Buying Heroin Mozambique

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Buying Heroin Mozambique

Each member is a full service law firm with expert knowledge and experience in both local law and the local business, political, cultural and economic environment. Our members and their lawyers are recognised by clients and major legal directories as leaders in various practice areas. Find out more about our members. We look at the complex problem. Mozambique hit the headlines in March when armed Islamic extremists rampaged through the town of Palma in northern Mozambique. The insurgents have killed hundreds of people and driven tens of thousands from their homes. Cabo Delgado is a historically neglected Muslim area in a Christian-majority country. The place is full of expat workers and services and supplies infrastructure — which was targeted by the armed gangs who claim allegiance to Islamic State and call themselves al-Shabaab. It was easy to conclude that the Islamists aimed to annex the gas fields and their cash flows — much as IS did when it seized territory in Iraq and Syria to establish its short lived Caliphate. However the attack on Palma helps distract from the crime and corruption at the heart of the problem. Mozambique has until recently shown great promise. After a grueling civil war that dragged into the s, the award-winning president Joaquim Chissano and his team of young technocrats like prime minister Luisa Diogo worked to turn the country around. There were new mining and energy projects, a smelter that had brought back international capital, a useful balance of Chinese infrastructure and European budget support. Tourists flooded over the border from South Africa. The economy was creating jobs. Nacala Port in northern Mozambique has been identified as a key channel for much of the illicit cargo that comes in and out of Mozambique. The amounts trafficked are eye watering. Heroin goes from Afghanistan to the Makran coast of Pakistan, and is taken by dhow to northern Mozambique. It is not just drugs. The loans were a front for bribery and kickbacks, and have been the subject of many legal investigations. Remember, at the time, people were jumping up and down about how Mozambique would be the next big thing, one of the largest gas producers in world, and people wanted to get in early. With limited other opportunities, the bonds provided a way in. He had cult leader status for his youthful supporters from the Ansar Muslim Youth Council, who were slowly pushed south. Radical imams in Tanzania welcomed them. The Islamist radicals were joined by artisanal miners kicked out of the Monte Puez ruby mine in northern Mozambique. In early , an insurgency known locally as Al-Shabaab, inspired by but unrelated to the Somali insurgents, briefly seized the port town of Mocambique de Praia in Cabo Delgado. It was the first time they would do so, but not the last. Those efforts squeezed drug traffickers south down the coast. As with all successful trading, it is useful to have goods travelling in both directions; the grim trade of heroin met with Asian demand for illicit Mozambican produce. The drugs syndicates were joined by gem and timber smugglers, wildlife traffickers and human traffickers — including those selling human body parts. To what extent do the insurgents and syndicates overlap? For certain, criminals have the run of the province, and they pay off the authorities or attack them if they get in the way. Collusion goes to the highest levels of military intelligence, argue some analysts. As the Mozambique government has not been able to end the insurgency, some international partners are calling for an international intervention force. There were also question marks over the length of time — several months — that the insurgency was able to hold on to Mocambique de Praia. Even former president Guebuza has told journalists that the government was not sending the best soldiers and commanders to the north. Journalists, academics and aid workers are mostly barred from the area. A UK journalist, Tom Bowker, was deported for reporting on the insurgency. Some local people are also being driven off the land. Brazilian media report Fuminho as having already made several smuggling deals across multiple African countries. Despite the arrest, cocaine busts continue. In January , five men were arrested by police on cocaine smuggling charges. Nyusi was wavering between the two options but still prefers to use forces from outside the region, such as trainers from Portugal and the United States. They are also huge investments for the energy companies and banks involved. There is also a rush to sew up the remaining large liquefied natural gas contracts — the huge China-Iran deal, for example, should shrink global gas appetite. A planned industrial hub will likely not happen. They would need all the services, creating opportunities for small and medium-sized enterprises to go. The Palma attack is a turning point for the insurgency: not just in its methods of attack, but in its victory, says security analyst Jasmine Opperman. The rebels stole between vehicles during the raid, busted into bank vaults and picked up telecoms equipment. They have money, wheels and communications, and perhaps now