Key Populations Newsletter

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1 National AIDS and STI Control Programme (NASCOP) Spearheading the fight against HIV and AIDS in Kenya Special Edition August - December 2015 Issue 8 Key Populations Newsletter Medically Assisted Therapy launched in 3 counties August 19, 2015 marked a great milestone in Kenya s history as the country launched the long awaited Medically Assisted Therapy (MAT) program to help people who inject drugs (PWIDs) reduce or stop injecting, decrease risks to their health, and return to productive lives. The launch was done by Kenya s Ministry of Health in collaboration with the United States Government and partners at Mathari Teaching and Referral Hospital. Speaking during the launch, the Cabinet Secretary for Health Hon. James Macharia said the launch was a great milestone in the health sector. The program is a component of a comprehensive approach to address illicit drug use and is endorsed as best practice by the World Health Organization, he stated. He revealed that this year his ministry, through the domestic HIV financing of Kshs 1.9B, will procure one year s supply of methadone for 1000 clients to supplement the development partner s support. The U.S. Ambassador to Kenya Robert F. Godec, on his part congratulated the Government of Kenya for being the third country in sub-saharan Africa to initiate a MAT program. He commended the government and the Ministry of Health for addressing the needs of Kenyans in fighting HIV and its related health risks. He equally recognized the roles played by the implementing partners and the civil society organizations that support the program. I applaud the Government of Kenya, the Ministry of Health, and the Governors of the participating counties for this historic step. I congratulate you for bringing drug dependency out of the shadows and into the public health arena. It is a challenging step, and I support the decision by Kenya in taking the journey, he stated. Mr Godec also congratulated the over 500 clients who have started the treatment program at Mathari and Malindi clinics. IN THIS ISSUE MAT reaches Malindi page 3 Kilifi County launches MAT page 4 Mombasa County launches MAT page 5 UNAIDS Director visits Kenya page 6 Scribes training on MAT page 6 TWG meeting page 6 MAT program Q & A page 7 Vox pops page 8 Poems page 10 Voices from the field page 11 1

2 Kenya launches treatment to reduce injecting drug use and its health risks You have demonstrated great courage and resolve to reclaim your lives from a long and painful journey of addiction. You represent the hope that awaits many more Kenyans who will choose to undertake this treatment. Hongera. he remarked. The Ambassador pointed out that the MAT program is about allowing people to free themselves from the disease of addiction and to regain productive and fulfilling lives. It is about supporting people as they recover their self-esteem, confidence, and the trust of their friends and family. It is about rebuilding communities and preventing future generations from succumbing to the illness of drug dependency, he said. The Cabinet Secretary commended health staff attached to MAT clinics for their dedication and urged the MAT clients to ensure that they continue with the treatment so as to avoid relapsing. The CS also thanked the media for their role of educating the public on issues of drug abuse and for being advocacy partners in many fronts in matters of health. Services for People Who Inject Drugs So far MAT program has initiated more than 400 injecting heroin users in Nairobi and 145 in Malindi. It is projected that over 9000 drug users will be enrolled on MAT over the next 5 years. MAT services include daily administration of a drug called methadone as part of a comprehensive package to reduce craving for heroin. This daily dose can be taken at an outpatient or day care MAT facilities at Mathari Teaching and Referral Hospital, Coast Provincial General Hospital and Malindi County hospitals. The treatment also helps to address health and social consequences of opioid use. In addition to the administration of methadone, MAT clinics also offers other services which include: HIV testing and counselling, HIV care and treatment, TB screening and treatment, hepatitis B & C screening and treatment, condom demonstration and distribution, and psychosocial counselling and support among others. The programme promotes family reintegration towards the healing of clients. Worrying statistics A significant health concern for PWIDs is HIV infection. The HIV prevalence rate for PWIDs in Kenya ranges from 18%-30% compared to only 5.6% HIV prevalence in the general population. This figure is attributed to high risk of injecting behavior, such as needle sharing and blood flushing, as well as unsafe sexual behaviour and practices among this population. In Kenya, it is estimated that 18,000 people are regular addicts of heroin and other opiates. The use of these drugs present a public health problem that includes risk of premature death infection with HIV, hepatitis B and C, and sexually transmitted infections (STIs). These addicts equally risk: and other physical and mental health problems. With the support from the U.S. President s Emergency