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. lthough bearing the brunt of the AIDS epidemic, Africa has long been considered largely free of injection drug use. Notwithstanding the assessments of the UN International Drug Control Programme 1, international organisations have been slow to recognise either the spread of heroin use in Kenya or the existence of injection drug use. The largely unheeded spread of injection drug use in East Africa has wide implications for public health in the region. Injection drug users (IDU) are a 'high risk' or 'core group' for HIV infection. Many IDU share needles and syringes as well as having unprotected sex, and have been identified as a 'bridging population', speeding the spread of HIV to the general population [and .
Heroin injection now appears to be occurring in most large towns of Kenya and Tanzania. A study of 336 heroin users in Nairobi, Kenya found that 44.9% were, or had been, injectors Of 101 current injectors, 52.5% were HIV positive.
This compares with a 13.5% prevalence rate among heroin users who had never injected. Hepatitis C prevalence also varied dramatically, from 61.4% among current injectors to 3.8% for those who had never injected. A similar study for Mombasa, Kenya's second city and main port, has been planned, but at the time of writing (November 2003) is yet to be carried out. However the UNODC and WHO are carrying out research in 2003 to establish links between HIV and drugs, with a focus on injecting, at the Kenya Coast.
Recent assessments in neighbouring Tanzania have found heroin injecting to be spreading throughout the country. Hence, a rapid situation assessment carried out in five Tanzanian towns found heroin to be a major concern in Arusha, Dar es Salaam and Zanzibar, to be emerging as problem in Mwanza, but not in Mbeya. Injection drug use was reported in all the study sites where heroin was in use. Similarly, a study of 624 young multi-drug (alcohol, cannabis, tobacco, heroin, Valium, khat) users in Dar es Salaam found that 75% of the sample were using heroin, and that 114 (18.3%) of the sample reported injecting drugs As many of the substances used by the 624 people interviewed are not usually injected, the percentage of heroin users injecting in Dar es Salaam will be considerably higher than is indicated by these data which are not disaggregated by substance.
Much less is known about injecting drug use in Uganda. Indeed, the UNODC covering Eastern and Southern Africa reports that there have been no drug assessments carried out in Uganda.