Current Addiction Reports

, Volume 5, Issue 4, pp 428–453 | Cite as

The Opioid Epidemic in Africa and Its Impact

  • Ann E. KurthEmail author
  • Peter Cherutich
  • Rosabelle Conover
  • Nok Chhun
  • R. Douglas Bruce
  • Barrot H. Lambdin
Opioids (D Fiellin and J Donroe, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Opioids


Purpose of Review

Opioid use disorder (OUD) is a global phenomenon and is on the rise in Africa, denoting a shift from historical patterns of drug transport to internal consumption. In contrast, opioids for clinical pain management in Africa remain among the least available globally. This region also has the highest HIV and HCV disease burden, and the greatest shortages of health workers and addiction treatment. We undertook a systematic review of the literature to describe opioid use in Africa and how it is being addressed.

Recent Findings

A total of 84 articles from 2000 to 2018 were identified. Descriptions of country-specific populations and patterns of opioid misuse were common. A smaller number of articles described interventions to address OUD.


OUD occurs in sub-Saharan Africa, with attendant clinical and social costs. Evidence-based policies and health system resources are needed to promote OUD prevention and management and infectious disease transmission reduction.


Addiction Opioid use disorder Africa HIV HCV Opioid agonist treatment People who inject drugs Health workforce 



We thank the colleagues engaged in opioid work and remediation in Africa.

Author’s Contributions

AEK wrote the first draft, RC conducted the literature review, and all authors contributed to writing, editing, and responsibility for the final manuscript.


This project was supported in part by award number R01MH085577 from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Compliance with Ethical Standards