Plan for AIDS Relief (PEPFAR), the Ministry of Health through the National AIDS & STI Control Programme (NASCOP) started MAT programme in Nairobi at Mathari Teaching and Referral Hospital in December 2014 and Malindi Sub County Hospital in February Plans are underway to expand the programme to: selected Nairobi County clinics, Kombani Dispensary in Kwale County, and Kisumu County. Scaling up the program According to the NASCOP s Key Populations Programme Manager, Ms Helgar Musyoki, it is anticipated that the MAT programme will be expanded to incorporate the Civil Society Organizations (CSOs), private clinics and hospitals. NASCOP has, in meantime, trained and built the capacity of health workers to dispense the treatment. While affirming on the significance of Medically Assisted Therapy, Ms Musyoki said, We are basically educating drug users to stop injecting themselves with drugs because it is unsafe but instead take safe drugs orally. She further noted that MAT will help drug users avoid stop criminal activities and engage in meaningful lifestyles since their craving for drugs will be controlled. This, she added, will benefit the local community because crime will reduce with the integration of addicts back into the society. The Ministry of Health and the respective County governments have realized that although the treatment for drug addiction is expensive, the exercise is necessary given its positive results. The Ministry has on her part pledge to continue to emphasize demand reduction and rehabilitation of people who are drug dependent to enable them engage in sustainable livelihoods. While the Ministry of Health mandate is limited to health service provision, it recognizes the need to engage various stakeholders within and outside the health sector in order to provide a more holistic approach to addressing the needs and welfare of people who use drugs. Program Partners The program is being implemented in partnership with PEPFAR, the U.S. Centers for Disease Control and Prevention, the U.S. Agency for International Development (USAID), the University of Maryland, the United Nations Office on Drugs and Crime (UNODC), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and civil society organisation s working on harm reduction in the country. These include Nairobi Outreach Services Trust (NOSET), Medecins du Monde - Kenya (MdM) and Support for Addictions Prevention and Treatment in Africa (SAPTA) in Nairobi, the Muslim Education and Welfare Association (MEWA), Reach Out Centre Trust, the Omari Project and Teens Watch in the Coastal counties. 2

3 Updates from NASCOP Methadone Finally Reaches Malindi Care Clinic (CCC) and the MAT clinic are adjacent to each other, thereby likely to fast-track drug users access to HIV/AIDS services. Several MAT Clinic staff have been deployed from the CCC. Thanks to all our partners who have made this dream become a reality. I believe that the services offered at this MAT clinic will compliment other harm reduction interventions targeting people who inject drugs and those who use drugs with an aim of reducing HIV transmission and other blood borne diseases that are currently afflicting this Key Population, said Godfrey Njoroge who further observed that MAT services will play a key role in the spirit of the Beyond Zero campaign being spearheaded by the First Lady. The lead civil society organization implementing Kilifi Governor HE Amason Kingi addressing the guests at the launch of Malindi MAT clinic February 26, 2015 was a historic day for People Who Inject Drugs in Malindi. It was the day Malindi Sub-County Hospital opened its doors to offer free Medically Assisted Therapy (MAT) services at the first MAT Clinic in a public health facility in the coast region. By the end of February 2015, a total 10 opiate dependent persons - 5 males and 5 males were on methadone and already acknowledging the positive effects. For sure, this medicine is our savior. I have been using heroin for the past 15 years and tried to give up but relapsed every time, said a male opiate-dependent client who started MAT on Feb 26, I woke up today without suffering any arosto, Female MAT client on Day 2. The first male MAT client from The Omari Project who has used heroin for over 15 years and is currently injecting had this to say a half hour after ingesting methadone: Niko sawa Arosto zimepungua. Matumaini ya kupona yako. (I feel well, withdrawals have gone down and I have hopes of recovering.) MAT Clinic The Malindi Sub-County Hospital MAT Clinic became operational in late February Services at the MAT Clinic include: medical and psychiatric assessment, methadone induction, stabilization and maintenance combined with psychosocial support plus referral and follow up for co-morbidities. These services are recommended in the Kenyan framework of the National Guidelines for the Comprehensive Management of the Health Risks and Consequences of Drug Use and the Standard Operational Procedures for Medically Assisted Therapy. The clinic is staffed by a multidisciplinary team comprised of general medical practitioners, psychiatric and general nurses, pharmacists, data clerk and volunteers. Security is provided by the hospital, as are other clinical support arrangements. From the outset, the MAT