Living library project on AIDS Memorial Day where the ‘books’ were real people with stories of their own to share © 2008 Alliance Ukraine Participants in the Photovioce project, India © 2006 Jenny Mathews / Alliance / Photovoice

Kenya: access to needle exchange and methadone to prevent HIV


Aids Alliance
When the Community Action on Harm Reduction project began its work in 2011, there were no needle or syringe exchanges or methadone replacement services in Kenya. But this is changing.


“I started using drugs in 1989, when I was 17. Eventually, I got married and had three children. I worked as a matatu driver for 12 years while I was using heroin but when I lost my ID and driver’s license, I also lost my job and then my house.

“Drugs came inside me. I was an addict. Since then, I’ve been living in the streets with my family. I survive with money from small jobs and stealing. Before, I was sharing needles with five other people and became HIV-positive.

“Now they (CAHR) give us good services: We have clean needles, free counseling, condoms, medicine and food. We’re doing better.“

Abubakar, 42 (pictured above) from the Muthurwa area in Nairobi, is talking about the difference that Community Action for Harm Reduction (CAHR) makes to his life. CAHR is run by the Alliance Linking Organisation, Kenya AIDS NGOs Consortium (KANCO) and five implementing partners in Nairobi and the Coastal Region.  It is supported by the Alliance through a management team based at harm reduction specialist organization, Alliance Ukraine and in the international secretariat


In 2011, a study found that 19% of people who inject drugs in Nairobi were living with HIV. This is four times the amount of HIV in the general population. For those people who shared needles, the HIV rate was 30%. CAHR also found that nearly 50% of drug users had shared a syringe during their last injection. The data was compelling. In 2013, CAHR began running a needle and syringe programme.

“There was lots of opposition to needle and syringe exchange when we started,” says Caleb Angira, the executive director of Nairobi Outreach Services Trust (NOSET), an organisation helping to implement the programme. NOSET did a huge amount of advocacy to build awareness and make it acceptable to people in the community. “Ultimately, we sold it as an HIV intervention.”

It has worked well. As of May 2014, more than 2800 injecting drug users have joined the harm reduction programme. They receive harm reduction packs containing needles and syringes, alcohol swabs, cotton balls, tourniquets, stericups and water for injecting. The packs ensure that all injections are hygienic and safe.

Despite all this, challenges remain. There are an estimated 18,327 injecting drug users in Kenya, and only 15% are currently receiving services. There are not enough resources to meet everyone’s needs. The police harass drug users and outreach workers, and local communities are wary about the programme and show resistance.


Methadone works because it produces a similar, but milder, effect to heroin. It helps deal with withdrawal and its effects are longer lasting, allowing a methadone user to hold a job.

Before 2012, the Kenyan government’s popular approach to injecting drug use was to promote abstinence. But in 2013, CAHR collaborated with the University of Maryland, a partner of the U.S. Centers for Disease Control and Prevention, to lay the groundwork for the first methadone therapy programme in Kenya, which is expected to start in mid-2014. When that happens, methadone will be provided free in certain government clinics in Nairobi and the Coastal Region. In Nairobi, the implementing partner will be NOSET.


Community Action on Harm Reduction is an ambitious project that aims to expand harm reduction services to more than 180,000 injecting drug users, their partners and children in China, India, Indonesia, Kenya and Malaysia. It is funded by the Ministry of Foreign Affairs of the Government of the Netherlands (BUZA), led by the International HIV/AIDS Alliance and implemented in Kenya by the Kenya AIDS NGOs Consortium (KANCO) and its implementing partners.  The project is managed on behalf of the International HIV/AIDS Alliance by Alliance Ukraine.







Ministry of Foreign Affairs of the Netherlands (BUZA)