Conflict of Interests

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Manjiani D, Paul DB, Kunnumpurath S, Kaye AD, Vadivelu N. Availability and utilization of opioids for pain management: global issues. Ochsner J. 2014;14(2):208–15.PubMedPubMedCentralGoogle Scholar
  2. 2.
    National AIDS Control Council (NACC). HIV prevention response and modes of transmission analysis. Nairobi, Kenya. 2009. Available at
  3. 3.
    UNODC. World Drug Report 2018: opioid crisis, prescription drug abuse expands; cocaine and opium hit record highs 2018. Available at Accessed 20 September 20 2018.
  4. 4.
    • Tiberio J, Laurent YI, Ndayongeje J, Msami A, Welty S, Ngonyani A, et al. Context and characteristics of illicit drug use in coastal and interior Tanzania. Int J Drug Policy. 2018;51:20–6. Most studies about drug use in Tanzania are set in Dar es Salaam or Zanzibar, this is the first study that examined injection and non-injection drug use in 12 other regions in Tanzania.CrossRefPubMedGoogle Scholar
  5. 5.
    Eluwa GI, Strathdee SA, Adebayo SB, Ahonsi B, Adebajo SB. A profile on HIV prevalence and risk behaviors among injecting drug users in Nigeria: should we be alarmed? Drug Alcohol Depend. 2013;127(1–3):65–71. Scholar
  6. 6.
    Charlson FJ, Diminic S, Lund C, Degenhardt L, Whiteford HA. Mental and substance use disorders in sub-Saharan Africa: predictions of epidemiological changes and mental health workforce requirements for the next 40 years. PLoS One. 2014;9(10):e110208. Scholar
  7. 7.
    WHO Statistical Information System (WHOSIS). Global Health Observatory data. Country Statistics for Tanzania and the United Kingdom. 2014. Available at
  8. 8.
    Sonderup MW, Afihene M, Ally R, Apica B, Awuku Y, Cunha L, et al. Hepatitis C in sub-Saharan Africa: the current status and recommendations for achieving elimination by 2030. Lancet Gastroenterol Hepatol. 2017;2(12):910–9. Scholar
  9. 9.
    Zumla A, Petersen E, Nyirenda T, Chakaya J. Tackling the tuberculosis epidemic in sub-Saharan Africa—unique opportunities arising from the second European developing countries clinical trials partnership (EDCTP) programme 2015-2024. Int J Infect Dis. 2015;32:46–9. Scholar
  10. 10.
    World Health Organization. Hepatitis C key facts, July 18, 2018. 2018. Available from: Accessed 14 August 2018.
  11. 11.
    Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(3):161–76. Scholar
  12. 12.
    UNAIDS (2018). 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Available at Accessed 20 September 2018.
  13. 13.
    Stengel CM, Mane F, Guise A, Pouye M, Sigrist M, Rhodes T. “They accept me, because I was one of them”: formative qualitative research supporting the feasibility of peer-led outreach for people who use drugs in Dakar, Senegal. Harm Reduct J. 2018;15(1):9. Scholar
  14. 14.
    Rhodes T. The becoming of methadone in Kenya: how an intervention's implementation constitutes recovery potential. Soc Sci Med. 2018;201:71–9. Scholar
  15. 15.
    • Oyaro M, Wylie J, Chen CY, Ondondo RO, Kramvis A. Human immunodeficiency virus infection predictors and genetic diversity of hepatitis B virus and hepatitis C virus co-infections among drug users in three major Kenyan cities. South Afr J HIV Med. 2018;19(1):737. This paper provides prevalence of co-infection of HIV, HCV and hepatitis B virus (HBV) among people who use drugs in Nairobi, Mombasa, and Kisumu and is only one of few studies to describe the genetic diversity of HBV and HCV in this population in Kenya.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Myers B, Williams PP, Govender R, Manderscheid R, Koch JR. Substance abuse treatment engagement, completion and short-term outcomes in the Western cape province, South Africa: findings from the service quality measures initiative. Drug Alcohol Depend. 2018;185:278–84. Scholar
  17. 17.
