Informing health-friendly drug policy in Africa : a comment on the challenge of drug consumption data

Considerable resources have been spent on estimating the size of populations of people who use drugs (PWUD) and people who inject drugs (PWID) in Africa. Precise estimates are elusive, not least because of stigma and criminalization faced by these populations. Bio-behavioral surveys focused on injection drug use can be useful but are expensive and have not always been designed and implemented with meaningful participation of PWID themselves. A pan-African effort of the African Union (AU) to collect drug-use data from drug treatment facilities is undermined by the dearth of facilities addressing the drug problems posing the greatest morbidity and mortality risks. Efforts that have involved PWID meaningfully and respectfully in designing and implementing data collection have shown some success in informing health service programming for PWID as well as sustained regular monitoring of drug use. But meaningful participation in data collection may be contingent on both concerted anti-stigma measures and some form of decriminalization of minor drug offenses to reduce the fear of arrest and incarceration experienced by people who use drugs, a change as yet little realized in Africa.