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Jason Kane Jason Kane. Victoria Fleischer Victoria Fleischer. Malindi, Kenya: A vacation destination with something for everyone. Sitting on the crystal coast of east Africa, the resort town offers glass-bottomed boat cruises, authentic Italian pasta, sex-for-hire and dirt-cheap heroin. But during the low season — the four months of the year when rain is more frequent and the hotels empty out — things turn darker here. When times are good, the business gives him enough cash to shoot heroin five or six times per day. The effect: Unintentional detoxification. Buska Ismail fights the pain as a clinical officer applies antiseptic to a severe wound on his back. Sometimes, Buska can only afford to shoot once per day, triggering withdrawal symptoms like abdominal pain, nausea and dizziness. The combined effect caused him to fall hard on the pavement recently, ripping the top two layers of skin off most of his back. Buska is 32 years old — about the same age as the booming hard drug business in Malindi. But they soon realized that hooking the locals would be much more profitable in the long-run. Shee Omar shoots up while Ahmed Mohamed smokes a joint filled with heroin and marijuana in a back alley of Malindi. The shift marked a turning point for the HIV epidemic in Malindi. Shee Omar readies himself for injection as his friend, Ahmed Mohamed, prepares the dose of heroin. So this is better. In the back alley of a neighborhood called Sea Breeze — with the Islamic call to prayer echoing over the tin-roof houses — Omar sat on a heap of dried coral and listened to his friend, Ahmed Mohamed, explain the best way to shoot. Sharing used needles — and the blood that comes with it — is one of the fastest ways to spread HIV. The Kenyan government estimates that along the coast, people who inject drugs account for 17 percent of new infections. And while the HIV prevalence rate in the general population stands at 5. Public health officials warn that ignoring such startling figures will come at a price. After shooting up, many of these drug users return home for unprotected sex with their spouses — or they sell sex for drug money. The higher HIV rates then spill into the general population. Ahmed knows the cycle all too well. But one thing he does without fail these days is use clean needles for every new injection. The recently opened Watamu Drop-In Center helps addicts in Watamu and Malindi with basic health care, as well as services to make their drug habits safer. Before it opened, most of the 1, people who come here had nowhere to go for even basic medical care. And these people are very impatient. Here, addicts receive fast and friendly treatment for just about any illness, as well as counseling for their addiction and evidence-based education on how to make their drug use safer. Hajji Fadhil Mohammed, right, listens to Ludovick Tengia, describe the steps of safe injection. Though he rarely shares his own history with clients, Tengia speaks to them from a place of experience. He spent more than a decade shooting and smoking heroin. His family watched as his circle of friends dwindled — many to drug overdoses, some to HIV. They were convinced he would follow them to the grave. In , he made his way to a rehabilitation center in Malindi. But when administrators there met him at the gate, they discovered he was carrying some leftover drugs and they refused to let him in. So Tengia waited outside the facility long enough to convince them that he was serious — that they should change their minds. Three days later, they finally did. As a former addict himself, Ludovick Tengia, the addictions counselor at Watamu Drop-In Center, tries to mitigate some of the harm the drug users cause themselves. But the No. No excuses. Photo by Mia Collis. Before they leave, drug users like Mohammed pick up free needles and syringes directly from the Watamu Drop-In Center. The theory goes that drug users will find a way to shoot regardless, so they should at least do it safely and without spreading HIV in the process — either to each other or to their sexual partners. But many conservatives cringe at the idea of handing drug users a tool for getting high. The U. President George W. Children deserve a clear, unmixed message that there are right choices in life and wrong choices in life, that we are responsible for our actions, and that using drugs will destroy your life. Similarly, when the government of Kenya launched a series of pilot needle and syringe programs along its coast in , Muslim clerics demanded they end immediately. This goes against the Islamic teachings. It is forbidden. So nine years ago, Issa checked himself into a rehabilitation program, where he quit cold-turkey. Because if they do that, they will just use more. Recently, one of his friends stepped on one while walking through town and was rushed to the hospital for tests and treatment. Shosi Mohamed, the Omari Project drug rehabilitation and outreach program coordinator, was among leaders responsible for bringing the needle and syringe programs to the coast. Elsewhere in the world — in cities from Amsterdam to New York — long-term studies show that implementation of needle and syringe programming has led to dramatically lower HIV rates without any uptick in drug use. Do they really need to keep on injecting? Are they injecting properly? It makes people think more about their best options. And the best options for most people is not sharing needles, or stopping injection altogether. Take, for