Slaves of a drug

SLAVES OF A DRUG By Albert Mwangeka.

The Coastal area of Kenya which harbours a population of 3 million people is known for its scenic beauty and sandy beaches.

 An area that is a major tourist attraction; from the expansive hills of Taita to the old towns in Lamu . The Coastal  towns are known by various slogans Mombasa raha(Mombasa is fun). Tukutane Mombasa(Lets meet at Mombasa) and even Lamu Tamu literally interpreted as Lamu is sweet. 

However, it is an area being slowly eaten away by the drug escapades doing rounds in the region.

‘I am not happy. I have been using drugs for 5 years. I am addicted.This is not what God had planned for me. I am the slave of a drug. I cannot function unless I use. There are very many girls in Ukunda, Kwale who are injecting drugs,’ says Malkia Sheba who also earns a living through sex work.

‘I live with my mother. She is tired of my habits. There comes a time when a parent cannot tolerate her own child’s unwanted behaviours. She knows I inject drugs. She has warned me but she has now given up. I do not intend to do drugs but I am addicted. Without getting a daily dose I feel sick. Look at my hands, they have no veins. My hands were almost cut because I inject a lot, ‘moans Merida who is also a person who injects drugs (PWIDs) and a Female Sex Worker (FSW) as well.

According to the Kenya National Guidelines for the Comprehensive Management of Health Risks and Consequences of Drug Use 2013, out of 10 drug users 8 started doing drugs as a result of peer pressure.

Rose says that she was married to a man who always cheated on her; something that stressed her mind.

 Rose says that this made her suffer from insomnia, a condition that renders one sleepless. 

She says that she addressed the issue to her friends who told her to use a substance that would make her get enough sleep. 

The substance that she smoked cured her insomnia but she says after a week got addicted. 

 She says that she did not know her friends were introducing her to hard drugs. 

Rose bitterly explains that she felt trapped by her friends.

There are 16 million PWIDs worldwide according to the Kenya National Guidelines for the Comprehensive Management of Health Risks and Consequences of Drug Use 2013.

An estimated 10 million injecting drug users are dependent on opiods, mainly heroin, and are concentrated in Europe, North America, central and South America and Australia , and more recently the east coast of Africa. East African towns include Unguja and Dar es Salaam from Tanzania and in Kenya they include Kwale, Lamu, Mombasa, Kilifi and Malindi.

‘I used to smoke and peddle bhang when I was still a student. Finally my teachers found out and I was expelled when I was in class 7. Since I could not further my education I became a sex worker. My drug condition worsened since I also started using hashish and later I became an injecting drug user,’ explains Arusha who hails from Mtwapa, Kilifi.

The Kenya National Guidelines for the Comprehensive Management of Health Risks and Consequences of Drug Use 2013 says that although female PWIDs are few, their HIV prevalence was almost thrice (44.5%) compared to their male counterparts.

Merida is HIV+ and does not use protection when handling her clients. She says she cares less since she is already HIV+. 

She says that she does not care spreading the virus since she suspects that most clients who prefer to practice unsafe sex with her are living with HIV. She has been living with the virus , almost 10 years now.

The drugs report continues to say that during their study it was found out most 10% of PWIDs started the habit as a result of influence from a drug peddler, a lover, a relative or even started injecting on their own. 

Reasons for engaging in drug use includes: desire better high and more friends, curiosity and peer pressure.

Sheba explains that a lover introduced her to drugs when they used to hang around the beach. 

The boyfriend used to smoke marijuana. 

He made me take a puff and it felt ecstatic. 

She adds that she had no idea that this would lead to damaging side effects inclusive of addiction. 

After using for a week she started feeling weary and getting bouts of diarrhea. 

She says that her boyfriend used to cater for her addiction expenses but after they fell out she had to look for her own means to get her drugs. 

She plunged herself into sex work. Finally, she met a white man from Germany who was came to visit Kenya.

 He then flew her to Frankfurt, Germany.

