Harm reduction can close critical gaps in healthcare for people who use drugs

Rwanda is looking to harm reduction to close critical gaps in healthcare for people who use drugs, with draft national guidelines proposing improved access to HIV prevention and treatment, mental health support and overdose response. The approach seeks to reach people who may otherwise miss out on essential services because of stigma, limited treatment options and barriers to care. Figures cited in the draft guidance estimate HIV prevalence among people who inject drugs at 11.2 per cent, compared with 2.2 per cent among adults aged 15 to 49 in the 2025 Demographic and Health Survey. While the figures come from different studies and populations and are not directly comparable, they point to the need for targeted health services that address the specific risks and barriers faced by people who use drugs, including stigma and difficulties accessing prevention, treatment and support. The proposed approach seeks to connect health facilities, community organisations and other services, while reducing stigma that can discourage people from seeking help. What the data reveals Rwanda’s 2024 mapping exercise identified 3,339 people who inject drugs, including 1,443 in Kigali. Research cited in the draft guidance found that 91 per cent of people who inject drugs in a 2022 study had shared needles at least once, while 43 per cent knew someone who had died of a suspected overdose. The findings come as Rwanda continues to make progress in its HIV response, having reached the 95-95-95 targets by December 2024, according to figures presented by the Rwanda Biomedical Centre (RBC). Dr Zephanie Nzeyimana, RBC’s HIV Key Population Strategic Officer, presented recommendations in the draft guidelines, which emphasise voluntary and informed care, confidentiality, non-discrimination and the involvement of people who use drugs in planning services. “Harm reduction is about responding to the health risks people face and ensuring they can access prevention, treatment and support without stigma standing in their way,” Nzeyimana said. “Rwanda’s progress in HIV prevention and treatment gives us a strong foundation, but we must also reach populations who remain exposed to preventable harm,” he added. Proposed interventions include HIV testing and treatment, sexually transmitted infection care, viral hepatitis and tuberculosis services, health education, condoms and overdose prevention. The guidelines are awaiting validation by the relevant technical working group. Treatment beyond drug use Frederic Nsanzumuhire, acting director of the Substance Abuse Prevention and Management Unit in RBC’s Mental Health Division, presented clinical recommendations for opioid agonist therapy (OAT). The draft guidance proposes methadone services at selected sites, with psychosocial support where feasible. It also recommends overdose education and access to naloxone at designated sites. The wider approach includes staff training, referral procedures and stronger links between community outreach and health facilities. Evidence from the Rwanda Mental Health Survey 2025 further illustrates the need for accessible support. The general population survey included 9,856 people aged 14 to 65, while a separate survey covered 1,693 genocide survivors and their descendants. The findings showed that 18.6 per cent of the general population had a mental disorder, compared with 30.5 per cent of survivors and their descendants. Non-alcohol substance use disorders were recorded at 0.8 per cent and 0.7 per cent, respectively. These figures refer to defined survey diagnoses, not all substance use. Jeanne d’Arc Mazimpaka, a health professional in RBC’s Mental Health Division, presented the findings and their implications for prevention and service planning. “Evidence helps us understand the needs of different groups and identify where the response must be strengthened. We need to invest in prevention, early identification, counselling and rehabilitation, while making services easier to access for people who need support,” Mazimpaka said. The survey identified stigma, limited mental health literacy, financial barriers and perceived inaccessibility of services among factors discouraging people from seeking care. Its recommendations include strengthening prevention, expanding addiction counselling and rehabilitation, and improving collaboration across sectors. Communities confront stigma and service gaps Community organisations and healthcare providers are central to connecting people with care, particularly where services and information are limited. Chantal Mutegarugori, representing the Joint Action Development Forum (JADF) in Nyarugenge District, emphasised collaboration among stakeholders to address the health and social consequences associated with drug use. At Kabusunzu Health Centre, director Charles Muneza said training had changed how healthcare providers understood and received people who use drugs. “Before, when they came to us, we sometimes thought they were patients or people who had lost their minds. Through what we have learned, we now understand that their conditions can be treated and that recovery can happen gradually,” Muneza said. He said people visit the health centre for medical assistance, including testing and treatment for illnesses associated with drug use. Training had helped providers better understand their circumstances and offer support without discrimination. Byiringiro Placide, representing Imboni Generation, said training had strengthened the organisation’s ability to explain the effects of different substances, associated health risks and the importance of seeking care. “Someone who uses drugs is a person like anyone else. They deserve care, kindness and help to access treatment,” he said. However, he highlighted gaps in Gicumbi, where his organisation works, saying rehabilitation support was unavailable locally and naloxone was not readily accessible. “We have learned about how to help someone experiencing an overdose, but these services and the necessary medicines are not available where we work,” Byiringiro said, calling for more facilities and support. Alfred Mwiko, a community coordinator with People Against Risks of Using Drugs Association (PARUDA), said training had improved his ability to share information, challenge stigma and refer people for help. He noted that poverty, limited financial resources and family separation can make access to care especially difficult for people in refugee communities. Mwiko called for services to be brought closer to underserved communities, including refugee camps. Elvis Benimana, who coordinated the stakeholder meeting, held on October 7 in Kigali, said effective implementation would depend on institutions understanding their responsibilities and working together. “Guidance only becomes meaningful when the people responsible for implementing it understand their roles and work together. We need a coordinated response that connects communities, health facilities and other services, while ensuring that people who use drugs can seek help without stigma becoming another barrier,” Benimana said. From guidance to action Through the TUBITEHO Project, Health Development Initiative (HDI), in partnership with L’Initiative/Expertise France, supports harm reduction, community engagement and access to respectful, rights-based healthcare. The stakeholder meeting discussed the draft national harm reduction guidance, clinical recommendations for OAT, community perspectives and mental health evidence. Turning these into effective services will require validated guidance, trained providers, reliable referral pathways, adequate resources and monitoring to establish whether people can access the support they need. Rwanda’s harm reduction response will ultimately be measured not only by the guidance developed, but by whether people can obtain appropriate care without discrimination and remain connected to treatment and support.

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Harm reduction can close critical gaps in healthcare for people who use drugs