Community and religious groups are failing to support needle exchange services for drug users in Kenya, despite government efforts to provide clean needles and reduce the spread of HIV.
According to the Kenya National AIDS and Sexually Transmitted Infection Control Program (NASCOP), there are nearly 50,000 injecting drug users in the capital Nairobi and the coastal region and 3.8 per cent of HIV infections are transmitted by the use of contaminated needles.
Globally, one out of every ten new HIV infections is caused by injecting drug use (World Health Organization), and it is critical that this issue gets addressed at the 20th International AIDS Conference in Melbourne, Australia (20-25 July).
Stigma over buying needles
“My attempts to buy needles from the local chemist shops have only earned me rebukes and scorn,” said Eve*, a 26 year old sex worker who also injects drugs. “There were even instances where the chemist attendant asked for a doctor’s prescription to sell me a needle. The process took so long, I gave up.”
Eve said that since she started injecting drugs over a decade ago, she has never used a clean needle. The mother-of-one has lived with HIV for the last five years and said needle exchange services are very important for sex workers.
“I suspect I contracted HIV from a contaminated needle which I got in exchange for sex,” she said. “The craving for drugs is so intense that I use the next available needle, regardless of the risks involved.”
Dr Hellen Barsulai, a Mombasa-based sexual and reproductive health researcher, describes discrimination against drug injecting users as punitive. “Denying users access to needles is a severe punishment because in desperation they will use risky methods anyway, to quench the craving,” she said.
Though drugs such as heroine and cocaine are criminalized in Kenya, health providers are urged to support needle exchange services as a means of preventing HIV transmission. “Pulling out of drugs is not a one day process and injecting drug users need support as they seek rehabilitation,” said Dr Barsulai.
But James Kimani, a coordinator with the Kenya Network of People Injecting Drugs, laments that members of the network are often refused treatment, even when their illness is unrelated to their drug use. He said: “Being a drug user is reason enough to be denied medical access in health facilities.”
Lack of community support
NASCOP’s Kenya National Guidelines for HIV prevention among drug users calls for communities to be involved in its harm reduction strategy by providing needle exchange services and raising awareness of them.
But many community and religious leaders strongly oppose such programmes, arguing that drug use is a major threat to development. “Anyone funding such a project is against Kenya’s development as it is encouraging the youth to continue abusing drugs, thus increasing crime in the country,” said a Christian leader, who asked to remain anonymous.
Injecting drug users and advocacy groups say that community resistance to progammes is hindering attempts to reduce the number of new HIV infections. They argue that there is dire need for intensified efforts to support such services if Kenya is to prevent new infections among injecting drug users in line with the Kenya 2009-14 strategic plan.
For the past two years in Kenya, the International HIV/AIDS Alliance and the Kenyan AIDS NGOs Consortium (KANCO) have been implementing the Community Action on Harm Reduction project (CAHR) which has recently introduced needle and syringe programmes to the country. Later this year, they will help introduce Kenya’s first methadone treatment pilot.
Dr Barsulai said: “Injecting drug users are people who have a right to health and should be treated with the same respect accorded to the general population. Drug addiction is a sickness rather than a crime, so any ill-treatment of drug users is a big stride backward. The needle exchange service is a very good move towards HIV prevention but communities need to be fully enlightened on its purpose.”
Advocates of harm reduction maintain that needle exchange services are among the most effective methods to prevent HIV among injecting drug users. The theme at the 20th International AIDS Conference is ‘picking up the pace’ – to do this all stakeholders must consider how to address the health and human rights issues for people who inject drugs. Otherwise the goal to achieve universal access to HIV treatment for all people remains futile.
*Not her real name