Anthropological report KE Kiambu

Background 

In 2020, approximately 284 million people worldwide used drugs, and around 60 million of them used opioids. The increasing availability of drugs such as heroin, cocaine, and methamphetamine, particularly in urban areas, compounds the burden of drug use in Africa. In Kenya, it was estimated that 26,673 people used opioids in 2021, with 3,312 of them in Kiambu County. The MSF Kiambu People Who Use Drugs (PWUD) project started in September 2019 in partnership with the Ministry of Health at the Karuri Level 4 hospital. By the end of April 2022, 590 PWUD had enrolled in the medically assisted therapy (MAT) program, with a retention rate of 69.8 percent. This study was launched to gain insight into PWUD's perceptions and experiences regarding their daily lives and drug use behaviours, as well as the challenges they face in engaging in the MAT program. 

Methods 

This qualitative research study involved in-depth individual interviews (39), paired interviews (7), and group interviews (15). Purposive and convenience sampling methods were applied, and participants were selected by PWUD peer educators and LVCT members. All interviews were audio recorded and transcribed verbatim. The transcriptions were manually coded and further coded using NVivo 11 and analysed using qualitative content analysis. Methodological triangulation was applied to enhance interpretation. The study was approved by the MSF Ethics Review Board (ERB) and the Kenya Medical Research Institute's (KEMRI's) Scientific and Ethics Review Unit (SERU) in Nairobi. 

Results 

The study found several challenges for PWUD to enrol and remain in the MAT program. Quitting heroin requires personal motivation and 'exit strategies' from the hotspots and dens that PWUD's lives revolve around. Respondents reported the motivation to manage withdrawal with MAT, as expressed by one female participant in a focus group: 'I can change and transform my life’. However, replacing heroin with MAT, or 'the medicine’, was not sufficient to ensure meaningful recovery. Coping with a change in lifestyle and behavioural patterns and the need to develop new perspectives on how to deal with "idleness" were identified as barriers. Structural challenges ranged from accessing the program daily to maintaining a job or finding occupational opportunities. 

Conclusion 

The study revealed the complex realities PWUD are confronted with when trying to stop using heroin. MAT is necessary but insufficient without addressing the mental, social, economic, and behavioural conditions that contribute to opiate dependency MAT programs need to be comprehensive and address medical, psychosocial and structural factors, supporting people as they re-build their lives and restore their broken social conditions through occupation and employment.