example, Hassan Abdul, who knows about the Omari Project through its needle and syringe services. When he missed a vein the other day and shot heroin directly into the tissue of his hand, he knew to come here for emergency treatment. Roughly 40 percent of injection drug users in Malindi have developed wounds from poor injection practices. One of them is Mbarak Salim. Before the Omari Project launched the needle and syringe program in , year-old Mbarak Salim used the same dirty needles so often they became dull. A bloody wound opened at his regular injection site, eventually spreading and becoming infected. He uses clean needles now, which reduces the risk that the abscess will grow. Omari Project paralegal Monica Wanja also meets with clients like Salim when they stop in for treatment. She tells them about their civil rights and advises that they can find legal support at the center should they get into trouble. She tells them that she was once so overcome by addiction that she resorted to injecting in her breasts and genitals because the veins everywhere else were too damaged. When she gave birth to a daughter, she breastfed with one-hand and injected with the other. She rummaged through hospital trash cans for used needles. She had sex with Italian tourists at night for drug money. And eventually, she contracted HIV. Monica Wanja, a recovering addict and a paralegal at the Omari Project, wipes away tears while describing her former life of drug abuse. When I am gone, you will have no one. It is you now that has to make the decision. The Omari Project Drug Rehabilitation Center sits several miles outside of the town of Malindi, far removed from many of the temptations the recovering addicts face in normal life. The gate is always open at the Omari Project Drug Rehabilitation Center, several miles outside of town. Those who check themselves in can leave at any time. But most find this a peaceful spot to heal — or at least try. They cook meals together and garden between counseling sessions and meditation. They care for baby goats and chickens. Fatima Lali Athman was once employed by the Omari Project as an outreach worker. She is now, once again, a patient. Fatima Lali Athman knows this piece of land well. She checked in here for treatment in , sobered up and became such a success story for the Omari Project that the rehabilitation center hired her as staff. But her husband — a recovering drug user himself — started into heroin again shortly after Fatima returned home. She tried to resist the urge but said the easy access and constant temptation became too much. When she started smoking again, she quickly lost control. Athman checked herself back in as a patient several months ago — a deep embarrassment for her and testament to the fragility of the recovery process. I stopped caring about everything. Traditional Swahili dhows sail in the Indian Ocean off the coast of Malindi. Drug use continues to thrive here. But disease rates seem to have leveled off, health officials say. And that in itself, most agree, is a reason to keep hoping for more. This photo essay was produced with the support of the International Center for Journalists. Support Provided By: Learn more. Monday, Oct The Latest. World Agents for Change. Health Long-Term Care. For Teachers Newshour Classroom. NewsHour Shop. About Feedback Funders Support Jobs. Close Menu. Yes Not now. By — Jason Kane Jason Kane. By — Victoria Fleischer Victoria Fleischer. Leave your feedback. Share on Facebook Share on Twitter. By — Victoria Fleischer Victoria Fleischer vlfleischer. Enter your email address Subscribe.

Counselling Kenyan heroin users: cross‐cultural motivation?

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Metrics details. There is paucity of data and information on injecting drug use in sub-Saharan Africa and there is sufficient evidence of existence of the environment for development and growth of injecting drug use. The seeds were drawn randomly from the population and interviewed to pick the one with the largest network and other unique characteristics. A maximum of twelve seeds were recruited. Three NGOs located in the coast region and one in Nairobi region were identified to assist in identifying drug injection locations and potential participants. A total of individuals in Nairobi and at the coast were recruited for the study between January and March Other non-injecting methods such as smoking or combining these two drugs with other drugs such as cannabis or Rohypnol were also common. Most PWIDs used other substances cigarettes, alcohol, and cannabis before initiating injecting drug use. While all PWIDs continue to be at risk in the two regions, those from the Western parts of Nairobi, Kenya were at a relatively higher risk given their increased propensity for sharing injecting equipment and solutions. Compared to the national HIV prevalence of 4. Peer Review reports. Substance use is increasingly becoming prevalent on the African continent, fueling the spread of HIV infection. Both injection and non-injection substance use constitute the global burden of substance use with Africa having an estimated 28 million substance users \[ 1 \]. The increasing availability of illicit drugs such as heroin, cocaine and methamphetamine especially in urban areas compound the burden of drug abuse in Africa \[ 2 , 3 \]. Kenya, like other countries in Africa, experiences a high burden of drug use with about Globally, about 13 million people inject drugs and about 1. Although benzodiazepines, amphetamine-like substances and