Introduction

Recent scientific evidence has singled out alcohol and drug abuse as one of the major drivers of the HIV/AIDS epidemic in Kenya and the world over. This is due to the fact that alcohol and drug abuse makes the individual lose self-control and the ability to make sound life decisions, which may drive him/her into risky sexual and other behaviour that promote HIV infection. As such, people who abuse alcohol and other drugs are more likely than the general population to contract HIV. Similarly, people living with HIV are likely to abuse alcohol and other drugs due to the denial, stigma and stressful conditions they find themselves in.

Alcohol and drug abuse in Kenya

Generally drug abuse is the non-medical use of drugs (alcohol, cigarettes and other chemical substance) that destroy health and reproductive life of an individual. According to World Drugs Report 2008, heroin is consumed by 0.3-0.5% of the Kenyan population, cannabis by 4%, miraa by 11% and cocaine by 0.1-0.5% of the population. A United Nations Office on Drugs and Crime (UNODC) study in April 2007 mapped over 12,000 heroin users and 103 drug dens in Nairobi and Coast Province. More worrisome statistics came from a NACADA Authority survey of 2007 that showed about 40% of Kenyans aged between 15 and 65 years have drank one type of alcohol or another, and that at least 13% of people from all provinces in Kenya except North Eastern are current consumers of alcohol. Worst hit are the youth, the 2007 study found that alcohol is abused by 77% of youths out of school and 28% of youths in school. It also established alcohol, tobacco and bhang as being the most easily known substances by over 50% of 15-65 year-olds. This drug culture and lifestyle fuels the HIV infection rates.

So, how does alcohol and drug abuse drive the HIV epidemic? Two major ways – through risky sexual behaviour after intoxication and sharing of contaminated drug injecting equipment.

Alcohol and HIV infection

Heavy alcohol use is associated with high-risk sexual behaviour - multiple sex partners, unprotected intercourse, sex with high-risk partners, and exchange of sex for money or drugs. Studies consistently demonstrate that people who believe that alcohol enhances sexual arousal and performance are more likely to practice risky sex when drunk. Among the youth, alcohol abuse is sometimes deliberately meant to provide an excuse for socially unacceptable behavior or to reduce conscious awareness of risk. Some youths in Kenya jam bars drinking themselves crazy to get courage to “tune” or make sexual advances they ordinarily would not if they were sober. Heavy drinking and HIV/AIDS has also been blamed for increased medical and psychiatric complications, delays in seeking treatment and reduced HIV medication compliance. Recent research has found that HIV patients on antiviral therapy and are currently drinking have greater HIV progression than those who do not drink since alcohol abuse compromises the immunity function. As such, preventing alcohol abuse among the youth is particularly important since HIV/AIDS is a leading cause of death among 15 to 24 year olds in Kenya.

Injecting drug use and HIV infection

The link between injecting drug use and HIV infection is clearly established. Injecting drug use refers to intravenous self-administration of drugs, especially heroin. Injecting drug users (IDUs) are at greater risk of HIV infection since they occasionally share injecting equipment at the spar of the moment owing to strong craving and also due to lack of new clean ones that cost money.

In December 2008, NACADA Authority learnt firsthand from IDUs in Mombasa of the “blood flashing” phenomenon. This involves retrieving blood from an IDU who has just injected heroin and injecting the blood in the vein of a second IDU. Apart from directly transmitting HIV, flashing exposes the user to hepatitis infection and death due to instant agglutination from incompatible blood. Blood flashing and sharing of needles make injecting drug use “the most efficient way of transmitting HIV.” In fact, a UNODC study in 2004 found high prevalence of HIV among IDUs in Nairobi and Mombasa - between 68% and 88%.

Interventions to reduce impact of drug abuse and HIV infection

Outreach activities involving education and care provision for alcohol and drug users help in mitigating the impact of drug abuse and HIV. NACADA Authority in its preventive education and public awareness campaigns targets to enlighten the public about the link between drug abuse and HIV/AIDS. Some of the IEC materials produced by the Authority specifically address this link with a view to empowering Kenyans to make informed decisions in regard to alcohol and drug abuse as well as their HIV/AIDS risk. This is supported by the life skills campaign conducted through youth and faith-based initiatives for behaviour and attitude change.

Another intervention is improving access to preventive education and commodities such as condoms, provision of VCT services, and availing anti-retroviral therapy. These services target most-at-risk populations such as alcohol and drug dependent persons. The UNODC is already running a project that refers IDUs for addiction treatment and HIV care. Statistics from their regional office in Nairobi show that by September 2008, over 24,000 heroin users had benefited from both drug treatment and HIV care services.

Conclusion

It is imperative that the Kenyan society appreciates the gravity of alcohol and drug abuse and the impact it has on all spheres of life. This way, efforts aimed at implementing interventions against alcohol and drug abuse as well as HIV/AIDS may receive community and national support. On the other hand, healthcare providers are encouraged to constantly screen their HIV/AIDS/STIs patients for alcohol and drug abuse and that patients being treated for chemical dependence are screened for HIV/AIDS.