OVERVIEW ON CSO EFFORTS TO ADVOCATE FOR THE PROVISION OF SERVICES FOR PEOPLE WHO USE DRUGS IN UGANDA WAMALA TWAIBU Executive Director -UHRN Website: Blog: 16 th April 2015

WHO IS UHRN?  Uganda Harm Reduction Network (UHRN) is a youth led drug user Network established in 2011 to respond to the drug use crisis in Uganda;  Since Inception UHRN seeks to provide a national platform for health and policy programs that promote good practices and advocate for a supportive environment for the implementation and expansion of harm reduction programs for drug users. Vision : A society where drug users are empowered to make informed decisions on the impacts of drugs use and live a life that gives them hope in Uganda. Mission : To improve the health and socio-economic well-being of drug users by offering prevention and intervention services aimed at reducing the harms associated with drug use in Uganda.

UHRN approach:  The overall approach of UHRN is benched-marked from a public health and human right based approach.  First, UHRN particularly focuses on community mobilization through outreaches, advocacy for human rights protection for drug users and drug policy reform, call for donor support for HIV-related harm reduction services, sustainable livelihood programs and advocacy for the inclusion and adoption of comprehensive harm reduction package.  Needle and Syringe Exchange programmes (NSE), Opioid Substitution Therapy (OST) and other drug dependence treatments (detox and non coercive rehab), HIV prevention, (HCT), Antiretroviral therapy, Prevention and treatment of STIs, Condom programmes for drug users and their partners, Targeted education and communication (IEC ) for PWUDs and other partners, Vaccination and diagnosis and treatment of viral hepatitis and Prevention, diagnosis and treatment of TB.  Building capacity of the Small to advocate for favourable legal and policy environment

Overview of drug use and HIV in Uganda  There is extremely limited information available on people who use drugs in Uganda, as for most-at-risk populations in general.  Yet Uganda is a key country in East Africa in terms of drug policy and harm reduction. The most common drugs used include cocaine, heroin, marijuana, alcohol and cannabis.  HIV prevalence amongst people who use drugs is unknown in Uganda, although the Country (combination of UNAIDS and UNODC data provided) estimates that HIV prevalence rate of PWID in Uganda is 11.7%, also a small-scale study of 67 sex workers who use drugs found a HIV prevalence rate of 34 per cent (IDPC Briefing Paper, HIV prevention among people who use drugs in East Africa; September 2013).  Another study conducted in Kampala (Most At Risk Population (MARPS) Network in ) highlighted HIV prevalence at 17% among injecting drug users;  However little attention is being given to them and yet they may have a major contribution to the 7.3% (Uganda AIDS Indicator Survey 2011) prevalence of the total population of Uganda.

Some of UHRN’s achievements  We have Trained 30 drug users as peer educators with support from MARPI Mulago National Referral Hospital.  Conducted 2 community meetings on human rights awareness targeting police officers, health workers and drug users.  Reached 5,918 drug users including 269 injecting drug users with HIV/AIDS, TB and HCV information.  We have referred 67 PWUD to Butabika national mental referral hospital for mental and psychotherapy treatment.  We have opened safe space(drop-in centre) for the drug users which serves as a hub where peer educators/drug users come for chats, to take their ARVs, Counseling, and health education sessions and share their personal stories and experiences, pick condoms and their referral cards to link them to treatment and other health service centres.

Achievements Cont’d...  Through our peer educators we have documented 15 drug user personal stories and experiences of human rights violations in the past six months of outreach.  5 Mediations and negations have been conducted by UHRN paralegal team for the release of our arrested members from 5 police stations.  Conducted 14 HCTs in the 5 divisions of Kampala in partnership with MARPI Mulago, and 98 out of 618 drug users whom we tested were found HIV positive and referred to MARPI Mulago for treatment. Also we Disseminated 1000 brochures with health tips on “safe & clean injecting  Conducted 8 Community sensitization dialogues on HIV and SRHR targeting drug users(IDUs and Female sex workers who use drugs),  As a result of UHRN’s Lobbying, and Networking with different stakeholders both at National and Regional level- UHRN is coordinating a Human Rights and Harm Reduction Working Group in Uganda comprising of representatives from different partner organizations that advocates for legal justice for KAPs groups in Uganda such as UGANET, HRAPF, CEHURD and Makerere University Faculty of Law-PILAC. The team is looking at providing Legal justice to cases of human rights and HIV targeting the drug users in Uganda.

