All it took were a few puffs on a friend’s cigarette at a university party to begin a life of addiction. Abiola* was 21 and the tobacco was laced with cocaine. “From that moment, the journey has been good, bad and ugly. I graduated from being a user to a dealer,” says the 53-year-old network administrator, who has spent time in prison over his drug use.
“I started smoking heavily and 10 years ago started injecting drugs. But here I am now,” he says, splaying his needle-scarred hands on the table.
Abiola is participating in Nigeria’s first needle and syringe exchange programme in Ibadan, Oyo state. He is still taking drugs, but now he should reduce his risk of contracting HIV and hepatitis C from shared needles.
About 1.9 million people in Nigeria are HIV positive, making it the fourth most affected country in the world. HIV rates among injectable drug users is more than double the national average – 3.4% compared with 1.4% – according to the Drug Use in Nigeria Survey. As of 2018, there were about 80,000 injectable drug users in the country.
The Nigerian government approved its first needle exchange programme in three states in 2020, a small but significant shift in attitude to drugs in a country where use and possession are punished by prison.
The move reflects the wider international shift. A report, published by Harm Reduction International in October, found a global rise in needle programmes, drug consumption rooms and opioid treatments in the past two years.
Nigeria’s pilot programme launched in Oyo, Abia and Gombe states in July, delayed by the pandemic and logistics between the National Drug Law Enforcement Agency and the ministry of health.
In Ibadan, Nigeria’s third-largest city, Goodworker Ministry International is leading the initiative. Staff visit “bunks” – the abandoned buildings frequented by drug users – to collect and exchange syringes and let people know about the programme. During the pilot, the organisation had given out needles to 2,739 people.
“The experience is OK. You just have to be patient to understand their stories. You must understand them and what they are facing,” says Olabode Kolawole, a monitoring and evaluation officer at Goodworker.
Project workers advise users on safer ways to take drugs, what to do in the event of an overdose, and ways to stay healthy.
Abiola is impressed: “Now I know better about things like naloxone [used to reverse the effects of opioids] and methadone.
“Before, when someone had an overdose what we used to do in the bunks was sprinkle water and slap the person, now I know that is endangering the life of the person.”
Habeeb*, 53, who began taking drugs at 13, says the programme has helped him. “Before, if I had 100,000 naira [£190] on me, I would spend everything on drugs immediately. But now, I can go a day or two resisting it,” he says.
But there is caution too. Nigeria has harsh laws that are rigorously enforced. Possession of cocaine or heroin can result in sentences of 15 to 25 years.
“We should not read too much into the government allowing this programme,” says Best Ordinioha, a professor of public health and community medicine at Nigeria’s University of Port Harcourt. “In the eyes of the Nigerian government, anybody using drugs is breaking the law and has to be prosecuted.”
Ordinioha says attitudes need to change to prevent disease.
“It is the habit of sharing needles and syringes that predispose them to those blood-borne infections,” he says. “It has been shown that [controlling them] is very important because diseases like HIV and hepatitis can kill faster than the drug abuse.”
Dr Olukayode Ogunkunle, project manager of Oyo’s Agency for the Control of Aids, says the federal government recognises the importance of the programme and will extend it but funding could be a problem. “For us to sustain this programme, we need to advocate for more funds and to sensitise the public because at first the public was sceptical.”
Tunji Agboola, the founder of Goodworker, adds: “The NGOs cannot do it alone, there has to be synergy with the primary healthcare sector and we need to penetrate more locations. The journey has begun but it is a long journey.”
*Names have been changed.