Tuberculosis (TB) is now a curable disease. Nevertheless, TB remains the leading cause of death among people who use drugs (PWUD) who are also living with HIV. The absence of appropriate TB care systems for PWUD causes low levels of TB diagnosis and treatment as well as the fast and concerning spread of multi-drug resistant TB (MDR-TB) among this key population.

As TB incidence has fallen or stabilized across most high-income countries it remains a big challenge in the sub saharan Africa Uganda inlclusive. The TB epidemic significantly and disproportionately affects PWUD, with TB being the leading cause of death among PWUD living with HIV. Death rates among people with TB in Uganda are incidentally very high.

This situation arises from a combination of factors. TB services are often difficult for PWUD to access or to remain engaged with as there is an over-reliance on lengthy inpatient treatment. This approach makes it very difficult for PWUD to sustain engagement in TB treatment. There is also a lack of integration of TB services with other healthcare services for PWUD; this further increases the challenges for PWUD trying to access and sustain engagement with TB treatment. The resulting low level of engagement in TB diagnosis and treatment results in extremely high TB and TB/HIV mortality rates, as well as in the development and spread of MDR-TB. Repressive drug policies coupled with stigma and discrimination against PWUD also undermine access to TB diagnosis and treatment services.

UHRN invites both drug user activists and harm reduction experts to join in building their TB knowledge and capacity as part of developing advocacy capacity within the region for change. A key advocacy demand remains the need to integrate TB into harm reduction and HIV treatment programs.

While much of the world is seeing declines in new HIV infections, the HIV epidemic in sub saharn Africa continues to expand. The HIV epidemic continues to be concentrated among people who inject drugs (PWID), the population severely affected by HIV worldwide and especially in Africa. Of the estimated 12.7 million (range from 8.9 to 22.4 million) PWID worldwide, 13.1% or 1.7 million (range from 0.9 to 4.8 million) live with HIV. The HIV prevalence among PWID is particularly high especially in the slum urban areas.

While the burden of injection drug use and the burden of HIV among PWID is heavy generally, harm reduction services are inadequate for an effective HIV prevention among PWID in most countries. Few countries achieve the recommended 200 sterile syringes per PWID per year. Most of the countries, including those considered middle or higher-income countries are way below the recommended “200” coverage level.

UHRN invites partners in effort to combat high HIV prevalence among PWIDs

Women who use drugs (WUD) in Uganda do not have equal access to health and harm reduction services. Social stereotypes and perceptions about a woman’s role in the family and society have prompted massive and systematic violence against WUD, including double stigma and structural discrimination in many countries. Gender-sensitive harm reduction services are largely absent for WUD and they are rarely represented in policy discussions. 

Women make a recognizable number of all people who use drugs in Uganda and in some countries the number is higher (Russian Federation 30%; Ukraine 26%). Rates of HIV are higher among women who inject drugs than their male counterparts: data from Europe indicates that HIV rates among these women may be 50% higher than their male peers.

Women who use drugs around the world share experiences of specific and additional barriers to accessing services when compared with their male peers. Uganda is no exception in this regard and significant inequality has been documented in accessing harm reduction services. In many countries where harm reduction services exist, they are not tailored to the needs of women and therefore ignore the specific needs of women who use drugs and/or live with HIV.

Women are disproportionately affected by the removal of parental rights, have inadequate access to sexual and reproductive health services (especially during pregnancy), and face increased levels of violence either from the police or in domestic settings. The multiple and compounded stigma faced by women makes them more susceptible and vulnerable to HIV and other infectious diseases.

UHRN invites its members and external partners to join the campaign on violence against women who use drugs and highlight barriers these women face in accessing harm reduction services as well as healthcare provision generally. UHRN has been cooperating with the International partrners to promote a series of regional level activities, including development of policy assessments and related training, delivering technical support to national partners on the development of gender sensitive services, and supporting advocacy campaigns that address gender equality and challenge gender-based violence. UHRN continues to invite women who use drugs themselves to be key partners so that women’s voices can be engaged in decision-making both at a policy and service level. EHRN has particularly supported this work through its small grants program.

