Rising drug, alcohol abuse threatens HIV/AIDS gains

Kenya recorded a drop in HIV prevalence from 6.1 percent in 2005 to 5.9 in 2006 but rising substance abuse could reverse advances made in the fight against HIV/AIDS if left unchecked, the National Agency for the Campaign Against Drug Abuse (NACADA) has warned.

Sexual transmission is the most common way the virus is spread, but NACADA national coordinator Jennifer Kimani said needle sharing by injecting drug users also contributed to the epidemic, while alcohol abuse led people to make risky sexual choices. "People lose their inhibitions when they use drugs and alcohol, they lose their sense of responsibility and that fear of HIV/AIDS that one usually has."

A study of 1,420 active and former drug abusers in several districts by the United Nations Office on Drugs and Crime in 2004 found that some intravenous drug users who knew they were HIV-positive continued to share needles and have unprotected sex despite being aware of the risk that they could infect others.

The study estimated that between 68 percent and 88 percent of all intravenous drug users in the country were HIV-positive, but only a minority used condoms every time they had sex, despite the fact that many had multiple sexual partners.

Government officials have also expressed concern over the role of alcohol in the spread of HIV across the country, particularly among the youth.

Dorothy Asunda, 23, (not her real name), a university student in the Kenyan capital, Nairobi, has had several sexual partners in the past two years and has not used condoms regularly. "I know all the risks; I know all about AIDS but, somehow, when you've had a few drinks, it doesn't seem so important. A condom is the last thing on my mind at that time." She said she was too afraid to go for an HIV test.

According to Sarah Macoun, executive director of the Nairobi Place Addiction Treatment Center, patients often said they had engaged in unprotected sex while under the influence of drugs or alcohol. "It is very common for patients, once they are clean, to ask for an HIV test, aware that they put themselves at risk when they were on drugs or drinking."

NACADA's Kimani said it was difficult to pinpoint the exact cause of increased drug and alcohol abuse, but there was little awareness of the consequences of drug use among the population.

Kenyan parents found it difficult to discuss alcohol, drugs and sex with their children for cultural reasons, which contributed to the growth of the problem. "People don't realise their children are into drugs until it is too late, and the few rehabilitation facilities we have are private and really expensive - out of reach of most families," she said.

Some nongovernmental organisations (NGOs) offer drug rehabilitation, and the National AIDS Control Council (NACC) is carrying out a mapping exercise to locate problem areas that require special attention. "We are discussing possible interventions, including the possibility of introducing a needle exchange programme," said Peter Mutie, head of communications. "However, since drugs are illegal in Kenya, we have to discuss all the implications of this with the authorities first."

Kimani was also uncertain about the idea of a needle exchange, as it had the potential of merely expanding the injected drug problem, and was in favour of a "holistic" approach to the drug crisis.

"We need to have the ministry of education, which is responsible for a child's learning, as well as the health ministry, which is responsible for their physical wellbeing, as well as bodies like ours, the Ministry of Youth Affairs and religious organisations, all working together," she said. "What we have in Kenya is all the stakeholders working, but working separately - drug control has to be done in collaboration with HIV prevention."

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