In Kenya, people who inject drugs have a constant daily battle with poverty and addiction. From waking to sleeping, they need to get money to live. This battle takes time. Their HIV care has to come second to the immediate need to survive. People who inject drugs say that lack of time is the main reason they do not access HIV care. This is an early finding from research by the Kenyan AIDS NGOs Consortium (KANCO) (our linking organisation in Kenya) and the London School of Hygiene and Tropical Medicine (LSHTM).
Understanding and responding to the needs of these people in Kenya - and elsewhere - is complex. We need to look at the range of things that affect their lives: big issues like national economics and society at large and also their immediate environment, and their community. At the Alliance, we know that community-level interventions with drug users can really help with their immediate health and social problems. Needle and syringe programmes are vital, and KANCO is already leading this approach in Kenya, as described in this case study. Another major support is methadone. Fortunately, soon the Kenyan government will be introducing a methadone programme in partnership with KANCO and other community-based organisations.
The impact of methadone based harm-reduction
What is methadone treatment and why is it good? Methadone – or methadone maintenance treatment – is an approach to treating addiction to heroin; it can allow people to reduce and stop their use of heroin. And methadone has a big impact, especially on HIV. We know from experience across America, Asia and Europe that it reduces the risk of getting HIV for people who inject drugs.
But we do not know exactly how to make it work best in Africa, with the current HIV epidemic. We are asking ourselves, what can be done with the resources available and within existing health and social care systems? Is integrated methadone and HIV care possible? And how? Community-based organisations that work with the Alliance and KANCO in Kenya are vital to these care systems, but how can they best support such a programme?
People who are using drugs in Kenya have invested hope in methadone. In our current research project, people tell us how methadone is a route to a life without addiction. For them, there are virtually no other options for treating drug addiction. Can this hope for methadone be met?
These questions are crucial to understand. If methadone lives up to its promise it has the potential to be a catalyst for HIV prevention and treatment for people who inject drugs in Kenya and the region. It could bring stability and support and allow people to regularly receive care and support in a way that suits them.
There are many more battles to fight to overcome the poverty and injustice that is linked with HIV. But introducing methadone could be a massive step forward.
KANCO and two community-based organisations – The Omari Project (TOP) and Nairobi Outreach Services Trust (NOSET) – are going to be at the centre of delivering methadone in Kenya, when it is introduced later this year. The organisations are also involved in the research effort to make sure the programme works.
LSHTM and the Alliance are working with KANCO to research the best way to introduce methadone. In Kenya, KANCO will be working with the University of Nairobi (UoN), the National AIDS Control Council (NACC) and the National AIDS and Sexually Transmitted Infections Control Programme (NASCOP). From further afield the University of California San Diego (UCSD) are contributing their expertise.
This global collaboration will mean the best possible outcome. There will be enormous expertise and experience to shape the research to make the programme as effective as possible. With this many organisations and people involved, there is a greater chance that programmes and policy will be able to incorporate the research findings.
And this is just the start. The Centre for AIDS Research at the University of California is funding this initial research but we hope it will be a stepping-stone to bigger projects. It will allow us to find out more about how methadone can make a real difference to people’s lives and to the HIV epidemic in Africa.
Andy and James were supported in this research by Sylvia Ayon, CAHR Programme Manager (KANCO) and Tim Rhodes (LSHTM). The same team will be leading work with the University of Nairobi and University of California San Diego to study methadone.
Is integrated methadone and HIV care possible? And how?