INJECTION DRUG USE ON THE RISE IN AFRICA

NEW DEHLI (Reuters Health) - Once considered a "foreign man's habit,"
injection drug use is fast catching up in Nigeria and Kenya, according to
new results from the World Health Organization's (WHO) largest ongoing
study on HIV.

"This is a completely new finding for Africa," Maristela Monteiro of WHO's
Department of Mental Health and Substance Dependence told Reuters Health in
an interview.

As part of the second phase of WHO's multi-center study, Nigerian
researchers recruited 82 injecting and 316 non-injecting street drug users
in densely populated Lagos--one of the 37 Nigerian states--over 11 months.

"That we were able to recruit 82 IDUs injecting drug users within a span of
one month reveals that injecting drugs is definitely emerging as a problem
in Nigeria," Dr. Moruf Adelekan, the study's lead author, told Reuters
Health. Adelekan is drugs and HIV/AIDS advisor to the United Nation's Drugs
Control Program in Vienna. The findings were presented at a conference
earlier this month in Delhi.

The HIV infection rate in the general Nigerian population has risen to
5.4%. "But among those injecting drugs, the HIV rate was found to be about
11%, while among non-injecting drug users it was 10%," Adelekan said.
"Statistically speaking, there was no difference when you compare injecting
and non-injecting drug users."

Females were 10 times more likely than men to test positive for HIV,
regardless of whether or not they injected drugs. Among the women tested,
half of the injecting drug users were HIV positive, while 43% of the
non-injecting drug users were, the researchers found.

"The only plausible reason (for such high HIV rate) is that most of the
females also engage in unprotected commercial sex work," said Adelekan.

The main risk factors identified in the study included non-sterile
preparation of the injecting solution and injections performed in dirty
environments such as drug "joints," roadsides and toilets. About 15% of
injectors shared needles, while 30% reused injecting equipment and about a
quarter draw their injecting solutions from a common pot.

Only one in four of the users always used condom when having sex with
partners of the opposite sex, and 27% reported having multiple sex
partners. The number of partners ranged from two to 15. Only 4% reported
sex with someone of the same sex.

"The most unfortunate thing is that services for drug treatment are very
few and ones that are available, most users cannot afford," Adelekan told
Reuters Health.

"As yet, there is no HIV education or prevention service in the system. The
government is formulating a strategy but everything is still on paper.

"The study revealed several indicators of a steady process of diffusion of
injecting practice, and the real potentiality for an escalation of the
injecting practice over the next few years," he added. "Urgent definitive
measures should therefore be put in place to stem this tide."

"Whereas in the past everybody said that heterosexual transmission of HIV
is the only way, we now know that injecting drug use is also contributing,
howsoever little," he concluded.

The rate of injecting drug use found in Kenya was surprising, WHO's
Monteiro said. "When we selected the site, we thought we would not find any
injectors," she said. But the researchers estimated there were between
7,000 and 50,000 drug injectors in Nairobi.