According to Harm Reduction International (HRI), which defined the term in 1990, “harm reduction consists of policies, programs, and practices whose primary goal is to reduce the negative health, social, and economic consequences of legal and illegal drug use without necessarily reducing drug consumption.”

This approach targets active drug users, emphasizing care and prevention strategies to minimize health risks (infections, abscesses, etc.) and social risks (exclusion, precariousness, etc.) associated with the use of psychoactive substances, particularly illicit ones.

In Senegal, harm reduction activities began in 2011 [1] , following the UDSEN (Usage de Drogues au Sénégal) survey conducted in 2011 [2] , which revealed the extreme vulnerability of injecting drug users, with an HIV prevalence rate of 5.2% and an estimated 1324 precarious injecting drug users in the Dakar region.

These harm reduction activities were enhanced with the opening of CEPIAD in 2015, introducing a methadone program and a needle exchange program, thanks to financial support from the Conseil National de Lutte contre le Sida (CNLS). IDUs are now recognized as a key population in national strategies and included as priority targets in national AIDS plans.

This article aims to:

To achieve these objectives, we will first present the activities carried out at CEPIAD. Then, we will present the results obtained from these activities, followed by our commentary before concluding.

From February 2015 to December 31, 2022, 21,178 consultations were carried out for 2781 drug users, including 577 CDIs (see Figure 1 and Figure 2 ).

3333 HIV tests were conducted from January 2015 to December 2022. The HIV prevalence rate decreased from 1% in 2015 to 0.21% in 2022 (see Figure 3 and Figure 4 ).

The results show the importance of the work carried out by the CEPIAD team, despite a reduced workforce and declining resources.

Consultation activities started in 2015, peaked in 2017, and then declined due to the deterioration of the building, which forced the team to close the three consultation offices by order of the hospital administration for safety reasons. Currently, a room previously used as a refectory is being used as a consultation room, pending the installation of containers provided by the CNLS.

This decline in activities was further impacted by the onset of the COVID pandemic in 2020, necessitating a reorganization to ensure continuity of care [4] .

CDIs account for 21% of CEPIAD consultants.

Cannabis (39%) is the main substance for which CEPIAD receives referrals, followed by alcohol (24%) and heroin (15%).

Injecting drug use is rapidly expanding in all regions, including Africa. It is estimated that about 10% of HIV infections worldwide are contracted through injecting drug use. In some European and Asian countries, more than half of all HIV infections are attributed to injecting drug use.

Whether injected or not, drugs are associated with behaviors that can increase the risk of HIV infection. For example, the lack of inhibition caused by some drugs can lead to unprotected sex, while states of inebriation can complicate condom use or render people unable to negotiate safer sex. Drug use can also be implicated in rape and sexual abuse.

At CEPIAD, VCT is systematically carried out for all patients, regardless of their reason for visiting the clinic. Screening sessions are also offered every three months as part of an advanced strategy outside CEPIAD.

The inclusion and retention of patients in the methadone program have been significantly impacted. The number of new patients in the methadone program has sharply declined since 2017 and worsened with the COVID-19 pandemic. Additionally, the program has recorded many exits due to various reasons, including treatment dropout, death, travel, incarceration, and loss of follow-up. Efforts are underway to track those lost to follow-up.

One of CEPIAD’s successes has been the sharp reduction in HIV prevalence, decreasing from 5.2% in the 2011 UDSEN survey to 1% in 2015 and 0.21% in 2022.

Harm reduction programs significantly impact the prevention of HIV and hepatitis B and C, and they help connect infected individuals with diagnosis, treatment, and care services. In contrast, counseling services or behavioral interventions aimed at convincing people to stop using drugs have failed to curb epidemics of HIV or viral hepatitis [5] .

The evidence for the effectiveness of harm reduction programs is indisputable. Harm reduction works. Opiate substitution therapy has been associated with a 54% reduction in the risk of HIV infection among injecting drug users, a decrease in the risk of hepatitis C infection, an increase in adherence to antiretroviral treatment for HIV, a reduction in non-reimbursed healthcare costs, and almost a 90% reduction in the risk of opiate overdose [6] .

In Australia, 10 years of needle-syringe programs have reduced HIV cases by up to 70% and hepatitis C cases by up to 43% [6] .

In eleven years, the establishment of the harm reduction field team has reached more than half of the estimated 1324 injecting drug users in the Dakar region at least once. The provision of new, sterile syringes, inclusion of opioid-dependent injecting drug users in the methadone program, and treatment of other addictions may partly explain the considerable drop in HIV prevalence among injecting drug users. A major asset of the reduction of risk program is that it facilitates access to care for injecting drug users through a referral system. However, the challenge remains to ensure a legal and social framework favorable to harm reduction activities.