Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance
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Injecting drug use and HIV in Africa


Isaiah Wabwire, DARAT outreach worker, sits with injecting drugs users ‘Niko’ & ‘Omar’ © Nell Freeman for the Alliance

Niko is 29 and an injecting drug user. His friend, Ali Omar, sits in the corner and ties a bandana around his arm. Adjusting the curtain which prevents anyone peering in through the crack in his bedroom door, Niko sits down on the floor and prepares the heroin he will inject into his ankle.

Spending around 100 shillings (£1) each for a fix, they are just two of what activists say are hundreds of injecting drug users in Mombasa.

Numbers difficult to estimate

The Kenya National AIDS Strategic Plan 2009 notes: “Although the number of injecting drug users in the population is relatively low, this is a group with a high potential to transmit disease.”

What isn’t clear though is how many injecting drug users there are in Kenya. As one of the most at risk populations injecting drug users have been targeted in the national AIDS plan. Very little is known about the numbers and distribution of people who inject drugs although it considers that drug use is increasing.

According to official figures, injecting drug users contributed 3.8% of new adult HIV infections in Kenya in 2008 but the plan points out that there are many reasons why this may be an underestimate.

Take the service to the shooting galleries

Since January this year, KANCO (Kenya AIDS NGO Consortium) has been working with Darat – a drug abuse, rehabilitation, treatment and HIV/AIDS project. Darat does outreach work in shooting galleries across Mombasa.

Former drug users talk to current users about HIV counselling and testing as well as prevention. They run advocacy meetings for drug users who want to reduce their dosage or stop using and talk to others about the dangers of drug use, including in schools.

According to Isaiah Wabwire, outreach worker at Darat, drug use was already known to be one of the causes of HIV in Kenya in 2004. Injecting drug use, he says, is both illegal and highly stigmatised. “Injecting drug users are seen as unproductive, they are outcasts. We think injecting drug use is a disease but few people think that…”

Pushed underground and at risk of HIV

The illegality of drug use means that few people are willing to seek services that might help them. Formal health settings may not be able to provide non-stigmatising services and as a result drug users avoid them, putting themselves and their partners at risk.

George Kissinger, the district AIDS and STD’s coordinator for Kilindi district, in Mombasa works with KANCO on a range of outreach projects. He says that most people don’t voluntarily tell medical staff they are injecting drug users. “We are finding more injecting drug users. Some people are spotted for instance when they go for malaria treatment. Many just deny it but you can see the physical signs.”

Wabwire says that the numbers of HIV positive injecting drug users accessing care services is not large. “Most of them have not been tested. A small number of positive people have accepted their status although it is very stigmatised.”

Harm reduction will help

According to KANCO what injecting drug users need – and what will reduce the HIV risk to them and their sexual partners – is information and education on harm reduction and HIV prevention. This, alongside community based outreach, care and support, access to condoms and needle and syringe exchange programmes, can reduce the risk of HIV infection.

Needle sharing is an obvious cause of the HIV increase. Wabwire estimates that 80% of people share needles either because they cannot get hold of new needles or because their immediate need for heroin is too great. “When you are addicted, withdrawal is physically painful. When you are in that state, you can’t think of HIV, you only have a desire to stop the symptoms.” Some people even pick up needles from the rubbish dump where hospital waste is discarded.

The need to change is recognised

According to Dr Sobbie Mulindi, Deputy Director, coordinator and support, Office of the President, National AIDS Control Council, there is a desperate need for change in addressing the needs of IDus which is recognised by the government.

“There is a big challenge. We want to change the guidelines, particularly on needle exchange and especially at the coast, but there are delays in the legal processes and policies. We have to do a lot in a short time,” he says.

Isaiah Wabwire, DARAT outreach worker, sits with injecting drugs users ‘Niko’ & ‘Omar’ © Nell Freeman for the Alliance

    80% of people share needles either because they cannot get hold of new needles or because their immediate need for heroin is too great