Intravenous drug users (IDUs) have been largely ignored by the government's HIV programmes on the basis that drug-taking is illegal, but a new policy is being drafted with the aim of reducing HIV transmission among this high-risk group.
"If we want to talk about HIV prevention, then we cannot afford to ignore any group," Nicholas Muraguri, head of the National AIDS and Sexually Transmitted Infections Control Programme, told IRIN/PlusNews, adding that the policy would treat drug addiction as a health issue rather than a criminal justice issue.
"We want to provide needle exchange, methadone for treatment and condoms," he said.
Kenya's change in approach to IDUs follows a similar turnaround by the US President's Emergency Plan for AIDS Relief (PEPFAR), which recently changed its policy of excluding needle exchange and opioid substitution therapy programmes from funding.
Julia*, 21, lives rough in the Kenyan capital, Nairobi, spending most of her days getting high on heroin or desperately searching for her next hit.
She often exchanges sex for drugs, and shares needles with other addicts in downtown Nairobi.
"I can't stop injecting it, I have to get it by any means," she told IRIN/PlusNews. "My body just craves drugs... I take anything that can make me high."
Julia found out she was HIV-positive during a government testing drive in November 2009, but has not sought treatment. "Even though I am positive, my body craves heroin more than ARVs [anti-retroviral drugs]," she said.
|Even though I am [HIV] positive, my body craves heroin more than ARVs|
For Derek*, another drug user in Nairobi, the government's change of policy is very welcome.
"We don't share needles because we like it, but because we can't buy them," he said. "If you get a little money you use it to buy the drug and use somebody else's needle, but if you can get a needle, that means you won't have to share."
"I hope they will also help us get treatment; we are sick and we have HIV and tuberculosis but we fear getting treatment because the police are always looking for us," Derek added.
A report by the International AIDS Society recommends expanding outreach to high-risk, hard-to-reach drug users and encouraging them to test for HIV. Those who test positive, the report recommends, should be referred for care and efforts made to keep them in treatment. According to the report, this "seek, test, treat and retain" model could be delivered from within the criminal justice system.
Muraguri said the government was conducting research to find out where the country's drug users are concentrated.
"Once we are ready to reach out to this group in a big way, it will be critical to estimate their numbers, know their networks and areas of concentration," he said.
According to the Kenya HIV Prevention Response and Modes of Transmission Analysis 2009, IDUs account for nearly 4 percent of new HIV infections nationally and about 6 percent in Nairobi and Coast Provinces.
|More on IDUs|
|"Seek, test, treat and retain" to stem HIV among drug users|
|Ali Mohammed, "If I go back to the drug, I will die"|
|"Flash blood" puts drug users at risk of HIV|
|A Cleaner Fix (film)|
However, the same report notes that the absence of good data makes it hard to calculate either the number of IDUs in Kenya, or the percentage that may be HIV-positive.
Muraguri said his department was working on ways to ease access to treatment for HIV-positive IDUs. "[We want to] learn from other countries where once [a person] is on [drug and HIV] treatment, they are provided with a card that will protect them from the police," he said. "This means the policy will only come out after wide consultations."
According to a study in The Lancet, just 1 percent of HIV-positive Kenyan IDUs were on ARVs in 2008. The study projected that increased ARV coverage, combined with opioid substitution and needle and syringe programmes, could avert some 1,800 new HIV infections in this group by 2015.
*Not their real names