    • Mburu G, Ayon S, Tsai AC, Ndimbii J, Wang B, Strathdee S, et al. “Who has ever loved a drug addict? It’s a lie. They think a ‘teja’ is as bad person”: multiple stigmas faced by women who inject drugs in coastal Kenya. Harm Reduct J. 2018;15(1):29. This paper provides a good overview of the challenges that females who inject drugs face including gender and power inequalities, discrimination, and being a person who uses drugs and is HIV positive.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Budambula V, Matoka C, Ouma J, Ahmed AA, Otieno MF, Were T. Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users. BMC Public Health. 2018;18(1):193. Scholar
  19. 19.
    Bazzi AR, Yotebieng KA, Agot K, Rota G, Syvertsen JL. Perspectives on biomedical HIV prevention options among women who inject drugs in Kenya. AIDS Care. 2018;30(3):343–6. Scholar
  20. 20.
    • Ayon S, Ndimbii J, Jeneby F, Abdulrahman T, Mlewa O, Wang B, et al. Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs: role of community-based outreach and drop-in centers. AIDS Care. 2018;30(4):480–7. This paper highlights the importance of integrating sexual and reproductive health services into community-based outreach and drop-in centers to address the unique needs of women who inject drugs.CrossRefPubMedGoogle Scholar
  21. 21.
    Van Hout MC, Rich E, Dada S, Bergin M. “Codeine is my helper”: misuse of and dependence on codeine-containing medicines in South Africa. Qual Health Res. 2017;27(3):341–50. Scholar
  22. 22.
    Semugoma NP, Rebe K, Sonderup MW, Kamkeumah M, De Swardt G, Struthers H, et al. Hepatitis C: a south African literature review and results from a burden of disease study among a cohort of drug-using men who have sex with men in Cape Town, South Africa. S Afr Med J. 2017;107(12):1116–20. Scholar
  23. 23.
    Parry CDH, Rich E, Van Hout MC, Deluca P. Codeine misuse and dependence in South Africa: perspectives of addiction treatment providers. S Afr Med J. 2017;107(5):451–6. Scholar
  24. 24.
    Parry CDH, Carney T, Petersen-Williams P. Reducing substance use and risky sexual behaviour among drug users in Durban, South Africa: assessing the impact of community-level risk-reduction interventions. Sahara J. 2017;14(1):110–7. Scholar
  25. 25.
    • Mpanza DM, Govender P. Rural realities in service provision for substance abuse: a qualitative study in uMkhanyakude district, KwaZulu-Natal, South Africa. South African Family Practice. 2017;59(3):110–5. Few studies focus on the mental health service delivery in rural communities. This study examines the challenges experienced by health providers in service delivery to people who use substances in a rural setting.CrossRefGoogle Scholar
  26. 26.
    Mmbaga EJ, Moen K, Makyao N, Leshabari M. Prevalence and predictors of human immunodeficiency virus and selected sexually transmitted infections among people who inject drugs in Dar es Salaam, Tanzania: a new focus to get to zero. Sex Transm Dis. 2017;44(2):79–84. Scholar
  27. 27.
    • Michie G, Hoosain S, Macharia M, Weich L. Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa. S Afr Med J. 2017;107(6):539–42. This study reports findings from the first publicly funded opioid agonist treatment programs in South Africa. Study findings suggest that opioid agonist treatment for OUD should be scaled up, with longer treatment durations recommended.CrossRefPubMedGoogle Scholar
  28. 28.
    Magidson JF, Gouse H, Burnhams W, Wu CY, Myers B, Joska JA, et al. Beyond methamphetamine: documenting the implementation of the matrix model of substance use treatment for opioid users in a south African setting. Addict Behav. 2017;66:132–7. Scholar
  29. 29.
    • Lambdin BH, Lorvick J, Mbwambo JK, Rwegasha J, Hassan S, Lum P, et al. Prevalence and predictors of HCV among a cohort of opioid treatment patients in Dar es Salaam, Tanzania. Int J Drug Policy. 2017;45:64–9. This is the first study to assesses the prevalence and predictors of HCV in East Africa among PWID enrolled into opioid treatment programs (OTP). It also demonstrates that the rate of HCV was higher than expected and highlights the need to address HCV in this population.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Khatib A, Matiko E, Khalid F, Welty S, Ali A, Othman A, et al. HIV and hepatitis B and C co-infection among people who inject drugs in Zanzibar. BMC Public Health. 2017;17(1):917. Scholar