‘It was a difficult life in Germany. I had no family. He did not want me to talk to anyone and he locked me in his house. He bought me a pet since he did not want to get kids. He was a drug dealer and he was also dealt with guns and ammunition. Further he was a pimp and a heavy cocaine user. 

Once during a fight he threatened to shoot me,' narrates Sheba.

'Finally I escaped but the German authorities caught up with me since I had no passport. My boyfriend confiscated it immediately I came to this country. 

When in prison I contacted the Kenyan embassy and they helped me fly back here,’ explains a bitter Sheba.'

Merida says she blames herself for throwing herself into the drug scene. 

She says she used to see her boyfriend use some substance that made him relax. 

She insisted that her boyfriend share with her what he was using despite the man advising her on the harmful effects of injecting drugs.

Drug abuse is a habit that is normally seen consistent with men. 

However women are slowly getting into this vice.

 Taib Abdirahman of Reach Out Centre Trust explains,’ More women are doing drugs because they are easily available. More women are going out of their way to buy the drugs themselves because they used to send their male counterparts because they no longer trust them.’

The 2013 Kenyan report on drugs and HIV says that the prevalence of HIV and drug use have recently emerged as twin epidemics in Sub Saharan Africa. 

It further states that well established HIV epidemics amongst PWIDs exist in Nigeria, Kenya, Tanzania and Mauritius. 

Recent evidence suggests that this population is becoming increasingly common within the region. 

There are now are reports that 16 Sub Saharan African countries , home to 53% of the total population in the region. 

 The full extent of injecting drug use in the region remains largely due to insufficient data, however injecting drug use is well established in Kenya, Mauritius, South Africa and Nigeria. HIV prevalence among PWIDs is estimated at 19.3% in Kenya, 44.7% in Mauritius and 20% in South Africa. 

Estimates on population sizes of drug users is 50,000 in Kenya; 17,500 in Mauritius and 262,975 in South Africa.

The report further says available data from a limited number of behaviourial surveillance surveys suggest that sharing of used injecting equipment is common, lack of access to clean water in some locations makes cleaning syringes difficult and drugs are often mixed with non-sterile water for injection.

 It has been noted that many people who inject drugs may not identify themselves as injecting drug users, and many switch between injecting and non injecting routes of administration multiple times.

‘We share syringes. Sometimes I could be craving for the drug yet I do not have money to both the drugs and the syringes. I use the money I have to buy drugs then I borrow my peers the needles. Chances are that he could be HIV+ but I have no option because the craving is very strong,’ says Merida.

‘Before the Needles and Syringe Programme NSP came to life I used to pick any used syringe in the areas where we converge and do drugs. This is because at times I could not afford to buy myself the needles,’ explains Sheba.

 In 2011 the National AIDS Control Council NACC announced a plan to provide free HIV prevention and treatment for People Who Inject Drugs.

 Included in the plan are previously disallowed harm reduction methods including needle exchange and neglected services such as psychosocial support for PWIDs.

 Medical Assisted Therapy (MAT) is not banned in Kenya but its availability is severely restricted. 

The Global Fund provided support for the piloting of NSP in Nairobi and Coast regions. 

NSP intended to give needles and syringes to injecting drug users so that they could not share such equipment. This was meant to curb spread of HIV amongst them since they fall under Most At Risk Populations MARPS. MARPS are people who are at risk of being HIV+. 

NSP was generally received harsh reaction from the society especially religious leaders.

‘We give the PWIDs syringes so that we avoid incidences of sharing and curb spread the HIV virus. We ask them to safely store theses equipment so that we can come and dispose the needles in a safe manner. When we started this program religious leaders opposed this move. We went on the ground and collected syringes that were carelessly being disposed by these users even before NSP started, " says Cosmas Maina co-ordinator of a Community Based Organisation Teens Watch in Kwale County.

' We collected over 5500 syringes and showed them to the leaders so that they could understand how sharing and careless disposing of needles was such a big issue. We needed them to understand that this project was meant to curb spread of HIV and not to encourage them to continue using.’ 

PWIDs are normally slaves of the drugs they use. 

