Needle-sharing by drug-users dangerous sign

Fellows Fall 2004

By Anita Srikameswaran

June 03, 2009

After 16 years of treating Cairo's drug addicts, Dr. Ehab El Kharrat thought he knew everything he needed to for helping his patients.

He was wrong.

Until he began talking with them about HIV, El Kharrat didn't know that many of his clients were sharing needles when they took drugs, a major factor in spreading the AIDS virus.

Syringes and needles are very cheap and are available without a prescription in Egypt's pharmacies, so El Kharrat had just assumed addicts would have no reason to reuse or share a dirty needle.

But he discovered a superstition among addicts that getting new needles jinxes the chance of scoring drugs.

"We found out some strange notions," El Kharrat said. "This was a notion widely spread among our addicts."

El Kharrat is director of Freedom, a Presbyterian organization based in a working-class neighborhood near Cairo's main train station.

"When we started with the drug addiction [program], we had two problems: People saying we don't have addicts and people saying addicts are just bad people [who] need to be reprimanded," El Kharrat said. Some were dismissive, saying, "Once an addict, always an addict."

The psychiatrist estimates that Egypt has about a half million "hard core" drug addicts, as he put it, and perhaps 300,000 injecting drug users.

Freedom started in an apartment 1989 treating five people. Since then, it has reached out to approximately 3,000 drug users, treated 450 people in an 80-bed hospital setting, and helped 250 to 300 people kick their addictions, El Kharrat said.

About a year ago, Dr. Cherif Soliman, head of the Cairo office of the aid agency Family Health International, approached El Kharrat about starting a pilot project to raise HIV awareness among drug users, a service that was new to Freedom.

"Even with my long experience, I didn't ask much about sharing needle practices and unsafe sex," El Kharrat acknowledged. "But when we systematically asked about it, we found that 67 percent of the people we talked to are practicing things that would give them HIV."

Another survey, conducted by the U.N. AIDS agency, showed that more than half of intravenous drug users interviewed had shared needles within the previous month, typically more than once.

In the pilot project, Freedom workers not only have taught clients about HIV, but also have encouraged addicts to get tested anonymously at a center that Family Health International helped the government establish.

About 40 drug users and several Freedom staffers who had been addicts have gone for the anonymous testing. While few were infected with HIV, two-thirds have tested positive for exposure to hepatitis C, a dangerous and highly infectious virus.

El Kharrat hopes to reach 5,000 drug users with HIV education during the next three to four years.

"I'm pretty much scared, yeah, that we're sitting on a ticking bomb," he said.