opiates are the main classes of injecting drugs, opiates in particular heroin is the most used worldwide by injecting drug users and indeed World Health Organization WHO regards drug dependence treatment, particularly opioid dependence treatment, as integral to the scale-up of HIV prevention, treatment, care and support. Cocaine was sixth at 2. With regard to method of drug use, the injecting method was among the popular methods used by a considerable number of drug users. According to Report of the International Narcotics Control Board \[ 7 \] and the UNODC World drug report \[ 8 \] injecting drug use is likely to increase or emerge in countries where it is not already established. There is cause for concern for regions which lack without adequate resources to deal with the problem. Little is known about injecting drug use in sub-Saharan Africa, but a constellation of risk factors exist for the development of injecting drug use, as has occurred in other regions such as central Asia \[ 9 \]. First, injecting drug use is already well-established in a number of countries Mauritius, Nigeria, South Africa, and Tanzania. Secondly, people are experiencing harsh socio-economic conditions and most are exposed to conflict situations and thirdly, the region is increasingly being used for transit of illicit drugs into Europe, all of which are likely to boost the number of injecting drug users. Given that the sub-Saharan Africa is a region with particularly high HIV-1 prevalence and a range of social and biological risk factors, \[ 10 \] the potential emergence of injecting drug use as an additional route of HIV transmission warrants close and serious attention.. Indeed, risky behavior such as sharing of needles among PWIDs even among those who know that they are positive has been reported in many areas. The most recent UNODC \[ 1 \] report, revealed that though regional HIV prevalence rates are high among injecting drugs users in all parts of the world, up to Nevertheless, few countries have produced estimates in different time periods to allow for trends to be observed. Injecting drug use has been documented in Kenya for more than two decades, with evidence showing that the vice contributes significantly to new HIV infections \[ 12 \]. Initial surveys showed increasing evidence of narcotics use in Mombasa and Nairobi with the practice of poly drug use being more common. Crosby et al. The drugs that were injected by this cohort were heroin, cocaine, valium and pethidine. In the same year, 25, people died from AIDS-related illnesses. This implies that the HIV prevalence ranges widely from one region to another. For instance Wajir had a prevalence of 0. The core public health message that AIDS is transmissible both through sex and through needle reuse has been taught consistently in developed nations because injection drug use PWID is common. However, many AIDS prevention programs in Africa have turned a blind eye on the risk of injection in HIV transmission in their communications with the public, perceiving the practice of injecting drugs as rare. Introducing this information and supporting efficacious infection control in primary health care is vital to protecting patients from HIV as well as other blood borne agents. Given that sharing or use of contaminated syringes and needles is a very efficient means of transmitting HIV, its spread among injecting drug users can be very rapid and even to the general population through sexual contact with people who are not drug users. Therefore, there is need to conduct a sound scientific contextualised study to obtain reliable data and statistics on the existence of high risk groups such as PWIDs, to understand and document the behaviours and activities that put them at risk of HIV infection and to develop effective prevention strategies and interventions that would address the findings. Accessing hard-to-reach populations for HIV prevention and research activities has historically been challenging owing to the stigmatization and criminalization of injection drug users, yet these high-risk populations are fundamental in the fight against the spread of HIV. This study therefore adopted the novel Respondent Driven Sampling RDS methodology to access hard-to-reach populations through their social networks for purposes of research whose findings can then inform policy \[ 16 \]. The choice of the study sites or study locations is critical to successful recruitment and turn-a-round of respondents into the study. Nairobi is the capital city and is inhabited by Kenyans from all parts of the country while the coastal region comprises of three main cities: Mombasa which happens to be the second largest city after Nairobi, Kilifi and Malindi towns are largely inhabited by the coastal Mijikenda, Swahili people and some few European people who either work or live there. The coastal region is renowned as a popular international tourist destination and has a resident Italian community in Malindi. These sites were selected on the basis of existing evidence from previous studies indicating the problem of drug use and especially injecting drug use was rampant in these locations. Respondent-driven sampling RDS , a new form of chain-referral network or snow-ball sampling designed to overcome many of the problems generally attributed to chain-referral sampling such as the choice of initial participants, volunteerism, and masking \[ 17 \]. These methods are predicated on the recognition that peers are better able than field workers to reach other members of the hidden