A case for the needle exchange program



Kennedy Nganga has survived two near death experiences. All self-inflicted. The latest one, three months ago on his 41st birthday. He never sets out to kill himself, but a series of unfortunate events have made sure to land him in the emergency rooms of private hospitals for resuscitation and a subsequent stab at life.

“I have tried to get clean. I have been to different centres, to church…taken sabbaticals in the country side… none of this has worked,” he says.

The rumour among his friends is that he once used to work for one of the major cement companies in the country in a management position.

“We used to meet up on Fridays and hang out. He would have tales of meetings in almost all the major capitals of the world. He had a wife but no child. But he got in too deep and started missing work. Eventually he was sacked,” Steve Maingi, Nganga’s friend for more than two decades told the Standard on Sunday.

“The drugs messed him up. He can’t stay clean for more than a day. As his friends we have even tried to lock him up just to get the drugs out of his system,” Maingi says.

The latest Kenya AIDS Response report survey estimates that up to 18 per cent of people who inject drugs (PWID) in Kenya are living with HIV. According to the report, an estimated at 18,327 people, largely concentrated in Nairobi and Mombasa are living with the virus contracted from needle use. On a normal day, Nganga can be found walking along Nairobi’s Kirinyaga Road with an old but neatly folded 16 page double ruled exercise book. On the books cover are the words ‘Medical Appeal’ written in a neat handwriting with a blue felt pen.

Whenever he sees a new face seated outside the numerous tyre shops along the road he approaches.

“Tafadhali, nipe dakika moja tu nikujulishe yaliyo nipata. Nina mtoto kidato cha kwanza na jana nimepigiwa simu na mwalimu mkuu akiniambia kuwa nisipo maliza kulipa karo, mwanangu atafukuzwa shule. Ninakusihi, kama unaweza kunipa chochote hata ikiwa shilingi kumi, utakua umenisaidia sana kumweka mwanangu shuleni.”

He then opens a page in the book on which random names are written on together with coinciding sums from well-wishers. He is well dressed with a navy blue dust coats with the name of one of the many tyre sellers on that street. He would pass for one of the many attendants. His daily target is Sh500, enough to cater for his daily rent and a fix of a cheap cocktail of injectable drugs.

For many years, it seemed Kenya was winning the war on new HIV infections, the prevention of mother- to- child transmission through various methods. Public awareness campaigns took credit for most of this win particularly on transmission through sex.

There were other battle fronts though like intravenous drug usage. Battlefronts that if left undefended could cause runaway infection rates.

At the end of the day, which to Nganga, is when the days target is achieved, he neatly folds his dust coat, put it in a yellow PIL paper bag and heads off disappearing into the maze of human beings, and cars all covered by brownish smog. His destination is a lodging on Accra Street where he pays his daily lodging fees of Sh300. With the rest he walks down towards Voi Road where an old storied building stands unsuspiciously Coast Bus offices. The building may pass for any other exhibition mall in town but within it lies a haven for shooters and peddlers.

The urban legend in the area is that people walk into the building and walk out even a week later.

“It all depends on how much you have on you,” Maingi, Nganga’s friend says. “This place just eats you up.”

The ground floor of the building is lined with different shops. Mobile money transfer shops, movie shops, mobile repair shops and a few stalls selling clothes. The first floor has fewer stalls with much more open space. It is here that men and women are huddled in groups of three or four. At first glance they would pass for individuals just taking a break from a hard day.

But after a few minutes one notices their incoherent conversations, shrieks and their blank stares. Others hunch too far forward and eventually tumble over. Sleeves rolled up. Ties, belts, shoe laces tying off upper arms as if preventing snake poison from moving from imaginary bites on the lower arms. Trouser legs are folded thigh high. The conversation is silence. Each to their own demons.

Nganga finds a spot against a pillar at the back of the room. As he settles down, a light skinned man in a brown hood walks up to him and hands him a sachet of a brownish powder. Nganga hands him a Sh200 note. The man walks over to a group of four, three men and a woman, and returns with a stained spoon and a used syringe.

The recently launched report says that about 3.8% of new HIV infections occur among PWIDs.

Statistics from NSCOP show that other HIV prevention measures among this group are also low with only 28.9 per cent of them adhering to condom use, while 51.6 per cent use safe injecting practice such as the needle exchange programme.

Nganga pours the contents of the sachet onto the spoon and with a hand held lighter puts on a little flame under the spoon. The contents melt and after a few seconds he draws the liquid into the syringe. His grabs a strip of rope next to him and ties of his left arm just above the elbow. He sees a vein pop up and pushes in the needle at an angle. Draws some blood then gently pushes the content back in. Slowly. A lady a couple of metres away stares lustfully. She is next in line for the syringe and as the drugs take control of Nganga, she slowly walks towards us and with the gentlest of touches undoes the thin rope from Nganga’s arm, unlatches the syringe, finds a place to lean on and goes through the motions.

In early 2008, the country initiated a programme to prevent HIV infections among the PWIDs mainly in Nairobi and Coast regions. Through this programme, about 271,941 needles and syringes were distributed over the last 12 months reaching about 2,000 users, which translates to about 135 needles and syringes per person per year.

This programme, according to government statistics, reaches only about 15 per cent of the total estimated number of PWIDs. 85 per cent remain unreached by this potentially lifesaving intervention in a vulnerable group that has an HIV prevalence rate of 18 per cent in comparison to the country’s 5.6 per cent. Nganga says he has heard of the needles exchange programme form some friends.

“But I do not know where to get them,” he says. “I once walked into a city council hospital to ask for a needle and syringe. They chased me away.”

In all his years of IDU, 18, he has never been tested for HIV or any other condition such as Hepatitis.

“I don’t have a reason for not testing. And I don’t have a reason for testing. I just want to be left alone,” he says and walks away.

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