Rapid Assessment of Injecting Drug Users (IDUs) in Nairobi and Mombasa counties, Kenya: A Respondent Driven Sampling Survey

Abstract Background: A Cross-sectional Rapid Situational Assessment of People Who Inject Drug (PWIDs) applying Respondent Driven sampling techniques (RDS) was used to recruit subjects/participants in a study aimed at assessing HIV prevalence and risk behaviors among injection drug users in Nairobi and Coastal region of Kenya. There is paucity of data and information on injecting drug use in sub-Saharan Africa and there is sufficient evidence of existence of the environment for development and growth of injecting drug use. Past studies on PWID and its association to HIV and AIDS that have been conducted in Kenya do not provide sufficient information to support effective planning and comprehensive national response to the HIV and AIDS epidemic.Methods: A cross-sectional study design was adopted in which a set of initial subjects referred to as ‘seeds’ were first identified from which an expanding chain of referrals were obtained, with subjects from each wave referring subjects of subsequent wave. The seeds were drawn randomly from the population and interviewed to pick the one with the largest network and other unique characteristics. A maximum of twelve seeds were recruited. The second stage involved conducting assessment visits to the sites to identify potential collaborators that included non-governmental organizations (NGOs), drug treatment centres, health facilities, Community based organizations (CBO's) among others. Three NGOs located in the coast region and one in Nairobi region were identified to assist in identifying drug injection locations and potential participants. Key informant interviews (KIIs) and Focus Group Discussions (FGDs) were also conducted using interview guides. Results: A total of 646 individuals (344 in Nairobi and 302 at the coast) were recruited for the study between January and March 2010. Of these 590 (91%) were male and 56 (9%) were female. Findings showed that most PWIDs initiated injecting drug use between the ages of 20-29 years, with the youngest age of initiation being 11 years and oldest age being 53 years. Most commonly injected drug was heroin (98%), with a small (2%) percentage injecting cocaine. Other non-injecting methods such as smoking or combining these two drugs with other drugs such as cannabis or Rohypnol were also common. Most PWIDs used other substances (cigarettes, alcohol, and cannabis) before initiating injecting drug use. HIV prevalence of PWIDs in Nairobi was (24.4% unadjusted) compared to their counterparts residing in the Coastal region (18.5% - unadjusted). The age specific HIV prevalence showed that PWIDs who initiated injecting at 11-19 years (44.7% adjusted) were most at risk in Nairobi compared to those who initiated injecting at age 20-24 years (23.2% - adjusted) in the coastal region. While all PWIDs continue to be at risk in the two regions, those from the Western parts of Nairobi were at a relatively higher risk given their increased propensity for sharing injecting equipment and solutions. Conclusions: Compared to the national HIV prevalence of (4.9%), the results show that People Who Inject Drugs (PWIDs) are at particularly high risk of infection in Kenya and there is urgent need for intervention (KenPHIA, 2018). This study also showed clear evidence that PWIDs engage in high risky injecting and sexual behaviors comprising sharing of injecting equipment, unprotected heterosexual and homosexual sex. Given that initiation of injection drug use begins early and peaks after formal school years (20-29 years), prevention programmes should be targeted at secondary school, college and out of school youth. Further, to protect People who inject drugs (PWIDs) from HIV infection, the country should introduce free Needle Syringe Programs with provision of condoms and Methadone Assisted Therapy (MAT) as a substitute for drug use.

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Rapid Situational Assessment of People Who Inject Drugs (PWID) in Nairobi and Coastal regions of Kenya: A Respondent Driven Sampling Survey

10.21203/rs.3.rs-44785/v3 ◽

2020 ◽

Author(s):

Francis Oguya ◽

Patrick Kenya ◽

Francisca Ongecha ◽

Patrick Mureithi ◽

Helgar Musyoka ◽

...

Keyword(s):