greater ambition. Queface expects larger towns like Nangade to be hit. Some analysts argue that the international community needs to get involved. Mayotte is France. Beyond that, there are fears that other kinds of international interventions could lead to calamity. There is a French military base in Mayotte. For Mahtani, there is a security stalemate in the north that requires intervention, but not at the risk of hurting Mozambique sovereignty. Does President Nyusi have a plan to keep Palma safe? Can the government retake Mocambique de Praia? That would be a start, but does it have the resources to do it on its own? That is where Mozambique could perhaps give some ground, suggests Mahtani. Although conditions have been deteriorating fast over the past six months, most regional analysts say that a decisive response now could stop that trend. The raid on Palma marks a watershed moment. Bukarti also highlighted the relative sophistication of the assault, with tactics to target banks and warehouses — for money and food — derived from other Islamist groups in Africa. The situation in Mozambique is complex. Amnesty also accuses Mozambique security forces of engaging in violent reprisals, including summary executions, when they have restored control after previous raids, making any future security partnerships potentially fraught. But the concern is that any emerging western support may struggle to keep pace with the worsening security situation. Search Close this search box. 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Insurgency in Mozambique: A drug problem

Buying Heroin Mozambique

Metrics details. Prior to , data about health seeking behaviors or service uptake for People who inject drugs PWID in Mozambique did not exist. The target sample size was not defined a priori, but instead KII and FGD were conducted until responses reached saturation. Data analysis was based on the principles of grounded theory related to qualitative research. Participants were majority male from diverse income and education levels and included current and former PWID, non-injection drug users, health and social service providers, peer educators, and community health workers. Respondents reported that PWID engage in high-risk behaviors such as needle and syringe sharing, exchange of sex for drugs or money, and low condom use. According to participants, PWID would rather rent, share or borrow injection equipment at shooting galleries than purchase them due to stigma, fear of criminalization, transportation and purchase costs, restricted pharmacy hours, personal preference for needle sharing, and immediacy of drug need. Barriers to access and utilization of health and social services include distance, the limited availability of programs for PWID, lack of knowledge of the few programs that exist, concerns about the quality of care provided by health providers, lack of readiness as a result of addiction and perceived stigma related to the use of mental health services offering treatment to PWID. Mozambique urgently needs to establish specialized harm reduction programs for PWID and improve awareness of available resources. Services should be located in hot spot areas to address issues related to distance, transportation and the planning required for safe injection. Specific attention should go to the creation of PWID-focused health and social services outside of state-sponsored psychiatric treatment centers. Peer Review reports. The use of injectable drugs is a known risk factor for the spread of Human Immunodeficiency Virus HIV and other blood borne diseases \[ 1 \]. In addition to socioeconomic and legal challenges, people who inject drugs PWID experience a range of health problems such as increased mortality compared with the general population \[ 1 \]. Given that injection drug use is increasingly common among young adults in sub-Saharan Africa and that drug use is also associated with increased sexual risk behaviors, PWID are known to play an important role in generalized HIV epidemics in the region \[ 2 \]. Harm reduction programs, based on effective substance use education and drug treatment services, are very limited, while imprisonment, due to the criminalization of drug use, is common \[ 2 \]. Studies have identified various structural barriers to access to health services in sub-Saharan Africa such as criminalization of drug use, punitive laws, uncoordinated services, lack of transportation, high cost of services and fear of stigmatization \[ 2 \]. Other barriers include systemic inequalities, such as discrimination, as well as intrapersonal factors, such as the preference of PWID to use addictive substances rather than seeking medical help \[ 3 \]. Other studies have pointed to barriers such as the restriction of treatment to in-patient services, which limits acceptability of such services, as well as the difficulty in meeting entry requirements \[ 4 \]. Prior to , there was no data about health seeking behaviors or service uptake specifically for PWID in Mozambique. Government interventions for this population mainly focused on educational campaigns to prevent drug use, and the provision of mental health services and psychiatric treatment for PWID at public health facilities \[ 2 \]. Interventions