PROBLEMS AND PROSPECTS OF IMPLEMENTING HARM REDUCTION FOR HIV AND INJECTING DRUG-USE IN HIGH-RISK SUB-SAHARAN AFRICAN COUNTRIES

The use and misuse of a broad spectrum of psychoactive substances, inc luding heroin and cocaine, is of growing concern in many African count ries. Approximately one-third of global HIV and AIDS cases are reporte d from Africa but injecting drug use has not yet been documented as a causative factor. The drug supply control strategy has recorded only l imited success in Africa, and the currently adopted demand reduction p rograms are beset with many problems. In this paper we review possible constraining and facilitating factors in the adoption of harm reducti on approaches in high risk sub-Saharan African countries. We conclude that appropriate needs assessments are urgently required to establish the extent of problem drug use and of injecting. This exercise may ide ntify clinical and psychosocial problems that could benefit from an in tervention approach based on a combination of the principles of harm r eduction and demand reduction.