  31. 31.
    Cooke A, Saleem H, Mushi D, Mbwambo J, Hassan S, Lambdin BH. Convenience without disclosure: a formative research study of a proposed integrated methadone and antiretroviral therapy service delivery model in Dar es Salaam, Tanzania. Addict Sci Clin Pract. 2017;12(1):23. Scholar
  32. 32.
    • Balaji D, Mlunde LB, Tran OC, Lambdin B, Mbwambo J, Nyandindi C, et al. First report of gender based violence as a deterrent to methadone access among females who use heroin in Dar es Salaam, Tanzania. AIDS Behav. 2017;21(7):2093–100. This is the first study to report gender-based violence and discrimination by health care providers as barriers to accessing HIV risk reduction services for females.CrossRefPubMedGoogle Scholar
  33. 33.
    Zamudio-Haas S, Mahenge B, Saleem H, Mbwambo J, Lambdin BH. Generating trust: programmatic strategies to reach women who inject drugs with harm reduction services in Dar es Salaam, Tanzania. Int J Drug Policy. 2016;30:43–51. Scholar
  34. 34.
    Ubuguyu O, Tran OC, Bruce RD, Masao F, Nyandindi C, Sabuni N, et al. Improvements in health-related quality of life among methadone maintenance clients in Dar es Salaam, Tanzania. Int J Drug Policy. 2016;30:74–81. Scholar
  35. 35.
    Syvertsen JL, Ohaga S, Agot K, Dimova M, Guise A, Rhodes T, et al. An ethnographic exploration of drug markets in Kisumu, Kenya. Int J Drug Policy. 2016;30:82–90. Scholar
  36. 36.
    Scheibe A, Makapela D, Brown B, dos Santos M, Hariga F, Virk H, et al. HIV prevalence and risk among people who inject drugs in five south African cities. Int J Drug Policy. 2016;30:107–15. Scholar
  37. 37.
    Mokwena K. “Consider our plight”: a cry for help from nyaope users. Health SA Gesondheid. 2016;21(1):137–42. Scholar
  38. 38.
    Mlunde LB, Sunguya BF, Mbwambo JK, Ubuguyu OS, Shibanuma A, Yasuoka J, et al. Correlates of health care seeking behaviour among people who inject drugs in Dar es Salaam, Tanzania. Int J Drug Policy. 2016;30:66–73. Scholar
  39. 39.
    Mlunde LB, Sunguya BF, Mbwambo JK, Ubuguyu OS, Shibanuma A, Yasuoka J, et al. A mismatch between high-risk behaviors and screening of infectious diseases among people who inject drugs in Dar es Salaam, Tanzania. PLoS One. 2016;11(2):e0148598. Scholar
  40. 40.
    • Mital S, Miles G, McLellan-Lemal E, Muthui M, Needle R. Heroin shortage in Coastal Kenya: a rapid assessment and qualitative analysis of heroin users’ experiences. Int J Drug Policy. 2016;30:91–8. This study qualitatively examines the impact of the shortage of heroin on people who use heroin and adds another dimension of opioid use.CrossRefPubMedGoogle Scholar
  41. 41.
    Guise A, Rhodes T, Ndimbii J, Ayon S, Nnaji O. Access to HIV treatment and care for people who inject drugs in Kenya: a short report. AIDS Care. 2016;28(12):1595–9. Scholar
  42. 42.
    Gouse H, Magidson JF, Burnhams W, Remmert JE, Myers B, Joska JA, et al. Implementation of cognitive-behavioral substance abuse treatment in sub-Saharan Africa: treatment engagement and abstinence at treatment exit. PLoS One. 2016;11(1):e0147900. Scholar
  43. 43.
    Derbel I, Ghorbel A, Akrout FM, Zahaf A. Opiate withdrawal syndrome in buprenorphine abusers admitted to a rehabilitation center in Tunisia. Afr Health Sci. 2016;16(4):1067–77. Scholar
  44. 44.
    Bouscaillou J, Evanno J, Proute M, Inwoley A, Kabran M, N’Guessan T, et al. Prevalence and risk factors associated with HIV and tuberculosis in people who use drugs in Abidjan, Ivory Coast. Int J Drug Policy. 2016;30:116–23. Scholar
  45. 45.
    Bassiony MM, Youssif UM, Hussein RA, Saeed M. Psychiatric comorbidity among Egyptian patients with opioid use disorders attributed to tramadol. J Addict Med. 2016;10(4):262–8. Scholar
  46. 46.
    • Tun W, Sheehy M, Broz D, Okal J, Muraguri N, Raymond HF, et al. HIV and STI prevalence and injection behaviors among people who inject drugs in Nairobi: results from a 2011 bio-behavioral study using respondent-driven sampling. AIDS Behav. 2015;19(Suppl 1):S24–35. This is the first study to provide population-based estimates of characteristics of PWID and HIV and sexually transmitted infection prevalence in this population in Nairobi, Kenya.CrossRefPubMedGoogle Scholar
