MELBOURNE, AUSTRALIA – During a symposium on harm reduction and people who use drugs today, researchers from Kenya and Tanzania pointed to strategies and services to increase the participation of people who use drugs in services aimed at reducing their risks of acquiring HIV while improving their well-being.
Hezron Okowe Ogembo from Kenya presented a study of the impact of social support services in a program for drug users participating in a program of the Nairobi Outreach Services Trust, an organization that has provided services to people who use drugs since 2005. An estimated 18,000 persons inject drugs in Kenya, and HIV prevalence among women who inject drugs is estimated to be about 44 percent.
The Nairobi Outreach Services Trust provided outreach services in 23 injection drug use hot spots in Nairobi and linked drug users to services ranging from HIV testing and referral to antiretroviral therapy and syringe exchange to addiction counselling, meals and showers, vocational education,and microcredit training with loan provision. Housing at a shelter was also provided to women with children.
Ogembo and colleagues conducted a retrospective review of service coverage and the impact of the interventions and found increases in economic productivity, reductions in needle sharing and in the number of clients who were still injecting and more condom use. The researchers found that the socioeconomic assistance increased retention in health services with the promise of increasing economic self sufficiency.
Ogembo concluded by noting that Kenya is beginning to launch methadone treatment and that services that enhance socio-economic empowerment will be vital, especially to retain women who use heroin.
Olivia Chang from the University of California at San Francisco presented findings from a program aimed at increasing the participation of women who inject drugs in a methadone program in Dar es Salaam, Tanzania. The program was a response to very low participation of women, an estimated third of all injecting drug users there, in the methadone program. HIV prevalence is estimated 64 percent among women who inject drugs, while it is estimated at about 28 percent among men.
Researchers conducted a qualitative study with the participation of four non-governmental organizations (NGOs) that conducted outreach to people who used drugs and worked to engage them in the methadone program housed in a district hospital. They interviewed men and women participating in the methadone program and their service providers and found that the women used heroin in different and more secluded spaces than the men. Moreover, about 85 percent of the women were engaged in street-based sex work, and were working most of the night and sleeping during the day. The outreach during the day was failing to reach these women. Women in the program also reported more stigma associated with their drug use and challenges paying for transportation to the methadone clinic on a daily basis. They also said that they faced discrimination and intimidation from their male counterparts at the clinic.
The findings suggested that alternative outreach times and locations conducted by peer former sex workers would help reach more women, and the program responded by training and employing a number of peer outreach workers. The program has also modified program enrollment requirements so that clients are no longer required to enroll through one of the outreach NGOs, do not have to show evidence of injection, and now can attend clinic through female-specific clinic hours and access medication from a dosing window dedicated to women.
Other retention strategies such as allowing “take away” methadone doses to reduce transportation costs, waiting time and the time in the health facility are under consideration. The authors of the study believe that the findings may also be relevant to other countries in the region like Kenya and Mozambique, which have similar social and epidemiological contexts.