HIV AND SUBSTANCE ABUSE: THE DUAL EPIDEMICS CHALLENGING ZANZIBAR

HIV prevalence in Zanzibar ranges from 0.6% in the general population to 0.9% in antenatal clinic attendees. As in most low prevalence countries, the epidemic is thought to be concentrated in most-atrisk populations (MARPs) including drug users (DUs) and commercial sex workers (CSWs). This study was conducted to determine the prevalence of HIV and other selected infections in a population of DUs in Zanzibar. Between September–October 2005, snowball sampling was used to identify DUs residing in Zanzibar on the islands of Unguja and Pemba. Consenting participants responded to a questionnaire on drug use practices and sexual behaviour. A blood sample was drawn and tested for HIV (Capillus & Determine), hepatitis B & C (Acon rapid test) and syphilis (RPR). A total of 508 persons (26 female and 482 male) self-identified DUs participated in the study. Median age was 31 years, ranging between 17 and 68 years. Injecting drug users (IDUs) accounted for 38.9% (n=198) of the study participants, of whom 46.1% reported to have shared needles; and 9.1% used flashblood (McCurdy et al, 2005). DUs spent an average of US$8.2 per day to support their habits. The prevalence of tested infections was higher in IDUs compared with non-IDUs (HIV: 30% v.12%; hepatitis C: 22% v.15%; syphilis: 17% v. 10% respectively). IDUs who shared needles had higher infection rates compared to those who did not (HIV: 28% v. 5%; hepatitis C: 31% v. 7%). Injection drug use and needle-sharing are common among IDUs in Zanzibar and result in high prevalence of blood-borne infections. IDUs could present a bridge population for the spread of HIV into the general population in Zanzibar, and interventions are urgently needed to prevent this spread.