clinical team is striving to adopt a low threshold public health approach that assures ready access to MAT within a user friendly setting, whilst adhering to national Standard Operating Procedures and clinical protocol/guidelines that have been tailored to the context of the Malindi Sub-County health system. Godfrey Njoroge, Malindi MAT Clinic Incharge stated that evidence shows a high burden of HIV and tuberculosis among people who use drugs (PWUDs). He said it is also fortuitous that at Malindi Sub- County Hospital the Comprehensive HIV targeted interventions for people who use drugs in Malindi is The Omari Project (TOP), which has established a strong partnership with the Malindi Hospital MAT Clinic. Over 100 eligible clients have already been mobilized and identified for MAT by TOP s outreach workers and other staff who are experienced in working with problem drug users. Opiate-dependent clients undergo initial screening at TOP s Drop in Centre prior to referral to the Malindi Hospital MAT clinic. Thanks to the positive working relationship with the clinic staff, all clients that have been initiated on MAT receive ongoing psychosocial support at TOP s Drop In Centre as well as at the MAT Clinic, said Dr Saade Abdalla, National Programme Officer, UNODC. PWIDs guidelines In line with its national drug strategy, Kenya is committed to developing and enhancing the care and treatment of drug users in the country. With financial support from USAID/PEPFAR, the United Nations Office on Drugs and Crime (UNODC) is supporting the Ministry of Health s National AIDS and STI Control Programme and County Governments at the Coast to establish an innovative HIV combination prevention, care and treatment program for people who use drugs in three counties at the coast region. By 2018, the program will have established 5 sites that offer Medically Assisted Therapy (MAT) as an effort to curb the spread of HIV/AIDS amongst at-risk drug users, including those hard to reach such as women and young people within Kilifi, Mombasa and Kwale Counties. 3

4 Updates from NASCOP Kilifi County Launches MAT Kilifi County became the first in Kenya to launch the Medically Assisted Therapy (MAT) program. The launch was held on June 26, 2015 at the Malindi District Hospital. Speaking during the event, the Chief Guest His Excellency (HE) Governor of Kilifi County Hon. Amason Kingi said he was opening the project with sadness as this was not a moment to be proud of. How did we get here, until we have a clinic for drug users? he quipped. He said the clinic should not last forever but help youths out of drugs and be closed thereafter. The purpose of this clinic is to remove our youths from the shackles of drug addiction and be responsible citizens, he said. The Governor warned that the MAT clinic should attend to those affected by the drug menace but should not attract more youths into drugs. The PWIDs who recover should be integrated into society and the clinic officially closed thereafter, he said. The Kilifi Governor appealed on youths who have not started drugs not to try because they will be enslaved to it. Getting out of drugs is a personal choice, he said and called on those currently on drugs to seek free treatment. He said his County Government wants the numbers enrolled into clinic to drop as more move out of drugs. He also noted that peddlers will fight the clinic and warned them that their days are numbered. Peddlers in my county should know that their business is coming to an end, he said. He said his county had put in place intelligence to arrest the peddlers. Drugs enslave the people who use them and those who sell becomes super rich and the users become useless, he revealed. The Governor promised the youth who have successfully completed treatment at the MAT clinic that they will be given a Kilifi Governor HE Amason Kingi receiving the World Drug Report from Dr Saade Abdalla of UNODC Kilifi Governor HE Amason Kingi signing the visitors book. Looking on is Malindi MP Dan Kazungu certificate and registered in communitybased organizations which will be formed by seed mbengu funds from the county kitty. We will give funding to ex-drug addicts to start projects of their choice. This will help those who are currently on drugs to quit as there is hope for a better future, he said. The Governor thanked development partners for supporting this noble program that will rescue youths from the chains of drug addiction. 4

5 Updates from NASCOP Treatment for drug users finally begins in Mombasa September 11, 2015 was a historic day in Mombasa County as the long-awaited treatment for people who inject drugs began. Mombasa County has borne the greatest share of Kenya s drug burden and its related consequences. Thousands of youths in the County have been hooked on illicit drugs, which has consequently destroyed their lives. The Ministry of Health through the National AIDs and STI Control Programme (NASCOP) handed over two Medically Assisted Therapy (MAT) clinics to the County government. The clinics will be dispensing the MAT using methadone, the drug of choice, to people who inject drugs at the Coast Provincial General Hospital and Kisauni Health Center in Mombasa County. Speaking during the launch, an elated Mvita MP Hon. Abdulswamad