Feature story

Empowering people who inject drugs in Uganda

18 January 2022

The hardships caused by the COVID-19 pandemic have magnified the challenges that people who use drugs face. 

In Uganda, during the COVID-19 lockdowns there was limited access to HIV treatment and other health services, including access to medically assisted therapy, which provides daily doses of methadone to people who use drugs. Access to support systems, such as drop-in centres, was also affected. 

“During the COVID-19 lockdown, access to medically assisted therapy for a daily dose was really hard for me, since movement was restricted and we required permission from the area local council. However, getting permission for a travel permit from the local council was very hard and took time, so it became challenging to sustain without access to these crucial services,” said Nsereko Joshua (not his real name), who is currently undergoing medically assisted therapy.

An analysis conducted by the Uganda Harm Reduction Network (UHRN) in July 2020 on the effects of the COVID-19 pandemic showed a decline in access to condoms, pre-exposure prophylaxis, counselling, psychosocial support, HIV testing, sexual and reproductive health services and legal aid services. It also highlighted a 25% increase in human rights violations reported among people who inject drugs during the COVID-19 lockdown. Issues included an increase in arrests and detentions, gender-based violence and eviction from their houses by the police at night.

When the UNAIDS Solidarity Fund for key populations was announced in December 2020, Wamala Twaibu, the founder and Chairperson of the Eastern Africa Harm Reduction Network and UHRN, saw an opportunity to empower people who inject drugs. He envisioned a transformed community that could support one another when in need, managing their own income sources.

“I was an injecting drug user for more than seven years, and I know what a drug user goes through daily. My aspiration is to improve the health, human rights and socioeconomic well-being of people who use drugs,” he said.

Mr Twaibu noted that injecting drug use and drug dependence often have long-term impacts on a person’s socioeconomic status and health outcomes. The lack of work skills, past criminal histories, stigma and discrimination and the criminalization of drug use are some of the main issues that people who inject drugs face regularly.

UHRN applied for the UNAIDS Solidarity Fund grant to kickstart the Empowered PWID Initiative for Transformation (EPIT) project, which was awarded in 2021. Through the EPIT project, community members currently on medically assisted therapy will be equipped with skills in craft-making for a sustained livelihood. Mr Twaibu noted that knowledge and skills in small-scale business management for people who inject drugs will form the core of the project. 

About 80 people who inject drugs on medically assisted therapy will be engaged in the EPIT project, clustered in 16 cohorts with five members in each cohort and with at least six women-led cohorts across the five divisions of Kampala. 

To ensure the sustainability of the initiative, a “Save, take and return” approach will be used. This strategy encourages beneficiaries to save some of the profits of the social enterprises every day, which they can get back after a few months. 

“This fund looks at the socioeconomic empowerment of key populations, led by the affected community. That is the catch. Community ownership of the initiative is important because nothing for us without us,” said Mr Twaibu. “Change is possible when we support each other without discrimination and stigma. I wish to see a transformed and empowered people who inject drugs community that can support one another when in need,” he added. 

Thinking about the effects of the COVID-19 pandemic so far, Mr Twaibu worries that the next wave of COVID-19 might affect the programme. However, he envisions a fully established and functional craft-making programme in the five divisions of Kampala and a scale-up in other regions where UHRN works. 

Now that he is a part of the EPIT project, Mr Joshua expresses hope for a brighter future. “I yearn to have a complete recovery from drug addiction, and I believe that medically assisted therapy will do this for me,” he said. “And I believe the EPIT programme will give me an opportunity to develop and demonstrate my readiness for my recovery with the ability to earn something for my survival and for transport to seek my treatment. I think even after this programme, the skills will help me to sustain my family and myself as well.”