At the International Harm Reduction Conference 2013, with all its’ many hundreds of people (usually almost 1000 or so) from at least 80 countries around the world, it is always a terrific chance to meet drug user activists from all around the world. I was fortunate enough to meet two really very special people from two emerging new INPUD sister networks, Tinga from Kenyan Network of People who Use Drugs KeNPUD, and Susan, from TaNPUD, the Tanzanian Network of People who Use Drugs.
To shed some light on the more technical side of these projects and what has actually been happening in East Africa amongst our bro’s and sisters there, please see Mick Webb’s article at the end of this blog and additional links. Mick is the programme manager of INPUD’s Bridging the Gaps project, a project aimed at drug user organising and capacity building in countries that are yet to have the seeds of any drug user network or using community. But before I include the article for you (see end), I just wanted to say a little about these two lovely East Africans’ who came to the conference at Vilnius. First, introducing Tinga Kalafa from Kenya…
Tinga Kalafa – Kenya
Tinga Kalafa who is from Kenya (and the network, KeNPUD) was one of the first Kenyan guys to come on board with INPUD through the Bridging The Gaps programme. I first glimpsed him at the conference, and yes, it was from across a crowded room; tall, graceful, with a permanently broad and engaging grin, I knew straight away – This must be him! We had heard a lot about Tinga and the formation of KeNPUD in East Africa and many of us in the activist community were extremely excited to hear that user empowerment, activism and harm reduction was being spearheaded by a fellow user on the ground in Africa. I soon learnt however, just how many personal challenges there are for the activist willing to put their head above the parapet – things many of us can only imagine sitting here at home.
There is a heroin scene in Kenya, low quality brown heroin from Afghanistan (much the same low quality that so many countries have it seems). There is definitely a South American connection but most of that heads to the ports (in Tanzania it seems) and that is where the white heroin is sold, as it heads its way to Europe.
The main dealers, those further up the chain, are, as usual, never seen on site, but Tinga tells me they employ the young guys to distribute their produce as well as young women. 3/4 of the dealers don’t actually use heroin (unlike so many countries in Europe), but are in business to make the fast money. One wonders though, just how long that will take to change? The police are also believed to be heavily involved in the local drug scene….
Kenya and its borders (notice its close connection with Tanzania)
When you look at the map above, you are quickly reminded of the incredible beauty that Africa holds; its secrets, its wildlife, its burning earth and sunsets. The nature of the surrounds and the famous warmth of its peoples, we have so much to be grateful for that people like Tinga, and his peers in KeNPUD and TaNPUD, are working so hard against such challenges; to prevent infections like HIV and Hep C, to give out clean syringes, to educate people to prevent stigma and discrimination and encourage people to make contact with the right services, and so much more necessary work that needs to be done to keep their countries moving forward..
Tinga, now with a front tooth now missing from his otherwise perfect set of pegs (courtesy of the local police who un-obligingly punched it out), he then went on to show me a stab wound and a bullet wound, all damage incurred thanks to a type of ready made mob justice; as a drug user he ended up being pushed out right to the edges of society, where there is a lawlessness that even the police participate in. Beatings are common for drug users as people dole out their own form of justice.
Despite formally having a well respected job as an accountant, Tinga’s ‘fall from grace’ into opiate dependence, meant that the complex, seemingly impenetrable layers of a communities ‘junkie stigma’, just kept being heaped upon him in layers. ”If your family cannot afford to send you to rehab, then they just kick you out – it brings shame on the family. If they can afford treatment they will coerce you into treatment”. Enforced rehabilitation in psychiatric hospitals you have to pay for (if you have the money), ‘treatment’ that hangs heavy with the weight of shame and guilt, metered out by the very people who are supposed to help you – the health professionals. It was slowly but surely eroding his spirit and his chances of making it back in one piece – the hope he had to create a better life for himself. NA groups, occupational therapies, relapse prevention etc are available – but it is, as Tinga says urgently, “basically just coercion”. ”We are taken as very bad people, people who are not fit to be in that society – we are isolated, nobody wants to identify with us”. Another alternative is that relatives will go to the local faith based healers for treatment – you are forced there – the whole community knows you are there.”
Yet when someone noticed Tinga as being a local leader among his peer group, he was enlisted into a WHO funded health programme (which even used the stigmatising language of ‘You can only use a thief to catch a thief‘ as their way of getting new ‘drug addicts’ engaging with the help on offer) and he found himself being trained up in harm reduction and the job of encouraging other injectors to consider harm reduction to stay safe and prevent HIV and HCV transmission in their communities.
