Emerging Health Challenges: Non-injecting Stimulant Drugs Use and the risk of HIV and Hep B & C infection

Beirut, Lebanon

Stimulants, or psychostimulants, are a class of drugs that act on the central nervous system and increase alertness, heighten arousal and cause behavioral excitement. Psychostimulants can be plant-based substances such as cocaine and "crack" cocaine (derived from the coca leaf), ephedrine and pseudoephedrine, and cathinone (Khat). Amphetamine, methamphetamine, and "ecstasy" group substances such as MDMA, represent some of the synthetic forms of stimulants.

According to the latest World Drug Report, about 29 million people used amphetamine-type stimulants (ATS) in 2017, 18 million used cocaine, and 21 million ecstasy. After cannabis, stimulants constitute the second most widely used category of drugs globally. The report finds that the stimulants most predominantly used in Africa are cocaine and methamphetamine while in the Near and Middle East the most used stimulants is "Captagon" (amphetamine).   

Since the beginning of the HIV epidemic, the focus on HIV prevention, treatment, and care among people who use drugs has concentrated on the needs of people who inject drugs, and mainly on those who inject opioids. However, data have shown that there are HIV-related risks associated with the use of non-injecting stimulant drugs, as well as with the unsafe injection of such drugs, including cocaine, amphetamine-type stimulants (ATS), and stimulant new psychoactive substances (NPS).

To address the current situation and to provide guidance on implementing HIV, hepatitis C (HCV) and hepatitis B (HBV) programmes for people who use stimulant drugs and who are at risk of contracting these viruses, the United Nations Office on Drugs and Crime (UNODC) in close coordination of the Middle East and North Africa Harm Reduction Association (MENAHRA) organized the first regional 3 day workshop on newly developed UNODC guidelines of HIV prevention, treatment, care, and support for people who use stimulant drugs. More than 25 Community Based Organizations (CBO), service providers and decision-makers from Afghanistan, Bahrain, Egypt, Iran, Iraq, Morocco, Lebanon, Pakistan and Tunisia  participated in the event in Beirut, Lebanon.

The workshop covered several subjects such as the nature and effects of stimulant drugs, the associated risks of HIV and hepatitis transmission, the packages of core HIV interventions for key populations who use stimulant drugs, and approaches to care and support.

Participants also provided country specific presentations on the current situations of stimulants drug use and HIV, potential interventions for HIV prevention, treatment, care and support for people who use stimulant drugs, and anticipated challenges and opportunities. Presentations incorporated the different perspectives of governmental, CBO, and representatives of people who use drugs (PWUD) and people living with HIV (PLHIV). 

To asses the impact of the workshop, participants were asked three questions pre and post the workshop;

1) How will the training help you in your future work?  

2) What changes will you bring about when you return to work as a result of the training? 

3) How will this training contribute to the improving access to core HIV and hepatitis prevention, treatment, care and support services in your country or community?

Before the workshop several responses focused on the subject's "What," for example about what are the risks of ATS, what are stimulant drugs, what is the relationship between women in prisons and the use of stimulant drugs, what to educate peers on HIV and stimulants, and what to implement in evidence-based interventions.

Post the in depth discussions, participants were able to better envision the "How," as numerous responses reflected on how to address different stimulant drugs situations, how to structure trainings for health workers, how to replicate the training in their countries, how to develop strategies and work plans focusing on harm reduction, and how to establish outreach efforts to include users of stimulants. 

                                                                                                         

Thanks to the collaboration of MENAHRA and generous contribution of the Joint United Nations Programme on HIV/AIDS (UNAIDS).