Significant steps have been made in harm reduction-what remains?

//Significant steps have been made in harm reduction-what remains?

In 2009, the government acknowledged people who inject drugs as most at risk populations. Based on the findings of the Mode of Transmission study in 2009, the findings indicated that people who inject drugs account for 3.8% of new HIV infections. The prevalence of HIV infection among this population is estimated to be at 18% according to the Kenya AIDS Response report 2014.

In response to this, the government in collaboration with civil society and development partners drafted guidelines for implementation of harm reduction programs in the country. These were adopted by the government through the ministry of health, considering that implementation of harm reduction in the country is based on public health.

In 2011, KANCO, in partnership with the ministry of health rolled out the first pilot needle and syringe program in Kenya. The initial focus of the program was Nairobi and coast regions, where data indicated had the biggest populations of people who inject drugs. This has since expanded to include Nyanza and central regions as a response to evidence pointing towards expanding PWID presence. Needle and syringe programs work towards reduction of risk of HIV infection by ensuring that people who inject drugs have access to clean injecting equipment and thereby reducing the potential of sharing used equipment.

Methadone piloting has also recently been rolled out in Kenya. Methadone is one of the medically assisted treatments available for managing opiate addiction. The program has been ongoing since late 2014, and has so far been rolled out in Nairobi, Mombasa and Malindi. There are plans to expand to Kwale and Nyanza.

Needle and syringe programs and methadone are considered among the most important interventions among the 9 recommended set of interventions for responding to drug use. These have been implemented alongside other HIV response interventions that have been contextualized to respond to the needs of people who inject drugs. Currently, both active and recovering PWID have access to a range of HIV prevention services including HIV testing and counseling, condom provision and Antiretroviral therapy.

Those still using heroin get their services predominantly from outreach projects- which are based in areas accessible to people using drugs. KANCO so far works directly with seven harm reduction partners in Nairobi, coast, Nyanza and central, and runs a drop in center that provides services specific to PWID in Ukunda, and another one for key populations in Mariakani.

Significant milestones have been made in response to reducing the negative health and social consequences of drug use among people who use drugs in Kenya. While acknowledging these, there are some areas that still need to be looked into to ensure that current responses can have lasting impacts. Among the key issue mentioned by people who use drugs, those who are still using heroin and those on methadone, is the limited space for economic opportunities, coupled with idleness and lack of spaces to engage. Supporting access to economic opportunities, be it through linkage to employment opportunities or support for income generating activities  would significantly support the outcomes of harm reduction interventions. In addition law enforcers  still need more sensitization on the principles  of harm reduction  to be more supportive in the process

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