NOUS SOIGNONS CEUX QUE LE MONDE OUBLIE PEU A PEU Starting needle exchange programming for injecting drug users (IDUs) in Temeke District, Dar-es- Salaam, Tanzania Dr Joseph Mbatia Assistant Director and Head, NCD, Mental Health & Substance Abuse Ministry of Health and Social Welfare

I.Issue » Increasing prevalence of injecting drug use in Eastern Africa » At least IDUs live in Tanzania with high HIV prevalence among this population (IRIN. Tanzania: Focus on drug abuse. UN Office for the Coordination of Humanitarian Affairs; 20 Jan 2004) » MdM Rapid Assessment and Response (RAR) 2011: >HIV prevalence of 36% among PWID (67% for female PWID). Consistent with earlier findings in Dar es Salaam (Williams, McCurdy et al. AIDS Educ Prev. 2009; 21(5): ) >Overall HCV prevalence was 28% >Co-infection was 15% among men and 28% among women. » Temeke is the poorest of the three urban Districts of Dar-es-Salaam and drug use is rather visible and widespread in the community. » Access to comprehensive and effective harm reduction services remains very difficult. » Harm reduction services are essential in reducing HIV transmission as well as other health and social risks.

II. Description » MoHSW, Temeke Council, Médecins du Monde France (MdM-F): Harm Reduction intervention with NSP in Temeke District since March DIC and Outreach: access to basic health care and social services; HIV and HCV testing; sterile injection material and behaviour change communication; special opening hours for women » Community information and peer support component. » Capacity building of local NGOs » Data as of October 2011: 1645 beneficiaries 45 IDUs/day at DIC 50 IDUs/day in outreach 400 sterile kits/week Average of 20 referrals to health facilities per month

III. Lessons learnt » First changes in IDUs’ behaviour: Sterile material is used » Community acceptance was high towards the program » Needle exchange programming clearly feasible and acceptable in a semi-urban African context.

III. Next steps » Significant challenges at the policy level. Pilot projects to be assessed and scaled up » The programme will continue focusing on capacity building of national stakeholders through training, study tours, and international conferences.