‘Nkpuru Mmiri’ use sometimes during sex raises HIV risk in eastern Nigeria

The rising popularity of using specific drugs like ‘Nkpuru Mmiri’ to enhance and prolong sex, often involving group sex, is pushing for a wider offering of harm reduction services, especially among youths and young persons, to prevent new HIV cases in Nigeria, Sade Oguntola reports.

A surge in the use of “Nkpuru Mmiri,” which translates to seed of water, in many Igbo communities is becoming a great concern, with the National Drug Law Enforcement Agency (NDLEA) raising the alarm over many youth getting addicted to this drug, recently in Enugu.

“Mkpulu Mmiri is the Igbo slang for methamphetamine, or crystal meth, a very dangerous illicit drug. It looks like ice or white chalk crystal and can sometimes be blue. This is why users occasionally refer to it as “ice.” It can be dissolved in water. Some also dissolve it in carbonated drinks, carrying it about.

Like wildfire, the effect of Nkpuru Mmiri has spread across most towns and even remote villages, although how it became popular in the southeast of the country is still a mystery.

In the communities where Nkpuru Mmiri has become common in Anambra State, it has been reported that rape has also become rampant, as it is believed that the drug increases the libido of the affected youths.

“It is commonly talked about in south-eastern Nigeria; they talk about dissolving it in water. Others also mention that it is put inside carbonated drinks, which makes them high. I never knew that when they hold its bottle, its content is not Lacaserra,” retorted Emeka Chunkundi, a journalist based in Aba.

He said Nkpuru Mmiri is commonly used as a stimulant to get high because it is cheap, but in other parts of Nigeria, they turn to other things like tramadol and cannabis.

The resurgence of drug addiction among youths today is unarguably of grave concern, which perhaps is why there is also concern that sexual activity under the influence of specific drugs, including alcohol, to enhance and stimulate the experience is a significant public health concern in the control of new HIV cases.

Men have reported that drugs and alcohol in a sexual setting facilitate relaxation, raise self-confidence, and alleviate social unease and fears about body image, age, and HIV status.

The intersection of risky sexual behaviour and drug use is also an increasingly emerging phenomenon in Nigeria.

Dr Murphy Akpu, an advisor on science systems and services at UNAIDS in Nigeria, said the emergence of drug use, regardless of the street name of such a drug, has also increased vulnerability to HIV in Nigeria.

According to Dr Akpu, “That is the reason why, as young men, our fathers advised us not to drink and chase women on the same night. When you want to chase women, don›t drink that night. Just drink water. This is because if you lose inhibition, you cannot make good decisions. And that intersection of risky sexual behaviour and drug use is also an increasingly emerging phenomenon.

“In Nigeria, drug use is one of the underlying social decadences that we have going on right now—the emergence of drug use under all manner of street names. The South East has its version of it, called Nkpuru Mmiri. And the whole drug experience is often about taking drugs and then engaging in marathon sex, often with multiple partners.”

Dr Akpu spoke at the HIV media training by Journalists Against AIDS (JAAIDS) Nigeria and LivingHealth International with support from PEPFAR Nigeria through the Henry Jackson Foundation Medical Research International in Lagos.

Specifically, the onset of drug use is predominantly attributed to curiosity towards experimentation with methamphetamine, peer influence, the propensity to lose weight, and increasing courage to approach potential sexual partners. Moreover, they continued taking drugs as they enhanced their sexual performance, thus perpetuating “chemsex.”.

The rising popularity of «chemsex,» the practice of using specific drugs to enhance and prolong sex, has also been linked to other risk-related sexual behaviours, including transactional sex and group sex, thus making those who engage in drug use during sex at higher risk of contracting HIV, hepatitis B, and other sexually transmitted infections than the general population.

A growing body of knowledge on “chemsex” indicates that adolescents are more vulnerable to sexualized drug use due to curiosity towards experimentation, peer influence, and increasing courage to approach potential sexual partners.

The first published study to demonstrate a significant association between chemsex disclosure and new HIV diagnosis said that gay men and bisexual men were five times more likely to be newly diagnosed with HIV during a 13-month follow-up period, according to London data published in HIV Medicine.

Dr Yetunde Olaifa, the deputy director overseeing the Gender and Human Rights Division at the National Agency for the Control of AIDS (NACA), says that many illicit drugs, including social drugs like alcohol, affect the ability to make good judgements.

“Once you are well informed, you know that if you›re going to have sex with somebody else who is other than your regular partner, you would use a condom. The probability that you would do that when you are using psychoactive drugs is less,” she declared.

According to Dr Olaifa, drug use during sex is coming to the fore because more and more young people, particularly those who use illicit drugs, are also engaging in sexual activities that are very likely to be risky and could be contributing to the transmission of HIV.

Olayide Akanni of the (JAAIDS) Nigeria stated that a lot of young people in Nigeria now have limited knowledge about HIV, even though there is also a growing incidence of new infections among them.

According to her, “If we’re not able to nip it in the bud and also respond to young people in a way that they can relate to, we may have an emerging problem on our hands. From the discussions around Chemsex, we see that there is an intersection between drug use and this growing HIV prevalence.”

Furthermore, Dr. Gbenga Adebayo of the LivingHealth International stated that the average young person in Nigeria has never seen a person who developed AIDS, so there is a need to engage with them in a way that they can understand HIV.

Adebayo declared, “For them, it just looks like something that is far away that people used to talk about. We need to find a way to communicate the risks associated with HIV. And with the digitalization of the hookup culture, with the click of a button, our young people nowadays can engage in high-risk sexual behaviour.

“So we need to find ways to meet these people where they are and communicate with them. Speak in the language that they can understand, and then promote those practices that help to prevent HIV because there are still gaps in the response as far as young people are concerned.”

Unprotected sex is the principal driver of HIV transmission in Nigeria. But many people still have sex with men who don’t know their HIV status without protection. However, Dr Akpu said there was a need to ensure everybody knew their HIV status and could access treatment if found to be HIV positive.

“The treatment they are taking is both for themselves and the community. We have to create an environment conducive to accessing treatment, for them to stay on treatment, and to achieve viral load suppression,” he said.

He declared that although populations like men that have sex with men, sex workers, and drug users, because of their behavioural, lifestyle, and sexual orientation choices, are criminalised but they have a higher vulnerability to HIV, and this therefore calls for the need to pay more attention to the intersection of risky sexual behaviour and drug use.

According to Dr Akpu, “the interface between their risky sexual behaviour and drug use that increases their HIV vulnerability,  though it has been criminalized, is a concern. And we also need to pay attention to it. If we get it right, it means that everybody will have access to treatment and will become virally suppressed. So, everybody will live longer, healthier lives.”

Scholars, advocates, and people from the chemsex community acknowledge that “traditional harm reduction services are often not appropriate for the needs” of people who engage in drug use during sex.

While policies for chemsex remain scarce in the region, researchers have documented ways in which individuals and communities can limit the harms of engaging in drug use during sex.

The pre-exposure prophylaxis (PrEP) medicine that reduces a person’s chances of getting HIV from sex or injection drug use, when taken as prescribed, is highly effective in preventing HIV.

Key findings from the 2022 Global State of Harm Reduction (GSHR) report by Harm Reduction International include the rising use of drugs like methadone and buprenorphine to treat opioid addiction, as well as harm reduction interventions like safe injection sites, needle exchange programmes, and opioid agonist therapy (OAT). These trends are particularly evident in sub-Saharan Africa.

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