In-depth: Deadly cocktail: HIV and drug use

KENYA: The rise and fall of injecting drug use in Malindi

Licking drugs is not easy
malindi, 23 November 2007 (IRIN) - Hard drugs first came to Kenya's beautiful tropical coast almost 30 years ago; men in their fifties in the resort town of Malindi can still recall the first few people trying 'brown sugar' after befriending European tourists.

"I remember one young Italian, the son of one of Italy's richest families, when we chased the dragon together, he told me that if he, with all his money, could not quit the drug, then what hope did I have, who had no money," said Abdul Guran*, now in his 50s and seeking treatment for his heroin addiction.

Heroin and marijuana have always been the main drugs of choice in Malindi. Brown sugar was consumed by inhalation, a process known as "chasing the dragon".

Initially, heroin was brought to Malindi to meet the needs of European tourists and businessmen but, as the locals tell it, the dealers soon realised the Kenyan coast was a legitimate market on its own.

Heroin would also occasionally flood the coast when drugs being smuggled through Kenya were confiscated and found their way from police custody onto the streets, but crackdowns are more serious today and a special military police unit is dispatched to transport drugs to the capital, Nairobi.

Brown sugar lost its popularity in the late 1990s with the arrival of "white crest", a crystalline form of heroin that can be smoked or injected. By 2000, white crest had a firm grip on the town, and many users were regularly shooting up.

Malindi district has a population of over 500,000, but the urban population, which is most affected by drug abuse, is closer to 117,000. Some unofficial estimates say between 600 and 1,000 people in and around the towns of Malindi, Watamu and Gede are still using heroin.

The area depends largely on tourism for its income, but most residents are poor and unemployment is one of the main reasons addicts give for starting their habit.

"I started injecting white crest when it first came ... this goes straight to your head," said a young man nicknamed 'Sumu Tamu', Kiswahili for 'sweet poison', in Malindi's urban slum of Kisumu Ndogo.

He allows a friend, a fellow drug user known in the area as 'the doctor', to do it for him; within seconds of injecting the drug, his eyes rolled back in his head. 'The doctor' flushed the syringe several times with Sumu Tamu's blood to get all the white crest from it.

"Now I feel like a millionaire," said Sumu Tamu. "Like I have no problems, no worries ... I could stay like this forever." Looking around his squalid surroundings, it's almost understandable that he should want to escape from the seeming hopelessness of his life.

"The situation here was very serious - so many of Malindi's youth were injecting this drug," said Shosi Mohammed, coordinator of a rehabilitation centre in Malindi, known as The Omari Project (TOP). "People used the needles repeatedly and shared them; they left them in the streets where children often stepped on them."

The HIV threat and the decline of IDU

TOP was started in 2000 with the express aim of rehabilitating heroin addicts and raising awareness about the link between HIV and injecting drug use - the most efficient way of transmitting the virus, even more so than sex - because addicts can act as a 'bridge', spreading the virus in the general population.

"Many of our friends began to die and we didn't know why," said Ali Mohammed*, who has used heroin for 18 years and recently discovered he was HIV-positive. "We later discovered that they had died of AIDS."

Once TOP began to visit the local drug dens and inform users about the dangers of HIV, the tide started turning. The stigma and fear associated with HIV has always been very high in Malindi, and while drug users might be prepared to put up with being stigmatised for their drug abuse, when it came to HIV they were too afraid.

"By 2004, most IDUs had switched to smoking the cocktail [a mix of heroin, marijuana and tobacco] again," Mohammed said. "The fear of HIV was, and remains really great."

At a voluntary counselling and testing (VCT) centre in Malindi town, counsellor Michael Nyamai said over the past year the centre had been piloting a drug and alcohol screening test as part of the HIV counselling and testing process, with the assistance of the Liverpool VCT, Care and Treatment centre, which is academically linked to the Liverpool School of Tropical Medicine in the UK.

"We can tell that not many people now inject drugs - maybe about two or three a month will admit it, out of more than 100 clients we get every month," he said.

Nyamai grew up on the drug-ridden streets of Kisumu Ndogo and worked for TOP for several years before becoming a counsellor. He said many of the friends he grew up with, although they were still addicts, rarely injected the drug anymore.

The few addicts who feel they cannot live without the injection have been informed about the risks of sharing needles. "In the old days people used injections so often that they'd get tetanus," Mohammed said. "Initially, chemists in Malindi would not sell needles to drug users, but we have told them that they are doing more harm than good, so now they agree."

TOP has also emphasised the need for disposing of syringes safely, and most users now throw them in the garbage rather than on the streets. But the battle is far from won. "An addict is still an addict, and if he or she is desperate, they will do whatever is available, be it injecting, smoking or pills," said Mohammed. "We must continue to try and root out the drug culture completely."

Sumu Tamu rinsed his needle with a little water after he'd shot up and put it away for his next fix. He said he would not share it, but had done so in the past.

In the meantime, TOP continues to trawl the streets with their message about the dangers of drug use and the threat of HIV, hoping to save a younger generation from becoming trapped in the same cycle of substance abuse.

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