An Overview of HIV Prevention Interventions for People Who Inject Drugs in Tanzania

Abstract

In the past decade, Tanzania has seen a rapid rise in the number of people who inject drugs (PWID), specifically heroin. While the overall HIV prevalence in Tanzania has declined recently to 5.6%, in 2009, the HIV prevalence among PWID remains alarmingly high at 35%. In this paper, we describe how the Tanzania AIDS Prevention Program (TAPP), Médecins du Monde France (MdM-F), and other organisations have been at the forefront of addressing this public health issue in Africa, implementing a wide array of harm reduction interventions including medication-assisted treatment (MAT), needle and syringe programs (NSP), and “sober houses” for residential treatment in the capital, Dar es Salaam, and in Zanzibar. Looking toward the future, we discuss the need to (1) extend existing services and programs to reach more PWID and others at risk for HIV, (2) develop additional programs to strengthen existing programs, and (3) expand activities to include structural interventions to address vulnerabilities that increase HIV risk for all Tanzanians.

Concentrated HIV subepidemics in generalized epidemic settings

“…44 Important barriers to implementation include the criminalization of drug dependency and needle possession in some jurisdictions, and explicit policies against OST. 42, 44 Tanzania is currently at the forefront of harm reduction in sub-Saharan African with its recent implementation of a first NSP site, medication-assisted treatment, and ‘sober houses’ 41, 45 – mostly in the urban centre of Dar es Salaam. Given that PWID have been described as the high-risk group with the largest unmet needs, 46 there are important opportunities to reduce HIV burden among PWID through the implementation of evidence-based strategies.…”

Perceived Cost Advantages and Disadvantages of Purchasing HIV Self-Testing Kits among Urban Tanzanian Men: An Inductive Content Analysis

“…While Tanzania has made great strides in increasing HIV testing rates from 27% in men and 37% in women in 2008 to 47% in men and 62% in women in 2012 with the provision of free HCT through the Tanzania AIDS Prevention Program (TAPP) [58,59], uptake of HCT remains low and novel testing interventions are needed. Half of Tanzanian people ages 15-49 have never tested for HIV, and fewer than onethird of previous testers have been tested in the past 12 months [57].…”

Harm reduction as a complex adaptive system: A dynamic framework for analyzing Tanzanian policies concerning heroin use

“…These activities include targeted outreach to disseminate information and cleaning kits, coordination of support groups and psychosocial services through partner NGOs, and HIV testing and counselling. Other internationally-funded programs conduct similar harm reduction activities in Dar es Salaam and on the island of Zanzibar (see Ratliff, et al, 2013). The supportive response from stakeholders, including people who use heroin, created the positive feedback to drive these changes forward.…”

“…First, it is one of the few countries in sub-Saharan Africa to implement harm reduction. Since 2007, government agencies and non-government organizations (NGO) in Tanzania have carried out a variety of strategies to reduce the incidence of the human immunodeficiency virus (HIV) and other blood-borne infections among people who inject drugs, including targeted outreach, HIV counseling and testing, medically-assisted therapy, and needle and syringe programs (Ratliff, et al, 2013). Second, because heroin entered the Tanzanian drug market relatively recently (in the 1980s), local policies do not reflect a lengthy and contentious history where the emphasis was on morality and criminality.…”