1. 1 Addictions and HIV in Sub-Saharan Africa Experience of the Corridor Project ICASA Satellite Symposium, Dakar 4 December 2008 J KOFFI, J OJO, L DE SOUZA, O CAPOCHICHI, H DE HARDT-KAFFILS Abidjan-Lagos Corridor Organization

2. 2 Outline 1.Introduction 2.Why people abuse drugs 3.Experience of the Corridor project 4.Corridor Project’s Response 5.Possible Barriers to interventions 6.What Next? 7.Conclusion

3. 3 INTRODUCTION Around 16 million people worldwide inject drugs, with 3 million infected with HIV IDU in 148 countries worldwide of which the five Corridor Countries IDUs now account for 10% of all new global HIV infections: growing Injection drug use has resulted in the spread of AIDS in the African nations: –Kenya, Nigeria, South Africa and Tanzania –IDUs in South Africa share and use same needle up to 15 times despiste risks associated with the practice Drug users have poor knowledge of HIV prevention techniques and other HIV/AIDS treatment services CSWs sometimes forced to take drugs and are not able to use condoms consistently.

4. 4 Why people abuse drugs Because of their workBecause of their work –Truck drivers –Sex workers Peer pressurePeer pressure – to join in with others and belong to a ‘special’ group. Escape routeEscape route –problems at home and school –outside pressures To relax and ‘feel good’To relax and ‘feel good’ Some medications, e.g. painkillers, physically addictiveSome medications, e.g. painkillers, physically addictive

5. 5 - Kraké Plage Noé Elubo Aflao Kodjoviakop é Sanvee Condji Hilla Condji Sèmè Experience of the Corridor Project Length: 1022 kmLength: 1022 km Resident population: 30.000.000 inhabitantsResident population: 30.000.000 inhabitants Population in transit: about 47,000,000 people/year migrate along the corridorPopulation in transit: about 47,000,000 people/year migrate along the corridor The most important corridor in West Africa (65% of West Africa economic activity)The most important corridor in West Africa (65% of West Africa economic activity)

6. 6 The Abidjan-Lagos Corridor Organization (ALCO) Project Established in 2001 by Govts. of the 5 countries (Cote d’Ivoire, Ghana, Togo, Benin, and Nigeria) Project Development Objective: To increase access to HIV/AIDS prevention, treatment and care services for vulnerable populations along the Abidjan-Lagos transport corridor, presently underserved by national responses. Particular attention to be paid to: Transport sector workers Migrant populations Communities living along the corridor Funding: World Bank (2003-2007), Counterpart funding by member countries, Global Fund (2007 – to date), Technical Assistance: UNAIDS

7. 7 Why should a multi-country, cross-border project pay attention to drug addiction and HIV?

8. 8 The Abidjan-Lagos Corridor border areas a melting point for activities predisposing to HIV infection Risk for HIV infection Migration & Delays at Borders Hot spot for Sex work Sex with Non-regularpartner Low Knowledge of STI/HIV/AIDS Low Condom Use High HIV Prevalence among Truckers & FSWs National HIV Prevention progs. weak at border Communities Illicit Drugs Sale and Use NointerventionsTargetingIDUs

9. 9 Substance Abuse among Truckers

10. 10 Drug Abuse among Truckers at selected borders along the corridor

11. 11 Substance Abuse among Female Sex Workers along the Corridor

12. 12 Commonly Abused Drugs ClassExamples Cannabinoids Marijuana, hashish Depresants Barbiturates, benzodiazepines Stimulants Amphetamine, cocaine, ecstacy, methamphetamine, Nicotine, ritalin Opioids and Morphine Derivatives Codeine, Fentanyl, Heroin, Morphine, Opium Hallucinogens LSD, Mescaline, Psilocybin Inhalants Glue, paint, solvents, nitrous oxide Other Compounds Anabolic steroids

13. 13 The Corridor project’s response Recognition of addiction (IDU) as an emerging problem Currently reviewing reference document to include these behaviours Some border AIDS control committees widening their interventions to include drug abuse

14. 14 Possible barriers we envisage to implementation of interventions Stigma associated with drug use No-man’s land between borders Easy availability of illicit drugs –‘If demand persists, it's going to find ways to get what it wants. And if it isn't from Colombia, it's going to be from someplace else.’ Rumsfeld, 2001 Interventions targeting drug users not a priority for national programs Lack of reliable statistics to support advocacy

15. 15 Suggested Next Steps Assessment of the magnitude of drug addiction along the corridor Planning and implementation of appropriate interventions targeting IDUs and other forms of addiction: –Harm reduction measures including needle exchange programs –Peer-based education of IDUs –Drug treatment Stigma and discrimination against drug users to be tackled Support from partners with core competence and comparative advantage in this area needed by ALCO.

16. 16 CONCLUSION HIV among injecting drug users very important in sub-Saharan Africa as it is globally It has been clearly identified as an emerging problem along the Abidjan-Lagos Corridor Based on the field assessment, what has been reported is just a tip-of-the-iceberg Therefore, an aggressive ownership by national programs and other key partners is needed to nip in the bud likely surge in new infections that may arise from these emerging behaviours

17. 17 Global Fund World Bank UNAIDS ALCO Board Chairman – Pr. B. Osotimehin Pr. S. EHOLIE RESAPSI SOLTHIS Acknowledgements

18. 18 Thank You End of presentation