Hope for people who use drugs in Kenya

It was Saalim’s fortieth day as a city street thief, and he stole because he needed the cash to buy his daily dose of heroin. The day ended with a close brush with death.

Saalim Abdalla had resigned his fate to an angry mob. “I was beaten, rolled into a tyre and doused with petrol,” recalls the young man from the Kibera slums in Nairobi, Kenya. “The only thing that was missing was a matchbox. By the time the mob found it, police officers had arrived and so I was rescued from certain death.”

It was Saalim’s fortieth day as a city street thief, and he stole because he needed the cash to buy his daily dose of heroin. This was not Saalim’s first brush with death. In his days as a drug addict, he was stabbed by a furious Somali trader, and witnessed his friend being shot dead along Uhuru highway. Despite such risks, he remains hooked.

“I have been taking heroin for 17 years, and I started when I was 17 years old,” he says.

However, the incident with the mob was a game changer in his life. Having narrowly escaped death, a group of drug reform advocates found him at the police cells where he was locked up.

The group helped him participate in the medically assisted therapy (MAT) programme to reduce drug addiction. Under the MAT programme, the Kenyan Ministry of Health and civil society organisations have been reaching out to people like Saalim to help them reduce their drug use.

Reducing drug addiction and risks of HIV

About 60,000 people inject drugs in Kenya, with Mombasa and Nairobi accounting for 18,000 users, according to the Kenya national AIDS and STI control programme (NASCOP).

The common practice of sharing injecting drug equipment puts people at greater risk of HIV transmission, and in Kenya an estimated 18 per cent of people who inject drugs are living with HIV (AVERT). However NASCOP says 80 per cent of injecting drug users don’t know their HIV status.

According to Helga Musyoki of NASCOP, the MAT programme has so far reduced needle use among people who use drugs to about 17 per cent in Nairobi and Mombasa. This is due to the successful uptake of methadone, a substitution drug which reduces the craving for heroin.

Dr Mercy Karanja, a consultant psychiatrist at Mathari National Teaching and Referral Hospital, says: “There are 338 heroin users enrolled free of charge at the Mathari clinic. The programme is voluntary, but those under treatment must take methadone for at least two years for the brain to begin functioning normally.”

This is all part of a ‘harm reduction’ approach to drug use. John Kimani is the coordinator of the Kenya Network of People who Use Drugs and says: “Harm reduction may be the solution to drug use at last. People have realised that a humane approach is the right way.”

Sylvia Ayon, the Drug Harm Reduction Manager at the Kenya AIDS NGOs Consortium, says: “The idea is to reduce the harm caused by drugs without necessarily stopping drug use.”

The legal situation

But not everyone shares such a hopeful outlook for people who inject drugs, and reform of policies and laws that relate to drug use still need to take place. According to the 1994 Narcotic Drugs and Psychotropic Substances Control Act, Cap 245, heroin use is still illegal in Kenya.

Ayon explains that this puts drug harm reduction programmes at conflict with government law enforcement agencies, because drug users are still arrested and harassed. It is an issue that civil society groups hope Kenya will address at the forthcoming UN General Assembly Special Session on Drugs (UNGASS).

This will be a test, since the representing agency at the meeting, the National Campaign Against Drug Abuse, is yet to integrate harm reduction into its programming.

Practical challenges

Another challenge reform advocates say they face is threats from drug barons. Details shared by officials allege that the barons bribe police officers to arrest clients at the treatment centers and at the injecting dens where people undergoing treatment are recruited. Investigations indicate that the barons are positioning spies in the methadone programme, who pass on intelligence that help barons to pass negative messages to the public.

Dr Karanja says: “We have security-manned gates at the treatment centers because we expect the possibility of attacks influenced by the drug barons since they claim we are taking business away from them.”

The high cost of going through treatment is also stalling efforts at drug reform. Medicines do More is an NGO that campaigns against heroin use, and says that the cost of rehabilitating one person is 70,000 to 100,000 Kenyan Shillings (USD 680 – USD 970). Programmes subsidised by the government cost 30,000 Kenyan Shillings per person (USD 290).

For now, Saalim thinks that his struggle with drug addiction may be coming to an end. But for many others the struggle continues and their only hope may be a government that is prepared to increase harm reduction programmes and decriminalise drug use. Advocates of this approach will be watching carefully to see how Kenya contributes to the UNGASS meeting.

Read: HIV priority for Kenya at UN summit on drugs