Chair: We will discuss drug policy from the perspective of health, and East African Drug Policy. The African plan of action was developed last year. African communities are supportive of the comprehensive approach to drugs. but how are we going to contextualise them?
Kunal Naik: We created the African Plan of action in 2018 in Cairo and finalised it in February last month. It was something I was looking forward to as an activist. It is the first plan of action that focuses on human rights, harm reduction and pwud. It is a comprehensive approach to what we can do in the region. Yesterday, beyond 2019 African Union, there were discussions between different member states and we need to be scared of the western world imposing ideas. The plan of action has the latest evidenced based info on drug use. As advocates, during the week of CND where I felt disconnection between policy and practice, it is our duty to follow up on this plan of action and engage with our government and show them the plan and use the plan to inform our national policy. It has 9 pillars and it a major step forward that harm reduction is mentioned. At the CoW you will have seen the disconnection between different states and people not recognising harm reduction. We have 10,000 injecting drug users. We have methodone but there is still a long way to go. This action gives an opportunity to engage policy makers and openly talk with them to harmonise drug control plans. I think that if we are able to do that, it will be a major step forward for the country. Some policymakers don’t understand why we need to move from a punitive to a supportive approach. In prison where there is no harm reduction, pwud, come out of it makes them more marginalised and vulnerable, just for using drugs which is ridiculous. In the International conventions, it is not mentioned that pwud are criminalised. Policy makers will be able to save money, so it lays out a plan for policymakers to save money and invest it where it will impact more positively in the economy and the country as a whole.
Chair: thank you for highlighting the main points that we as representatives need to look at. I appreciate that the African Union mentions harm reduction explicitly and recognises that punitive drug policies are not working.
Kassim: I mention AFRICANPUD. We have been engaged initially through our national networks in variety of ways- technical working groups, country delagations. africanpud is representing subsaharan africa, but for this project we have been engaged in 8 networks in 8 different countries.
Chair: we have challenges of getting communities to forums, so we appreciate your voice and it is upon us to ensure that we know the challenges and we have the community voices and have policy that will work for the community. Tanzania is one step ahead as their policy has already incorporated an alternative to punishment.
Dr Peter Mfisi (Drug control and enforcement authority): We do supply reductions, international cooperation etc. Today we are talking about health and drug policy. Drug users are associated with mental and physical problems-40% of pwid live with hiv and hep c. pwid are at high risk of contracting tb. Should address these health issues. You cannot separate between drug use and health. pwud should be involved in making these policies. In many countries, the policies are very punitive and prohibitive. Not many of these will reduce the transmission of HIV. Street drugs cannot be controlled which is a cause of sudden death by overdose. Such policies prohibit their access to services such as needle exchange, OST. They suffer with discrimination. Aggressive policy leads to the overrepresentation of pwud in prisons. Repressive policies have negative outcomes. In Tanzania, ECA has developed drug policies strategies. The ECA was established in 2017. We didn’t find drug policy existing. We started collecting ideas from stakeholders. Tanzania has 60m people. The problem of drugs is using drug control and enforcement. It governises drug addiction as a health problem that needs medical attention. Instead of being incarcerated, they are sent for treatment. Instead of jailing, they are taken to a medical facility for detoxification. It has reduced the number of drug users in prisons- Section 31 of Drug Control and Enforcement Act.
According to National Consensus, there were 300,000 pwud. The prevalence of hiv- 35%. In female 65%. The needle syringe programme started in 2010. We have 6 drop-in centres. The plan is to go through all the regions affected by drug use. The retention rate is 78%. Challenges: there are a number of people who have not yet been reached. Fewer women are coming forward for treatment. The treatment of HBV is not part of treatment programme.
Way forward: reach more people who use drugs, to establish a rehabilitation centre for training for recovering addicts, build special programmes to attract more women, to continue to provide training to law enforcement.
Dr Michael J Katende: This programme was funded by Global Fund 2016-2018. We brought together EAC. We were bringing together civil society, different communities, communities of people wud. We are aware that the picture of drug using is not clear- we do not have statistics for some of the countries. This is why implementation is becoming a challenge. There is an increasing availability of drugs. There is a growing epidemic arrising from the use of drugs. there is a desire to address the health effects and impacts of drugs. There is a desire for evidence-based practice. The epidemic is due to easy access. It provides a framework to comprehensively manage the effect of alcohol and other substances. The area of focus is rehabilitation with aims of scaling up evidence based practice. The goal of EAC is to move away from the effects of substances. Approved by Council of ministers of health, policy has 5 objectives: system strengthening, prevention management and control, Monitoring and learning, evidence-based research, supply reduction, mobilisation of resources.
Policy objectives: Review national legal policy framework, establish relevant structures. Builiding infrastructure. The partner states are expected to build capacity, make resources available and report on harm reduction. Facilitate documentation, and capacity building. EAC has a regional policy with clear high level guidance. All levels are at different levels of adopting and finalising the policy. Our wish is that all countries adapt and implement the policy. We require standard operation procedures- spiritual, technique, financial etc.
Chair: It is clear that we have tools. We have the UNGASS Outcome, Africa Action Plan etc which are very clear and how to review the punitive drug policies. We need a regional approach. Any questions?
Audience: I am happy to see things moving. It is important for the global movement. I congratulate you for all the exciting things.
Ancella Voets: Africa is a huge continent with many people involved. What can we do to make sure the documents start to gain attention throughout the continent?
Anne: re Hep C- it is not part of the programme, do you have any plans of incorporating it as part of the intervention?
Audience: We have working with CS in Kenya, and you always ensured that HR is included in the government policies. We appreciate your input and the work that has been done.
Dr Michael J Katende: Re Ancella’s question- we are on the right path. When we began this work, many policymakers didnt know what HR is. All we need to do is push further, engage policymakers more and are made to understand HR and the economic benefits.
Dr Peter Mfisi (Drug control and enforcement authority): We organised resources from different governments to help.
Chair: We will discuss about hep c after.