Nassir said time was ripe to bring a long lasting solution to the drug menace at the coast. We cannot have our society rot and do nothing, he quipped. The MP further called on all injecting drug users in Mombasa to avail themselves for this important treatment. Methadone not only saves lives by reducing harm but it is the only way for people who inject drugs to come out of addiction, he said. Hon. Nassir was glad that Kenya is the third country in sub-saharan Africa to implement the MAT program after Tanzania, Seychelles and.. He particularly thanked the United Nations Office on Drugs and Crime (UNODC), USAID and NASCOP for the effort they have played in ensuring that this great day becomes a reality. The County Executive Committee for Health in Mombasa Binty Omar said that MAT is a solution to reduce HIV and Hepatitis infection among drug users and called on them to be committed to the treatment. She said her County is looking forward to having a working program which is evidence-based. We should all support people who inject drugs on MAT, she said and added that her ministry will ensure that these facilities work to the optimum to provide this most crucial treatment for drug users. She thanked the MAT Technical Working Group (TWG) in Mombasa that has worked around the clock to ensure that this day becomes a reality. She at the same time thanked the partners for their support. Head NASCOP Dr. Martin Sirengo reiterated the national government s commitment to ensuring adequate supply of methadone for as long as required. He at the same time appreciated the role played by law enforcement agencies and applauded them for understanding the magnitude of the drug problem. Drug addiction starts as a pleasure activity but getting out of it is the problem, he said. That is why we are setting up this program because we realize that addiction is a disease. We are here for the long haul and not just to put up this centres and go away, he promised. UNAIDS Country Director Jantine Jacobi said MAT was an opportunity to break the trajectory of HIV and bring change. She said there is a need for community engagement from different levels and was optimistic that all partners working together will surmount the challenges that will come along the way. UNODC Regional HIV Advisor Sylvie Bertrand said Mombasa was a trail blazer in the continent and observed that her organization and others have been working together on harm reduction on a daily basis at the coast. She said the time was ripe to fast track the HIV response in the County. The UNODC advisor said MAT is a sound economic decision and an important contribution to the HIV response. For every dollar we save in harm reduction, other costs are averted, she said. She applauded the County government for their dedication in making this event a reality. These facilities are a sign that all Kenyans are important no matter where you come from, she stated. Drug problem The drug problem in Kenya has become a matter of concern to the government, parents, teachers, non-governmental organizations and other agencies. This prompted President Uhuru Kenyatta to declare war on drug and substance abuse in Kenya during the just concluded Mombasa International Agricultural show on 27th August Following the President s directive for a crackdown on drug supplies in the coastal counties, many affected family members and other community leaders have appealed to the Government authorities for immediate intervention for their loved ones who have been affected by the situation. Experience from previous crackdowns has resulted in scarcity and shortage of the drugs which leads drug users have withdrawal syndromes that can sometimes lead to death. It is estimated that more than 18,000 people in Kenya are currently addicted to heroin and other opiates. The coastal region carries the biggest burden with 8500 people who inject drugs according to the 2012 Most-at-Risk-Populations (MARPs) size estimate consensus report. An aerial view of the MAT clinic at Kisauni Health Centre in Mombasa 5

6 Updates from NASCOP UNAIDS Executive Director visits Mathari MAT clinic in Nairobi Michel Sidibé, UNAIDS Executive Director today visited the Medically Assisted Therapy clinic in Mathari to see harm reduction progress in Kenya. Mr Sidibe congratulated the country for being very progressive in harm reduction interventions. Kenya does not consider people who inject drugs as criminals but as human beings and is giving them dignity he stated. Sidiibe said Kenya is leading from the front in fighting HIV and termed HIV interventions in the country as taking the right direction. Scribes trained on reporting on MAT Journalist training workshop at NASCOP UNAIDS Executive Director Mr Michel Sidibe talks to an MAT client Ms Amina Abdulaziz NASCOP, in collaboration with other partners working with people who inject drugs (PWIDs), organized a media training workshop on August 7th 2015 at NASCOP. The training was held in order to give proper information to the media on the new medically assisted treatment for drug users that the country has adopted. One of the immediate outcomes of the training was media interviews on radio and TV with MAT clients, PWID programs and NASCOP. The journalists who had been trained were