The passing of this bill has already ignited widespread controversy, particularly concerning the various clauses that prescribe severe penalties for the possession and distribution of banned narcotics.
TWAIBU WAMALA, the executive director of the Uganda Harm Reduction Network (UHRN), is a critic of the bill and asserts that it falls short of effectively addressing the underlying issues associated with drug addiction. In an interview with Geofrey Serugo, he says punitive laws alienate people from crucial health and social services.
What specific concerns do you have regarding the bill?
The escalating issue of drug use in Uganda has prompted a pressing need for an open and transparent environment in which information can be freely shared, and discussions about addiction can take place. Unfortunately, the impending law, which further criminalizes drug addiction and dependence, threatens to drive individuals grappling with this disease into the shadows.
The fear of legal repercussions may discourage people from seeking the vital medical assistance they require. Regrettably, by definitively positioning drug addiction and dependence as a matter of justice rather than a public health concern, the government risks exacerbating the problem.
Punitive laws of this nature tend to alienate individuals from crucial health and social services that are essential for managing drug dependence. These services play a pivotal role in preventing the transmission of diseases such as HIV/Aids, tuberculosis, hepatitis B, and hepatitis C, as well as reducing the associated harms of drug dependence.
Furthermore, they provide much-needed support to individuals, enabling them to live fulfilling and productive lives. In light of these concerns, it is a heartfelt plea from experts in harm reduction and human rights to President Museveni not to assent to this bill in its current form.
This plea is made to prioritize the sanctity of life, the preservation of health, and the safeguarding of dignity for those suffering from drug addiction and dependence. It is a call to rise above prejudice and stigma, and to strive toward a nation where individuals with drug and substance use disorders are met with understanding and unwavering support.
Can you provide examples or statistics that illustrate the challenges faced by addicted people in Uganda and why you believe a different approach is needed?
Between 2010 and 2019, Uganda has witnessed a significant decline in new HIV/Aids infections, registering a commendable reduction of 43%. Simultaneously, related mortality linked to HIV/Aids has also seen a substantial decrease of 61%. These encouraging statistics demonstrate the effectiveness of the country’s efforts in combating the HIV/Aids epidemic during this period.
However, despite these overall improvements, there remains a concerning trend. More than 60% of new HIV/Aids infections in Uganda are concentrated among specific groups, notably adolescent girls and young women (AGYW) as well as key and priority populations. This underscores the need for targeted interventions and comprehensive strategies to address the unique challenges faced by these vulnerable demographics.
Another critical aspect of Uganda’s HIV/Aids landscape is the estimated 9,500 individuals who engage in drug injection practices. National data, derived from a combination of sources including UNAIDS and UNODC, reveals that HIV/Aids prevalence among people who inject drugs stands at a significant 17%.
These findings emphasize the importance of tailored approaches to address the specific needs of this population, ensuring access to prevention, treatment and support services to reduce the spread of HIV/ Aids among them. In light of these statistics, it is evident that while progress has been made in the fight against HIV/Aids in Uganda, there is still much work to be done, particularly in addressing the disparities in infection rates among different demographic groups and effectively targeting interventions to reduce HIV/ Aids prevalence among people who inject drugs.
Meanwhile, the prevalence of hepatitis B virus (HBV) and hepatitis C Virus (HCV) among people who inject drugs (PWID) in Uganda stands at 8.4% and 2%, respectively, according to data from the UNAIDS Country Factsheet for 2021. This is a concerning statistic, highlighting the significant risk factors faced by PWID in the country.
The 8.4% prevalence of HBV among PWID underscores the urgent need for targeted interventions and harm reduction strategies within this vulnerable population. HBV is a highly infectious virus, and its prevalence among PWID underscores the potential for rapid transmission within this community.
What alternative measures or policies do you advocate for when it comes to addressing the issue of drug use?
In addressing the pending legislation, I earnestly call upon the president to carefully consider the critical harm-reduction approach before assenting to the bill. It is imperative that the new law embraces a progressive harm reduction-based strategy.
This approach involves providing comprehensive support to individuals grappling with drug dependence, including access to medical treatment, psycho-social support, rehabilitation services, and medication assisted treatment (MAT). Drug addiction is a complex and challenging medical condition that necessitates a gradual process of recovery. Criminalizing those in need of life-saving interventions not only fails to address the underlying issues but also exacerbates harm.
Recognizing drug addiction as a health issue, rather than solely a criminal one, is essential to fostering successful rehabilitation and recovery, with the invaluable support of family and relatives. What’s more, we should adopt the medication-assisted therapy. I urge government to allocate sufficient funding for medication assisted treatment programs and to decentralize these initiatives across the country.
Furthermore, it is vital for the government to endorse community-based service delivery points that offer specialized harm reduction services in a non-discriminatory and welcoming environment. Additionally, the inclusion of methadone, a crucial medication for treating drug use-related medical conditions and addiction, on the list of essential drugs is paramount.
This would enable clinical officers and nurses, under the prescription of a licensed medical officer (doctor), to dispense opioid-based medications, ensuring greater accessibility to essential treatment options.
Lastly, we need to invest in job-creation for at-risk groups. To effectively combat the recruitment of at-risk individuals as drug mules and errand boys by drug traffickers, investment in job creation programs is essential.
These programs should be strategically designed to cater to vulnerable groups, offering them alternative opportunities that can remove them from the grasp of drug traffickers. Additionally, there is a collective hope that the government will uphold the promises outlined in the recently passed bill, which includes investments in treatment and rehabilitation centers throughout the nation.
Are there any international best practices or models that UHRN believes Uganda could learn from when it comes to dealing with addiction?
The World Health Organization (WHO) has raised significant concerns about the criminalization approach and its adverse effects on public health. Specifically, punitive measures associated with drug addiction have been criticized by the WHO for their role in exacerbating the epidemics of HIV/Aids, viral hepatitis, and tuberculosis (TB). This criticism stems from the recognition that punitive actions can deter individuals addicted to drugs from seeking essential harm reduction and health services.
The punitive approach to drug addiction tends to stigmatize and marginalize affected individuals, pushing them further away from seeking help. When people who inject drugs (PWID) face criminalization, they are less likely to access harm-reduction services, such as needle exchange programs and supervised injection sites, which are critical in preventing the transmission of HIV/Aids, hepatitis C, and hepatitis B.
This lack of access to harm reduction services not only puts PWID at increased risk of contracting and spreading these infections but also contributes to the overall burden of these diseases in the community. In response to these challenges, the World Health Organization strongly advocates for a comprehensive package of harm reduction interventions.
These interventions not only play a crucial role in reducing the transmission of HIV/Aids, hepatitis C, and hepatitis B but also aim to prevent overdose-related deaths among people addicted to drugs. Importantly, these harm-reduction strategies are designed to create an enabling environment where individuals addicted to drugs can access the healthcare system and engage with essential services such as TB care and mental health support.
By emphasizing harm reduction over punitive measures, the WHO aims to promote a more compassionate and effective approach to addressing drug addiction and its associated public health challenges. It underscores the importance of treating addiction as a health issue rather than a criminal offense, ultimately leading to better outcomes for both affected individuals and the broader community.
Countries that have embraced and rolled out harm-reduction interventions, such as Seychelles, Kenya and Tanzania among others, have managed to reduce morbidity and mortality associated with illicit drug use, reduced new HIV/Aids infections and other blood-borne infections, reduced drug-related crimes and promoted effective social re-integration.
inarticle} inarticle}