people who use drugs, including 30,000 people who inject drugs
% of people who inject drugs in Dar es Salaam are living with HIV
of people who inject drugs are infected with hepatitis C
Because Tanzania is one of the major transit hubs for heroin trafficked from Central Asia, drug use has spread in the country and with it the transmission of AIDS and hepatitis. There are over 300,000 people who use drugs in Tanzania, of whom one in 10 inject drugs. In the absence of adequate prevention and care services which are tailored to and accessible by these groups, risky practices such as sharing used needles and unprotected sex are very widespread among people who use drugs. The impact on their health is considerable - over a third of people who use drugs are infected with HIV and a quarter are living with hepatitis C.
There are many obstacles to access to healthcare for groups that are disproportionately affected by HIV and hepatitis.
Although harm reduction services exist, such as access to opioid substitution therapy and needle exchange programmes, they are not sufficient to meet the significant level of need. Stigmatisation and discrimination are common in the health services and in the general population and represent additional barriers for people who use drugs in accessing healthcare. The repressiveness of the legal framework and the political environment results in greater marginalisation and people being excluded from healthcare.
The Médecins du Monde teams have been working since 2010 in Tanzania on promoting harm reduction in relation to drug use and tackling HIV and hepatitis.
Between 2010 and 2018, Médecins du Monde implemented the country’s first comprehensive harm reduction programme in Dar es Salaam. Despite an unpromising political environment in recent years, this pilot project integrated a comprehensive range of services tailored to people’s needs through a reception centre and mobile outreach activities for the most isolated and vulnerable people who use drugs.
Developing appropriate services for the most vulnerable in Tanzania
With the aim of securing the long-term sustainability of its interventions, Médecins du Monde has continued its advocacy work to persuade the authorities to engage with the harm reduction agenda and has worked to build the capacity of local partners through its training and resource centre.
As a result we have succeeded in:
- transferring our programme in January 2019 to a Tanzanian partner, Mukikute, which is continuing to offer harm reduction services to around 2,900 people per year who use drugs;
- securing a decision from the government to roll out harm reduction services across the country, with technical support from Médecins du Monde and help with coordinating the different parties involved.
Médecins du Monde is now playing a central role in the institutionalisation and promotion of harm reduction in Tanzania. As a national technical expert, Médecins du Monde is seeking to:
- support the transfer of our pilot programme to ensure its quality in the long term;
- coordinate the roll-out of harm reduction services across the country, in collaboration with the Ministry of Health and relevant institutions;
- strengthen the capacity of local organisations to implement good quality harm reduction services;
- support a Tanzanian network of people who use drugs;
- support the development of national policies and strategies that promote harm reduction;
- lobby political decision-makers for healthcare services which are tailored to the needs of people who use drugs within the national healthcare system.
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