Susan Beckerleg

The rise of injecting drug use in east Africa: a case study from Kenya

Studies on injecting drug use in East Africa are reviewed. The existingstudies document the spread of heroin injection in Kenya and Tanzania, both countries where HIV rates are high. No data from Uganda on injecting drug use was found by the authors. A case study of the growth of heroin injection in a Kenyan coastal town is presented. The need for needle-exchange programmes and other prevention services is discussed.

The characteristics and recent growth of heroin injecting in a Kenyan coastal town

This article discusses the challenges of estimating levels and patterns of heroin use in a setting where there were no official records. Ethnographic fieldwork, carried out in a Kenyan Coastal town, utilised a range of qualitative research methods in an attempt to estimate numbers of male and female users and the proportion of them who were injectors of heroin. In the town of at least 85u2009000 people, it was estimated that there were perhaps about 600 heroin users, of whom about 30 were women. The ratio of male to female users was estimated to be 20u2009:u20091. Fifty per cent of users in the town were estimated to be injectors of heroin. They were found to have poor injecting techniques, to share equipment from time to time and to have low awareness of the link between injecting drug use and HIV infection. An urgent need for harm reduction strategies was identified.

Women's health custom made: building on the 40 days postpartum for Arab women.

The 40-day postpartum period is characterised in the Middle East and elsewhere by an observance of seclusion, congratulatory visiting, the reciprocal exchange of gifts and money, and a special diet. Based on primary data from in-depth interviews among the Negev Bedouin in Israel, health enhancing practices are reviewed. The data are a subset from a larger study carried out in this setting. Often postnatal checkups, family planning counselling, and immunization services may not be routinely available or used. It is argued that these health services could be provided at the end of the 40-day period for mother and child, as in a pilot study in Tunisia some years ago. Health service provision would thus build on the health enhancing practices of the 40-day period.The 40-day postpartum period is characterised in the Middle East and elsewhere by an observance of seclusion, congratulatory visiting, the reciprocal exchange of gifts and money, and a special diet. Based on primary data from in-depth interviews among the Negev Bedouin in Israel, health enhancing practices are reviewed. The data are a subset from a larger study carried out in this setting. Often postnatal checkups, family planning counselling, and immunization services may not be routinely available or used. It is argued that these health services could be provided at the end of the 40-day period for mother and child, as in a pilot study in Tunisia some years ago. Health service provision would thus build on the health enhancing practices of the 40-day period.

Eliciting local voices using natural group interviews

Abstract As part of a 5 year intervention study to improve maternal and child health care, natural group interviews were carried out amongst a minority group of Israeli citizens, Palestinian Arabs of Bedouin origin living in the Negev. This paper argues that the use of individual questionnaires, in this setting, is inappropriate in that it would ignore the views of other household members, likely to be crucial to the parents’ decisions about health care utilisation. The interviews utilised the natural groups of women gathering to visit mothers during the first 40 days post‐partum, and of men who gather in family or sub‐tribal guest sections. Their views on issues concerning difficulties of access owing to distance, social and linguistic barriers and cost are reported. These local views are placed in the wider context of health care provision to disadvantaged ethnic minorities in Israel and elsewhere.

A Rapid Assessment of Heroin Use in Mombasa, Kenya

This article reports on a rapid assessment (RA) carried out in the city port of Mombasa, Kenya in March 2004 by the Omari Project to inform the scaling up of their services to heroin users. Heroin has been a street drug in Mombasa for over 25 years. From 1998, white crest, probably from Thailand, started to replace brown sugar, and there was a major shift from inhalation of the vapor (“chasing the dragon”) to injecting. The Omari Project has been monitoring the heroin situation in Mombasa and treating heroin users from Mombasa since 1997. In the course of the RA, 496 heroin users were interviewed of whom 95% were men and 5% were women. A range of methods were used, including mapping of the Mombasa region, work with a key informant/guide who was a heroin user, administration of a brief questionnaire and informal interviews, and feedback of findings to other local agencies working with drug users. Respondents were from a wide range of cultural/ethnic groups, the two largest being Mijikenda and Swahili, who are indigenous to the Kenya coast. Overall, 15% of respondents had “ever injected” heroin, and 7% were current injectors (n = 37). These data indicate a shift away from injecting but also reflect the death of many established injectors, either through overdose or AIDS or hepatitis. The figure of 7% of the sample reporting being current injectors is likely to be an underestimate. Syringes were available from a number of pharmacies and most injectors reported using a syringe for 1–3 days. The majority reported injecting in a group of three or more and described risk behaviors for HIV transmission. The results of the assessment highlight the need for a range of services, including needle exchange, counseling, and referral to residential treatment programs. However, progress toward responding to the findings of the RA by establishing effective services are hampered because of legal impediments to operating needle exchange programs in Kenya.

A view from the refugee camps: new Somali khat use in Kenya

Catha edulis, known in the drugs literature as khat and in Kenya as gat, miraa, murungi, veve, gomba, abounds with paradoxes. One of the curious features of khat is that it has become so closely associated with Somalis, both at home and in the diaspora, that consumption of twigs and leaves of miraa are widely assumed to be part of Somali culture and tradition. Yet, khat consumption by Somalis only gained wide popularity in the second half of the twentieth century (Goldsmith, 1997). So, how did miraa use and distribution in Kenya come to be a marker of Somali identity?

Counselling Kenyan heroin users: cross‐cultural motivation?

The Omari Project has been working with heroin users in the Kenyan towns of Watamu, Malindi and Mombasa for the past five years. The paper reports on the piloting, adaptation and evaluation of motivational interviewing carried out with 20 heroin users living in coastal Kenya, a cultural context in which participatory approaches and counselling in general, and motivational interviewing in particular, are not familiar. The findings indicate that motivational interviewing was nevertheless acceptable and useful to the study participants.

A survey of Zanzibari heroin users

This paper reports on a questionnaire survey of 300 heroin users in Zanzibar town, in Tanzania. It was found that about 13% of respondents were current injectors of heroin, but that 38% of respondents reported have ‘ever injected’ heroin. Many injectors reported hiding their needles and syringes and almost half of them had shared their equipment during the past four weeks. Most of the respondents reported that they had not had sexual intercourse during the past four weeks. Of those who were sexually active most reported not having used a condom the last time they had intercourse. These findings highlight the need for a wider recognition of the extent of heroin use in East Africa as well as the urgent need to provide harm reduction and treatment services.

Heroin use in Zanzibar: a survey

Heroin has been a street drug along the East African coast for 25 years (Beckerleg, 1995) but it has only recently been recognised and documented (Kilonzo et al, 2001; Jones & Needle, 2005). Heroin use is risky and HIV transmission an increasing problem (McCurdy et al, 2005). Susan Beckerleg and colleagues uncover high rates of unprotected sex, excessive needle sharing and continued re‐use of old and dirty needles often kept in old tins, pockets, or as most do, hidden under rocks.