‘HIV can kill faster than drug addiction’: Nigeria opens first needle exchange to fight infection | Global development

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AAll it took was a few puffs on a friend’s cigarette at a college party to start a life of addiction. Abiola* was 21 years old and the tobacco was mixed with cocaine. “Since then, the journey has been good, bad and ugly. I went from being a user to that of a dealer,” explains the 53-year-old network administrator, who has spent time in prison for his drug use.

“I started smoking a lot and 10 years ago I started injecting drugs. But I’m here now,” he said, spreading his needle-covered hands on the table.

Abiola participates in Nigeria’s first needle and syringe exchange program in Ibadan, Oyo State. He still takes drugs, but now he should reduce his risk of contracting HIV and hepatitis C by sharing needles.

About 1.9 million people in Nigeria are HIV-positive, making it the fourth most affected country in the world. The rate of HIV among injecting drug users is more than double the national average – 3.4% compared to 1.4% – according to the Nigeria Drug Use Survey. In 2018, there were approximately 80,000 injection drug users in the country.

The Nigerian government has approved its first tri-state needle exchange program in 2020, a small but significant change in attitude towards drugs in a country where use and possession are punishable by prison.

This decision reflects broader international change. A report, released by Harm Reduction International in October, found a global increase in needle programs, drug consumption rooms and opioid treatment over the past two years.

Nigeria’s pilot program was launched in Oyo, Abia and Gombe states in July, delayed by the pandemic and logistics between the National Drug Enforcement Agency and the Ministry of Health.

In Ibadan, Nigeria’s third largest city, Goodworker Ministry International is leading the initiative. Staff visit “dormitories” – abandoned buildings frequented by drug addicts – to collect and exchange needles and tell people about the program. During the pilot project, the organization had distributed syringes to 2,739 people.

“The experience is okay. You just have to be patient to understand their stories. You have to understand them and understand what they are up against,” says Olabode Kolawole, a monitoring and evaluation officer at Goodworker.

Project workers advise users on safer ways to take medication, what to do in case of an overdose and ways to stay healthy.

Abiola is impressed: “Now I know things like naloxone better [used to reverse the effects of opioids] and methadone.

“Before, when someone overdosed what we did in the dorms was splash water and slap the person, now I know it’s life-threatening to the person.”

Habeeb*, 53, who started using drugs at age 13, says the program has helped him. “Before, if I had 100,000 naira [£190] on me, I would spend it all on drugs immediately. But now I can spend a day or two resisting,” he says.

But there is also caution. Nigeria has tough laws that are rigorously enforced. Possession of cocaine or heroin can result in sentences of 15 to 25 years.

“We shouldn’t over-interpret the government allowing this scheme,” says Best Ordinioha, a professor of public health and community medicine at the Nigerian University of Port Harcourt. “In the eyes of the Nigerian government, anyone who uses drugs is breaking the law and should be prosecuted.

Ordinioha says attitudes must change to prevent disease.

“It’s the habit of sharing needles and syringes that predisposes them to these blood-borne infections,” he says. “It has been demonstrated that [controlling them] is very important because diseases like HIV and hepatitis can kill faster than drug abuse.

Dr. Olukayode Ogunkunle, project manager of the Oyo Agency for AIDS Control, says the federal government recognizes the importance of the program and will extend it, but funding could be an issue. “In order for us to maintain this program, we need to advocate for more funds and raise awareness because at first the public was skeptical.”

Tunji Agboola, the founder of Goodworker, adds: “NGOs cannot do it alone, there needs to be synergy with the primary health care sector and we need to penetrate more places. The journey has begun but it is a long journey.

*Names have been changed.

theguardian

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