t mind sharing with others.”

Uganda’s approach to drug use focus overwhelmingly on criminalization and the imposition of harsh penalties rather than on public health measures. For example the Anti-narcotics Law penalizes possession of illicit drugs with 10 to 25 years in prison. Trafficking—which encompasses everything from small sales to international export—is punishable with a life sentence. Even those who never come across an illicit substance can find themselves ensnared. The law goes so far as to levy a five-year prison sentence for failure to disclose prior prescriptions for narcotic drugs or psychotropic substances (including those held for pets and farm animals) when receiving a new prescription. Punitive laws like this push people away from health and social services that are vital to managing drug dependence, preventing transmission of HIV, and supporting people to live full and productive lives. As long as their behavior (drug use) is punishable by law and the cause of intense stigmatization and discrimi­nation, they are unlikely to get tested and treated for HIV, viral hepatitis and TB. All of which they are most at risk of contracting, due to their life­style and habits. Uganda also has policies of compulsory detention in prisons or in drug rehabilitation centres, as ‘treatment’ for people who use or inject drugs People who use drugs are routinely detained, and are denied any health services while in prison, including HIV prevention or treatment, drug overdose or withdrawal management services. 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 adopt the WHO, UNODC and UNAIDS guideline on Universal Access to HIV prevention, treatment and care for drug users (2012 revision) and not incorporating the international best practices such as harm reduction programmes, such ill-informed interventions may cause irreparable harm to particular communities such as IDUs, sex workers and other sexual minorities, and serve to further stigmatize and discriminate them from public health services and care. This is already evident in provisions for mandatory testing for HIV among sex workers and injecting drug users under the HIV Prevention and Control Act 2014.

Lack of ‘evidence’ on drug users and HIV in Uganda is often cited as a reason for not including drug users in national HIV plans. Lack of evidence means a total lack of visibility in policy terms for drug users. Drug users are often considered to be social outcasts and are subjected to violence, arrest and other legal sanctions. One way to address this issue is to support drug user-led research initiatives where drug users themselves set priorities and research questions, and they collect, analyze, interpret, and own the data/evidence. Drug user-led research enables necessary steps to be taken to safeguard data so that drug users do not come to any harm through identification of themselves or of geographical sites they frequent for work or leisure. Lack of national data on HIV and people who use drugs (PWUDs) has been holding back the inclusion of people who used drugs and the implementation of HIV prevention initiatives for people who use drugs, as well as for hepatitis C and other co-infections. Strategic information produced under this project will inform a national program planning. Standardized methodology which will allow cross country comparisons and will identify and describe regional diversity and rich contextual factors. This will in turn, support the development of highly targeted and combination interventions.

Meaningful involvement of PWUDs is one way of strengthening leadership and drug users capacity for advocacy and also a key to bridging the data gap. Capacity among drug users champions to represent their constituencies needs to be strengthened so that international organizations or researchers are not representing drug users in decision making forums – without proper endorsement or mandate from them. Making sure that drug users can participate and have a voice and can engage effectively in decision-making forums is also extremely important not only for evidence generation but for credible analysis, interpretation and use of data. Drug users need to be much more involved in policy and programme development, just as people living with HIV have become much more engaged in these processes over the last decade or so.

Without greater attention to the needs of drug users, the concept of “reaching the 90–90–90 targets, Zero New HIV infections, Zero Death, Zero Discrimination will not be possible without reducing new HIV infections among people who inject drugs in Uganda. Service coverage and policy responses for this population remain grossly inadequate. The pace of scale-up remains far too slow to drug users. The situation demands an intensified, systematic, evidence-based and well coordinated HIV prevention and treatment response among drug users. “I witnessed many effective harm reduction programmes throughout the world, stressing that those that enable people who inject drugs to be part of the solution have the greatest impact……….the 2016 Special Session of the United Nations General Assembly on the World Drug Problem was widely seen as critical and offers a key opportunity to redirect and reform global and national policies to reduce the adverse impact of drugs on public health” said Mr Sidibé.

Hepatitis c:

Hepatitis C (HCV) is the most common blood-borne virus among Drug users.Injecting drugs with contaminated syringes or other injecting equipment is the leading cause of HCV infection, with the majority of people who inject drugs having been infected. Left untreated, hepatitis C can cause serious liver disease, including cirrhosis and liver cancer and HIV-positive persons co-infected with hepatitis C are at greater risk for liver damage. Managing HCV can often be complicated by stigma, criminalization and even denial of basic human rights and health care.

Fortunately, there is increasing evidence to support a range of prevention approaches as well as newly approved medications that have doubled cure rates and shortened the length of treatment for many. In addition, a new rapid hepatitis C test gives us another chance to make counseling, diagnosis, and linkage to care work.

Syringe access among Injecting Drug Users is essential in the prevention of HIV and hepatitis C (HCV).

Research consistently demonstrates the effectiveness of syringe access in preventing transmission of infectious disease and skin and soft tissue infections, while also supporting the overall health and well being of drug users through linkages to drug treatment, medical care, housing, overdose and other vital social services.

Syringe access programs respect, value and prioritize the human rights and dignity of people who use drugs, while challenging drug use related stigma.

Drug Users Activism in Uganda

People who use drugs (PWUD) in Uganda are often not considered valid policy or service partners in issues that directly affect their lives. However, UHRN recognizes that PWUD are part of the solution and should not be seen as the problem. UHRN works to support the meaningful participation and community mobilization of PWUD in Uganda.

Sex Workers Who Use Drugs (SWUD) do not have equal access to health and legal services. Social stereotypes and perceptions about sex worker’s role in the family and society have prompted massive and regular violence against SWUD, including double stigma and structural discrimination. On the other hand, harm reduction services are largely absent for Sex Workers who use drugs just like any other drug user in Uganda and they are rarely represented in policy discussions.

Drug Policy Reform in Uganda

Repressive drug policies that are predominant in the Uganda are costly, ineffective and in breach of international standards on human rights and health. The hostile legal environment drives both brutal human rights violations and epidemics of HIV, TB and viral hepatitis among people who use drugs in Uganda.

Drug Use and Human Rights

People who use drugs (PWUD) in Uganda face systematic human rights violations. Mass incarceration, ill-treatment by police, denial of essential medicines and basic healthcare services are common in the country and are driven by repressive drug policies. Existing drug enforcement practices increase the exposure of PWUD to drug-related harms and undermine the regional, global response to HIV, TB, viral hepatitis and other public health issues.