population. To conduct a respondent-driven sample, one begins by selecting a set of initial seeds that are chosen based on pre-existing contact with the study population. These seeds are paid to be interviewed and from wave 0 of the sample. Interviews for the recruited injection drug users were conducted in various previously identified and selected research offices in Nairobi and coastal regions. The research office needed to be in a place which was considered safe and accessible to the target population such as existing drop-in-centres, store front or a well-known meeting centre \[ 18 \]. No matter how the interview was conducted, each seed from wave 0 was supplied with unique recruitment coupons. Subjects were told to give these coupons to other people they knew in the target population. Because each coupon was unique, it can be used to trace the recruitment patterns in the population. When a new member of the target population participates in the study, the recruiter of that person is paid an additional bonus. Thus, subjects are paid to participate and to recruit others. Hidden populations are often subject to social stigma, criminal prosecution and fear, as a result respondents tend to be hesitant to give information about their colleagues in the population. This phenomenon is referred to as masking \[ 19 \] and can cause respondents to provide inaccurate information leading to biases in the sample selection process. Normal random sampling procedures are hampered by inherent difficulties in locating respondents for interview. Respondent-driven sampling solves these problems by allowing the subjects to do the recruitment themselves. Participants did not have to divulge any sensitive information on the respondent and the researcher did not have to look for the recruitee. Concerns about introduction of unknown bias into the sampling process due to lack of randomisation resulting from subject based recruitment exists but evidence indicates that respondents recruited randomly from their friends \[ 18 \]. Critical to the process is the documentation of coupons to record the recruitment patterns linking each respondent to the person who recruited them. There are two additional important steps in the sample selection process: non-duplication and population membership verification. The process must ensure respondents do not participate in the study multiple times in order to earn additional money \[ 20 \]. This duplication can affect the quality of the data and thus accuracy of the estimates. To ensure quality of the sample data is also critical to verify that sample members are indeed members of the target population. This is done by ensuring that respondents are only counted once and not numerous times \[ 21 \]. The RDS design is relatively simple and robust and has been used successfully in a number of studies. Reviewers have stated that it is cheaper, quicker, and easier to implement compared to other methods that have been used for sampling hidden populations in evaluations of HIV risk-reduction interventions \[ 22 \]. The RDS method is most suitable when members of the target population know one another and are densely interconnected chain referral sampling as is the case with PWIDs. A maximum of twelve seeds were recruited for each of the regions. For this study the quota was set at three and the numbers of waves were also limited to three \[ 19 , 20 , 21 , 22 , 23 \]. The quota is the number of persons coupons any one participant can recruit see Fig. These numbers were based on the calculated sample size, projections on potential participants based on the RDS methodology. The purpose of imposing the quota system on recruitment was to reduce respondent duplication and impersonation so as to discourage recruiters from monopolizing recruitment rights. The quota was set at three recruits after the initial interview and each follow-up interview. The quota system was implemented using a coupon system, in which potential recruiters were each given three identification card sized coupons to give to recruits see Fig. The coupon contained the name of the study, phone number of the researcher for purpose of enquiries , a serial number that documented the link between the recruiter whom it was given and the recruitee who returns it to the research office as shown on Fig. These four sites were located within a diameter km. To ensure faster turnaround time and that respondents were resident within the locality of the site, the seeds and their subsequent recruits were required to be from within their local networks only and given a period of 3 days within which to have distributed and had their recruitment coupons returned. Most respondents were also identifiable by the local community workers who were also working as research assistants in the study. The duration from entry into the survey office and undergoing all procedures to exit ranged from 50 to 75 min. Apart from the initial waiting time in the survey site, each respondent underwent a screening interview lasting about 5 min, modified WHO Drug Injecting Study II. However, drug users who were ill, experiencing severe withdrawal symptoms or were high on drugs were excluded from the study. The implementation of the study commenced with visits to Nairobi Outreach Services Trust NOSET , an NGO that provides outpatient drug treatment services for high-risk injecting and other drug users in Nairobi, to discuss and make collaborative arrangement on implementation of the study. The NOSET representatives were requested to identify appropriate