  47. 47.
    • Tran OC, Bruce RD, Masao F, Ubuguyu O, Sabuni N, Mbwambo J, et al. Linkage to care among methadone clients living with HIV in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr. 2015;69(2):e43-e8 This study provides a descriptive overview of the first methadone treatment clinic in Tanzania, launched to address the developing HIV epidemic among PWID.CrossRefGoogle Scholar
  48. 48.
    Tan AX, Kapiga S, Khoshnood K, Bruce RD. Epidemiology of drug use and HIV-related risk behaviors among people who inject drugs in Mwanza, Tanzania. PLoS One. 2015;10(12):e0145578. Scholar
  49. 49.
    • Syvertsen JL, Agot K, Ohaga S, Strathdee SA, Camlin CS, Omanga E, et al. Evidence of injection drug use in Kisumu, Kenya: implications for HIV prevention. Drug Alcohol Depend. 2015;151:262–6. This study provides the first descriptive analysis of injection drug use and HIV prevalence in western Kenya; this study is important because this region has the highest HIV prevalence.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Sorsdahl K, Stein DJ, Corrigall J, Cuijpers P, Smits N, Naledi T, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: a randomized controlled trial. Subst Abuse Treat Prev Policy. 2015;10:46. Scholar
  51. 51.
    Rhodes T, Ndimbii J, Guise A, Cullen L, Ayon S. Navigating the poverty of heroin addiction treatment and recovery opportunity in Kenya: access work, self-care and rationed expectations. Glob Public Health. 2015;10(7):867–80. Scholar
  52. 52.
    • Rhodes T, Guise A, Ndimbii J, Strathdee S, Ngugi E, Platt L, et al. Is the promise of methadone Kenya’s solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study. BMJ Open. 2015;5(3):e007198. Opioid agonist treatment is promoted globally as an evidence-based intervention to treat heroin addiction among PWID and prevent HIV infection. This study mathematically models different levels of opioid agonist treatment intervention coverage, and the impact on HIV prevention in Nairobi, Kenya.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Mwatelah RS, Lwembe RM, Osman S, Ogutu BR, Aman R, Kitawi RC, et al. Co-infection burden of hepatitis C virus and human immunodeficiency virus among injecting heroin users at the Kenyan coast. PLoS One. 2015;10(7):e0132287. Scholar
  54. 54.
    Messersmith LJ, Adjei R, Beard J, Agyarko-Poku T, Wondergem P, Falconer A, et al. Drug use and sexual behavior: the multiple HIV vulnerabilities of men and women who inject drugs in Kumasi, Ghana. J Acquir Immune Defic Syndr. 2015;68(Suppl 2):S124–30. Scholar
  55. 55.
    Meade CS, Towe SL, Watt MH, Lion RR, Myers B, Skinner D, et al. Addiction and treatment experiences among active methamphetamine users recruited from a township community in Cape Town, South Africa: a mixed-methods study. Drug Alcohol Depend. 2015;152:79–86. Scholar
  56. 56.
    Matiko E, Khatib A, Khalid F, Welty S, Said C, Ali A, et al. HIV prevalence and risk behaviors among people who inject drugs in two serial cross-sectional respondent-driven sampling surveys, Zanzibar 2007 and 2012. AIDS Behav. 2015;19(Suppl 1):S36–45. Scholar
  57. 57.
    • Lepretre A, Ba I, Lacombe K, Maynart M, Toufik A, Ndiaye O, et al. Prevalence and behavioural risks for HIV and HCV infections in a population of drug users of Dakar, Senegal: the ANRS 12243 UDSEN study. J Int AIDS Soc. 2015;18:19888. This study provides data on drug use, HIV and HCV and HBV infection in Senegal and is important because data from the West Africa region is often lacking.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    • Kurth AE, Cleland CM, Des Jarlais DC, Musyoki H, Lizcano JA, Chhun N, et al. HIV prevalence, estimated incidence, and risk behaviors among people who inject drugs in Kenya. J Acquir Immune Defic Syndr. 2015;70(4):420–7. This study is one of the first to describe baseline PWID risks prior to evaluation of the potential effect of NSP in this population. In addition, this is the only study to discuss NSPs in detail.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Guise A, Dimova M, Ndimbii J, Clark P, Rhodes T. A qualitative analysis of transitions to heroin injection in Kenya: implications for HIV prevention and harm reduction. Harm Reduct J. 2015;12:27. Scholar
