28 September 2017

Uganda: Why Drug Addicts Shun Butabika

Although recent statistics show high rates of addiction to alcohol and injectable drugs in the country, many addicts are not willing to go to Butabika national referral mental hospital or Serenity Centre for help.

Some of the confessed addicts The Observer talked to said Butabika hospital and Serenity Centre are places for 'mad' people, and not for addicts. Some said that recovering at the hospital's rehabilitation unit carries alot of stigma.

Peter Makhoha, 36, a former drug addict from Mbale, said leading a normal life after rehabilitation is very difficult, especially if the community knows you were once a patient at Butabika hospital.

"There is a lot of stigma; I had been doing drugs for the last 15 years and it reached a point where I was out of control. Some church members in Mbale took me to Butabika where I stayed for seven months," he said. "When I was released, I went back to Nakaloke, my village, but I became the talk of the community and people were always avoiding me; I had to leave the village and come to Kampala where no one knows me."

He said he used heroin, which is one of the most injected drugs in both Kampala and Mbale. He said brown heroin was also a common drug in Mbale.

As for Ssegirinya, a former addict who is now a peer trainer, he said after rehabilitation, the community never believed in whatever he said because they still thought he was 'mad' because he had been to rehab.

Ssegirinya said at one point, he has a relapse because he could not cope with the stigma and backbiting by his people; he had to go for intense counseling before he could stabilize.

"Life was really hard. I wanted a shoulder to lean on after the several months at Butabika hospital, but when I came out, I became a subject of gossip, and finger pointing; people could not believe I was healed. If I relapsed again, I would not go back to Butabika," he said.

These are some of the cases of addicts who accessed rehabilitation services and the public branded them 'mad', something that has made some addicts shy away from going to rehab at Butabika hospital where officials say services are free.

Unfortunately, mental health in Uganda is still a subject of great shame in many communities and getting treatment at a mental health facility tends to become a banner of shame, due to the widespread ignorance.

An accident patient can leave Mulago national referral hospital after months in coma and live their life as a celebrated overcomer in spite of possible debilitating aftereffects, but another leaves Butabika fully healed and they are forever shunned as 'mad'.

Dr Brian Mutamba, a psychiatrist at Butabika, admitted there is a lot of stigma towards addicts, something that derails individual and institutional efforts to fight alcohol and injectable drugs addiction in Uganda.

"Stigma affects the institution and our patients who come here, because it is branded as a hospital for the 'mad'; this has, however, not affected our work," he said. "We don't want [patients] to stay at Butabika hospital because we don't have much space; however, we expect the community to help those coming back after rehabilitation," he said.

And that is where the problem lies; instead of supporting those returning from rehabilitation, communities sometimes push them back into relapse due to the stigma and labeling.

Statistics of people who inject drugs

A according to a recently launched study by Community Health Alliance Uganda (CHAU) and Uganda Harm Reduction Network titled Population estimation and rapid assessment on harm reduction and HIV prevention among people who inject drugs in Uganda carried out in Mbale and Kampala, cases of injectable drug abuse are on the increase.

Researchers said injectable drug use is a growing problem in Kampala and Mbale, and is well entrenched amongst the groups that practice it. The study has estimated 589 people who inject drugs (PWID) in Kampala and 186 in Mbale.

PWID think their numbers are growing, telling from the increase in the number of dealers trading in drugs. The study also found that PWID cut across all socio-demographic characteristics and include male and female, youths and adults, the rich and the poor, the educated and the uneducated, among others.

Denis Muhangi, the Principal Investigator and Team Leader from Makerere University, said Butabika and Serenity Centre were found as providers of drug dependence treatment services to PWID. However, the addicts are not keen on seeking help.

"Butabika hospital services are stigmatized as services for 'mad people'. Private providers such as Serenity Centre were said to be expensive and inaccessible to PWID, whose families cannot afford to pay the treatment costs," he said.

The study was conducted as part of the HIV and Harm Reduction in Eastern Africa Regional Project, a three-year (2015-2018) initiative funded by the Global Fund and implemented in eight countries including Burundi, Ethiopia, Mauritius, Seychelles, Uganda, Tanzania and Zanzibar.

The survey sampled 125 PWID in the two towns (95 in Kampala and 30 in Mbale); most addicts were unemployed and sustain their injecting practice by hanging out with friends who can afford to buy drugs and share with them. This sharing of drugs and needles has in turn exposed users to HIV and Aids.

"Whereas the Narcotic Drugs and Psychotropic Substances (Control) Act 2015 provides for the establishment of rehabilitation centres for providing care, treatment and rehabilitation of persons addicted to narcotic drugs, the law does not provide any specific details on what such services should consist of," Muhangi said.

"Instead, the law came with more stringent punishments for drug-related crimes; these laws also make people shy away from looking for rehab services."

Most survey respondents (85.3 per cent of the PWID in Kampala and 93.3 per cent in Mbale) revealed they knew where to access the services such as HIV testing and counseling, ART, and condoms.

"Some PWID reported that they are stigmatized and discriminated against when they visit service centres, because they are perceived to be [criminals]," he said.

Muhangi further explained that some PWID fear to access medical services, because they don't want to be identified and possibly get arrested, prosecuted, and incarcerated.

According to the survey, majority (85.1 per cent) of the PWID who participated in the survey reported that they would be willing to use harm reduction services if they were available.

Police take

Sources from police indicate that the numbers of addicts and people who inject drugs are increasing, yet society and family seem uninterested.

"We have registered more cases compared to the last two years. I expect to see school heads, religious and community leaders coming out to condemn drug abuse and also help rehabilitate these people who inject drugs," said a senior police officer from the antinarcotics department of police.

He further explained that a typical person that injects drugs is a young adult aged between 18 and 35, single, not highly educated and employed in informal jobs. They are likely to be living away from parents; living with friends or are homeless. If they are female, they are also likely to be sex workers.

"Injecting is initiated after the drug users have been consuming drugs in other non-injecting forms. Peer influence is a key factor in the transition to injecting practice," he said.

"Sometimes we arrest these addicts, but as we keep them in our cells, they fall sick and the only medication, before we take them to Butabika, is to give them some [of their drugs] to keep them alive."

Sudden withdrawal symptoms from drugs can be life-threatening, hence the impracticability of police arresting drug users without professional rehabilitation.

For now, drugs abuse remains a big social and health problem, spreading like a wildfire through schools and among the youth, as government scratches its head for lasting solutions.

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