individuals who could be involved in the study as interviewers, coordinators and HIV testing personnel. Several interviews of staff and other individuals were conducted at each centre and seven individuals selected - comprising of five interview staff, two VCT counselors and one coordinator. A 2 day training workshop was conducted in Mombasa and another one in Nairobi for the respective research teams. Sample size for this study was calculated based on the Fisher et al. The questionnaires were pretested to identify any potential problems in both administration of interviews and logistics and the data collection tools revised appropriately. Data was acquired through a multi-stage approach. The first stage involved the acquisition of information on the magnitude and prevalence of PWIDs, existing policies, the status of service delivery, barriers and opportunities, and gaps in accessing services. The data was collected using a checklist. The purpose of the assessment visits was to determine incidences of drug use and identify presence of injectable drugs and users. Three NGOs in the Coastal region and one in Nairobi region were selected to assist in identifying drug injection locations and potential participants. Focus group discussion and Key informant interviews were conducted with this group using —KII guide. The third stage involved the collection of primary data using a modified version of the WHO drug injecting questionnaire. The modifications to the questionnaire were guided by the analyses of information obtained in the first and second stages. The questionnaire was administered to each respondent by research assistants after which the respondent undertook HIV testing using the serial algorithm for rapid HIV testing according to the National guidelines for HIV testing and Counseling \[ 28 \]. Data entry was conducted using MS Access database where it was cleaned, verified and double checked to ensure data quality. The RDSAT software was used to perform Key of Group and Trait Correspondence, recruitments, transition probabilities, demographically-adjusted Recruitment Matrix, and various options of population estimates \[ 16 \]. RDSAT software was used to calculate PWID size estimates and to obtain individual data weights which were used to obtain adjusted estimates in subsequent analysis. Association between risky sexual behavior, drug use and HIV status were also performed. Statistical significance was assessed at the conventional probability value of 0. A total of ten seeds were recruited in the Coastal region comprising of two women and eight men, while 8 seeds were recruited in Nairobi comprising of two women and six men. The minimum network size was 1, the maximum was 60 and the average was 6. Each seed resulted in at least 2 waves of recruitment and Homophily in key variables was 0. The Net Draws diagrams below Fig. Net Draw Diagram Nairobi and Coast regions. NB: The red large round circles or squares indicate the SEEDs while the small round circles represent males and the small squares represent females. The red colour indicates those who subsequently tested HIV positive and the blue colour are respondents who tested HIV- negative. Of the participants recruited in the study, Considering the two regions, a total of A majority , Of the female population, 33 Overall adjusted mean and median ages for the whole study population were The mean age among coastal men was The mean and median ages for women were The mean and median age for men in Nairobi region was Figure 3 below shows skills level per study region. On average, most Up to Generally, Only 0. A large proportion of respondents in Nairobi Heroine and cocaine were also used through other non-injecting methods such as smoking or in combination with other drugs such as Cannabis or Rohypnol. Majority of the respondents reported using other substances like cigarettes, alcohol and cannabis before initiating injecting drug use. The mean and median age for commencement of initiation for women was Men initiate injecting at a much later mean and median age of About two thirds All women respondents in the coast region reported getting their first injection administered by a man. However in Nairobi at least 4. Figure 5 shows the relationship to person who administered the injection during initiation. A primary sex partner injected 4. Overall, Women and men differed on the third reason as men thought it was safe to share since they were cleaning the needles and syringes while women cited pressure from other drug users as their reason for sharing the needles and syringes. Majority used water Respondents cited the procedure and steps employed in the use of bleach which they consider to be unfriendly as the reason for not using it. None of the PWIDs got drugs as a result of trading for sex. The reasons for initiating injecting drug use varied between the two studied regions. In Nairobi, majority In the Coast region, The proportion that initiated injection drug use because of curiosity and depression were much higher in Coast than in Nairobi. At initiation, majority thought that they would inject once or twice and then stop, but they continued to inject more regularly as they got addicted to the drugs. Majority have been active injectors in the last 6 months with a few having injection free months. HIV testing for each of the study sites is reflected on Table 5. Response was highest in Nairobi compared to Coast where some respondents refused to test or were missing test results for some other reason such as they were incapable