The document discusses findings from a study on access to HIV care and treatment among people who inject drugs (PWID) in Kenya, noting that 118 PWID participated in the study, with 44 reporting living with HIV. It describes challenges PWID face in managing addiction while adhering to HIV treatment, as well as stigma surrounding HIV status. The document advocates for expanding harm reduction programs like needle exchange and opioid substitution treatment to improve HIV outcomes for PWID.

1. Supporting community action on HIV & AIDs and TB
Access to care for HIV
infected PWID- what can
be done?
James Ndimbii
KANCO
CAHR/Access2Care Study

2. Supporting community action on HIV & AIDs and TB
Increasing Numbers of drug users in sub-Saharan Africa
including Kenya
Overlap of drug use and generalized HIV epidemic in the
region
High HIV Incidence among PWID
Introduction of harm reduction in Kenya (2012)
Introduction &
background

3. Supporting community action on HIV & AIDs and TB
 Three sites – Malindi (Omari Project), Ukunda
(Teenswatch), Nairobi (NOSET)
 Qualitative: In-depth interviews with PWID,
observation, stakeholder interviews
 Longitudinal: 3 waves of data collection
 Purposive and Theoretical sampling
Methods

4. Supporting community action on HIV & AIDs and TB
118 PWID
33 women (29%)
85 men (71%)
44 PWID reported living with HIV
16 women
28 men
109 reported testing for HIV, 4 had never tested, 5 didn’t report whether
or not they had tested.
Findings

5. Supporting community action on HIV & AIDs and TB
Managing addiction and HIV care and treatment
•Requires a commitment-time and money-competing with
addiction and everyday survival
‘Sometimes I go to the doctors, they give me medicine, but I
have to go to [nearby town], sometimes I don’t have fees to
go there.’(Alfred)
‘I queue…It is hard. If I have not recovered [managed
withdrawal], it will mean I line up till one or two [pm]’. (Baba)
ART Delivery at outreach project level addresses this to a large
extent

6. Supporting community action on HIV & AIDs and TB
There is still a secrecy around HIV-people unwilling to
talk about it-social stigma
‘I have many challenges, since I was sick, the challenge is not about my
sickness, about the people, because some people they know that I am HIV
positive, they tell me ‘Ahhh you, you are going to die, you have HIV’.
(Ismail)

7. Supporting community action on HIV & AIDs and TB
HIV Positive PWID still likely to share injecting
equipment-linked to hopelessness around being HIV
infected:
‘R And when you tell them they say we are already dead
I: Right how do you mean?
R Yaani, they tell you they are already dead because they have already get
HIV…so they use one needle for three people. (Abraham)

8. Supporting community action on HIV & AIDs and TB
Supporting outreach projects in delivery of ART at drop
in centres makes it easier to access HIV care and
treatment-better adherence outcomes
Support for scale up of MAT- improves HIV treatment
and care outcomes- higher coverage= more infections
prevented
Sustained support for NSP programs even in the advent
of MAT-supportive and wholesome interventions
How do we respond?

9. Projected impact of opioid substitution treatment (OST) on HIV prevalence and incidence at varied
coverage levels.
Tim Rhodes et al. BMJ Open 2015;5:e007198
©2015 by British Medical Journal Publishing Group

10. Supporting community action on HIV & AIDs and TB
10
The case of Russia—Rhodes et al, British Medical Journal, 2010: 349; c3439
Impacts of policy changeImpacts of policy change
0%
25%
50%
75%
100%
10%coverage NSP 10%NSP and10%
OSTcoverage
10%NSP and25%
OSTcoverage
10%NSP and50%
OSTcoverage
JustNSP NSP andOST
RelativereductioninHIVincidenceafter5years
OSTinterventionparameters
0%
25%
50%
75%
100%
10%coverage NSP 10%NSP and 10%
OST coverage
10%NSP and 25%
OST coverage
10%NSP and 50%
OST coverage
JustNSP NSP and OST
RelativereductioninHIVprevalenceafter5years
OSTand NSPinterventionparameters

11. Supporting community action on HIV & AIDs and TB
NOSET: Calleb Angira, Abbas Said Abdulaziz, Hussein Rama
Owino, NoSET
The Omari Project: Mohammed Shosi, Athman Mohammed
Famau, Alphonce Maina Thuo, Ali Omar Haji.
Teenswatch: Cosmas Maina, Athuman Bundo, Tabitha Waithera.
KANCO Sylvia Ayon, James Ndimbii
London School of Hygiene and Tropical Medicine Tim Rhodes
Andy Guise
With NASCOP and NACC
The Access to Care Study