Shakilah

Shakilah¹ was desperate to break her addiction to heroin. It seemed a miracle when she learned that a new opioid substation program was opening in Kampala, Uganda’s capital, in 2020, particularly given the country’s harsh drug laws.

Except, she was told she didn’t meet the qualifications for the program. She can’t remember in what way she was wanting, but decided she would not allow it to disqualify her. She is a quiet, halting speaker, but very persistent. It was not long before she claimed access to the program.

The methadone provided by the clinic almost immediately curbed her desire for heroin. That freed her from needing to sell sex to support her habit. Her relief was immense, both at interrupting her dependence on the drug and because she no longer had to feed an addiction that demanded she put herself at risk of getting infected with HIV.

Treatment became her priority. She moved to be within walking distance of the clinic. She was always among the first of the more than 900 patients who trickled in over the course of the day. With her newly free afternoons, she would return to the hotspots where people bought and used drugs. She was not there to purchase, but to encourage people to join her in treatment. She brought the conviction of the newly converted.

It was overwhelming to learn, then, that the clinic was abruptly closing following President Donald Trump’s suspension of all foreign aid on January 24. The services had been entirely supported with money from the U.S. President’s Emergency Plan for AIDS Relief.

I met somebody who was coming from the clinic who told me that was the last day they were taking medication. There was no prior communication. It just stopped. And that was the last day people could get medication.

I was devastated. The medication we got at the [medication assisted treatment] clinic is a substitute for the opioids that we use. So when you do not get medication, it definitely means you are going to withdraw.

I am speaking to her 17 days later. The clinic is still closed.

The only option now is to use again. A number of people have gone back into using, which is terrible. And being injected, it’s risky. Especially if there is not [HIV prevention] medication now. You will not have money enough to buy yourself a syringe. You will be forced into sharing with somebody else whose [HIV] status you probably do not know. So it is terrible.

For women who use and inject drugs, the risk is doubled. The biggest percentage of women and men have gone back into using. I’d say more than 50 percent have gone back.

Yet, Shakilah is enduring the withdrawals, desperate to avoid relapsing.

It is terrible. The withdrawals are so, so painful. Sometimes it takes its toll on me. But I am holding on to not going back to the ghetto, the place where we buy drugs.

Today, my cousin called me, actually.

He is also a recovering injection drug user.

He called me and he was in terrible pain. I was actually asking him if he’s almost dying. I haven’t seen him. I don’t know what is going on. But he was in terrible pain. I could hear his voice. He was scared. He thinks he may die if he doesn’t get his fix. It was more like an SOS. I’m hoping he doesn’t shoot himself. Otherwise, he might go into an overdose.

I told him to hang in there. I told him to hang in there and I would go to see him.