1. 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:

2. Zanzibar Islands : (Unguja and Pemba)

3. 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.

4. 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)

5. 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.

6. 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.

7. 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.

8. 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)

9. 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.

10. 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.

11. Data & sample collection

12. Blood sample collection

13. 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.

14. Study Results:

15. General demographic information:
Study Participants:
% -(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%

16. 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

18. 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.

19. Infection patterns among SU/IDUs

22. 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≤ )
HIV infection among flashblood IDUs: 17.6%.
HIV infection among SA with anal sex preference :18.5% (p=0.03 )

23. 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≤ )

24. Hepatitis infections (2)
HCV infection among males IDU’s> Females IDUs [29.2% by 16.7%] p≤
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%).

25. 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

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

27. 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

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

29. Thanking you all for your attention .