Despite significant success, harm reduction measures still controversial in Africa

Despite evidence of effectiveness, harm reduction measures have remained controversial and highly contested in many African countries, fueling the menace of substance abuse on the continent.

The Founder/Executive Director, Global Initiative on Substance Abuse (GISA), Dr. Martin Agwogie, who disclosed this during his presentation at the fourth Harm Reduction Exchange, in Nairobi, Kenya, on Friday, attributed the challenge to government, faith based and social-cultural barriers.

In the presentation titled, ‘Harm Reduction in Africa: Evolution, Concept, Principles, Practices, Barriers and Way Forward’, Agwogie said prejudices and stigma associated with drug use both from the public and practitioners have hindered the provision of adequate care, creating problems for both the patients and the harm reduction services.

He said: “The restrictive policies of drug consumption rooms often place users in the situation of having to use the drug alone or in public spaces. Funding constraints are also not unconnected with public perception of harm reduction. In many countries in Africa, neither methadone nor buprenorphine for OST are on the Essential Medicines List (EML) largely due to negative perception/misconception and in some cases political reasons and myths.

“There is also a similar negative perception/misconception about NRT. Funding for harm reduction has also significantly reduced as HIV to which it is tied has reduced. In many settings, the primary focus of treatment interventions still remains abstinence.”

Agwogie, who described harm reduction as part of coordinated efforts to minimise the harms associated with drug use, said over 100 countries have now adopted at least one form of harm reduction or the other.

On his part, Samuel Hanu from Harm Reduction Alliance, Ghana, who said there has been a slight increase in the availability of harm reduction services since the Global State of Harm Reduction report in 2022, noted that substantial regional differences still exist.

He added that the stigmatisation and criminalisation of people who use drugs remain significant issues, noting that this impedes access to existing harm reduction services, which undermine the political and financial support needed to implement and expand these services.

While speaking on the role of scientific evidence in shaping policy and regulation for tobacco harm reduction, Mr. Uche Olatunji, who lamented that eight million smoking-related deaths are record worldwide yearly, said while millions are spent on tobacco control efforts, the number of smokers is the same as it was over 10 years ago.

He noted that over the past few decades, a wealth of scientific evidence has highlighted the risks associated with traditional cigarette products, while also paving new ways for harm reduction strategies.

Olatunji stressed that as the market continues to evolve with the introduction of innovative nicotine delivery systems, additional research is essential, as well as regulations and policies to address possible challenges. He further said one of the main goals of public health research is to inform health-related policies.

“Despite the evidence in favour of Tobacco Harm Reduction (THR) using safer nicotine products – such as vaping devices, snus, nicotine pouches and heated tobacco products, the World Health Organisation remains opposed to these approaches in their regulation guidelines. Scientific evidence, like the highly respected and independent organisation – Cochrane, has consistently shown that switching to less harmful alternatives can dramatically reduce the risks associated with smoking,” Olatunji said.