  60. 60.
    Bassiony MM, Salah El-Deen GM, Yousef U, Raya Y, Abdel-Ghani MM, El-Gohari H, et al. Adolescent tramadol use and abuse in Egypt. Am J Drug Alcohol Abuse. 2015;41(3):206–11. Scholar
  61. 61.
    Adebajo S, Eluwa G, Njab J, Oginni A, Ukwuije F, Ahonsi B, et al. Evaluating the effect of HIV prevention strategies on uptake of HIV counselling and testing among male most-at-risk-populations in Nigeria; a cross-sectional analysis. Sex Transm Infect. 2015;91(8):555–60. Scholar
  62. 62.
    Were T, Wesongah JO, Munde E, Ouma C, Kahiga TM, Ongecha-Owuor F, et al. Clinical chemistry profiles in injection heroin users from Coastal Region, Kenya. BMC Clin Pathol. 2014;14:32. Scholar
  63. 63.
    Saban A, Flisher A, Laubscher R, London L, Morojele N. The association between psychopathology and substance use: adolescent and young adult substance users in inpatient treatment in Cape Town, South Africa. Pan Afr Med J. 2014;17(Suppl 1):8. Scholar
  64. 64.
    Lambdin BH, Masao F, Chang O, Kaduri P, Mbwambo J, Magimba A, et al. Methadone treatment for HIV prevention-feasibility, retention, and predictors of attrition in Dar es Salaam, Tanzania: a retrospective cohort study. Clin Infect Dis. 2014;59(5):735–42. Scholar
  65. 65.
    Jhugroo A, Ellayah D, Norman A, Hulse G. Naltrexone implant treatment for buprenorphine dependence—Mauritian case series. J Psychopharmacol. 2014;28(8):800–3. Scholar
  66. 66.
    Gupta A, Mbwambo J, Mteza I, Shenoi S, Lambdin B, Nyandindi C, et al. Active case finding for tuberculosis among people who inject drugs on methadone treatment in Dar es Salaam. Tanzania Int J Tuberc Lung Dis. 2014;18(7):793–8. Scholar
  67. 67.
    Trenz RC, Scherer M, Duncan A, Harrell PT, Moleko AG, Latimer WW. Latent class analysis of polysubstance use, sexual risk behaviors, and infectious disease among South African drug users. Drug Alcohol Depend. 2013;132(3):441–8. Scholar
  68. 68.
    Mirzoyan L, Berendes S, Jeffery C, Thomson J, Ben Othman H, Danon L, et al. New evidence on the HIV epidemic in Libya: why countries must implement prevention programs among people who inject drugs. J Acquir Immune Defic Syndr. 2013;62(5):577–83. Scholar
  69. 69.
    Lambdin BH, Bruce RD, Chang O, Nyandindi C, Sabuni N, Zamudio-Haas S, et al. Identifying programmatic gaps: inequities in harm reduction service utilization among male and female drug users in Dar es Salaam, Tanzania. PLoS One. 2013;8(6):e67062. Scholar
  70. 70.
    Bowring AL, Luhmann N, Pont S, Debaulieu C, Derozier S, Asouab F, et al. An urgent need to scale-up injecting drug harm reduction services in Tanzania: prevalence of blood-borne viruses among drug users in Temeke District, Dar-es-Salaam, 2011. Int J Drug Policy. 2013;24(1):78–81. Scholar
  71. 71.
    Onifade PO, Somoye EB, Ogunwobi OO, Ogunwale A, Akinhanmi AO, Adamson TA. A descriptive survey of types, spread and characteristics of substance abuse treatment centers in Nigeria. Subst Abuse Treat Prev Policy. 2011;6:25. Scholar
  72. 72.
    Dos Santos MM, Trautman F, Kools JP. Rapid assessment response (RAR) study: drug use and health risk—Pretoria, South Africa. Harm Reduct J. 2011;8:14. Scholar
  73. 73.
    Brodish PS, Singh K, Rinyuri A, Njeru C, Kingola N, Mureithi P, et al. Evidence of high-risk sexual behaviors among injection drug users in the Kenya PLACE study. Drug Alcohol Depend. 2011;119(1–2):138–41. Scholar
  74. 74.
    Atkinson JM, McCurdy SM, Williams M, Mbwambo J, Kilonzo G. HIV risk behaviours, perceived severity of drug use problems, and prior treatment experience in a sample of young heroin injector s in Dar es Salaam, Tanzania. Afr J Drug Alcohol Stud. 2011;10(1):1–9.PubMedPubMedCentralGoogle Scholar
  75. 75.
    Soliman CR, Rahman IA, Shawky S, Bahaa T, Elkamhawi S, El Sattar AA, et al. HIV prevalence and risk behaviors of male injection drug users in Cairo, Egypt. AIDS. 2010;24(Suppl 2):S33–8. Scholar