of giving consent for testing, or there was a mismatch between the questionnaire and the blood sample, or there was a technical problem in taking the blood sample. In Nairobi respondents were interviewed, were tested, tested HIV negative and 69 tested positive. Out of respondents recruited at the Coast were tested out of which tested negative and 54 tested positive. Despite being fewer in number, women exhibited heightened HIV prevalence of A very small proportion of the study population of This age group also exhibited the highest prevalence of HIV across the two regions. The effect that heroin has on the brain chemistry makes it very easy for users to become addicted and very difficult to return to sobriety thus explaining the ever increasing numbers of heroin users. Studies elsewhere have shown that heroin can increase the chance of transition into premature or early regular injection \[ 30 \], and that the risk of transition to injection among heroin users was higher compared to users of other types of drugs \[ 31 , 32 \]. It has been suggested that heroin, specially injecting type, has a higher degree of dependency compared to other drugs \[ 33 \]. In addition, heroin is one of the more inexpensive drugs making it easily accessible to a variety of demographics \[ 31 \]. As such, injecting drug users in Kenya continue to be at high risk like is the case in other parts of the world. A number of socio-demographic factors influence substance abuse and risk of HIV infection among substance users on the African continent \[ 34 \]. The youngest age at initiation was 17 years while the oldest was 55 years age, with the median age at initiation being about 31 years. Studies show that socio-demographic factors such as age, gender, income levels, marital status and even level of education are primary determinants of the health status of drug users \[ 35 \]. These factors indirectly influence individual drug-use behavior including sharing of needles and soliciting for sex in exchange for drugs or police protection \[ 36 , 37 \]. In the current study for instance, majority of those who initiated injecting drug use at a relatively younger age 11—24 years had the highest prevalence of HIV in both Nairobi and the coast regions. These current findings are consistent with a study by Baluku et al. These findings however, contrasts with other studies which have reported older ages of first injection drug use for up to Nevertheless, intervention services in Kenya including prevention of transitioning should target young people with information on relative demerits of commencing drug use and the dangers of peer pressure when associating with drug users. The current study also established that women are at an increased risk of acquiring HIV compared to their male counterparts and the mean age for initiation of drug injection for women was slightly lower than that of men. Qualitative findings indicated that women were likely to be influenced easily into injecting by their male peers and clients especially if they engaged in sex work. This suggests, in part, that adolescent girls and young women who inject drugs in the study area are likely to transition earlier than their male counterparts. Studies elsewhere have also established that transitioning, like other injecting drug practices have significant gender differences \[ 40 , 41 , 42 \]. Studies show that low education among injection drug users is an indicator of a likelihood of needle sharing and non-participation in HIV interventions \[ 43 , 44 , 45 \]. Consistent with the current study, other studies show evidence that drug-related activity globally has been associated with age, low level of education, familial dysfunction, unemployment, poverty, drug-related violence and gang activity \[ 46 , 47 \]. While different methods of using drugs are associated with social and health harms, injecting - whether intravenous, subcutaneous, or intramuscular, carries the highest risk for multiple types of infections, overdoses, and their complications \[ 48 , 49 \]. Studies indicate that majority of drug users transit from use of non-injection drugs to injection substances or simultaneously use of both substances \[ 50 , 51 , 52 \]. Furthermore, substance consumption differentially predicts HIV infection. For example, previous studies in Texas, USA and China showed that injection substance users have an increased risk of HIV infection in comparison to non-injecting drug users \[ 53 , 54 \]. In the current study, several reasons were put forth for initiating injecting practice among them to achieve a better high, peer pressure from friends and companions, and curiosity among others. Among the motivators for first injection this study, like others elsewhere, underscores the importance of peer influence cited by a majority of the participants. Studies suggested that people who already inject may encourage injection initiation, enthusing about the benefits of drug injection linked to pleasure or cost-efficiency \[ 39 , 55 , 56 \]. Encouragement by people who already inject could extend to peer pressure \[ 57 , 58 \], and more direct coercion \[ 59 , 60 \]. Other studies have also established that peers and social networks make transitioning acceptable and appealing \[ 61 , 62 \]. As such, the relevant authorities need to consider interventions that target social networks for prevention of transitioning. Effective peer-education interventions and those targeting social networks as part of harm reduction have been implemented elsewhere requiring little