Assessment of risk behaviour and HIV prevalence among people who inject drugs in Nairobi county, Kenya
Oguya, Francis Ochieng’
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Kenya is experiencing a mixed HIV epidemic with characteristics of both „generalised‟ epidemic among the mainstream population, and a „concentrated‟ epidemic among specific Most at Risk Populations including Injecting Drug Users (IDUs). The KNASP 2009-2013 recognizes that this group has a high potential to transmit HIV and present a lot of challenges for effective intervention because of overall lack of data on how to access them, their numbers and distribution. The objectives of the study were to document Injecting Drug Use Practices, assess the behaviours that predispose IDUs to risk of HIV infection, estimate the HIV prevalence among IDUs and determine the services available for HIV and AIDS prevention, care and treatment among IDUs in Nairobi county. Using a cross-sectional survey design on IDUs who had been injecting drugs for the last twelve months in Nairobi. The study used Respondent Driven Sampling methodology for its proven effectiveness in sampling hidden populations. Key Informant Interviews, Focus Group discussions and a structured questionnaire were used for data collection. The study was approved by the KNH/UoN Ethical Review Board. The study comprised 344 (322 men, 22 women) respondents from the eastern and western regions of Nairobi. Written and verbal informed consent was voluntary provided by all respondents. RDSAT software, MS Access, MS Excel and SAS were used for data management, presentation and statistical analyses. Statistical methodology comprised descriptive statistics, cross tabulations and Multivariate Logistic Regression on HIV status with other predictor variables. Chi squared tests were used to test significance at 0.05. The age range for study respondents were from 17 to 55 years. Although awareness of HIV was universal, their knowledge of HIV transmission and prevention ranged from limited and severely limited. The HIV prevalence for IDUs was determined to be 18.3% with women exhibiting higher prevalence (37%) compared to men (17%). Injecting drug use commenced early from 11 years and the age group exhibiting the highest HIV prevalence ranged between 15-29 years among both genders. Residential location (χ2 =19.2, 2df, p<0.0088) and sex of respondent (χ2 =25.1, 1df, p<0.0001) were found to be highly associated with HIV status. Significant behavioral variables were age at first drug injection (χ2 =11.4, 4df, p<0.04), Reason for starting to inject - a better high (χ2 =5.0, 1df, p<0.02), sharing needles and syringes (χ2 =8.9, 2df, p<0.01), Injecting with HIV positive person (χ2 =18.3, 2df, p<0.0001), Injecting with a female injector (χ2 =5.8, 2df, p<0.04). Significant risky sexual behaviours comprised Unprotected sex with multiple partners (χ2 =9.2, 3df, p<0.03), casual sex with HIV positive partners (χ2 =6.3, 2df, p<0.04) and transactional sex (χ2 =20.6, 6df, p<0.0021). The study found that specialised health and support services for IDUs were minimal or non-existent. HIV prevention, health management and drug treatment services for IDUs do not exist and may be contributory to the high HIV risk being experienced by this group. Due to risky injecting and sexual behaviours, HIV prevalence for IDUs was three times the national average. The findings in this study showed extensive vulnerability of IDUs to HIV infection and identified lack of knowledge and awareness of HIV transmission and prevention; lack of IDU friendly health and drug treatment services, antagonistic national policies and negative societal attitudes were the key associative factors. Based on this, the study recommends urgent, comprehensive and targeted intervention programs comprising of contextualized IEC and BCC interventions on risks associated with drug use; provision of free injecting equipment; national campaign to in school and out of school youths at risk of drug use; provision of free, convenient and IDU friendly medical treatment and drug treatment for IDU; HTC and ART treatment.