  76. 76.
    Parry CD, Petersen P, Carney T, Needle R. Opportunities for enhancing and integrating HIV and drug services for drug using vulnerable populations in South Africa. Int J Drug Policy. 2010;21(4):289–95. Scholar
  77. 77.
    McCurdy SA, Ross MW, Williams ML, Kilonzo GP, Leshabari MT. Flashblood: blood sharing among female injecting drug users in Tanzania. Addiction. 2010;105(6):1062–70. Scholar
  78. 78.
    Johnston LG, Holman A, Dahoma M, Miller LA, Kim E, Mussa M, et al. HIV risk and the overlap of injecting drug use and high-risk sexual behaviours among men who have sex with men in Zanzibar (Unguja), Tanzania. Int J Drug Policy. 2010;21(6):485–92. Scholar
  79. 79.
    Dos Santos MML, Rataemane ST, Fourie D, Trathen B. An approach to heroin use disorder intervention within the south African context: a content analysis study. Subst Abuse Treat Prev Policy. 2010;5:13. Scholar
  80. 80.
    Williams MLM, McCurdy SA, Bowen AM, Kilonzo GP, Atkinson JS, Ross MW, et al. HIV seroprevalence in a sample of Tanzanian intravenous drug users. AIDS Educ Prev. 2009;21(5):474–83. Scholar
  81. 81.
    Parry CD, Carney T, Petersen P, Dewing S, Needle R. HIV-risk behavior among injecting or non-injecting drug users in Cape Town, Pretoria, and Durban, South Africa. Subst Use Misuse. 2009;44(6):886–904. Scholar
  82. 82.
    Ross MW, McCurdy SA, Kilonzo GP, Williams ML, Leshabari MT. Drug use careers and blood-borne pathogen risk behavior in male and female Tanzanian heroin injectors. Am J Trop Med Hyg. 2008;79(3):338–43.CrossRefPubMedGoogle Scholar
  83. 83.
    Pluddemann A, Parry CD, Flisher AJ, Jordaan E. Heroin users in Cape Town, South Africa: injecting practices, HIV-related risk behaviors, and other health consequences. J Psychoactive Drugs. 2008;40(3):273–9. Scholar
  84. 84.
    Parry C, Petersen P, Carney T, Dewing S, Needle R. Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drug-using populations in Cape Town, Durban and Pretoria, South Africa. Sahara J. 2008;5(3):113–9.CrossRefPubMedGoogle Scholar
  85. 85.
    Needle R, Kroeger K, Belani H, Achrekar A, Parry CD, Dewing S. Sex, drugs, and HIV: rapid assessment of HIV risk behaviors among street-based drug using sex workers in Durban, South Africa. Soc Sci Med. 2008;67(9):1447–55. Scholar
  86. 86.
    Williams ML, McCurdy SA, Atkinson JS, Kilonzo GP, Leshabari MT, Ross MW. Differences in HIV risk behaviors by gender in a sample of Tanzanian injection drug users. AIDS Behav. 2007;11(1):137–44. Scholar
  87. 87.
    McCurdy SA, Ross MW, Kilonzo GP, Leshabari MT, Williams ML. HIV/AIDS and injection drug use in the neighborhoods of Dar es Salaam, Tanzania. Drug Alcohol Depend. 2006;82(Suppl 1):S23–7.CrossRefPubMedGoogle Scholar
  88. 88.
    Beckerleg S, Telfer M, Sadiq A. A rapid assessment of heroin use in Mombasa, Kenya. Subst Use Misuse. 2006;41(6–7):1029–44. Scholar
  89. 89.
    Parry CDP, Plüddemann A, Myers BJ. Heroin treatment demand in South Africa: trends from two large metropolitan sites (January 1997-December 2003). Drug Alcohol Rev. 2005;24(5):419–23. Scholar
  90. 90.
    McCurdy SA, Wiliams ML, Kilonzo GP, Ross MW, Leshabari MT. Heroin and HIV risk in Dar es Salaam, Tanzania: youth hangouts, mageto and injecting practices. AIDS Care. 2005;17(Suppl 1):S65–76. Scholar
  91. 91.
    Myers B, Parry CD, Plüddemann A. Indicators of substance abuse treatment demand in Cape Town, South Africa (1997-2001). Curationis. 2004;27(2):27–31.CrossRefPubMedGoogle Scholar
  92. 92.
    Parry CD, Bhana A, Pluddemann A, Myers B, Siegfried N, Morojele NK, et al. The South African community epidemiology network on drug use (SACENDU): description, findings (1997-99) and policy implications. Addiction. 2002;97(8):969–76.CrossRefPubMedGoogle Scholar
  93. 93.
    Othieno CJ, Kathaku DM, Ndetei DM. Substance abuse in outpatients attending rural and urban health centres in Kenya. East Afr Med J. 2000;77(11):592–5.PubMedGoogle Scholar
  94. 94.
    Beckerleg S, Telfer M, Hundt GL. The rise of injecting drug use in East Africa: a case study from Kenya. Harm Reduct J. 2005;2:12. Scholar
