In our work to identify the reasons why people start injecting drugs in Kenya we are exploring ideas from a range of disciplines and areas of research. Heroin use is increasing as a public health challenge in Kenya. There are many ways of using heroin, with injecting being the most dangerous, mainly because of the risk of HIV; smoking, chasing or snorting heroin aren’t so dangerous. Injecting drugs is a risk for HIV when two people share the same needle to inject heroin and so create the potential for blood with HIV to be exchanged. Injecting drug use is a major aspect of the global HIV epidemic, with 3 million people who inject drugs living with HIV.
Understanding why people in Kenya shift from smoking to injecting heroin is an important public health question; if we can understand the factors shaping it we can try and develop interventions and strategies to respond, and so reduce the risk of HIV. Experts in public health, sociology, political science and criminology from the London School of Hygiene and Tropical Medicine (LSHTM), SOAS and Birkbeck have been brought together under the LIDC to explore this.
The Kenyan Ministry of Health, the Kenyan AIDS NGOs Consortium and an NGO called the International HIV/AIDS Alliance are working to introduce health services for people who inject drugs. LSHTM is working in partnership the International HIV/AIDS Alliance to help understand the impact these services are having. A separate SOAS study is exploring the heroin supply in Kenya and the implications for the role of the state. Through conversations between the teams we realised how our studies were highlighting other research questions that separately we weren’t able to fully address. Why people start injecting heroin is one of them.
By exploring our existing data from new theoretical directions and gathering more data we are building an increasing understanding of the reasons why people start injecting. One area we are exploring is the role of prisons as a place where people start using drugs. This is common in the UK, but not yet in Kenya; we are trying to understand the potential for this to happen in the future and what steps can be taken to prevent it. Across East Africa, and especially places like Rwanda, community level forms of government and justice have prominent roles in daily life. We are exploring the role these play now and why they aren’t stopping injecting drug use, and then what role they potentially could play.
These are just two of the areas where our ideas are coming together. The wide-ranging perspectives on injecting drug use the collaboration is allowing will bring a much more comprehensive analysis of the issue, and correspondingly, much greater potential for meaningful interventions with the communities in Kenya and those most affected.
Contributed by Dr Andy Guise, Research Assistant, LSHTM and International HIV/AIDS Alliance
Collaboration partners: Prof. Tim Rhodes (LSHTM), Dr Phil Clark and Margarita Dimova (SOAS), Paul Turnbull (Birkbeck)