At Risk ◽

Drug Use ◽

People Who Inject Drugs ◽

Coastal Region ◽

Injecting Drug Use ◽

Hiv Prevalence ◽

Hiv And Aids ◽

Respondent Driven Sampling ◽

Cross Sectional ◽

Situational Assessment

Abstract Background: A Cross-sectional Rapid Situational Assessment of People Who Inject Drug (PWIDs) applying Respondent Driven sampling techniques (RDS) was used to recruit subjects/participants in a study aimed at assessing HIV prevalence and risk behaviors among injection drug users in Nairobi and Coastal region of Kenya. There is paucity of data and information on injecting drug use in sub-Saharan Africa and there is sufficient evidence of existence of the environment for development and growth of injecting drug use. Past studies on PWID and its association to HIV and AIDS that have been conducted in Kenya do not provide sufficient information to support effective planning and comprehensive national response to the HIV and AIDS epidemic.Methods: A cross-sectional study design was adopted in which a set of initial subjects referred to as ‘seeds’ were first identified from which an expanding chain of referrals were obtained, with subjects from each wave referring subjects of subsequent wave. The seeds were drawn randomly from the population and interviewed to pick the one with the largest network and other unique characteristics. A maximum of twelve seeds were recruited. The second stage involved conducting assessment visits to the sites to identify potential collaborators that included non-governmental organizations (NGOs), drug treatment centres, health facilities, Community based organizations (CBO's) among others. Three NGOs located in the coast region and one in Nairobi region were identified to assist in identifying drug injection locations and potential participants. Key informant interviews (KIIs) and Focus Group Discussions (FGDs) were also conducted using interview guides. Results: A total of 646 individuals (344 in Nairobi and 302 at the coast) were recruited for the study between January and March 2010. Of these 590 (91%) were male and 56 (9%) were female. Findings showed that most PWIDs initiated injecting drug use between the ages of 20-29 years, with the youngest age of initiation being 11 years and oldest age being 53 years. Most commonly injected drug was heroin (98%), with a small (2%) percentage injecting cocaine. Other non-injecting methods such as smoking or combining these two drugs with other drugs such as cannabis or Rohypnol were also common. Most PWIDs used other substances (cigarettes, alcohol, and cannabis) before initiating injecting drug use. HIV prevalence of PWIDs in Nairobi was (24.4% unadjusted) compared to their counterparts residing in the Coastal region (18.5% - unadjusted). The age specific HIV prevalence showed that PWIDs who initiated injecting at 11-19 years (44.7% adjusted) were most at risk in Nairobi compared to those who initiated injecting at age 20-24 years (23.2% - adjusted) in the coastal region. While all PWIDs continue to be at risk in the two regions, those from the Western parts of Nairobi were at a relatively higher risk given their increased propensity for sharing injecting equipment and solutions. Conclusions: Compared to the national HIV prevalence of (4.9%), the results show that People Who Inject Drugs (PWIDs) are at particularly high risk of infection in Kenya and there is urgent need for intervention (KenPHIA, 2018). This study also showed clear evidence that PWIDs engage in high risky injecting and sexual behaviors comprising sharing of injecting equipment, unprotected heterosexual and homosexual sex. Given that initiation of injection drug use begins early and peaks after formal school years (20-29 years), prevention programmes should be targeted at secondary school, college and out of school youth. Further, to protect People who inject drugs (PWIDs) from HIV infection, the country should introduce free Needle Syringe Programs with provision of condoms and Methadone Assisted Therapy (MAT) as a substitute for drug use.

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Rapid situational assessment of people who inject drugs (PWID) in Nairobi and coastal regions of Kenya: a respondent driven sampling survey

BMC Public Health ◽

10.1186/s12889-021-11373-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Francis O. Oguya ◽

Patrick R. Kenya ◽

Francisca Ongecha ◽

Patrick Mureithi ◽

Helgar Musyoka ◽

...

Keyword(s):

