In the past decade, Tanzania has seen a rapid rise in the number of people who inject drugs (PWID), specifically heroin. While the overall HIV prevalence in Tanzania has declined recently to 5.6%, in 2009, the HIV prevalence among PWID remains alarmingly high at 35%. In this paper, we describe how the Tanzania AIDS Prevention Program (TAPP), Médecins du Monde France (MdM-F), and other organisations have been at the forefront of addressing this public health issue in Africa, implementing a wide array of harm reduction interventions including medication-assisted treatment (MAT), needle and syringe programs (NSP), and “sober houses” for residential treatment in the capital, Dar es Salaam, and in Zanzibar. Looking toward the future, we discuss the need to (1) extend existing services and programs to reach more PWID and others at risk for HIV, (2) develop additional programs to strengthen existing programs, and (3) expand activities to include structural interventions to address vulnerabilities that increase HIV risk for all Tanzanians. 1. Introduction Until recently, heroin use and associated health risks were not perceived as major issues in sub-Saharan Africa. However, in the mid-1980s and early 1990s, East Africa became an important stop along international drug trafficking routes thereby introducing heroin in the region [1]. Consequently, heroin injection emerged in Dar es Salaam, Tanzania, in the late 1990s [2, 3]. The Tanzanian government acknowledges that injection drug use is a well-established problem across many cities in the country [4]. During the 2000s, the rapid escalation of injection drug use in Tanzania accompanied a synergistic rise in HIV prevalence among people who inject drugs (PWID) due to unsafe injection practices and risky sexual behavior. Since 2003, the majority of PWID in Dar es Salaam reported injecting three times per day [2, 5, 6], with 41% of all users sharing needles in the past 30 days [6]. In addition, 28% of PWID reported reusing used rinse water [1], which is not effective in preventing HIV. With regard to sexual risk behavior, only 42% of PWID reported using condoms during sex in the last 30 days [7]. Studies conducted between 2003 and 2007 estimated an HIV prevalence of 42% among PWID [6, 8], compared to an estimated prevalence of 9% in the general population [9]. Subsequent studies conducted between 2009 and 2010 found an HIV prevalence among younger PWID of approximately 31% and 35%, respectively [5, 10]. These studies also found a much higher prevalence among women who inject drugs from 55% to 68%, respectively.
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