  95. 95.
    Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372(9651):1733–45. Scholar
  96. 96.
    United Nations Office on Drugs and Crime (UNODC), International Centre for Health Intervention and Research in Africa (ICHIRA). Rapid situational assessment of HIV prevalence and risky behaviours among injecting drug users in Kenya. Nairobi: UNODC/ICHIRA; 2012.Google Scholar
  97. 97.
    Tanzania National AIDS Control Programme (NACP). Consensus estimates on key population size and HIV prevalence in Tanzania. Ministry of Health and Social Welfare: Dar es Salaam, Tanzania, July 2014. 2018. Available at Accessed on 19 August 2018.
  98. 98.
    Reid SR. Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review. Harm Reduct J. 2009;6:24. Scholar
  99. 99.
    Sullivan LE, Levine BG, Chawarski MC, Schottenfeld R, Fiellin D. Addiction and HIV in Kenya: a description of treatment services and integration. Afr J Drug Alcohol Stud. 2007;6(6):17–26.Google Scholar
  100. 100.
    Salm-Reifferscheidt L. Tramadol: Africa’s opioid crisis. Lancet. 2018;391(10134):1982–3. Scholar
  101. 101.
    World Health Organization (WHO). Expert Committee on Drug Dependence. 39th Meeting Agenda Item 5.3. 2017. Available at Accessed on 26 August 2018.
  102. 102.
    Shalaby AS, El-Hady Sweilum OA, Ads MK. Does tramadol increase the severity of nicotine dependence? A study in an Egyptian sample. J Psychoactive Drugs. 2015;47(3):197–202. Scholar
  103. 103.
    Csete J, Gathumbi A, Wolfe D, Cohen J. Lives to save: PEPFAR, HIV, and injecting drug use in Africa. Lancet. 2009;373(9680):2006–7. Scholar
  104. 104.
    Harm Reduction International. n.d. Sub-Saharan Africa Regional Overview. Available at Accessed August 26, 2018.
  105. 105.
    Petersen Z, Myers B, van Hout MC, Pluddemann A, Parry C. Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries. Harm Reduct J. 2013;10:13. Scholar
  106. 106.
    Ratliff EAM, McCurdy SA, Mbwambo JK, Lambdin BH, Voets A, Pont S, et al. An overview of HIV prevention interventions for people who inject drugs in Tanzania. Adv Prev Med. 2013;2013:183187–6. Scholar
  107. 107.
    Ndimbii J, Guise A, Ayon S, Kalama M, McLean S, Rhodes T. Implementing needle and syringe programmes in Kenya: changes, opportunities and challenges in HIV prevention. Afr J Drug Alcohol Stud. 2015;14(2):95–103.Google Scholar
  108. 108.
    WHO, UNODC, UNAIDS. WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users—2012 revision. 2013. Available at Accessed 19 August 2018.
  109. 109.
    WHO. Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. 2004. Available at Accessed 19cAugust 2018.
  110. 110.
    UNAIDS, WHO (2007). Guide to starting and managing needle and syringe programmes. Available at Accessed 19 August 2018.
  111. 111.
    CDC (2018). Syringe Service Programs. Available at Accessed on 19 August 2018.
  112. 112.
    Wodak A, Maher L. The effectiveness of harm reduction in preventing HIV among injecting drug users. N S W Public Health Bull. 2010;21(3–4):69–73. Scholar
  113. 113.
    Bruce RD. Methadone as HIV prevention: high volume methadone sites to decrease HIV incidence rates in resource limited settings. Int J Drug Policy. 2010;21(2):122–4. Scholar
  114. 114.
    O'Connor PG, Shi JM, Henry S, Durante AJ, Friedman L, Selwyn PA. Tuberculosis chemoprophylaxis using a liquid isoniazid-methadone admixture for drug users in methadone maintenance. Addiction. 1999;94(7):1071–5.CrossRefPubMedGoogle Scholar
  115. 115.
    McNeil Jr. DG. ‘Opiophobia’ has left Africa in Agony. 2017. Retrieved from

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Ann E. Kurth
    • 1
    Email author
  • Peter Cherutich
    • 2
  • Rosabelle Conover
    • 1
  • Nok Chhun
    • 1
  • R. Douglas Bruce
    • 3
    • 4
  • Barrot H. Lambdin
    • 5
  1. 1.Yale University School of NursingOrangeUSA
  2. 2.Ministry of HealthNairobiKenya
  3. 3.Cornell Scott-Hill Health CenterNew HavenUSA
  4. 4.Yale University School of MedicineNew HavenUSA
  5. 5.RTI InternationalResearch Triangle ParkUSA

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