At Risk ◽

Drug Use ◽

People Who Inject Drugs ◽

Coastal Region ◽

Injecting Drug Use ◽

Hiv Prevalence ◽

Hiv And Aids ◽

Coastal Regions ◽

Cross Sectional ◽

Situational Assessment

Abstract Background A Cross-sectional Rapid Situational Assessment of People Who Inject Drug (PWIDs) applying Respondent Driven sampling techniques (RDS) was used to recruit subjects/participants in a study aimed at assessing HIV prevalence and risk behaviors among injecting drug users in Nairobi and Coastal regions of Kenya. There is paucity of data and information on injecting drug use in sub-Saharan Africa and there is sufficient evidence of existence of the environment for development and growth of injecting drug use. Past studies on PWID and its association to HIV and AIDS that have been conducted in Kenya do not provide sufficient information to support effective planning and comprehensive national response to the HIV and AIDS epidemic. Methods A cross-sectional study design was adopted in which a set of initial subjects referred to as ‘seeds’ were first identified from which an expanding chain of referrals were obtained, with subjects from each wave referring subjects of subsequent waves. The seeds were drawn randomly from the population and interviewed to pick the one with the largest network and other unique characteristics. A maximum of twelve seeds were recruited. The second stage involved conducting assessment visits to the sites to identify potential collaborators that included non-governmental organizations (NGOs), drug treatment centres, health facilities, community based organizations (CBO’s) among others. Three NGOs located in the coast region and one in Nairobi region were identified to assist in identifying drug injection locations and potential participants. Key informant interviews (KIIs) and Focus Group Discussions (FGDs) were also conducted using interview guides. Results A total of 646 individuals (344 in Nairobi and 302 at the coast) were recruited for the study between January and March 2010. Of these 590 (91%) were male and 56 (9%) were female. Findings showed that most PWIDs initiated injecting drug use between the ages of 20–29 years, with the youngest age of initiation being 11 years and oldest age being 53 years. Most commonly injected drug was heroin (98%), with a small (2%) percentage injecting cocaine. Other non-injecting methods such as smoking or combining these two drugs with other drugs such as cannabis or Rohypnol were also common. Most PWIDs used other substances (cigarettes, alcohol, and cannabis) before initiating injecting drug use. The adjusted national HIV prevalence of PWIDs was 18.3% (19.62% unadjusted) with PWIDs in Nairobi region registering 18.33% (20.58% unadjusted) compared PWIDs for Coastal region indicating 18.27% (18.59% - unadjusted). The gender based HIV prevalence showed that women were more at risk of acquiring HIV (44.51%-adjusted) compared to men (15.97%-adjusted). The age specific HIV prevalence showed that PWIDs who initiated injecting at 11–19 years (44.7% adjusted) were most at risk in Nairobi compared to those who initiated injecting at age 20–24 years (23.2% - adjusted) in the coastal region. While all PWIDs continue to be at risk in the two regions, those from the Western parts of Nairobi, Kenya were at a relatively higher risk given their increased propensity for sharing injecting equipment and solutions. Conclusions Compared to the national HIV prevalence of (4.9%), the results show that People Who Inject Drugs (PWIDs) are at particularly high risk of infection in Kenya and there is urgent need for intervention (KenPHIA, 2018). This study also showed clear evidence that 70% of PWIDs are primary school educated, engage in high risk injecting and sexual behaviors comprising sharing of injecting equipment, unprotected heterosexual and homosexual sex. Given that initiation of injecting drug use begins early and peaks after formal school years (20–29 years), prevention programmes should be targeted at primary and secondary school students, college and out of school youth. Further, to protect People who inject drugs (PWIDs) from HIV infection, the country should introduce free Needle Syringe Programs (NSP) with provision of condoms and Methadone Assisted Therapy (MAT) as a substitute for drug use.

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Tideline and Turn: Possible Reasons for the Continuing Low HIV Prevalence among Glasgow's Injecting Drug Users

The Sociological Review ◽

10.1111/j.1467-954x.1994.tb00108.x ◽

1994 ◽

Vol 42 (4) ◽

pp. 738-757 ◽

Cited By ~ 6

Author(s):

Michael Bloor ◽

Martin Frischer ◽

Avril Taylor ◽

Robert Covell ◽

David Goldberg ◽

...

Keyword(s):

Drug Users ◽

Early Report ◽

Community Sample ◽

Injecting Drug Users ◽

Cross Sectional Study ◽

Hiv Prevalence ◽

Cross Sectional ◽

Drug Injectors ◽

Substantial Risk ◽

Low Prevalence

This is an early report of data from an on-going, repeated, cross-sectional study of a community sample of Glasgow injecting drug users. Although HIV was first detected among Glasgow's drug injectors in 1985, data from the first two years of our annual samples (1990 and 1991) indicate that HIV prevalence continues to be low in this population, in the order of 1 or 2 per cent. Possible reasons for this apparent continuing low prevalence are examined. It is suggested that substantial risk reduction – reductions in injection equipment-sharing, reductions in numbers of sharing partners and restrictions in social circles of sharing partners – may have been sufficient reasons, in conjunction with limited contributions to near-stabilisation from the disproportionate attrition of the numerator population through death and cessation of injecting.

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HIV Prevalence and Frequency of Risk Behavior in Injecting Drug Users Entering Treatment and Out of Treatment: A Cross-Sectional Study in Five Italian Cities

Journal of Drug Issues ◽

10.1177/002204269402400312 ◽

1994 ◽

Vol 24 (3) ◽

pp. 527-535 ◽

Cited By ~ 6

Author(s):

Giovanni Rezza ◽

Stefania Salmaso ◽

Damiano Abeni ◽

Giovanna Brancato ◽

Alessandra Anemona ◽

...