If they do not inject themselves they normally feel sick and they say that they feel that their body cannot function unless they get a dose.  

 They say that this causes them to have headaches and experience nausea.

 At the Coast they have coined a term for it-Arosto. 

One female user says that arosto is the worst feeling a user can never get.

 They say that when this feeling comes they have to engage in prostitution to get money to buy their daily dose of drugs.

 This puts them at a higher risk of being HIV+.

 Some say they have to lie to their parents to give them money to seek medical treatment. 

They do not use the cash for medical attention but rather they opt to buy drugs to quench their thirst for the drug.

 They explain that some of their counterparts have been lynched to death because they cause stealing stuff that they would later sell to buy themselves a dose.

PWIDs are always at risk of contracting Hepatitis B, Hepatitis C and being HIV+.

 This is contributed largely to sharing of needles. Both the United Nations On Drugs and Drugs and Crime (UNODC)/ICHIRA study and the IBBS Population Council revealed that between third and half of PWID had ever shared injecting equipment with close friends or close sex partners during the preceding months. 

Common reasons for sharing injection equipment include the lack of personal needles when needed (23%), difficulty in accessing new needles or cost (17%), pressure from other users (14%) or being in prison (2%). 

UNODC further says that many women who do drugs get help in administrating the drugs from their sex partners. 

This situation is quite different in Kwale as prefer ‘Bush Doctors’. 

Bush Doctors are male drug users who are heads of their dens and normally administer the drugs to their counterparts for a fee. This has adverse effects.

‘These doctors are very careless. Sometimes they inject you yet their hands are sometimes filled with blood. This puts me at risk of being HIV+. They are very careless while injecting us and they are even capable of stealing the drugs from us. They have once exchanged my drugs with fake powder which was very dangerous. If you have a debt with him they take confiscate my drugs then ‘arosto’ catches up with me. We at risk of getting an overdose from them’, lamented Sheba.

UNODC/ICHIRA study says that majority (81%) of PWIDs have been incarcerated, 30% had been confronted by police or other authorities in the past 6 months while some had their equipment confiscated. 

About 7% had ever injected drugs in jail and of these 61% shared needles while they were in prison. 

Despite high incarceration rates among injecting drug users, current HIV prevention interventions in prison are inadequate deterring inmates from drug use and other risky practices while in prison and post release.

‘I was not a peddler I used to do drugs in Mwembe Tayari area of Mombasa. I am serving a jail term of 10 years after agreeing to the charges laid before me in the Municipal Courts of Mombasa. When I was using drugs I gave birth to twins but one died because of the effect of the drugs I was using. It is hard being a mother and a PWID,’ says Ngina from the Shimo la Tewa prison.

UNODC/ICHIRA RSA estimates there approximately 50,000 PWIDs within Nairobi and Coast Provinces, (26,667 at the Coast and 22,500 in Nairobi).

 The research further says that there is insufficient data on injecting drug use in other parts. 

Abbas Gullet, Secretary General for Red Cross Kenya says that this is a big issue at the Coast. Gullet says that Red Cross has donated a mobile van worth 10 million shillings  to the Mombasa County government that will cater for Key Populations which include drug users. 

He says the vehicle will reach the grass root areas of Mombasa to ensure that they get proper medical attention.

 Gullet says Key Populations have often complained that they do not get enough attention and face stigmatization from medical facilities. 

The UNODC/ICHIRA study reports that only 16% of all respondents have ever been reached by existing outreach services targeting people who use drugs. 

The report says that PWIDs have disproportionately limited access HIV prevention, care and treatment services relative to their high HIV burden.

Despite almost a third of respondents perceiving their health as poor due to history of malaria, mixed infections, tuberculosis and abscesses(a swollen area within body tissue, containing an accumulation of pus).

No more than 20% of all respondents had pursued any medical attention during the previous 12 months. 

Common reasons for PWIDs not pursuing any medical treatment when sick include: unfriendly health workers, fear of arrest by authorities, logistical constraints inability to pay and fear of painful treatment.