also taken to the MAT clinic at Mathari Teaching and Refferal Hospital to see the clinic and interview MAT clients for in-depth stories. National Technical Working Group meets The national Key Population Technical Working Group was held in July 2015 at NASCOP. The meeting brought together KP partners from across the country. The topics discussed included: programme update on service uptake of HTC, STI screening, risk reduction counselling for all Key Population types. Other updates included the KP apid Results Initiative that was done in The national Key Population Technical Working Group was held in July 2015 at NASCOP. The meeting brought together KP partners from across the country. The topics discussed included: programme update on service uptake of HTC, STI screening, risk reduction counselling for all Key Population types. Other updates included the KP apid Results Initiative that was done in four counties; adolescent KP programme data and plan, and linkages project gender analysis. Progress made by the advocacy taskforce was also shared and a violence response tink tank was developed to coordinate the KP related violence prevention and response at the national and county level. The Technical Working Group at the same time laid a framework to guide the development of a strategy to intervene with adolescents and young KPs. A section of participants at the Technical Working Group meeting held in July at NASCOP 6

7 Updates from NASCOP Medically Assisted Therapy (MAT) Program Questions and Answers How many people in Kenya inject illicit drugs for nonmedical reasons? It is estimated that there are more than 18,000 people in Kenya who inject illicit drugs like heroin for non-medical reasons. What health problems does injecting drug use create for the user? Injecting drug use puts people at risk for infections like HIV and hepatitis B & C due to unsafe and shared needle injection. It is estimated that the HIV prevalence of people who inject drugs in Kenya ranges from 18-30% compared to a national HIV prevalence of 5.6%. Injecting drugs result in abscesses and recurring wound infections. What is Medically Assisted Therapy? Medically Assisted Therapy (MAT) is a treatment program for people who inject drugs like heroin. The program aims to reduce or eliminate craving for opiods and drug dependency. It is part of a harm reduction strategy. It uses drugs, including methadone, buprenorphine and naltrexone, to treat people with opiod addiction. What is methadone? Methadone is a long-lasting, man-made (synthetic) drug which belongs to a group of drugs called opiods or narcotics. It is used in the treatment of individuals with drug problems (substance use disorders). Why is methadone used to treat drug addiction? Methadone is used to reduce or eliminate the high or euphoria associated with heroin and similar drugs when used to treat addiction to opiod drug addiction. It does not cause a high like heroin does. It allows the person being treated to gradually obtain sobriety, and work and resume normal activities. It reduces the experience of drug withdrawal symptoms. In Kenya, it is given in liquid form, reducing the health risks associated with injecting drugs. Where is the Medically Assisted Therapy program being implemented in Kenya? The MAT program was started in Mathari Teaching and Referral Hospital in Nairobi December 2014 and in Malindi District Hospital in February Plans are underway to expand the program to Coast Provincial General Hospital, Kisauni Health Centre, Kwale Hospital, and Nairobi County clinics. How many people are currently being provided treatment? To date, over 400 people have begun MAT for treatment of heroin or other opiod addiction since the programs started in December It is anticipated that over 9,000 people will be on treatment in the next five years. How do you encourage people who inject drugs to reduce their risk of harm? Do they stop injecting drugs right away? The program seeks to reduce the risk of harm to an injecting drug user. Harm reduction is the concept of decreasing the risks to health and wellbeing associated with drug use. The program recognizes that it is not always easy to stop injecting drug use. People who inject drugs are encouraged to take steps to reduce their injecting drug use and adopt safer injecting practices with the ultimate goal to eliminate drug use. The hierarchy of actions recommended, with the first being the most desirable: Don t use drugs If you use drugs, don t inject If you inject drugs, use sterile injecting equipment and never share If you use non-sterile equipment and share equipment, use bleach to clean In addition to MAT, what other services are provided to those who inject drugs to reduce the risks of or to treat associated health problems? The Ministry of Health, together with its partners and Civil Society Organizations (CSOs), provides the following services to MAT clients: HIV Testing and Counseling (HTC) Antiretroviral Therapy (ART) for those who are HIV positive Tuberculosis (TB) screening and treatment Hepatitis B & C screening and treatment Condom demonstration and distribution Psychosocial counseling and support What organizations are participating in the MAT program? The Ministry of Health through the National AIDS & STI Control Programme (NASCOP) is leading the MAT program with funding support from the U.S. President s Emergency Plan for AIDS Relief (PEPFAR). The program is being implemented in partnership with the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Agency for International Development (USAID), the University of Maryland, the United Nations Office on Drugs and Crime (UNODC), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and CSOs working on harm reduction in the country. These include Nairobi Outreach Services Trust (NOSET), Medecins du Monde - Kenya (MdM) and Support for Addictions Prevention and Treatment in Africa (SAPTA) in Nairobi; and the Muslim Education and Welfare Association (MEWA), Reach Out, the Omari Project and Teens Watch in the Coastal counties. 7

