Burundi has historically lacked any protection of the rights of people who use drugs. So much so, in fact, that when the Burundi Network of People who Use Drugs was set up, they were contacted by government agents to change their name to the Burundi Association of People who Used People (BAPUD), as they are now known, to ensure they’re seen as dissuading people from using drugs.
BAPUD was founded in 2017 as part of the East African HR-HIV sub-regional project, where the Burundian organisation ABS (Burundian Alliance against AIDS) helped direct funds to establish this network. Since then, BAPUD has been fighting to uphold the human rights of people who use(d) drugs, particularly by ensuring they have access to health interventions their population needs.
HIV remains a key threat for people who use drugs in Burundi. The American President’s Emergency Plan for AIDS Relief (PEPFAR) found in 2022 that 1% of Burundian adults between the ages of 15-49 were HIV positive. Prevalence was higher among older age groups (2.1% among 50–54 year-olds), and particularly within female populations, that had higher (3.2%) rates than men (2.1%) within this age group. Prevalence was three times higher in urban than rural areas. A 2019 study found that around 10% of tested Burundians who inject drugs were HIV positive. This figure was replicated in the Ministry of Health’s surveys which found 10.2% seroprevalence in identified hotspots in the capital in 2019.
Despite these rates, bringing harm reduction to the East African nation has been an uphill battle. As UNAIS reported on Burundi in 2019: “Drug use is widely criminalised and stigmatised and its complexities misunderstood.” This widely stems from the lack of national acknowledgement of injecting drug use, preventing evidence-based harm reduction interventions from getting public support.
“You can find 8 to 10 users for the same needle” a member of BAPUD told a Burundian news outlet in 2020. This stark reality needed an immediate intervention, one that they took into their own hands.
Underground peer-led care
“Because all harm reduction services are not allowed in Burundi, like MAT [Medication Assisted Treatment] programme, NSP [Needle and Syringe Programmes], BAPUD staff board took a dangerous decision to do a hidden NSP inside hotspots,” a BAPUD member told TalkingDrugs, on the condition of anonymity.
BAPUD staff began in February 2019 to educate six drug using peers to distribute syringes in Bujumbura, Burundi’s largest city, to 400 identified intravenous drug users. Beyond providing them with sterile equipment, they trained peers to educate others on the risks of sharing needles, to signpost people with skin infections to existing health services, and to connect new injecting users with HIV-related associations. This attests to BAPUD’s health-centred approach to drug use, stemming from their involvement with regional HIV alliances like the KANCO (Kenya Aids NGOs Consortium).
“Each drug user was given a syringe to be used during a short period like one month until the next day of distribution. We also taught them to sterilise needles before re-using. This was not a legal programme, to ensure that BAPUD was not exposed and then erased like other Burundian NGOs,” a member of BAPUD explained to TalkingDrugs.
“This programme had to be done just like drug dealers: during the night to escape all suspicious eyes. The injecting drug users were educated and told during the day that the peer educator will pass in certain hotspots to distribute syringes,” he added.
Funding for syringes was collected from the community, primarily BAPUD members with enough to contribute. However, the lack of external funding from public or private agencies meant that the programme ended after 10 months, in November 2019.
“They [people injecting drugs] appreciated the project, because as you know, nothing about us without us. They believed in us because we are the same.”
“Some of them still ask us to do it [restart the NSP] but we fear the repression. We could be jailed.”
Police harassment, extortion and imprisonment are common challenges to BAPUD’s work. Police will frequently come to drug using hotspots, and demand bribes in exchange for people’s freedom. Earlier this year, police was called to one of these hotspots, arresting several BAPUD members, including three peer educators, after a police officer claimed they had threatened to beat him. Two members remain in prison, unable to pay the fine of $30 USD for their release.
If we don’t do it, no one will
One of BAPUD’s largest concerns is that the lack of recognition of a worsening condition not just for people who use drugs, but other key populations as well. HIV prevalence rates have continued to spiral for key populations. The latest Annual Report on the National Fight Against AIDS (PNLS-IST) of 2021 [available for download below]
The lack of updated information on health indicators does not only apply to drug using populations. There is a general lack of evidence on other marginalised groups: the most recent study on HIV prevalence among men who have sex with men and sex workers was conducted in 2013, which estimated 4.8% and 21.3% prevalence, respectively.
Until then, BAPUD continues to support the growing population of injecting drug users, however they can. “If no advocacy like ours is done, drug users from Burundi will continue to be victims of the Government’s war on drugs.”
If you wish to get in touch with BAPUD, they are contactable through their Facebook page.