also included HIV counseling, testing and linkage to care at health facilities \[ 5 \]. However, needle and syringe exchange programs and opioid substitution therapy - key components of national harm reduction strategies - were not available in Mozambique \[ 1 \]. There is a critical need to describe the health seeking behaviors and barriers to care among this population in order to inform the design of effective interventions and evidence-based policies. In addition, the survey assessed access to and use of health and social services for PWID in those urban areas. Before survey implementation, a formative assessment was conducted to inform the design and implementation of the BBS survey using qualitative research methods and tools common to ethnographic research. A Formative Assessment is an important element of any BBS survey because it provides the design and implementation of the survey and also establishes a relationship between the research team and key stakeholders. According to the WHO, the Formative Assessment is exploratory and multimethod with the following objectives: a understand the target population and context; b identify existing services and gaps; c inform survey methods e. The Formative Assessment included two phases: \[ 1 \] ethnographic observation and mapping and \[ 2 \] stakeholder engagement through semi-structured interviews with key informant and focus group discussions. We present the results of the key informant interviews and focus group discussions to assess access to and use of health and social services among PWID \[ 8 \]. The purpose of the formative assessment was to examine the logistics of carrying out this Integrated Biological and Behavioral Survey IBBS and assess the characteristics of PWID, locations these populations often visit, availability of social welfare and health services, and other information particular to this key population. KII and FGD were conducted until responses reached data saturation — a point at which further data collection is unlikely to produce any new information \[ 9 \]. These key informants were a diverse group that included community leaders, current and former PWID, lay counselors, community activists, peer educators, current drug dealers, researchers working with PWID, health professionals and other service providers \[ 10 \]. The FGD were conducted by two trained research assistants who served as moderator and annotator \[ 11 \]. The FGD were designed to provide information on topics of interest such as risk behaviors in the community of interest and social networks of PWID. Recruitment of FGD participants was done through purposive sampling to provide a comprehensive description of PWID in each study location \[ 12 \]. Standardized interview guides were used during KII and FGD to facilitate discussion of issues related to socio-demographic characteristics of PWID, risk behaviors, access to and use of health services, barriers to the provision of health care, and social assistance offered to PWID. The interview guide has been previously published \[ 13 \] The acceptability of the BBS research procedures such as the proposed sampling method, biological testing and treatment for sexually transmitted diseases STIs and blood borne diseases were also discussed, however these results are beyond the scope of the current manuscript. Data analysis was based on the principle of grounded theory and aligned with data analysis procedures by the WHO for formative assessments \[ 7 \], whereby codes were grouped into categories and then categories grouped together to form themes \[ 11 \]. Two study investigators independently coded the transcripts and compared codes. Any ambiguities or discrepancies in coding were discussed and resolved. Categories and themes were also determined jointly. For the purpose of this manuscript, quotes were translated into English by two co-authors fluent in both English and Portuguese and then verified by other bilingual co-authors. We conducted 22 key informant interviews and 4 FGD with 6—12 participants for each group , including a total of 40 FGD participants Table 1. The majority of participants were male 51 male and 9 women and represented different socioeconomic and educational levels. KII participants were representative of several organizations such as drug abuse prevention services, faith-based organizations, social reintegration services, psychological and psychotherapeutic assistance, treatment organizations, and government institutions. A participant described the diversity of socioeconomic status among PWID, as follows:. I can see people who consume \[drugs\] that have limited financial resources, so poor. Sometimes I do not know how they can afford the drugs they consume. And also, there are people of high social level who are consuming cocaine, even injecting heroin \[ Participants reported that although some PWID have regular jobs and can in some way afford drugs, others often have unstable economic conditions and are eventually involved in unlawful activities to support their drug use:. There are those who live from garbage bins, there are those who are street vendors, there are those who sell second hand clothes, there are street burglars, there are others who use knives to steal money, there