A Harm Reduction Exchange webinar was held online on January 20th, 2022. In collaboration with Integra Africa (Brand and Strategy consulting company) and Philip Morris International.
The main objective of the Harm Reduction Exchange was to bring together harm reduction advocates to reach a common position on reduced risk products. The exchange was an engagement and communication platform to discuss and advocate for evidence-based regulation as opposed to a ban of alternative reduced risk products.
The concept of harm reduction refers to policies, programs and practices aiming at minimizing health, social and legal impacts associated with use of harmful products. There is fierce opposition between those advocating for the use of less harmful product as a pragmatic and realistic approach and those who think prevention and cessation are the only solution to stop the use of harmful products.
Skin Bleaching is as addictive as alcohol or tobacco
Prof. Moussa Diallo is a Senegalese dermatologist and Head of the dermatology department at Hopital Aristide Le Dantec since 2000. He is a unique specialist in pathological anatomy and a strong advocate for harm reduction. He extensively discussed the problematic elements around skin bleaching in Africa: which, from his point of view, must be seen and treated as an addiction especially if other solutions are not effective enough:
"Bleaching is a practice whereby a man or woman will use bleaching agents to change the complexion and make it lighter by using chemicals that would be injected, swallowed or spread over the skin (within creams, soaps or lotions).
This dangerous practice (as it implies the misuse of specific medicine such as corticoid and hydroquinone for instance) blocks the process of melanin production, a natural pigment present in the body and responsible for hair and body pigmentation.
It is also responsible for photo-protection (protection from the sun) of the skin and eyes. As the protector against the sun, without it the skin cannot defend itself from harm. Therefore, skin bleaching could lead to skin cancer. In fact, bleaching is the first cause of black skin cancer on the continent.
The practice of skin bleaching is spread around the world with prevalence rates that can reach over 50% according to the Senegalese dermatologist. In Africa, one woman out of 2 at least would be practicing artificial bleaching at some level.
"The media, government, women's association and the international association against bleaching, have tried over the years to prevent the use of these products mainly through visual sensitization campaigns (TV, posters, social media influencers…). Very recently in Senegal there has been an increase in taxation of these bleaching products to make them less accessible.", he stated.
A growing number of people who seek for a lighter complexion come to their doctors asking for products that would help them achieve their goals without running any health risks. Nowadays, the addictive nature of bleaching is increasingly taken seriously with interdisciplinary studies that show that quitting is hardly doable and unlikely for most users:
"Some studies have indicated that bleaching can be considered as an addiction. As indicated by a user: "if you are used to practicing bleaching you become like a slave to it and you run the risk of considering yourself incomplete when you are not bleaching. And when you have money, instead of using it to buy food, you would straight away go to buy these bleaching products just like a smoker would rush to buy a pack of cigarettes instead of eating a healthy meal.", said the Senegalese Pr.
Since bleaching has not been successfully eradicated, medical professionals have considered harm reduction as a new and potentially efficient strategy:
"Unfortunately, prevention has not been successful. We have noted an increase of bleaching rates. In some regions in Senegal, the prevalence keeps on increasing, not with standing the fact that these products represent only 10% of the cosmetic products in the world. We have therefore tried to understand through surveys why these policies have failed. What came out is the fact that there are no alternatives safer products available, and the majority of bleachers cannot or will not quit. That is why new strategies were proposed based on a transdisciplinary approach taking into consideration the addictive nature, providing psychological support to those who want to stop. Our proposition is non-toxic products as an alternative because there are indeed natural products that are less dangerous but would give you a lighter complexion without the side effects."
As a practical approach, harm reduction adapts with the way people behave and how societies work and evolve. It is viewed as an intermediary, practical solution which can eventually lead to the cessation of the use of harmful products.
As an example, there is an intense discussion around tobacco harm reduction. Those who advocate for it promote the use of nicotine alternatives such as electronic cigarettes or heated tobacco. Those who are fiercely against, advocate for a pure and simple cessation of nicotine whether it is traditional cigarettes of other new nicotine devices which are proven to be much safer than combustible cigarettes. For Prof. David Khayat, oncologist and former president of the national cancer institute in France, prevention and cessation policies are not enough to put an end to smoking related diseases. It is still to this day the first cause of death by cancer in the world:
"We have to accept that bad behaviors are inevitable. Although we know that some behaviors like eating too much, not doing any exercise, smoking and excessively drinking alcohol are not good for our health, it is very hard to get people to stop these habits. We know that quitting is by far the best option. Eliminating completely the exposure of carcinogens that are present in tobacco smoke is the best option. Is it easy? Not at all! Why? Because Smoking is an addiction and it is very hard to quit an addiction. It is a fact that 64% of patients who you give the diagnosis of lung cancer and who start chemotherapy … continue to smoke until death." So, the innovation of less harmful alternatives in harm reduction in the field of cancer related to tobacco smoking is the only way that we can save some lives"
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Dr. Imane Kendili is a Moroccan specialist in drug addiction and behavior. Currently President of MAPA (Moroccan Association for Addictive Medicine and Associated Pathologies) and Vice-President of CARS (African Center for Health Research). She also coordinated the published Harm Reduction Manifesto in 2021. According to her, harm reduction constitutes anoptimal solution and tends to reduce the stigma around users of harmful substances:
"The all or nothing approach doesn't work. It's not about judging people. Even some people who already have lung cancer continue to smoke because it is an addiction.The best way is not to have a risky behavior but if you can't then the best way is to find the optimum solution. We are all predestined to have certain behavior whether it is because of biology or culture that can cause a person to be addicted to something."
All experts affirmed that the consumer perspective remains the most important factor as they are the ones who eventually will use these products. She added that wide access to reliable information in order for the consumer to make the right choice pertaining to their health must be at the core of all of it.