8 Vox pops Eight months in to the MAT program this is what the PWIDs had to say Lucy Wachu Methadone is good. It finished my withdrawals arosto. At night I sleep so well like a baby and the drug does not affect me. The different feeling you get when you take methadone as compared to heroin is that methadone eliminates the high but with heroin you get very high, become drowsy and sleepy 'kuyoyoma'. I don t feel like ever going back to taking heroin ever again. Zulfikar Ali Khan Methadone has given me my life back. I have been addicted to heroin for 29 years and wasted my life away. I even did not cry during my mother s funeral because I had not feelings at the time. With methadone, I now have feelings and for the first time, I cried at my mother s grave. I now know what a woman is and I am getting married in December. Mark Mbiu My high was really nothing to write home about. Since I started taking methadone in December 2014, I have become normal again. If I don t get my methadone I don t get Mark, if I don t get my methadone I don t get a job, if I miss my methadone I will miss Mark, so methadone right now is my life. Abdalla Salim Methadone has helped me get normal again. I feel fresh and don t even have cravings for drugs anymore. Now I am doing bobber jobs to fend for my self and dont have to engage in petty theft to sustain my cravings. Thanks to methadone, i have my life back. I am now a peer educator at SAPTA. Nancy Achieng I feel I am ok now and even my 8 months old baby who had cravings for heroin is now fine. I feel fresh and don t even have cravings for drugs anymore. Now I will have to come every day to take methadone because it is good for my body. Dorothy Achieng Methadone has finished my withdrawals. I now feel like a normal person. After taking methadone I felt like I had taken heroin but was not having a craving for more, the methadone dose was enough to sustain me. 8

9 Partners Corner Comments from NASCOP, Mathari and University of Maryland staff The start-up of MAT was an exciting moment for the clients and all other partners involved. These are a few excerpts from the team when MAT began in Mathari Teaching and Referral Hospital. Congratulations to all the team for the hard work and dedication. This is a perfect Christmas present for PWIDs in Kenya. Helgar pongezi sana. Dr. Martin Sirengo, Head NASCOP. I am one very excited Kenyan. I shed tears of joy today and I just want to thank God for making this day a reality. Thanks to everyone for your support and prayers. Thanks to all for your hard work! Helgar Musyoki, Key Populations Program Manager, NASCOP. Wow, this is truly a momentous event. This surely marks the dawn of a new era particularly to the lives of the PWUDs/PWIDS. Congratulations to all who of you who have not relented in ensuring that MAT becomes a reality in Kenya. Helgar you deserve special praise for making this a reality, Bernard Ediedu Ogwang, Technical Manager - KP Outreach & Mobilization, NASCOP. It truly marks the beginning of a new lease of life for this community and a milestone in the KP Programming. It was an exciting moment and kudos to you Helgar for your tireless efforts and sleepless nights in ensuring this dream comes true and the larger team for supporting this process. What a remarkable way to end the year!!!! Jacqueline Kerubo, Regional Field Coordinator Nairobi, NASCOP. The commencement of MAT services is like finally seeing a mother who has had a difficult pregnancy finally giving birth to a baby who is still delicate and requires a lot of nurturing until maturity. MAT is our baby who we hope to strengthen and will bring a major impact in our society. Dr. Mercy Karanja, Psychiatrist, Mathari Hospital. I want to appreciate the Ministry of Medical Services through NASCOP in collaboration with the University of Maryland and Mathari Teaching and Referral Hospital in ensuring that methadone, the long awaited treatment for People Who Inject Drugs is finally available at a public health facility. This is indeed good news to all PWID. Janet Muema, PWID Clinical Improvement Specialist, University of Maryland Kenya. 9

