In Maputo, Mozambique's capital, the neighbourhoods of Serrano and Mafalala are the most popular places for buying drugs. Users visit small, ordinary-looking houses there to buy and shoot up heroin, cocaine and amphetamines.
"Addicts always leave syringes that others pick up and use," said Ezequiel, a former heroin and cocaine user, who did not wish to give his full name. "Buying a syringe costs money; addicts prefer to use their cash to buy more drugs."
Ezequiel began snorting cocaine when he was 23. Six years later, he has paid a heavy price for the habit; it has cost him his home, his friends and his health.
"I began to use cocaine just to feel better at night ... to talk with women," he said. "But I became dependent on it, and I also started shooting heroin."
Ezequiel said prices dropped when the supply of drugs in Maputo was plentiful, and most users then preferred to snort or smoke them, but when drugs were scarce "it's better to inject because it's more economical".
Many addicts started by selling personal items, like their watches, sneakers or clothes, to pay for drugs but ended up stealing, he said. "One time I had sex with another man to get money, but I used a condom. I needed heroin and I had run out of money."
After three years of using drugs, Ezequiel's parents kicked him out of the family home when they discovered he was selling their things. Soon afterwards he lost a friend, who had also been injecting drugs, to an AIDS-related illness.
Worried about his own status, Ezequiel took an HIV test and discovered he was positive.
"I shot up heroin with people I knew were HIV-positive," he told IRIN/PlusNews. "But when you're doing drugs, you forget. I thought that cleaning the syringe with water and lemon would cleanse it of HIV. I think that I caught the virus while shooting up."
Not a priority
HIV infection via injecting drug use is not considered a priority in the fight against AIDS in Mozambique, which has an HIV prevalence rate of 16.2 percent, one of the 10 highest in the world. The 2005 - 2009 National Strategic Plan to Fight HIV/AIDS doesn't cite injecting drug users as a vulnerable group.
But Ana Leão, a senior researcher at the Institute for Security Studies in Pretoria, South Africa, believes that despite the relatively small numbers of injecting drug users in Mozambique, the problem exists and should not be ignored.
Jonathan Lucas, the Southern African representative of the UN Office on Drugs and Crime (UNODC), pointed to East Africa as an example of what could happen in Mozambique if no action was taken.
Kenya has a national HIV prevalence rate of 6.1 percent, but infection among its 30,000 or so injecting drug users is close to 50 percent, according to a government study.
A 2005 study in Zanzibar, a semi-autonomous island off the coast of Tanzania, Mozambique's northern neighbour, showed that 30 percent of injecting drug users were HIV-infected, compared to 12 percent of the rest of the adult population.
The Mozambican government has asked John Snow Inc., a US-based consultancy that provides technical and managerial assistance to public health programmes, to investigate the relationship between injecting drug use and HIV transmission.
"Where there is information, I believe there is HIV prevention, but where information is lacking, we run great risks," said Mario Marrengula, who is helping coordinate the study.
According to UNODC, between five percent and 10 percent of all HIV infections worldwide are the result of drug users sharing contaminated syringes or needles.
|REMAR is a Christian NGO, which assists drug users|
About 78 percent of the estimated 13 million injecting drug users live in the developed world, but drug use is on the increase in a number of sub-Saharan countries.
According to Lucas, heroin arrives in Mozambique from Pakistan and Afghanistan, while cocaine comes from Latin America. Much of the amphetamines are made in Southern Africa, because they are simple to manufacture and the risks involved in trafficking them are small.
Struggling against drugs
Three years ago, a friend introduced Ezequiel to Reabilitação de Marginalizados (Rehabilitation of the Marginalised - REMAR), which focuses on drug users but also helps orphaned children and the homeless.
REMAR is a Christian NGO founded in Spain 25 years ago; today it operates in 58 countries, including Mozambique, where it has reached 500 people in the coastal cities of Maputo, Xai-Xai and Beira since 1998. "It was my salvation," Ezequiel told IRIN/PlusNews.
The strategy is to keep addicts busy, said Mozambican REMAR missionary Diogo Fonseca, himself an ex-user. "We dispatch many to work in the fields because there they sweat out the toxins. When they get home, they are too tired to even think of using drugs," he explained. Others work in a homeware store on one of Maputo's main commercial avenues, which operates to the benefit of REMAR.
Fonseca believes harm reduction is the best strategy for preventing HIV infection among injecting drug users. This controversial approach, which includes distributing disposable syringes to addicts, has successfully reduced HIV infections among drug users in Latin America and Eastern Europe.
Lucas of UNODC says harm reduction needs to be part of a package of HIV prevention and treatment for drug users. "Distributing disposable syringes and needles to addicts won't work if adequate treatment isn't offered."
Ezequiel has been taking antiretroviral drugs for a year now, but believes that if he had received disposable needles and more information he wouldn't have contracted HIV in the first place.
"Drugs can't be treated as a criminal matter, but rather as a health issue," he said. "We need to help addicts, not marginalise them."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
We uncovered the sex abuse scandal that rocked the WHO, but there’s more to do
We just covered a report that says the World Health Organization failed to prevent and tackle widespread sexual abuse during the Ebola response in Congo.
Our investigation with the Thomson Reuters Foundation triggered this probe, demonstrating the impact our journalism can have.
But this won’t be the last case of aid worker sex abuse. This also won’t be the last time the aid sector has to ask itself difficult questions about why justice for victims of sexual abuse and exploitation has been sorely lacking.
We’re already working on our next investigation, but reporting like this takes months, sometimes years, and can’t be done alone.
The support of our readers and donors helps keep our journalism free and accessible for all. Donations mean we can keep holding power in the aid sector accountable, and do more of this.