Drug trafficking, use, and HIV risk: The need for comprehensive interventions

Abstract

The rapid increase in communication and transportation between Africa and other continents as well as the erosion of social fabric attended by poverty, ethnic conflicts, and civil wars has led to increased trafficking and consumption of illicit drugs. Cannabis dominates illicit trade and accounts for as much as 40% of global interdiction. Due to escalating seizures in recent years, the illicit trade in heroin and cocaine has become a concern that has quickly spread from West Africa to include Eastern and Southern Africa in the past 10 years. All regions of Africa are characterized by the use of cannabis, reflecting its entrenched status all over Africa. Most alarming though is the use of heroin, which is now being injected frequently and threatens to reverse the gain made in the prevention of HIV/AIDS. The prevalence of HIV infection and other blood-borne diseases among injection drug users is five to six times that among the general population, calling for urgent intervention among this group. Programs that aim to reduce the drug trafficking in Africa and needle syringe programs as well as medication-assisted treatment (MAT) of heroin dependence while still in their infancy in Africa show promise and need to be scaled up.

Drug use as a driver of HIV risks

“…Other countries in sub-Saharan Africa have witnessed epidemics of heroin and cocaine use (8, 17, 46), especially among FWID who trade sex (48). Recently, West Africa came to the fore as a drop-off point on a major cocaine trafficking route from South America to Western and Central Europe.…”

“…In six of these countries, the majority of which are in Eastern Europe and Central Asia (2, 3), IDU was the major mode of HIV transmission. While the highest concentration of PWID remains in Eastern Europe and Central Asia (7), South East Asia and some countries in Africa, including Kenya, Tanzania, Nigeria, Mauritius, and South Africa (8, 9) are experiencing increases in the number of people who inject drugs (PWID). Furthermore, the emergence of some forms of non-injection substance use (particularly stimulants) is occurring in a number of countries including parts of Africa.…”

Addiction and treatment experiences among active methamphetamine users recruited from a township community in Cape Town, South Africa: A mixed-methods study

“…Globally, ATS is the second most widely used class of drugs, and they are generally more prevalent in high-income countries (United Nations Office on Drugs and Crime, 2014). The prevalence of ATS use remains relatively low in Africa, but notable increases have emerged in the southern and western parts of the continent (Mbwambo et al, 2012). Providing quality treatment for ATS addiction in low- and middle-income countries (LMICs) remains compromised by overstretched health care facilities and the dearth of accessible drug treatments (Coovadia et al, 2009; Mbwambo et al, 2012; Odejide, 2006).…”

An ethnographic exploration of drug markets in Kisumu, Kenya

“…We have few comparative data on drug use from newly developing drug markets in sub-Saharan Africa, where similarly chaotic situations may be emerging in parallel to Kisumu’s. Given that the global burden of HIV infection remains concentrated in sub-Saharan Africa, we join further calls for research to characterize and respond to the contribution of injection drug use to an already serious HIV epidemic (Guise et al, 2015; Guise et al, 2015; Mbwambo et al, 2012; McCurdy et al, 2007). …”

“…International airport and sea links, weak law enforcement, corruption, expansion of telecommunication and global financing, and increased connectivity in global commerce networks have strengthened drug trafficking across sub-Saharan Africa over time (Needle, Kroeger, Belani, & Hegle, 2006). Since the 1980s and 1990s, trafficking of South American cocaine through West Africa and Asian heroin through East Africa has intensified to meet demand in European markets (Adelekan, 1996; Mbwambo et al, 2012). While early research pointed to such increasing trafficking patterns and indications of heroin and cocaine availability across the region, data have historically been limited on the extent and modes of local drug consumption (Adelekan, 1998; Adelekan & Stimson, 1997).…”