10 Poems Life ni story By Ronald Wairiuku Mariu - MAT Client Life ni story, But yangu niliinvite worries Ilikuwa hard kuihandle Nilisurvive na struggles Nika link-up na bad boys Ilikuwa hard kwangu Kumaintain addiction Ya cocaine na heroin Kutumia sindano na mi sio mgonjwa Kumeza matembe, ungedhani nitapona Nashukuru mungu kwa DIC na Mathari Hospital Wakatushow tuarise na tushine na methadone Methadone impact ya power Methadone mwalimu kwa maisha Methadone inaunganisha familia Methadone imetupa second chance kwa life Nilidhani ni wise kutumia heroin Nikajiona master kujidunga Yote ikawa kuwaste life, Injuries kwa streets za cities zinatawala Mifupa zimevunjika, alama kwa sura Uongo machoni na utapeli mdomoni Ni risasi na pingu kutuandama Tunashukuru aliye kwa bingu Kwa maisha mapana na mapya Kwa kuwa jela hatutapatana The Methadone Story By Felix Nyaga MAT Client This is a story, a story of the past, the now and the future. A past so painful it can only be felt. A now so dramatic it can only be explained and a future so promising it can only be dreamt. This is a story, a story of the salvation of the junkie, the addict, the user. Once was too much because a thousand times would never be enough. The daily morning doses which would never quench the morning lock, the monkey on my back, the shiver, the shakes, the yawns all gone by the mention of methadone. This is a story, a story of the search of more, and the stealthily played game each day to quench the thirsts. The story of the pickpocket, the snatcher, the impersonator, the story of the highway robber, the signal, the signal, the side mirror snatcher, the wheel spare at the back of the pickup just to quench the thirst. This is a story, a story of the induction, the interviews, the protocols, the red tape, the waiting, the decisions, and the manmade decisions. This is a story of the practicability, the great thesis of hope, the essence of normal routine in a normal environment at a normal time and place. This is a story, a story of the glorified first drops of methadone in the dry throat of a junkie, the thirty minute wait, the finality, the confirmation, and the new dawn of tomorrow. This is a story of the euphoria, the story telling, the I couldn t sleep all night reaction, the first, second, third day kuzoea (getting used), the new feeling of the sense of belonging, the fulfilment that only comes from such great and timely doses of methadone, the feel, the thrill of a changed person, a new person, a whole life awaiting that person. This story shall continue in your mind. Methadone impact ya power Methadone mwalimu kwa maisha Methadone inaunganisha familia Methadone imetupa second chance kwa life Hiari ni yako kuiwacha Madawa ni blunder Njia ni panda Kuwa wise na urise Weh imagine kuna mtu anakumind Ame bring methadone Hautaitwa the sick man tena Kwa kutumia madawa Nikama uko na tender Naitenda wema kabla sijaenda Niweze kuijenga nchi MAT client Felix Nyaga reciting a poem he authored at the launch in Nairobi 10

11 Voices from the Field Nurturing an addict The struggles of a mother who has endured over 20 painful years watching her son waste away due to drugs When every mother holds his/her bundle of joy after painful hours in labour, their hopes and aspirations are that their child will become the best he or she can be and make her proud. No mother wishes anything less for her son or daughter other than success, joy and happiness. Mrs. Grace Kathukya, known commonly as Mama Mark, remembers the many years she has had to endure nurturing a son who, year after year, got more and more hooked to the drug menace. Mark grew up like any normal child and, coming from a privileged background, the sky was the limit for him. But at age 13, Mark started doing drugs. I got into drugs at the age of 13 going to 14 due to peer pressure. My aim was to feel good and enjoy life, says Mark who did not know that this habit would led to many painful years of being chained into addiction that he would be unable to come out of. Being from a well to do family, Mark was provided with everything and even went to an international school. We raised Mark just like our other children and gave him everything that he needed. Mark is our last born son and we love him very much, said the mother. Remembering those long painful years, Mama Mark does not seem to put a finger to one reason why Mark turned out to be a black sheep in her family. We raised him well but wondered why he couldn t conform to the correct ways of life. As a mother, it is painful to watch your son waste away due to drug addiction, she painfully recounts. Her mother started noticing his odd behavior when he was about 14 years old. I noticed that he was hyper, and I did not know what was wrong with him. I later took him to a psychiatrist who never told me what was wrong with him, she explains. Mark s mother decided to befriend her son so that he can open up to her, and he did. This revelation drove her crazy and she knocked on every door to find a solution. She went to the CID to be educated about drugs, and they showed her various types of drugs and told her to search in his room when he was absent so that she could find out what he was using. She did and found out that he was using heroin. She later went to UNODC and found a lady who helped her know more about drugs, their harmful effects, side effects, and coming to terms with her son s addiction. Mama Mark admits that initially it was shameful to admit that her son was a drug addict. I wondered how you could raise your son well and take him to a good school only for him to become an addict. She gave herself