"The Needle's Edge: How Drug Abuse Imperils Kenya's Fight Against HIV/AIDS"

On a fateful day in Nairobi, February 26, 2025, Nacada officials showcased an array of confiscated Shisha pipes from a club on Langata Road. This scene is emblematic of a larger, graver issue plaguing Kenya. Abdullahi Noor, a harm reduction advocate, carries a haunting narrative that epitomizes the deadly intersection of drug abuse and HIV/AIDS. His recollection of two brothers, ensnared by addiction, reveals the tragic consequences of shared needles. The elder, secretly HIV-positive, watched helplessly as his younger brother, in a desperate quest for a high, demanded to use his contaminated needle. Despite the elder's warnings, the younger brother's insistence turned violent, culminating in a fatal injection that sealed both their fates. The younger succumbed to AIDS-related complications in 2020 at 25, followed by his guilt-ridden elder brother a year later at 38.

Noor, who founded Ngaza Mwangaza Global, a rehabilitation center, met the brothers during his own recovery journey. Their story, he asserts, is a microcosm of a national crisis. Drug abuse is undermining Kenya's efforts to eradicate new HIV infections and AIDS deaths by 2030. Alarmingly, two in every ten people who inject drugs in Kenya test HIV positive. According to Nacada, 4.7 million Kenyans, or one in every six individuals aged 15 to 65, abuse drugs, with men disproportionately affected. The Coast region, notorious for heroin use and needle sharing, records the highest rates of multiple drug use at 10.5%, closely trailed by Nairobi and Central regions.

Cannabis use has surged by 90% over the past five years, with Nairobi, Nyanza, and Coast leading in prevalence. The misuse of prescription drugs and polydrug use is also on the rise, with one in every 15 Kenyans engaging in the latter, particularly in the Coast region. These trends exacerbate public health challenges, amplifying HIV transmission among drug users and threatening Kenya's 2030 goal.

Currently, 1,378,457 Kenyans live with HIV, with key populations like people who inject drugs facing heightened infection risks. In 2011, these groups accounted for nearly a third of new infections. Nairobi tops the list of HIV cases linked to drug use, followed by Kilifi, Mombasa, Lamu, and Kwale. Inland counties like Uasin Gishu and Nakuru are witnessing rising drug use and related HIV cases, a trend linked to enhanced connectivity via the Standard Gauge Railway.

Douglas Bosire, acting CEO of the National Syndemic Diseases Control Council (NSDCC), emphasizes the need to "close the tap" of new infections. The NSDCC's needle and syringe program, part of a harm reduction strategy, aims to curb HIV transmission by providing clean injecting equipment. This initiative, in collaboration with NACADA and other agencies, has reduced the proportion of new infections among drug users from 33% in 2011 to 13% in 2022.

Despite progress, reintegration challenges and stigma persist for those in rehabilitation. NSDCC and NACADA are working with local leaders to foster community acceptance. The harm reduction program, active in coastal counties, also includes methadone therapy to aid recovery. Taib Abdulrahman, founder of Reach Out Center, attributes the Coastal region's drug issues to trafficking via the Indian Ocean and porous borders. The average age of drug users has plummeted to 15, cutting across socio-economic lines.

Wangai Gachoka of Miritini Rehabilitation Centre highlights the program's comprehensive approach, offering clean syringes, methadone, and condoms to curb HIV and other infections. The center supports 359 individuals daily on methadone, providing holistic care including ART, PrEP, and treatment for various diseases. Gachoka warns of the growing menace of miraa and muguka, stimulants that are cheap, legal, and accessible, often combined with prescription depressants from unethical pharmacies.

Brian Mtwapa, a 46-year-old recovering addict, embodies the struggle and hope of those battling addiction. His journey began at age 10, working for traffickers, and led to severe health consequences, including Hepatitis B from shared needles. Now in rehabilitation, Brian is determined to educate others on the perils of drug abuse.

Prof. Omu Anzala, a virologist, underscores the risks of reusing needles, which are single-use and plastic, posing a direct threat of HIV and Hepatitis transmission. Hospitals are urged to incinerate waste to prevent syringe scavenging by drug users. Anzala laments the sight of young men injecting on the streets, perpetuating the cycle of infection.

The narrative of drug abuse in Kenya is a complex tapestry of personal tragedy, public health challenges, and systemic issues. As the nation strives to meet its 2030 goals, the stories of individuals like Noor, Brian, and countless others serve as poignant reminders of the urgent need for comprehensive solutions.