are others who steal clothes in buildings, there are others who steal bottles, there are others who have money because of work, there are scammers, there are taxi drivers, there are the children whose papa and mama give them money \[ Participants also mentioned sex work as a common practice among PWID. Women who inject drugs were reported to trade sex for drugs or for money to buy drugs. Often, gays in their fancy cars go to the places frequented by the PWID and call one and ask if they want cigarettes. They then invite them to stroll and go to a discrete location. Here, they propose to trade sex for money. When the act takes place, these men do not pay little, they pay well \[ Participants mentioned that although PWID had knowledge of where to access clean needles, needles were often bought through illicit means because of stigma and fear of criminalization:. And even dealers themselves purchase a certain amount of syringes and you purchase the syringe there, done. Some employees collect used syringes that should be disposed off in the trash, and sell them. Despite knowledge of where to obtain clean needles, sharing was reported to be a result of barriers to transportation, as one participant explained:. The need for health and social services for PWID was mentioned during both KII and FGD especially given that this population often suffers from problems resulting not only from drug use but also from associated risk behaviors and poor living conditions. Participants also perceived there to be a shortage of PWID-targeted programs. Some respondents felt that HIV counseling and testing services have to be more accessible in terms of location and working hours. For PWID who were aware of health services, the poor quality of these services was a barrier to health-seeking behavior:. The distance between where PWID live and socialize and health care and social services was another barrier to the access and use of services. People are closed off isolated in certain areas so it automatically gets complicated for them to go to an institution \[providing services\]. The first thought is that there is lack of trust for these people \[health workers\] … they want to collect information about us that can be referred to the police about where we are to later cause problems. Finally, the participants mentioned that state-sponsored treatment services located at psychiatric hospitals was a barrier to use of such services because of the stigma associated with mental illnesses:. The psychiatric hospital deters young PWID because they have the fear of being labeled as mentally ill, crazy and somehow end up crazy. PWID also mentioned their experience with stigma from healthcare providers or centers as a barrier to care:. So, these are the conditions we need in a health center. We got there, we are well received as anyone else, but because there are those who go there and So these are things \[equal treatment\] we also need as drug addicts. One key informant described the long referral process and the resulting gap in linkage to services:. Despite most participants being dissatisfied with the quality of services received, some described a positive experience with the health system. One participant noted that a staff member from a treatment organization explained the purpose of treatment in order to address the stigma associated with the use of psychiatric services:. So eventually, I accepted and went there. Participants mentioned the existence of different institutions and organizations where they could obtain physical and mental health support, which included disease and drug abuse prevention, peer educators, counseling and public informational meetings; voluntary HIV counseling and testing at health facilities; psychosocial support including psychological and psychotherapeutic assistance for detox; social reintegration through the development of professional skills and competencies, and social re-integration programs Table 2. A key informant, who worked as a service provider, described a comprehensive list of services offered by a local institution:. You know, therapy for a process of transformation and also capacity building so people can be self-sustainable. The socio-demographic characteristics of PWID as described by our participants was similar to previous studies, including diverse age range and economic backgrounds and mostly male \[ 2 \]. The exchange of sex for drugs or money to buy drugs was also described as a common practice, especially among female injection drug users. A systematic review also found that stigma, distance and fear of criminalization due to drug use were reported to impact the access to safe injection materials, thus contributing to needle sharing behaviors \[ 16 \]. A study conducted among PWID in South Africa also reported that the immediacy of drug need contributed to needle sharing because of the perceived lack of time required to go the pharmacy or hospital \[ 15 \]. Participants mentioned structural barriers to access to health and social services such as distance, reluctance to appear in public services and fear of criminalization, as well as the identification requirement for the use of these services. These barriers were also reflected in research conducted in Tanzania