Keyword(s):

Risk Behavior ◽

Drug Users ◽

Injecting Drug Users ◽

Cross Sectional Study ◽

Hiv Prevalence ◽

Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

Outreach Programs ◽

Male To Female

We conducted a study to describe current patterns of drug-related behaviors, and to identify characteristics that may distinguish injecting drug users entering treatment from those out of treatment, in five Italian cities. Overall, 1,180 subjects were recruited — 568 entering treatment and 612 out of treatment. Male to female ratio was 6.6:1. The median age was similar in the two groups. A high proportion of injecting drug users recruited out of treatment had been in treatment at least once. HIV prevalence among injecting drug users entering treatment was not higher than that of those who were out of treatment. Furthermore, a large proportion of injecting drug users who still were out of treatment reported having adopted safe behaviors. The results of the study emphasize the need to implement outreach programs aimed at harm reduction.

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HIV prevalence and risk behaviors among new initiates into injection drug use over the age of 40 years old

Drug and Alcohol Dependence ◽

10.1016/s0376-8716(98)00142-2 ◽

1999 ◽

Vol 54 (1) ◽

pp. 83-86 ◽

Cited By ~ 42

Author(s):

Mariangela Carneiro ◽

Crystal Fuller ◽

Meg C Doherty ◽

David Vlahov

Keyword(s):

Drug Use ◽

Risk Behaviors ◽

Injection Drug Use ◽

Hiv Prevalence ◽

Injection Drug

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Pattern of Drug Use and Associated Behaviors Among Female Injecting Drug Users From Northeast India: A Multi-Centric, Cross-Sectional, Comparative Study

Substance Use & Misuse ◽

10.3109/10826084.2015.1013130 ◽

2015 ◽

Vol 50 (10) ◽

pp. 1332-1340 ◽

Cited By ~ 2

Author(s):

Atul Ambekar ◽

Ravindra Rao ◽

Alok Agrawal ◽

Shrigopal Goyal ◽

Ashwani Mishra ◽

...

Keyword(s):

Drug Use ◽

Comparative Study ◽

Drug Users ◽

Injecting Drug Users ◽

Northeast India ◽

Cross Sectional

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Socio-Demographic Correlates of Injection Drug Use Among Male Drug Users: A Cross Sectional Study in Nepal

Journal of Community Health ◽

10.1007/s10900-014-9867-1 ◽

2014 ◽

Vol 39 (6) ◽

pp. 1124-1132 ◽

Cited By ~ 1

Author(s):

Sanjeev Raj Neupane ◽

Shiva Raj Mishra ◽

Samaj Adhikari ◽

Amod Kumar Poudyal

Keyword(s):

Drug Use ◽

Injection Drug Use ◽

Drug Users ◽

Cross Sectional Study ◽

Injection Drug ◽

Sectional Study ◽

Cross Sectional ◽

Demographic Correlates

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High HIV Prevalence in a Respondent-Driven Sampling Survey of Injection Drug Users in Tehran, Iran

AIDS and Behavior ◽

10.1007/s10461-014-0904-y ◽

2014 ◽

Vol 19 (3) ◽

pp. 440-449 ◽

Cited By ~ 10

Author(s):

Mohsen Malekinejad ◽

Minoo Mohraz ◽

Nooshin Razani ◽

Gholamreza Akbari ◽

Willi McFarland ◽

...

Keyword(s):

Injection Drug Users ◽

Drug Users ◽

Hiv Prevalence ◽

Injection Drug ◽

Respondent Driven Sampling ◽

Sampling Survey

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Theorising stigma and the experiences of injecting drug users in Australia

Australian Journal of Primary Health ◽

10.1071/py09026 ◽

2010 ◽

Vol 16 (2) ◽

pp. 119 ◽

Cited By ~ 27

Author(s):

Christine Tindal ◽

Kay Cook ◽

Nena Foster

Keyword(s):

Health Status ◽

Drug Use ◽

Drug Users ◽

Injecting Drug Users ◽

Social Determinant ◽

Injecting Drug Use ◽

Poor Health ◽

Poor Health Status ◽

Policy And Practice ◽

The Poor

This paper examines the stigma of injecting drug use as an underlying factor in the poor health status of Australian injecting drug users. Drawing on various models of stigma described in the literature, we examine injecting drug users’ experiences. As a case study, examples from Victorian (specifically Melbourne) policy and practice are included to exemplify community and societal attitudes towards injecting drug users and the implications of these for injecting drug user health. We conclude that redressing the negative effects of stigma requires political will, financial support, increased community commitment and a better understanding of the links between the social determinant of health and the poor health status of injecting drug users. Without reducing the stigma of injecting drug use the health of this marginalised population is likely to get worse, which will have broader negative population health effects.

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