UNIT PRICE

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Colum bia H IV CenterG rand Rounds M arch 26 , 2009 The G row th ofD rug U se in Sub-Saharan A frica : Public H ealth and Policy Im plications ErnestD rucker, PhD

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UNIT PRICE. PRODUCTION. A paradoxical peace: HIV in post-conflict states J Becker and E Drucker. - PowerPoint PPT Presentation

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Columbia HIV Center Grand Rounds

March 26 , 2009

The Growth of Drug Use in

Sub- Saharan Africa :

Public Health and Policy Implications

Ernest Drucker , PhD

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UNIT PRICE PRODUCTION

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Number of Blood Transfusions in Selected Countries 1940-1980 with Logarithmic Regression Lines

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10

100

1000

10000

100000

Year

Num

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of T

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Angola

Cameroon (Yaounde Hop YaoundeCtry)Congo (Kinshasa)

Ivory Coast

Kenya (Nairobi Red Cross Med ResLab)Sierra Leone (Connaught Hosp)

Tanzania (Dar es Salaam WholeCountry?)Togo

Uganda

Linear (Ivory Coast)

Linear (Kenya (Nairobi Red CrossMed Res Lab))Linear (Sierra Leone (ConnaughtHosp))Linear (Tanzania (Dar es SalaamWhole Country?))Linear (Togo)

Linear (Uganda)

Linear (Angola)

Linear (Cameroon (Yaounde HopYaounde Ctry))Linear (Congo (Kinshasa))

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Estimated Transfusions in SSA by Decade: 1940s Š 1980s

Decade SSA Popmidpointdecade- millions

Range ofReportedTrans per100,000/yr

Est Trans/yearSSA Region( Min – Max)

Est Median# of Transfin SSA fordecades inMillions

1940s 165 36- 47 59,400- 77,500 .681950s 190 44- 100 83,600-190,000 1.371960s 244 157- 265 383,000- 646,600 5.151970s 330 300 – 400 990,000-

1,320.00011.55

1980s 370 500 – 600 1,850,000-2,200.000

20.25

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DHS Comparative Reports No. 21

Medical Injection Use and HIV in Sub-Saharan Africa US AID Oct 2008 Execut ive Summary This report describes the extent of use of medical injections and blood transfu sions,characteristics of medical injection users, and associated knowledge and perceptions about h ow to avoid HIV infection among adul t women and men in 10 sub-Saharan African countries. It also examines the association between number of medical injections received and HIV serostatus . The analysis is based on data from eight Demograph ic and Health Surveys (DHS): Kenya, Ghana, Burkina Faso, Cameroon, Lesotho, Malawi, Ethiopia, and Zimbabwe, and two AIDS Indicator Surveys (AIS): Tanzania and Uganda, conduc ted between 2003 and 2006. In most countries stud ied, receivin g multiple medical injections is significantly positively associated with being HIV-infected, for both women and men. Ever having received a blood transfu sion also ten ds to be positively associated with being HIV-infected. The stu dy also finds that knowledge that HIV infection can be avoided b y avoiding injections, including medical injections, avoiding having sex with injecting dr ug users (IDUs), and avoiding blood transfusion remains low in most countri es studied. Few adults perceive the risk of HIV infection from havi ng medical injections or blood tran sfusion.

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A paradoxical peace: HIV in post-conflict states

Joseph U. Becker a; Ernest Drucker b a Department of Surgery, Division of Emergency Medicine, Yale University, New Haven, CT, USA b Departments of Epidemiology and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA Online Publication Date: 01 May 2008

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Conflict has traditionally been thought to contribute to the epidemic spread of HIV… the ‘post-conflict phase’ may be a particularly dangerous time for HIV transmission. The post-conflict phase is characterized by a potentially disastrous confluence of factors including:

Demobilization of combatants,

the presence of foreign peacekeeping forces, the return of potentially infected soldiers and refugees, high-risk sexual and drug use behaviours ,

persistent economic and social debilitation.

concentration of populations into cities and urban areas,

A paradoxical peace: HIV in post-conflict states

J Becker and E Drucker

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NYT

March 10, 2009

2 West Africa Slayings May Signal a New Day

By LYDIA POLGREENBISSAU, Guinea-Bissau — Just after sunset, the general got up from under his favorite mango tree. As he climbed toward his second-floor office, a remote-controlled bomb under the staircase exploded, crumpling the building’s flank into a jumble of rubble.His nemesis, the president, died less than 12 hours later, after heavily armed men fired a rocket-propelled grenade into the front door of his house.

The drug trade is the nations new scourge. According to United Nations officials, as much as $1 billion a year of cocaine is funneled through the country en route to Europe. Both Mr. Vieira and General Tagme Na Waie were suspected of involvement in drug trafficking, according to diplomats and analysts in the region, an allegation their supporters vehemently denied.

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VOICE of AMERICA

Illegal Drugs Ravage West AfricaBy Nico Colombant Dakar, Senegal23 April 2008Nico Colombant's Focus Report - Download (MP3) Nico Colombant's Focus Report - Listen (MP3)

Illegal drugs coming from South America to rich European markets increasingly are going through West Africa because of its porous borders and vast unpoliced areas. The growing illicit traffic seems to be feeding local drug networks, creating more addicts in Africa. According to a recent study, out of some15 million cocaine addicts in the world, about one million are Africans -- most of them in West Africa. But doctors say they don't have the means to help them

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BBC NEWS / AFRICA |

Monday, 9 July 2007, 00:31 GMT 01:31 UK

Africa - new front in drugs war

By Joseph WinterBBC News website

How can you hope to battle organised, rich and ruthless international drugs gangs when there is not even a proper prison in the country?

This is the problem faced by the authorities in Guinea-Bissau, which some fear could be on its way to becoming Africa's first "narco-state".Guinea-Bissau is the most glaring example of the increasing use of West Africa by Latin American cocaine traffickers to get their wares into Europe. The country is wracked by poverty, coups, political unrest and has a coastline full of uninhabited islands, creeks and swamps, providing the perfect cover

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MAJOR DRUG TRANSIT ROUTES IN THE East REGION

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Lt Grn = <5000Green = 5000- 10000Blue= >10000Gray = Unk

Numbers of people who inject drugs

Source : SAHRN 2008

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HIV prevalence rates amongpeople who inject drugsMore than 50%Not Known (nk)

0 - 20%20% - 50%More than 50%Not Known (nk)

Blue = 0 - 20% Gray = unknown

HIV Prevalence Among IDUs

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Table 9.2: HIV prevalence rates in prisons in Sub-Saharan Africa

There are no available data on HCV prevalence rates in prisons.

rate amongprisonersYearBurkina Faso 11% 1999Cameroon 12% 2005Cote D’Ivoire 28% 1993Djibouti 6.1% n/aMalawi 60–75% n/aNigeria 9% 2004Rwanda 14% 1993Senegal 2.7% 1997South Africa 45% 2006Uganda 8% 2002Zambia 27% 1999

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NYT November 26, 2008

Study Cites Toll of AIDS Policy in South Africa

By CELIA W. DUGGER

JOHANNESBURG — A new study by Harvard researchers estimates that the South African government would have prevented the premature deaths of 365,000 people earlier this decade if it had provided antiretroviral drugs to AIDS patients and widely administered drugs to help prevent pregnant women from infecting their babies.

The Harvard study concluded that the policies grew out of President Thabo Mbeki’s denial of the well-established scientific consensus about the viral cause of AIDS and the essential role of antiretroviral drugs in treating it.

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