where programs fail to reach those who could benefit because of requirements that make it difficult to enter and remain in the services \[ 4 \]. While some participants reported the existence of key population friendly services and comprehensive services as facilitators to access and use of services, there was a general low awareness about the services currently available for PWID. Low awareness of services was also reported in the literature \[ 16 \] and not surprisingly, one study found that health seeking behavior among PWID in Tanzania was directly correlated to knowledge of services \[ 17 \], thus highlighting the importance of awareness campaigns targeting PWID about the existence of services. Low quality of health services, including interaction of health care professionals and non-coordinated services \[ 4 \] was also mentioned as a barrier to access among participants. In South Africa \[ 14 \], a study reported that there is usually a long wait for access to both treatment as well as HIV testing, and generally, PWID feel that negative attitudes and unprofessional behavior from healthcare providers exacerbate the problem where they feel that they are treated with disrespect. Similar to our findings, previous studies have outlined various structural and environmental barriers to access to services including uncoordinated services, complicated requirements for treatment access, lack of transportation, high costs, and fear of stigmatization and criminalization \[ 2 , 4 , 12 , 13 , 15 , 16 \]; other important structural issues from the literature that were not mentioned in our study included homelessness and precarious housing \[ 19 \]. Many of these strategies can be a cost-effective particularly in resource-limited settings such as Mozambique \[ 1 \]. Our findings represent the first exploration about access to and use of health and social services by PWID in Mozambique, however there are important limitations to consider. Second, there are potential experiences and risk behaviors of some PWID subgroups, including women and people with higher income, that may not have been well represented in this assessment since the number of female participants and people of high income was virtually nonexistent. Next, there was also potential selection bias because current or former PWID already engaged in services were more likely to have participated than PWID who are isolated from health and human services or support networks. Self-exclusion could have meant that more vulnerable subgroups may have declined to participate in FGD. However, we attempted to address this by ensuring that KII and FGD were continued until responses reached a level of saturation. Finally, given that injection drug use is a highly stigmatized and criminalized behavior in Mozambique, responses are potentially subject to information bias and social desirability bias. However, despite these limitations, the study provides important information about risk behaviors for HIV infection for PWID in Mozambique as well as their access and use of services. Understanding service delivery gaps identified during the Formative Assessment was used to strengthen referral systems during survey implementation. However, in general, the results helped to improve service delivery access and quality of services, both of which are necessary efforts aimed toward epidemic control in Mozambique. Interventions to support this key population must systematically address the barriers related to access to and use of health and social services \[ 2 \]. Several policies and harm reduction programs must urgently be introduced such as detox and rehabilitation services, methadone treatment services, and prevention programs incorporating peer educators. Government-sponsored syringe exchange programs have the potential to reduce injection drug use behaviors in Mozambique; to date, there is only one needle and syringe exchange demonstration project. Finally, a patient-centered model of care, through the creation of mental health and psychiatric treatment services in public health facilities, rather than in-patient psychiatric facilities, is of the utmost importance. This model could ensure high-quality of services and also address the stigma and discrimination experienced by this population. In order for harm reduction efforts for PWID to be successful, a coordinated effort is necessary between health professionals, civil society, policy makers and donors. Further research is necessary to explore the specific gendered-experience of access and use of services by female PWID in Mozambique-education programs Asher Google Scholar. Reid SR. Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review. Harm Reduct J. Article Google Scholar. Qualitative investigation of barriers to accessing care by people who inject drugs in Saskatoon, Canada: perspectives of service providers. Subst Abuse Treat Prev Policy. Service integration: opportunities to expand access to antiretroviral therapy for people who inject drugs in Tanzania. High prevalence of HIV, HBsAg and anti-HCV positivity among people who injected drugs: results of the first bio-behavioral survey using respondent-driven sampling in two urban areas in Mozambique. BMC Infect Dis. Geneva: World Health Organization; Formative research to optimize respondent-driven sampling surveys among hard-to-reach populations in HIV behavioral and biological surveillance: lessons learned from four case studies. AIDS Care. How many interviews are enough? An experiment with data saturation and variability. Field Methods. Garro LC. In: Field Merthods 1st. University of California. Los Angeles: Sage Publications, Inc; Focus groups \[internet\]. Methods of data collection in qualitative research: interviews and focus groups. Final report: the Mozambique integrated biological and behavioral survey among people who inject drugs, Mozambique: Maputo; Drug use and sexual behavior: the multiple HIV vulnerabilities of men and women who inject drugs in Kumasi, Ghana. Rapid MN. Pretoria: South Africa; Correlates of health care seeking behaviour among people who inject drugs in Dar Es Salaam, Tanzania. South Africa Subst Use Misuse. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. Download references. The authors would like to acknowledge the contribution of every institution involved in the preparation and execution of this activity, the participants of the survey, field workers, provincial health directorates of Maputo and Nampula, as well as members of the IBBS technical group for their valuable contributions to the success of this survey, in particular, Katia Ngale, Heidi Frank, Peter Young and Beverley Cummings. The views expressed in this article do not necessarily reflect the views of the U. Centers for Disease Control and Prevention or the U. Makini Boothe, Henry F. You can also search for this author in PubMed Google Scholar. All authors contributed equally for the writing of this manuscript. The author s read and approved the final manuscript. Correspondence to Liliana Dengo-Baloi. Written informed consent was obtained from each key informant and focus group participant; identifying information was not collected. Centers for Disease Control and Prevention CDC as a research activity involving human subjects but in which CDC involvement did not constitute engagement in human subject research. Administrative approval was obtained from the Ministry of Health of Mozambique. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Dengo-Baloi, L. Access to and use of health and social services among people who inject drugs in two urban areas of Mozambique, qualitative results from a formative assessment. BMC Public Health 20 , Download citation. Received : 25 October Accepted : 05 June Published : 22 June Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Research article Open access Published: 22 June Access to and use of health and social services among people who inject drugs in two urban areas of Mozambique, qualitative results from a formative assessment Liliana Dengo-Baloi ORCID: orcid. Conclusions Mozambique urgently needs to establish specialized harm reduction programs for PWID and improve awareness of available resources. Introduction The use of injectable drugs is a known risk factor for the spread of Human Immunodeficiency Virus HIV and other blood borne diseases \[ 1 \]. Focus group discussions The FGD were conducted by two trained research assistants who served as moderator and annotator \[ 11 \]. Data collection tools Standardized interview guides were used during KII and FGD to facilitate discussion of issues related to socio-demographic characteristics of PWID, risk behaviors, access to and use of health services, barriers to the provision of health care, and social assistance offered to PWID. Discussion The socio-demographic characteristics of PWID as described by our participants was similar to previous studies, including diverse age range and economic backgrounds and mostly male \[ 2 \]. Limitations Our findings represent the first exploration about access to and use of health and social services by PWID in Mozambique, however there are important limitations to consider. Conclusions Understanding service delivery gaps identified during the Formative Assessment was used to strengthen referral systems during survey implementation. Recommendations Further research is necessary to explore the specific gendered-experience of access and use of services by female PWID in Mozambique-education programs Asher World drug report Google Scholar Reid SR. Article Google Scholar Download references. Acknowledgements The authors would like to acknowledge the contribution of every institution involved in the preparation and execution of this activity, the participants of the survey, field workers, provincial health directorates of Maputo and Nampula, as well as members of the IBBS technical group for their valuable contributions to the success of this survey, in particular, Katia Ngale, Heidi Frank, Peter Young and Beverley Cummings. View author publications. Ethics declarations Ethics approval and consent to participate Written informed consent was obtained from each key informant and focus group participant; identifying information was not collected. Consent for publication Not Applicable. Competing interests The author declares no competing interest. About this article. Cite this article Dengo-Baloi, L. Copy to clipboard. Contact us General enquiries: journalsubmissions springernature.

Buying Heroin Mozambique