Achievements Cont’d...  From our lobbying, partnerships and networking, UHRN and peer educators worked with a team of journalists from Al Jazeera to publish a documentary on “Uganda’s thriving drug scene” uganda-thrivingdrug htmlhttp:// uganda-thrivingdrug html  UHRN has worked with ARASA, KANCO and other regional partners from 8 selected countries in the drafting of the EOI and the recently submitted Regional Concept Note (RCN) on harm reduction targeting IDUs and the ARASA RCN on strengthening the legal and policy environment to reduce the impact of HIV and TB on key populations in Africa through organizing National consultative dialogues on harm reduction, presenting the two RCNs to the country’s Global fund CCM up to the point of their endorsements.  UHRN has had its concept to conducting a situation analysis to establish the drug user burden in Uganda approved by the Global fund under the cost extension funding for KAPs in Uganda...to be conducted in the Eastern border towns of Uganda (along the transit routes of drugs)

Achievement Cont’d....  UHRN also seats on the MARPS Steering Committee at Uganda AIDS Commission (UAC) which is now in the process of developing the MARPs Priority Action Plan which is ongoing.  UHRN has continued to work with SAFE under Gulu Medical Institute- School of Public Health Makerere University, Uganda Centre for Disease and Control, MARPs Network, MARPI Mulago, Butabika National Mental referral hospital, Uganda Aids Commission, HEPs, WONETHA (Women's Organization Network for Human Rights Advocacy), WGNRR (Women Global Network Reproductive Right), Civil Society Coalition On Human Rights and Constitutional Law, CHAU (Community Health Alliance Uganda), EANASO, UNDP-Ethiopia Office, CSMMUA (Coalition on Safe Mortality and Morbidity on Unsafe Abortion), ATHENA- Project to strengthen advocacy and promote the visibility of drug users human rights in Uganda, so that their human and health rights are recorganised and protected for them to access quality and comprehensive health care services and hence adopting the Harm Reduction Model in Uganda and across Eastern and Southern in the long run.

Drug users preparing their stuff for injecting and sniffing

Gaps or challenges faced by drug users/UHRN in Uganda  Lack of data for evidence-Data on PWIDs not readily available,...the available data is not provable with questionable quality and minimum efforts on generation of evidence  Thus, minimum or none PWIDs indicators in Uganda.  Drug users not a priority despite the magnitude of HIV prevalence in NSP.  Cases of overdose and homelessness which interferes with drug users HIV treatment and adherence.  Lack of treatment for drug users in cases of drug dependency Harm Reduction interventions.  Lack of data/ evidence/involvement of PWUDs in knowledge production showing good practices on PWUDs related issues (e.g. need to train People Who Use Drugs as researchers).

Gaps or challenges cont’d...  Inadequate political environment coupled with criminalization of drug use, weak policies due to limited focus.  Rampant police harassments of drug users  Stigma and discrimination of drug users in health service centres and in the community.  Limited financial support/funding for drug user tailored projects in Uganda

UHRN Recommendations:  Treat drug use as a public health issue, rather than as a criminal justice matter;  Adopt and spread harm reduction services such as needle syringe exchanges and methadone treatment services in Uganda.  Need for a national wide situation analysis to establish the drug use burden in Uganda.  Uganda need to adopt a drug policy plan, inclusive of health standards;  Create an enabling environment for drug users to develop health seeking behavior;  Need to strengthen law enforcement for more selective deterrence, focusing on high-level targets;  We Advocate for government’s investment in HIV and harm reduction programs targeting people who inject drugs in Uganda

THANK YOU !!