By Nomasonto Pooe
Nicotine patches, sugar-free drinks, zero-alcohol beverages and seatbelts. These are all harm-reducing products. The term harm reduction became prominent in the 70s and 80s as part of efforts to define the alternative movement in the fight against drugs. Rather than saying no to drugs and addiction completely, harm reduction seeks to provide alternatives. But with time the term has evolved, it now also includes measures that help reduce the reliance on harmful products and behaviors. The Harm Reduction Exchange Forum 2024 took place in Kenya’s capital, Nairobi. The annual forum is in its fourth year and here are a few key takeaways.
PRIORITISING MENTAL HEALTH AND THERAPY
One of the biggest challenges when trying to end the reliance on substances is social judgment. According to Nigeria’s Dr Martin Agwogie, the founder and Executive for Global Initiative on Substance Abuse, one of the key principles is Humanisation, he says “understanding that judging people with addiction will neither change their situation nor provide them with help.” Dr Agwogie explains that harm reduction also “looks at HOW and WHY people have a relationship with substances” Drug centers, wellness programmes, social workers, and therapists all look into this. Agwogie also says that it is important to celebrate mild steps for individuals “A little reduction in quantity used or positive step towards patients’ personal goal should be commended and celebrated” Kenya’s Dr Vivian Manyeki says “Not everything can be treated with medicine, therapy helps. Just talking and behavior as well as lifestyle changes can help.”
SIN TAX
Most African countries have a tax on ‘sins’; these are products like cigarettes, alcohol and now even products that contain a high sugar content. In South Africa, the sugar tax was introduced as part of efforts to reduce diabetes and obesity. For cigarette lovers, there is a tax on tobacco, while most of that tax goes into the country’s coffers, Dr Vivian Manyeki says there needs to be a review of this. Currently, all African countries where cigarettes are sold are bound to display on the packaging the harmful effects of smoking. Manyeki is calling for governments to take this one step further by “Putting sin tax funds towards harm reduction campaigns” this could be more investments into care centres, awareness campaigns and even paying for research into alternatives.
SMOKING POLICIES
Designating areas for smoking is the leading way governments have ensured that people have a choice to be exposed to cigarettes. Kenya’s Dr.Kariuki Michael says the Kenyan government introduced a bill in parliament to regulate the use of additives in tobacco products. The ongoing policy discussions with Kenyan lawmakers has aided in having more smokingless alternatives on the market. Governments are also funding more research and allowing for greater discussions that will impact how policies are determined into harmful products
CIGARETTE ALTERNATIVES
During the Harm Reduction Exchange Forum, it was agreed that it is unrealistic to expect people to stop engaging in harmful practices overnight. They are instead calling for alternatives to be continuously regulated. Currently, governments in Nigeria, South Africa and Kenya have given the green light on products that offer some form of Nicotine Replacement Therapy. Kenya’s Dr Michael presented research that shows that “trans-dermally via patches, directly into the mouth by aerosol sprays, or chewed like gum or lozenges which can be flavoured” are helping.
WHAT STILL NEEDS TO BE DONE?
The Harm Reduction Exchange like many similar platforms is imploring policymakers to come to the table. During a panel discussion, the need to bridge the gap between younger stakeholders and policymakers was earmarked as key. While harm reduction looks at more pre-emptive steps to health and wellness, this often means data and research are changing. Policymakers would therefore need to have continuous engagement to ensure relevant policies. Dr Haul says “it is important to meet people where they are, that means engaging community leaders to take part in initiatives where harmful behavior can be rectified.”
POLICY GOING THROUGH FASTER
One major challenge is the slow pace of changing policies, this can be attributed to changes between administrations, conflict in some regions or lack or awareness. According to Martin “Africa has been known for repressive and draconian drug-related laws” he cites how most African governments are “slow in evolving public health approach to drug use prevention, treatment, and recovery, and Policies that complicate the lives of victims of drug use.” While the data is evolving most laws are not. According to Dr Manyeki “there needs to be continuous education and engagement with lawmakers, we need to keep showing them that the money they are spending on cardiovascular disease can be intertwined with harm reduction, we need to demonstrate this daily and eventually the money will go towards harm reduction.”
INCLUSIVITY
Africa is a melting pot of cultures and traditions. For effective harm reduction, there needs to be engagement with everyone. The DRC’s Dr Emmanuel Rocha says in a country like his there are over 400 cultural customs that need to be considered when there are initiatives. According to Dr Hanu, bringing everyone from policymakers to community leaders and even individuals from the communities themselves to the table is the solution. The engagement at the grassroots level will provide effective insight into how harm reduction can be achieved.
To conclude, harm reduction is important for Africa because pre-emptive health care will result in lessening the burden on an already stretched healthcare sector. Ensuring that programmes, initiatives, and policies are in place will have long-term benefits.