support \[ 63 , 64 , 65 \]. In Addition, most PWIDs admitted that they still continued to initiate others into drug injection practice with increasingly regular frequency, with most of the equipment used in the injection process being sourced from friends. Studies elsewhere have established that PWIDs who had shared their injection equipment at the first injection were more likely to repeat this practice over the course of their injecting career than those who had injected with new syringes This emphasises the need for harm reduction interventions through the Needles Syringe Program NSP involving the provision of free syringes, needles and related injecting equipment \[ 68 \]. This burden has been partly attributed to recreation drug use which increases the risk of HIV infection and poor adherence to ARVs \[ 69 , 70 \]. The risk of acquiring HIV for people who inject drugs in was 22 times higher than that for people who did not inject drugs \[ 71 \]. In Kenya, 1. Of additional concern is the potential bridging effect, whereby an epidemic, initially fueled by the sharing of contaminated injecting equipment, is spread through sexual transmission from PWIDs to non-injecting populations and through perinatal transmission to newborns. This vulnerability underscores the need for responsive programming to better meet the specific and comprehensive needs of both male and female PWIDs. Therefore, the most effective way to reduce the risk of contracting HIV among PWIDs who share injecting equipment is to provide free injecting equipment through the needles syringe program NSP as well as free condoms and lubricants. Additionally treating drug dependence as a prevention strategy can be adopted through provision of Methadone Assisted Therapy MAT or OST which involves ingestion of Methadone as a substitute to heroine but does not have similar addiction properties. This study therefore advocates that curbing the high HIV infection among people who inject drugs, it is necessary to implement programs in behavioral change, harm reduction through NSP and medication-assisted treatment MAT , including opioid treatment programs OTPs , which combines behavioral therapy and medications to treat substance use disorders. World drug report Google Scholar. Drug Alcohol Depend. Article Google Scholar. The temporal relationship between drug supply indicators: an audit of international government surveillance systems. Br Med J. Rapid situation assessment of the status of drug and substance abuse National Commission against Drug Abuse, Kenya. World drug report. United Nations Office on Drugs and Crime. Ndetei D. International Narcotics Control Board. Report of the International Narcotics Control Board for Epidemics of HIV and sexually transmitted infections in Central Asia: trends, drivers and priorities for control. Int J Drug Pol. Nairobi; Global AIDS report Changes in HIV prevention programme outcomes among key populations in Kenya: data from periodic surveys, 1—16; Ithaca: Cornell University; Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Erickson BH. Some problems of inference from chain data. Sociol Methodol. Biernacki P, Waldorf D. Snowball sampling: problems and techniques of chain referral sampling. Sociol Methods Res. Sampling and estimation in hidden populations using respondent-driven sampling. Street and network sampling in evaluation studies of HIV risk-reduction interventions. AIDS Rev. Goodman L. Snowball sampling. Ann Math Stat. Handbook for family planning operations research. Population Council. Marshall MN. The key informant techniques. Fam Pract. Breen RL. A practical guide to focus-group research. J Geogr High Educ. Transition from first drug use to regular injection among people who inject drugs in Iran. Addict Health. Patterns of drug use and abuse among aging adults with and without HIV: a latent class analysis of a US veteran cohort. Does type of drug lead to quicker onset of injection? From initiating injecting drug use to regular injecting: retrospective survival analysis of injecting progression within a sample of people who inject drugs regularly. Article PubMed Google Scholar. Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users. BMC Public Health. HIV risk behaviors, perceived severity of drug use problems, and prior treatment experience in a sample of young heroin injectors in Dar es salaam, Tanzania. African J Drug Alcohol Stud. Police sexual coercion and its association with risky sex work and substance use behaviours among female sex workers in St Petersburg and Orenburg, Russia. Int J Drug Policy. HIV- and hepatitis C-related risk behaviors among people who inject drugs in Uganda: implications for policy and programming. Harm Reduction J. Profile of people who inject drugs in Tehran, Iran. Acta Med Iran. PubMed Google Scholar. Tuchman E. Harm Reduct J. Spittal, P. Female injection drug users in Vancouver. Are females who inject drugs at higher risk for HIV infection than males who inject drugs: an international systematic review of high seroprevalence areas. Indian J Med Res. Risk behaviours among HIV positive injecting drug users in Myanmar: a case control study. Women, drug dependency and consequences: a study from a developing country. J Addict. The impact of social structures on deviant behaviors: the study of high risk street drug users in Iran. Toots, tastes and tester shots: user accounts of drug sampling methods for gauging heroin potency. Nationwide increase in hospitalizations for heroin-related soft tissue infections: associations with structural market conditions. 