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Addictions and HIV in Sub-Saharan AfricaAddictions and HIV in Sub-Saharan Africa

Experience of the Corridor ProjectExperience of the Corridor Project

ICASA Satellite Symposium, Dakar ICASA Satellite Symposium, Dakar 4 December 20084 December 2008

J KOFFI, J OJO, L DE SOUZA, O CAPOCHICHI, H DE HARDT-KAFFILSJ KOFFI, J OJO, L DE SOUZA, O CAPOCHICHI, H DE HARDT-KAFFILS

Abidjan-Lagos Corridor OrganizationAbidjan-Lagos Corridor Organization

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Outline

1. Introduction

2. Why people abuse drugs

3. Experience of the Corridor project

4. Corridor Project’s Response

5. Possible Barriers to interventions

6. What Next?

7. Conclusion

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INTRODUCTION

• Around 16 million people worldwide inject drugs, with 3 million infected with HIV

• IDU in 148 countries worldwide of which the five Corridor Countries

• IDUs now account for 10% of all new global HIV infections: growing Injection drug use has resulted in the spread of AIDS in the African nations:

– Kenya, Nigeria, South Africa and Tanzania – IDUs in South Africa share and use same needle up to 15 times despiste risks

associated with the practice

• Drug users have poor knowledge of HIV prevention techniques and other HIV/AIDS treatment services

• CSWs sometimes forced to take drugs and are not able to use condoms consistently.

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Why people abuse drugs• Because of their workBecause of their work

– Truck driversTruck drivers– Sex workersSex workers

• Peer pressurePeer pressure– to join in with others and belong to a ‘special’ group. to join in with others and belong to a ‘special’ group.

• Escape route Escape route – problems at home and schoolproblems at home and school– outside pressuresoutside pressures

• To relax and ‘feel good’To relax and ‘feel good’• Some medications, e.g. painkillers, physically Some medications, e.g. painkillers, physically

addictiveaddictive

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--

Kraké Plage

NoéElubo Aflao Kodjoviakop

é Sanvee Condji

Hilla Condji

Sèmè

Experience of the Corridor Project

• Length: 1022 km Length: 1022 km

• Resident population: Resident population: 30.000.000 inhabitants30.000.000 inhabitants

• Population in transit: about Population in transit: about 47,000,000 people/year 47,000,000 people/year migrate along the corridormigrate along the corridor

• The most important corridor The most important corridor in West Africa (65% of West in West Africa (65% of West Africa economic activity)Africa economic activity)

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The Abidjan-Lagos Corridor Organization The Abidjan-Lagos Corridor Organization (ALCO) Project(ALCO) Project

• Established in 2001 by Govts. of the 5 countries (Cote d’Ivoire, Ghana, Togo, Benin, and Nigeria)

• Project Development Objective: To increase access to HIV/AIDS prevention, treatment and care services for vulnerable populations along the Abidjan-Lagos transport corridor, presently underserved by national responses.

• Particular attention to be paid to:• Transport sector workers• Migrant populations• Communities living along the corridor

• Funding: World Bank (2003-2007), Counterpart funding by member countries, Global Fund (2007 – to date), Technical Assistance: UNAIDS

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Why should a multi-country, cross-border project pay

attention to drug addiction and HIV?

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The Abidjan-Lagos Corridor border areas a melting The Abidjan-Lagos Corridor border areas a melting point for activities predisposing to HIV infectionpoint for activities predisposing to HIV infection

No No interventionsinterventions

Targeting Targeting IDUsIDUs

Illicit Drugs SaleIllicit Drugs Saleand Useand Use

National HIV National HIV Prevention progs.Prevention progs.

weak at borderweak at borderCommunitiesCommunities

High HIV High HIV PrevalencePrevalence

among Truckersamong Truckers& FSWs& FSWs

Low Condom Low Condom UseUse

Low Low Knowledge ofKnowledge ofSTI/HIV/AIDSSTI/HIV/AIDS

Sex withSex withNon-regularNon-regular

partnerpartner

Hot spot for Hot spot for Sex workSex work

Migration & Migration & Delays Delays

at Bordersat Borders

Risk for Risk for HIV infectionHIV infection

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Substance Abuse among Truckers

3,4

45,8

0

10

20

30

40

50

%

Average Drug Consumption Average AlcoholConsumption

Drug and Alcohol Consumption among Truckers along Abidjan-Lagos Corridor

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Drug Abuse among Truckers at selected borders along the corridor

10

7

4

0

2

4

6

8

10

%

Kodjoviakope Aflao Hillancondji

Drug Consumption at selective border sites

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Substance Abuse among Female Sex Workers along the Corridor

100

41

11 7

0

10

20

30

40

50

60

70

80

90

100

%

Alcohol Cigarette Non-injectabledrugs

Injectable drugs

Substance Abuse among Female Sex Workers along the Abidjan-Lagos Corridor

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Commonly Abused Drugs

ClassClass ExamplesExamples

CannabinoidsCannabinoids Marijuana, hashish

DepresantsDepresants Barbiturates, benzodiazepines

StimulantsStimulants Amphetamine, cocaine, ecstacy, methamphetamine, Nicotine, ritalin

Opioids and Opioids and Morphine Morphine DerivativesDerivatives

Codeine, Fentanyl, Heroin, Morphine, Opium

HallucinogensHallucinogens LSD, Mescaline, Psilocybin

InhalantsInhalants Glue, paint, solvents, nitrous oxide

Other CompoundsOther Compounds Anabolic steroids

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The Corridor project’s response

• Recognition of addiction (IDU) as an emerging problem

• Currently reviewing reference document to include these behaviours

• Some border AIDS control committees widening their interventions to include drug abuse

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Possible barriers we envisage to implementation of interventions

• Stigma associated with drug use• No-man’s land between borders• Easy availability of illicit drugs

– ‘If demand persists, it's going to find ways to get what it wants. And if it isn't from Colombia, it's going to be from someplace else.’ Rumsfeld, 2001

• Interventions targeting drug users not a priority for national programs

• Lack of reliable statistics to support advocacy

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Suggested Next Steps• Assessment of the magnitude of drug

addiction along the corridor• Planning and implementation of appropriate

interventions targeting IDUs and other forms of addiction:– Harm reduction measures including needle

exchange programs– Peer-based education of IDUs– Drug treatment

• Stigma and discrimination against drug users to be tackled

• Support from partners with core competence and comparative advantage in this area needed by ALCO.

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CONCLUSION

• HIV among injecting drug users very important in sub-Saharan Africa as it is globally

• It has been clearly identified as an emerging problem along the Abidjan-Lagos Corridor

• Based on the field assessment, what has been reported is just a tip-of-the-iceberg

• Therefore, an aggressive ownership by national programs and other key partners is needed to nip in the bud likely surge in new infections that may arise from these emerging behaviours

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• Global Fund• World Bank• UNAIDS• ALCO Board Chairman – Pr. B.

Osotimehin• Pr. S. EHOLIE• RESAPSI • SOLTHIS

AcknowledgementsAcknowledgements

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Thank Thank YouYou

End of presentation