Médecins du Mondetanzania

médecins du monde /

tanzania /

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healthcare Plusmédecins du monde is an international humanitarian organisation providing medical care to vulnerable populations affected by war, natural disasters, disease, famine, poverty or exclusion. originally established in France in 1980, the médecins du monde international network now extends to 16 countries in europe, asia and the americas. médecins du monde’s work depends on the efforts of nearly 3,000 medical and logistics professionals who volunteer their time. thanks to their dedication and expertise, we are able to run emergency and development programmes in more than 60 countries while minimising costs.

Beyond Medical carealthough médecins du monde’s primary aim is to provide medical care, our work goes further to ensure long-lasting effectiveness. We draw on our experience on the ground to bear witness to obstacles to health- care and to advocate for change.

at hoMe and aBroadour projects take place in both developing and developed countries. across the countries where the médecins du monde network is present, our medical teams provide healthcare to the most vulnerable groups in their society.

Médecins du Monde: a Medical ngo

w Why intervening in tanzania?

médecins du monde /

tanzania /

While HiV transmission is predominantly attributed to heterosexual sex in tanzania, since 2000 the number of people who inject drugs (idus) has been increasing (it is reported that nationwide there are 25,000 drug users who inject drugs), with growing potential significance for HiV and HcV transmission and control.

the Rapid assessment & Response conducted by mdm in 2011 confirmed that the HIV infection rate among IDUs in Dar es Salaam was alarming, with 67% of female IDUs and 30% of male IDUs testing positive, and an HCV infection rate of 28%. the prevalence of HiV infection was estimated at 8.9% in 2007 for the general population in this city (unaids).

international experience and research proves that concentrated epidemics among idus can be reduced through an early scale-up of comprehensive harm-reduction services. Harm reduction is a community-based approach which aims to reduce social and health risks associated with drug use through a set of interventions, such as voluntary testing and counselling, needle and syringe exchange, antiretroviral and opioid-substitution therapy.

Based on its long experience on harm-reduction programmes (since 1987 in France, Russia, serbia, china, myanmar, Vietnam and afghanistan), mdm has built up strong medical and human expertise in HiV prevention and treatment with high-risk groups.

real-life storymaRiam, temeke distRict, kigamBoni WaRd, daR es-salaam (apRil 2011)

mariam is a 23-year old woman, who just started injecting drugs a month ago. she injects herself, and already her arms and hands look very bad. she came to dar es salaam in 2009 to be a domestic worker, but the family for whom she worked maltreated her, so she left. she started using drugs with friends, smoking, and then she continued by her-self and decided to inject. she explains: “the availability of drugs is uncertain, and nowadays it is more complicated to get heroin, so i decided to inject, because the effects last longer, then it’s simpler for me. i can inject 2 times per day, in the morning and in the evening, and i am fine like this.”she has a boyfriend; he is a fisherman so he gets money and he can buy heroin for both of them. He is not injecting it but smoking. she lives in a container at the harbour, and explains: “it is so hard to live here, we have no place to stay. We can be caught by the police at any time. it is very stress-ful. But i don’t know where else to go.” she would like to be tested for HiV, to take better care of her health than now, but she feels access to health services is not possible for her. she is trained in handicrafts so would like the opportu-nity to work in that field one day. For the moment, she doesn’t expect much.

w What are our actions in tanzania?

médecins du monde /

tanzania /

| 1992-2010

w pRomotion oF access to HigHly actiVe antiRetRoViRal tHeRapy and suppoRt to decentRalization oF pReVention, caRe and tReatment at distRict leVel

MdM-france was present in tanzania, in the Kagera region, covering first paediatric primary healthcare, then hiv-related activities such as counselling and testing (c&t), prevention of mother-to-child transmission (pmtct) and HiV care & treatment, for the benefit of the general population.

during this lengthy period, MdM accompanied and sup-ported the implementation of an overall policy to combat hiv/aids by developing innovative approaches, focusing in particular on decentralizing prevention work and on access to treatments, and integrating them into primary healthcare.

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fight against hiv/aids20 years of Presence in tanzania

| since 2011

w stRengtHening capacities oF stakeHoldeRs on HaRm Reduction in daR es salaam, tHRougH a model pRojectdespite a decrease in the HiV/aids epidemic which affects 6.5% of the tanzanian population, HiV prevalence is very high among the most at-risk populations and especially (injecting) drugs users (idu). they are particularly stigmatized and have limited access to healthcare.

in cooperation with the Ministry of health and social Welfare and temeke council, mdm decided to set up a pilot programme of prevention, counselling, care and support for the most vulnerable drug users at risk of HiV infection in dar es salaam, in the district of temeke.

mdm’s intervention actively contributes to the national harm-reduction policy by building the capacity of national stakehol-ders (institutional bodies and some tanzanian associations) to provide appropriate services.

the programme includes access to basic healthcare and social services at a drop-in centre and through outreach activities, provision of sterile injection material and behaviour change communication, referral to the public health system for medical treatment (including aRt).

mdm actively promotes meaningful involvement of (i)dus in harm-reduction efforts with a peer-support component.

special attention is given to female users who are stron-gly stigmatized and who are exposed at an even higher risk of HiV infection due to the fact that they are also sex workers.

| Key figures

w on september 2011, an average of 30 idus attend the drop-in centre (dic) every day, Female idus are rather difficult to approach, but the introduction of a specific day dedi-cated to women idus at the drop-in centre has helped reach them.w 700 contacts have been made during outreach work including mobile unit with 900 safe injection kits dis-tributed.

w the first changes in idus’ behaviour have been noticed: sterile material is used by the idus as soon as they can get free access.

w community acceptance of the programme has been high towards the program, thanks partly to awareness- raising through workshops and open days.

ProMoting a harM-reduction aPProach in suB-saharan africa

the spread of the hiv/aids pandemic amongst vulne-rable populations, including drug users, is barely addressed in africa. mdm wishes to emphasize this serious public health issue, and share good practice on the various responses currently implemented around the world within the framework of harm-reduction programmes.

this would be done through: participating in events and conferences in tanzania and in eastern africa, reinforcing the network of organizations working with drugs users in africa and supporting a further harm-reduction project in kenya.

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Médecins du Monde dar el salaam, temeke, tandika, soko la maguruwe, po BoX 105948 dar el salaam, tanzania

tel+ 255 222 856 222

emailgenco.tanzania@medecinsdumonde.net

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