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“I’m glad I learned before I got more problems,” she said.“I now use [antiretroviral] drugs.” She was growing tired of the way her life was progressing.She found regular clients, and when sex work didn’t fulfill her financial needs, she broke into people’s homes and stole their iron pots.Several years later, Hamadi participated in a class for people who inject heroin at MDM.With aid from the United States and Canada, Tanzania’s Ministry of Health approved a comprehensive plan to help prevent and treat heroin addiction. According to the United Nations Office on Drugs and Crime (UNODC), there are more than 500,000 heroin users in East Africa, where popular Indian Ocean drug trade routes make landfall.Nearly 60 percent of these users may live in Tanzania, UNODC believes, with a heavy concentration in the port city of Dar es Salaam.An estimated 40 percent of Tanzanians who inject drugs are HIV-positive — compared with 5 percent of the general population.Statistics are worse for women who inject heroin; the Tanzanian Ministry of Health estimates that two-thirds of them are HIV-positive.

If someone is short on cash, users say that injecting heroin-laced blood can give a mild high.“Honestly the first time I didn’t feel good,” Hamadi recalled. “If she has a male partner, he can be very influential in getting her to start [using].” Though most Tanzanian women either sniff or smoke heroin, within two years Hamadi started experimenting with needles.She was seeking the purer highs she remembered from when she began using.The same year, she gave birth to a healthy baby boy.Her partner supported the family, she said, by conning people into believing he was a fortuneteller.Her son lived with his grandmother, and she was rarely consulted on any family decisions.Sex work and robbery had their difficulties and indignities.It was getting more difficult for her to inject heroin, since the veins in her arms and legs had been used so often. Fortunately for her, this was when the Tanzanian government began consulting with international donors to offer heroin users a path out of addiction.International donors became interested in Tanzania because heroin use correlates highly with HIV/AIDS prevalence.DAR ES SALAAM, Tanzania — Every morning, hundreds of Tanzanians make their daily sojourn to a breezy open-air methadone clinic at Muhimbili National Hospital. Some travel on overcrowded local buses, and others walk for hours in Dar es Salaam’s sweltering heat.One by one, the patients are called to a window, where a nurse behind a metal grate offers a plastic cup filled with liquid methadone.

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