People who use drugs (PWUD) are often not considered valid policy or service partners in issues that directly affect their lives. However, UHRN recognizes that PWUD are part of the solution and should not be seen as the problem. UHRN works to support the meaningful participation and community mobilization of PWUD.

People who use drugs (PWUD) face high levels of stigma and social exclusion and they may not be considered either worthy or capable of participating in high-level policy discussions, even though these have a direct impact on their lives. However, the latest developments in the region, including the campaigning by drug user groups to be heard, have demonstrated that HIV prevention can only take place among people who inject drugs (PWID) if they are meaningfully involved in the process of designing, implementing and evaluating harm reduction policy and services.

In 2001, governments endorsed the UN General Assembly’s Declaration of Commitment on HIV/AIDS which calls for the greater involvement of people living with HIV; this principle is now generally applied to other key populations affected by HIV, including PWID. However, EHRN has identified that meaningful engagement of PWUD in decision-making processes in the region remains very low. Lack of access to relevant information, isolation, and discrimination are all barriers to creating a conducive environment for PWUD to effectively engage in decision-making processes.

UHRN has a sustained and longstanding commitment to the meaningful involvement and mobilization of PWUD. Firstly, UHRN has modeled a participative approach in its own internal governance and project delivery systems; this has led to PWUD participating directly in the activities of UHRN and operating as consultants on consultation and development projects. Secondly, UHRN has supported drug user groups directly through small grants fundS; these small grants enabled the development of practical resources and capacity for drug user groups to undertake focused work and to build their advocacy and campaigning abilities. 

UHRN calls on harm reduction services to recognize drug user groups as key partners and to meaningfully engage people who use drugs in the design, delivery and review of harm reduction services. EHRN invites people who use drugs to build partnerships with harm reduction services and to develop drug user networks at a regional and national level.

People who use drugs (PWUD) face systematic human rights violations world over. Mass incarceration, ill-treatment by police, denial of essential medicines and basic healthcare services are common in the region and are driven by repressive drug policies. Existing drug enforcement practices increase the exposure of PWUD to drug-related harms and undermine the regional response to HIV, TB, viral hepatitis and other public health issues.

Uganda is among regions where widespread and systematic human rights violations take place in the name of drug control. PWUD face torture and ill treatment by the police, mass incarceration, arbitrary and prolonged detention, as well as the denial of essential medicines and basic healthcare services. Drug enforcement has led to systematic discrimination against people who use drugs, undermining the ability of PWUD to access needed healthcare services. Many human rights abuses committed against people who use drugs in the name of drug enforcement go unreported due to fear of harmful consequences including prosecution. Investigations by government into violations of rights against people who use drugs remain rare.

Access to healthcare services and investment in a comprehensive public health response are further undermined by the financial demands of running drug enforcement programmes. The high costs of bolstering law enforcement and penitentiary systems drain resources that could be invested in tried and tested harm reduction and other public health strategies.

International human rights standards, including the UN Convention on Civil and Political Rights, the Convention on Economic, Social and Cultural Rights, the Convention on Rights of the Child, and the Convention on Elimination of All forms of Discrimination against Women, place mandatory expectations on governments to promote and protect rights. Governments have an obligation to respect, protect and fulfill these obligations by adopting relevant legislative, judicial, administrative, educative and other appropriate measures. However, drug policy enforcement practices in EECA result in PWUD being systematically denied the opportunity to exercise their human rights, leading to PWUD being further exposed to violence, multiple stigma and discrimination.

UHRN has worked with drug user activists to document human rights abuses against PWUD. This evidence was submitted to the Global Commission on HIV and the Law in 2011. EHRN also documented abuses against women who use drugs, highlighting the role of state actors in the commission of such violent acts. EHRN helps to undertake strategic advocacy and litigation to highlight and challenge the denial of the right to health and other human rights violations committed against PWUD.

Uganda Harm Reduction Network -UHRN invites harm reduction networks, drug user groups and human rights organizations to join in championing and defending the human rights of PWUD in Uganda.