united republic of tanzania effective drugs policy and harm reduction in tanzania dr. jessie mbwambo...

United Republic of Tanzania

Effective Drugs Policy and Harm Reduction in Tanzania

Dr. Jessie Mbwambo – MUHAS

Neema Makyao – NACP

Amani Msami – DCC

Dr. Cassian Nyandindi – MNH/Mwananyamala RRH

Sandrine Pont – MdM

Dr. Eva Matiko – CDC|PEPFAR

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Outline of the presentation

What is Harm Reduction, principles, evidence Magnitude & impact of drug use in Tanzania Drug Policy in Tanzania Best practices Achievements Challenges Way forward

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What is Harm Reduction?

‘Harm Reduction’ refers to policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. HR benefits users, their families and the community. –HRI

‘Harm Reduction’ refers to public health interventions that seek to reduce the negative consequences of drug use and drug policies. –IDPC

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Harm reduction principles

Harm Reduction International A strong commitment to public health and human

rights International Drug Policy Consortium

Targeting risks & harms Evidence based & cost effective Rooted in dignity & compassion Acknowledging human rights Challenging policies & practices that maximise harm Transparent, accountable and participatory

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Support for harm reduction

Evidence of paradoxical effect of greater restrictions

Evidence of reduction in violence, HIV Opportunity for other health care services UN E4A (Evidence for Action) Series:

http://www.who.int/hiv/pub/idu/idupolicybriefs/en/index.html




Drug use in Tanzania

Population size & HIV prevalence –NACP, May 2014 PWUD # 300,000 (200,000-350,000)

HIV prevalence 18-25% PWID # 30,000 (20,000-42,500) 30-50% reside in Dar

HIV prevalence 36% (22-43%) ♀ PWID: no national consensus on population

HIV prevalence in various samples 64-71% High reported sexual risk additional to injection risk

HIV prev Natl 5.1% (♀6.2%) Dar 6.9% (♀ 8.2%)

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Principles of Effective Drug Policy

Assessment of priorities and evidence Human rights Focused on reducing the harmful

consequences of use and markets Social inclusion of marginalised groups Build open and constructive relationship

between civil society and government


Drug Policy in Tanzania

Tanzania Anti Drug Act no. 9 of 1995Drugs and Prevention of Illicit Traffic in Drugs Act CAP 95 Amendment no.2 of 2012

National Drug Control Policy (awaiting endorsement) National Strategic Framework for HIV/AIDS Prevention for

Injecting Drug Users (2012-2016) Policy Guidelines for MAT 2010 Minimum Standards for MAT facilities 2010 National KP communication strategy 2013 Strategy for reduction of stigma and discrimination & impact

of HIV on KP (2014 – 2018) NACP with WHO developing M&E for KPs (in progress)

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Guidelines for HIV/Health Services

Outreach Service Guide for HIV Prevention among Drug Using Populations 2010

Guide for Screening and Brief Intervention for Substance Abuse Disorders 2010

A clinical guide for Medically Assisted Treatment for Opioid Dependence 2010

Advocacy Communication and Social Mobilization Strategy on HIV/AIDS Prevention for PWID, 2013-16

KP Comprehensive HIV & Health Services Delivery 2014

KP HCW Comprehensive training manual 2014

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Comprehensive package for PWID


Best Practices

New strategies and guidelines aligned with the harm-reduction approach recommended by UN

Allows access and support for treatment as needed

Strong support at highest level of government translates to other levels

Emerging success in treatment and recovery encourages others to access treatment

Initial partner-led efforts gaining government support

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Achievements

44,443 PWUD reached by CBOs (2007- 9/2014) 6,154 PWID accessing NSP ~990,000 distributed

(July 2011-Sep 14) 2,000 on MAT (Feb 2011-Sep 2014) ~98% tested & received HIV results @ MAT (many

more through outreach!) 178 on ART & MAT 927 diagnosed and treated for TB (incl. 5 MDR) 5,054 Police trained plus 29,806 members of

community policing initiative


Challenges

Law prohibiting possession of needle/syringe is a barrier to NSP

Repressive laws push clients into hiding hence barrier to accessing care e.g. possession of minimal amounts, trace amount in body fluids criminal offence

Positive steps in collaboration with police but sustained response requires integrating HR in the law & mainstream training

Fundamental problem of unemployment continues post recovery

Resource allocation to for coverage of services

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Way Forward

Aim to reform drug law to accommodate minimum health standards and create enabling environment for health-seeking behavior among PWUD

Support LGAs to map and plan for comprehensive response according to needs (PWID/PWUD population size and risk behaviors)

Innovative livelihood options as primary prevention and rehabilitation (multi-sector involvement)

Publicly recognize and reward positive actions Recovery and reform from criminality Law enforcement supporting access to care

National MAT scale-up plan to treat 25,000 PWUD by 2018

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THANK YOU!

united republic of tanzania effective drugs policy and harm reduction in tanzania dr. jessie mbwambo...

Documents

drug policies

drug consumption

hri harm reduction

national drug control

reduction of stigma

hiv prevention

government slide

injecting drug users