people who use drugs, including 18,000-30,000 people who inject drugs
of people who inject drugs in Nairobi have HIV
of people who inject drugs in Nairobi are living with hepatitis C
Lack of prevention and treatment for people who use drugs
Since the early 2010s, Kenya has become a prime transit route for heroin trafficking. Drug use has spread through communities which are already fragile and is accompanied by transmission of AIDS and hepatitis. The country has over 130,000 people who use drugs, of whom almost one in six inject drugs.
Lack of adequate prevention and treatment services that are tailored and accessible to these communities means that high-risk practices such as sharing used needles and unprotected sex are widespread among people who use drugs. The impact on people’s health is significant: over a third of people who inject drugs are infected with HIV and almost half are living with hepatitis C.
Repressive measures, stigmatisation, inadequate or inappropriate services: the many obstacles faced by people who use drugs in accessing healthcare makes this one of the groups most exposed to HIV and hepatitis C infection.
Having long been reluctant to adopt any approach other than the promotion of abstinence, the Kenyan government, encouraged by Médecins du Monde and local partners, has finally introduced promising measures to make healthcare accessible to people who use drugs. Over the last few years, services of harm reduction have been implemented throughout the country. These include access to opioid substitution treatment and needle exchange programmes. 80% of people who use drugs now have access to sterile injecting equipment, although supplies are still frequently disrupted.
However, the existing services are unable to meet the scale of the need and stigmatisation and discrimination from healthcare staff and the general population seriously impede access to healthcare. Furthermore, the legal framework remains very repressive in relation to people who use drugs and insufficient resources are invested in implementing the encouraging policies adopted by the Ministry of Health for the comprehensive management of the consequences of drug use.
Médecins du Monde in contact with people who use drugs
Since 2012, Médecins du Monde has established a healthcare project which provides comprehensive prevention and treatment for people who use drugs through a reception centre and mobile activities to reach the most isolated and vulnerable users. In 2019, we sought to ensure the sustainability of our projects by continuing work to strengthen the capacity of local partners and prepare for the planned transfer of the programme to a local organisation in January 2020.
With almost half of those who inject drugs being infected with hepatitis C, Médecins du Monde, in partnership with Médecins Sans Frontières Belgium, developed a pilot project in 2016 to provide hepatitis C treatment for people who use drugs. Following the pilot project and intensive advocacy work by the team to enable people who use drugs to access the treatment, national guidelines on viral hepatitis were produced in 2018 and a strategy is being developed for the treatment of 1,000 people infected with the hepatitis C virus, thanks to support from the Global Fund.
Promoting harm reduction and strengthening the capacity of local actors
From 2018 Médecins du Monde made the most of the favourable political context in Kenya to develop a pilot project which sought to integrate harm reduction services (in particular, the distribution of sterile injecting equipment) into existing public healthcare facilities in the country. In 2019, we thus supported the integration of these services – primarily by training healthcare staff – into a health centre in Nairobi, Kenya’s capital. This centre now provides harm reduction services to over 50 drug users every month.
In the light of the success of this initiative, the local authorities asked Médecins du Monde to roll out the project to other healthcare facilities in 2020.
At the same time, the Médecins du Monde team is working with Kenyan institutions to develop long-term national policies on harm reduction. We are also engaged in advocacy work around reforms to the legal framework for drug policy which is currently repressive and harmful to people’s health. The aim of this work is for people who use drugs to be decriminalised.
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