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United Republic of Tanzania
Effective Drugs Policy and Harm Reduction in Tanzania
Dr. Jessie Mbwambo – MUHAS
Neema Makyao – NACP
Amani Msami – DCC
Dr. Cassian Nyandindi – MNH/Mwananyamala RRH
Sandrine Pont – MdM
Dr. Eva Matiko – CDC|PEPFAR
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United Republic of Tanzania
Outline of the presentation
What is Harm Reduction, principles, evidence Magnitude & impact of drug use in Tanzania Drug Policy in Tanzania Best practices Achievements Challenges Way forward
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United Republic of Tanzania
What is Harm Reduction?
‘Harm Reduction’ refers to policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. HR benefits users, their families and the community. –HRI
‘Harm Reduction’ refers to public health interventions that seek to reduce the negative consequences of drug use and drug policies. –IDPC
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United Republic of Tanzania
Harm reduction principles
Harm Reduction International A strong commitment to public health and human
rights International Drug Policy Consortium
Targeting risks & harms Evidence based & cost effective Rooted in dignity & compassion Acknowledging human rights Challenging policies & practices that maximise harm Transparent, accountable and participatory
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United Republic of Tanzania
Support for harm reduction
Evidence of paradoxical effect of greater restrictions
Evidence of reduction in violence, HIV Opportunity for other health care services UN E4A (Evidence for Action) Series:
http://www.who.int/hiv/pub/idu/idupolicybriefs/en/index.html
United Republic of Tanzania
Drug use in Tanzania
Population size & HIV prevalence –NACP, May 2014 PWUD # 300,000 (200,000-350,000)
HIV prevalence 18-25% PWID # 30,000 (20,000-42,500) 30-50% reside in Dar
HIV prevalence 36% (22-43%) ♀ PWID: no national consensus on population
HIV prevalence in various samples 64-71% High reported sexual risk additional to injection risk
HIV prev Natl 5.1% (♀6.2%) Dar 6.9% (♀ 8.2%)
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United Republic of Tanzania
Principles of Effective Drug Policy
Assessment of priorities and evidence Human rights Focused on reducing the harmful
consequences of use and markets Social inclusion of marginalised groups Build open and constructive relationship
between civil society and government
United Republic of Tanzania
Drug Policy in Tanzania
Tanzania Anti Drug Act no. 9 of 1995Drugs and Prevention of Illicit Traffic in Drugs Act CAP 95 Amendment no.2 of 2012
National Drug Control Policy (awaiting endorsement) National Strategic Framework for HIV/AIDS Prevention for
Injecting Drug Users (2012-2016) Policy Guidelines for MAT 2010 Minimum Standards for MAT facilities 2010 National KP communication strategy 2013 Strategy for reduction of stigma and discrimination & impact
of HIV on KP (2014 – 2018) NACP with WHO developing M&E for KPs (in progress)
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United Republic of Tanzania
Guidelines for HIV/Health Services
Outreach Service Guide for HIV Prevention among Drug Using Populations 2010
Guide for Screening and Brief Intervention for Substance Abuse Disorders 2010
A clinical guide for Medically Assisted Treatment for Opioid Dependence 2010
Advocacy Communication and Social Mobilization Strategy on HIV/AIDS Prevention for PWID, 2013-16
KP Comprehensive HIV & Health Services Delivery 2014
KP HCW Comprehensive training manual 2014
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United Republic of Tanzania
Best Practices
New strategies and guidelines aligned with the harm-reduction approach recommended by UN
Allows access and support for treatment as needed
Strong support at highest level of government translates to other levels
Emerging success in treatment and recovery encourages others to access treatment
Initial partner-led efforts gaining government support
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United Republic of Tanzania
Achievements
44,443 PWUD reached by CBOs (2007- 9/2014) 6,154 PWID accessing NSP ~990,000 distributed
(July 2011-Sep 14) 2,000 on MAT (Feb 2011-Sep 2014) ~98% tested & received HIV results @ MAT (many
more through outreach!) 178 on ART & MAT 927 diagnosed and treated for TB (incl. 5 MDR) 5,054 Police trained plus 29,806 members of
community policing initiative
United Republic of Tanzania
Challenges
Law prohibiting possession of needle/syringe is a barrier to NSP
Repressive laws push clients into hiding hence barrier to accessing care e.g. possession of minimal amounts, trace amount in body fluids criminal offence
Positive steps in collaboration with police but sustained response requires integrating HR in the law & mainstream training
Fundamental problem of unemployment continues post recovery
Resource allocation to for coverage of services
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United Republic of Tanzania
Way Forward
Aim to reform drug law to accommodate minimum health standards and create enabling environment for health-seeking behavior among PWUD
Support LGAs to map and plan for comprehensive response according to needs (PWID/PWUD population size and risk behaviors)
Innovative livelihood options as primary prevention and rehabilitation (multi-sector involvement)
Publicly recognize and reward positive actions Recovery and reform from criminality Law enforcement supporting access to care
National MAT scale-up plan to treat 25,000 PWUD by 2018
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