XVI international AIDS conference Prevalence of HIV, Hepatitis B & C and Syphilis infections among substance users in Zanzibar - Tanzania XVI international AIDS conference Date:16/08/2006 Toronto-Canada Authors: Mohamed J. Dahoma, Ahmed A. Salim, Reychad Abdool, Asha A. Othman, Asha Abdullah and Ali S. Ali. Contact: zacp@zanlink.com/ mjudahoma@yahoo.com

Zanzibar Islands : (Unguja and Pemba)

General background information General population – around 1,078,964 with 3.1% annual growth rate (2002,census) 2. From 1980s: Zanzibar started to document an incremental growth of two intertwining epidemics namely: (i) The HIV and AIDS (ii) Exponential use of illegal substances e.g. heroin & Cocaine.

Background contd. First HIV index case- 1986. Documented HIV Epidemic -concentrated. HIV prevalence in general population- 0.6% (MOHSW-2002) HIV prevalence among pregnant women- 0.87% (MOHSW- 2005)

Study rationale: The nature and type of HIV epidemic in Zanzibar, has defined the national needs by addressing the Most At Risk Populations (MARPS). Absence of reliable information to guide interventions and de-bridge HIV and Substance use (IDU in particular) in Zanzibar.

Substance users (SU) in Zanzibar. Study objectives: Main Objective: To determine the magnitude and patterns of HIV and Sexual Transmitted Infections (STI) among Substance users (SU) in Zanzibar.

Specific objectives Identify HIV, Syphillis and Hepatitis (HCV & HBV) infection rates and patterns between general Substance abusers and IDUs. Establish risky behaviours (including sexual) among Substance Abusers and IDUs in particular.

Methodology (1): Study period: conducted between September–October 2005. Ethical clearance: sought from the Zanzibar health research council & District authorities and from the police anti-narcotics unit. Study participants- self acknowledging “hard Substance users “including Injecting Drug users (IDUs)

Methodology (2): Study design: (i) A cross-sectional study using a snow-balling approach. (ii) Reformed/rehabilitated substance users supported the recruitment and mobilisation of study participants.

Data collection & Analysis Verbally consenting participants responded to a questionnaire on substance use practices and sexual behavior. User friendly facilities were used Biological samples (5 mls of blood) were collected through the median cubital vein. DBS were used when there was failure to draw venous blood.

Data & sample collection

Blood sample collection

Data collection & Analysis contd. Blood samples were centrally processed and tested for HIV (Capillus & Determine), Hepatitis B & C (Acon rapid test) and syphilis (RPR). Internal control – process and quality were instituted in analysing biological markers.

Study Results:

General demographic information: Study Participants: - 81.9% -(Unguja); - 93% - urban residents. - 5.1%- Females ; 94.9% males. 2. Marital status: - Singles: males- 62.2%, Females-7.7% Cohabiting: males- 3.3%.Females-30.8% Married: Females- 7.7%, males- 15.4%

Age and Sex Distribution of Study Participants Age Group Female Male Total n % 15-19 2 7.7 12 2.5 14 2.8 20-24 7 26.9 71 14.7 78 15.4 25-29 11 42.3 136 28.2 147 28.9 30-34 4 113 23.4 117 23.0 35-39 1 3.9 94 19.5 95 18.7 40+ 56 11.6 57 11.2

Injecting drug users: 12% of IDUs – married 23% of IDUS – Divorced or separated 46% of IDUs (n=198) share needles Flash Blood: Accounts for 9.9% among IDUs in Unguja. Flashblood entails blood sharing tendencies (2-5mls of blood with partner) has started been documented in urban district –Unguja.

Infection patterns among SU/IDUs

Infections (HIV): Higher HIV infection rates in females (30.4%) compared to males (12.04%). (p= 0.02). HIV infection among IDU> non-IDUs (26.31% by 4.5% (p≤ 0.00001) HIV infection among flashblood IDUs: 17.6%. HIV infection among SA with anal sex preference :18.5% (p=0.03 )

Hepatitis infection patterns SU/ IDUs in Zanzibar HCV infection rates (15.5%) among SU in Zanzibar. HCV females >males (21.7% by 15.2% respectively) HIV/HCV co-infection among Substance users-4.2% HCV infection among IDU’s > non-IDUs (29.51% by 6.8%) . ( p≤ 0.00001)

Hepatitis infections (2) HCV infection among males IDU’s> Females IDUs [29.2% by 16.7%] p≤ 0.00001 HIV/HCV co-infection among IDU: 10.4% while in needle sharers: 30.9% Hepatitis B: 2.1% of SU . infection was only documented in males (2.2%).

Co-infection Number in Sample Prevalence of Co-infection n % HIV and HepC 59 20 33.9 HIV and Syphilis 55 9 16.4 HIV and HepB 1 1.7 HepC and HepB 74 4 5.4 HepC and Syphilis 61 14 23.0 HepB and Syphilis 8 12.5

Anal sex and HCV infection Negative Positive no 306 48 (15.7%) yes 96 26 (27.1%) Total 402 74 P=0.04

Conclusion: Injection drug use and needle-sharing are common among SUs in Zanzibar. IDUs have high prevalence of blood-borne infections. IDU could present a bridging population for spread of HIV into the general population in Zanzibar. Special designed interventions for MARPS

Acknowledgement: Study community: Substance users 2. Partners (international): - UNODC - CDC - TMAP/WB 3. Local partners - Anti- narcotics department - ZAIADA - ZAYADESA - SWAZA

Thanking you all for your attention .