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The first injection event: differences among heroin, methamphetamine, cocaine, and ketamine initiates. J Drug Issues. New injectors and the social context of injection initiation. Killing time with enjoyment: a qualitative study of initiation into injecting drug use in north-East India. Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed. The risk avoidance partnership: training active drug users as peer health advocates. Outcomes of a peer HIV prevention program with injection drug and crack users: the risk avoidance partnership. The first shot: the context of first injection of illicit drugs, ongoing injecting practices, and hepatitis C infection in Rio de Janeiro, Brazil. Circumstances surrounding the first injection experience and their association with future syringe sharing behaviors in young urban injection drug users. Needle R, Zhao L. HIV prevention among injection drug users: closing the coverage GAP, expanding access, and scaling up Core interventions. Factors associated with non-adherence to highly active antiretroviral therapy in Nairobi, Kenya. Goodman J, Packard MG. Memory systems and the addicted brain. Front Psychiatry. Miles to go: closing gaps, breaking barriers, righting injustices. Download references. Appreciation also goes to Douglas N. Anyona who supported the compilation and editing of the manuscript. To our data entry clerks, Maureen Apondi, Dennis Owuor, Judith Akinyi belated , and Rachael Adoyo for the hours dedicated to entry and cleaning of data. The funding agencies assisted in policy support and analysis, technical review and insight, general oversight and ensuring the study was funded and supported logistically. You can also search for this author in PubMed Google Scholar. FO1, PK and FO2 conceived the idea, collected the data from the field and conducted the statistical analyses and drafted the manuscript. JO GD and OO helped in critically evaluating the manuscript and provided feedback on the planning, study design and methodology. NM and HM helped in facilitation of meetings, communications, logistical planning, provision of reagents and general support; PM and BM provided policy support and approvals from Government ministries. RA and SA provided technical review and insight, and were responsible to ensure the study was funded and supported logistically. All parties read and edited the manuscript and provided useful critique. All authors approved the final version of this article. Correspondence to Francis O. Oguya or Gabriel O. Participation in this study was voluntary for all participants and each gave their written informed consent to participate in the study. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Oguya, F. Rapid situational assessment of people who inject drugs PWID in Nairobi and coastal regions of Kenya: a respondent driven sampling survey. BMC Public Health 21 , Download citation. Received : 22 July Accepted : 18 June Published : 14 August Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Oguya 1 , Patrick R. Oyore 10 , Otieno G. Ochieng 10 , Gabriel O. Results A total of individuals in Nairobi and at the coast were recruited for the study between January and March Conclusions Compared to the national HIV prevalence of 4. Background Substance use is increasingly becoming prevalent on the African continent, fueling the spread of HIV infection. Methods Study sites The choice of the study sites or study locations is critical to successful recruitment and turn-a-round of respondents into the study. Respondent driven sampling methodology Respondent-driven sampling RDS , a new form of chain-referral network or snow-ball sampling designed to overcome many of the problems generally attributed to chain-referral sampling such as the choice of initial participants, volunteerism, and masking \[ 17 \]. Recruitment coupon Reach out Rehabilitation centre. Full size image. Results Response rate following the RDS strategy — net draws diagrams A total of ten seeds were recruited in the Coastal region comprising of two women and eight men, while 8 seeds were recruited in Nairobi comprising of two women and six men. Table 1 Socio-demographic characteristics education level, marital status and religion of respondents in Nairobi and Coast regions Full size table. PWID respondents by skills level. Table 3 Sexual orientation of the respondents Full size table. Age at initiation of drug injection. Relationship to person who administered the first injection. Place of first drug injection. Table 4 Prevalence of injecting with used needle and whether injected in current residence Full size table. Reasons for sharing needles and syringes. Reagents used for cleaning needles and syringes. Reasons for initiating injecting drug use. HIV status versus age at initiation of drug injection. Availability of data and materials Not Applicable. Google Scholar Ndetei D. Google Scholar Heckathorn DD. Google Scholar Goodman L. Google Scholar Download references. Oguya View author publications. View author publications. Ethics declarations Ethics approval and consent to participate Ethical approval to carry out this study was obtained from the Kenyatta National Hospital Ethical Review Committee. Consent for publication None required. Competing interests The authors declare that there is no conflict of interest. About this article. Cite this article Oguya, F. Copy to clipboard. Contact us General enquiries: journalsubmissions springernature.

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