Injection drug use is associated with high risk of HIV infection through the sharing of needles and syringes. The risk of HIV transmission among injecting drug users (IDUs) in Kenya is of great concern, but studies of drug users in Africa are rare. It is apparent that effective intervention will only succeed if prevention measures focus on local values and beliefs.   

International organisations have been slow to recognize the spread of heroin use on the Kenya coast, where the practice of inhaling (‘chasing’) brown heroin was replaced in the late 1990s by intravenous injection of white heroin.  As part of a UK Economic and Social Research Council study of female heroin users and their reproductive health, qualitative research methods were used to observe the lives of around 40 heroin users, of whom 24 were women, in the Kenyan coastal town of Malindi. 

For this research, the approach used was to view heroin users as members of a drug sub-culture within mainstream Swahili culture, which has for long had the ability to absorb outside influences.   Participant observation and in-depth interviews were conducted, and during the early stages of fieldwork a ‘key informant’ was used.  This person also acted as a guide and bodyguard, and helped the researcher gain the trust of members of the sub-culture.  The research notes that the concept of ‘cool’, to denote fashionable status in coastal Kenya, was first adopted by young people as part of street culture, but is spreading to mainstream society. 

Awareness of the risk of HIV transmission through injecting equipment was poor.

Further significant research findings include:

• Injecting heroin can give enhanced status in the drug sub-culture, but the rise in standing is not automatic.
• High status, or ‘cool’, was associated with injecting alone rather than in company, and with perceived self-control and personal autonomy.
• Injecting practices were similar to those reported in other parts of the world. 
• While most users appear to have their own equipment, sharing of injection equipment did occur.

High-risk behaviour among IDUs on the Kenyan coast takes place in a context where 20% of the population is HIV positive.  There is therefore a clear need for interventions that reduce high risk behaviour amongst users.

HIV prevention measures should build on local values of individual effort, autonomy and self-control, which have been incorporated into the concept of ‘cool’ among heroin users.  Such values complement messages discouraging sharing of injection equipment.

Source(s):
‘How ‘cool’ is heroin injection at the Kenya coast?’, Drug, Education, Prevention and Policy 11(1): 67-77, S. Beckerleg, 2004
'The characteristics and recent growth of heroin injecting in a Kenyan coastal town', Addiction Research and Theory 12(1): 41-53, S. Beckerleg et al., 2004
'Structural violence in a tourist paradise', Development 47(1): 109-114, S. Beckerleg et al., 2004

Funded by: UK Economic and Social Research Council

id21 Research Highlight: 26 May 2004

Further Information:
Susan Beckerleg
Honorary Lecturer
Department of Public Health and Policy
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Contact the contributor: susan.beckerleg@lshtm.ac.uk

Economic and Social Research Council, UK

London School of Hygiene and Tropical Medicine, UK

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