courage and decided to fight this battle to the end and vowed that the situation would not pull her down, and it didn t. Some parents chase their addicted children out of their home and deny them food. That is how they end up dying. I decided I will not chase mine away but give him all the food I had. I noticed when they take drugs they cannot eat much, she says. She says they took Mark to the rehabs so many times and each time he came out he would sober up and do something creative like painting and drawing. But that wouldn t last long since he would relapse and slip back to addiction. Mark went to rehabs 28 times and was even given free rehabs and ran away after some time. His mother decided to give him a room close to the house so that they could closely monitor him. I got very worried that these addicts inject themselves and die and so I decided to bring him closer so that I can see him die from the window, she says. One day as his mother was outside his Mrs. Grace Kathukya window, she heard him breath like he is making his last breath. I went in, held him and his body was dead cold, I thought he was gone. I called friends and relatives who came and we started singing funeral songs and praying, she recounts. Mark later woke up and asked them why they were mourning. Mark s mother had tried everything to rescue her son from the chains of drug addiction including taking him to rehabs, going to church, seeking medical health and reading all drug-related literature but to no avail. She even tried to get drug peddlers arrested to stop this menace and contacted a former police spokesman who advised her to talk to her son and educate him on the dangers of drugs. With nothing bearing fruit, she finally left everything to God. Mark says that he had given up hope and even tried to commit suicide but thank God that he never died. He tried all manner of things to sustain his addiction including pickpocketing people, conning, and stealing. His mother says that one thing which helped her was talking to her son a lot and treating him like her other children. We wiped away the shame and believed if Mark stopped his drug taking behavior, he would be a normal person. 11

12 Voices from the field One day as she read the newspaper she saw NASCOP talking about methadone which was to come through civil society organization and be administered in Mathari Teaching and Referral Hospital. I said if it was something better than heroin, why not. Let them try and we will see the result, she explains. Mark says his high was really nothing to write home about. I was not happy and so when methadone came, I said let s see how this goes. His biggest problem was that even if he had heroin, it was difficult to inject since his veins had collapsed. Smoking and injecting heroin for 20 years had taken a toll on his health. Mark began treatment and the journey was not so smooth at first. He developed side effects such as scratching, sweating and the mother suspected that he was mixing the medicine with heroin. I told him that he has finally gotten an effective treatment to help him stop taking heroin and he has a responsibility of wanting to stop. We are affected because we are his relatives but at the end of the day, he has a responsibility to stop. After all, it is his life! Mark Mbiu Mark s parents Mark and Mother Preparing for change: 5 key steps to addiction recovery 1.Remind yourself of the reasons you want to change 2.Think about your past attempts at quitting, if any. What worked? What didn t? 3.Set specific, measurable goals, such as a quit date or limits on your drug use 4.Remove reminders of your addiction from your home and workplace 5.Tell friends and family that you re quitting and ask for their support. Source: I injected myself in the head and felt like I was hit on the head. I had this intense pain and fell on the ground. I immediately started praying because I knew that I was about to die. My heart was racing and I started sweating, I could taste heroin in my mouth and it was scary. I remember praying and telling God, please save my life Mark Mbiu 12

13 Pictorial page - MAT Launch MAT National Launch Pictures 13

14 Advisory Team Dr. Martin Sirengo - Head, NASCOP Ms Helgar Musyoki - Key Populations Program Manager, NASCOP Dr. Chesang Kipruto - Chief and Technical Advisor, HIV Prevention Branch, DGHA/CDC Kenya Mr John Anthony - Head, NASCOP Technical Support Unit (TSU) Mr John Mathenge - Director, HOYMAS Ms Phelister Abdalla - Country Coordinator, KESWA Ms Peninah Mwangi - Executive Director, BHESP Ms Catherine Mwangi - Program Manager, SAPTA Editorial Team Writer: Ms Redemtor Atieno - Technical Manager, Advocacy and Communications, NASCOP TSU Editor: Nadine Sunderland, Health Communication Specialist CDC Kenya Design and Layout: Ms Redemtor Atieno Photography: Ms Redemtor Atieno Contributors Mr John Anthony Dr Saade Abdalla Dr Mercy Karanja Mr Ronald W. Mariu Ms Catherine Mwangi Mr Felix Nyaga Mr Mark Mbiu Mr Fred Makori Ms Rose Closson For more information, contact us at: National AIDS & STI Control Programme (NASCOP) Kenyatta National Hospital Grounds P. O. Box , Nairobi, Kenya Tel: +254 (20) info@nascop.or.ke Facebook; National AIDS and STI Control Programme-NASCOP. Twitter; NASCOP. Website: www. nascop.or.ke