The stigma that surrounds HIV is still extremely high and people are still afraid to disclose their status and will often avoid health centres that provide HIV services, from fear of being seen by neighbours or community members. HIV transmission through injecting drug use is increasing, particularly in the capital and in coastal areas. HIV prevalence among people who inject drugs was 18.3 percent in 2011 and in Nairobi around 1 in 3 PWID are infected with HIV. Tinga tells me that even when injectors in Kenya know how HIV can be transmitted, needle sharing and unprotected sex is still commonplace because of the low level of needle and syringe coverage. Syringes are now available to buy in chemists but it seems pharmacists are unwilling to sell them to drug users. Up to 4 percent of all new infections are as a result of injecting drug use. (refs, Avert)
Tinga relayed further statistics from Kenya, “HIV survives predominately in the hetrosexual community, often in partners – like married couples having outside relations and in the key populations it is still high”. For women -44% of the incidence of HIV is with females, 18.3% amongst the injecting pops. Regarding Hepatitis C – our figure a figure of about 57% in the injecting community. Tinga would go out distributing syringes on his own, first through learning about bleach via the UNODC and cleaning works for re-use (the best option available at the time -2004), what small amount of syringes that were available, until he was finally able to distribute sterile ones through a NSP. Opioid substitution therapy (OST) is not banned in Kenya but the availability of OST has traditionally been severely restricted. As part of the governments new prevention plan, twelve primary health care centres in Mombasa have begun to offer opioid substitution therapy in 2011 yet it appears the numbers of people allowed in treatment is low.
Changes regarding empowering drug users officially began when Medecin Du Monde began work in Kenya and INPUD touched base with Tinga who quickly became instrumental in working with INPUD’s programme manager, Mick Webb to develop KeNPUD as a network and in doing so, worked towards spreading the seeds across the border to Tanzania to start TaNPUD. Although Kenyan drug laws and government policy have hindered the prevention of new infections among IDUs, there has, as mentioned, been a recent change of view in the Kenyan government. This follows a similar turnaround by the American initiative PEPFAR (the largest foreign funder of HIV and AIDS programmes in Kenya), which now supports a variety of harm reduction approaches to HIV prevention among Injecting drug users, whereas, when US president George Bush was in power, he refused PePFAR to fund programmes that relied on harm reduction rather than total abstinence -of both drugs and sexual partners! Incredible lunacy!
However, Kenya still faces huge problems. For example, corruption is a major deterrent to donors and a lack of transparency of the distribution of funds may result in donors withholding funding. In 2009 Kenya was ranked in the bottom third of countries worldwide for corruption (146 out of 180).These problems have directly affected the influx of funding, as in 2003, 2008 and 2009 the Global Fund delayed and refused applications for funding to Kenya. It has been suggested a lack of clarity and accounting problems were the cause of Kenya’s most recent grant refusal in 2010.Other sources have attributed the refusal to the rivalries between the ministries of Medical Services and Public Health who are both responsible for the management of donor funds. The effects of the Global Fund’s rejection of recent applications will inevitably be felt by future programmes. Thankfully, the Bridging The Gaps project which funds KeNPUD falls outside of this (see article below for more info). (refs from Avert)
Tinga finally spoke quietly about his family, how they now understand what he is doing, “they are realising I am helping to save lives, I’m structured now and my behaviour is changing , and im focusing. They still look at me with one eye….’you are still not the same person – we are still watching you.’
Most memorably in Vilnius, I will remember him for his speech at our INPUD meeting one lunchtime, where he was visibly moved by the inner strength he received from the INPUD ‘Family’. From that silent but solid warmth that comes from knowing that he wasn’t alone, that understanding that he had something unique to offer, he was actually valuable to our community -and by God junkies DO have a community! Like coming in from the cold, having people all around the world who understand your struggle on so many critical levels -it was indeed a special moment to be able to welcome Tinga into our ever growing international family of people who use drugs, and, to have Tinga -and Susan join with our expanding one.
Before I tell you about the amazing Susan from Tanzania, who incredible grace and inner strength truly captivated me, let me just add some context to the Bridging the Gaps programme.
The Seeding of Drug User Activism in East Africa, (below) taken from INPUD’s recently published newspaper. (This will be posted shortly in its entirety and in both Russian and English languages)
The Seeding of Drug User Activism in East Africa
There is something happening in East Africa amongst people who use drugs. At a meeting in Nairobi on 3rd of May, with the Kenyan Network of People who Use Drugs (KeNPUD), KANCO*, Médecins du Monde (MdM) and NASCOP (the Kenyan ministry directly mandated to address the HIV/AIDS response in most at risk populations); John Kimani, the Chair of KeNPUD stated - “People who use drugs should not be seen as the problem……but as the cornerstone of the solution to not only reducing drug related harm, but as the most significant contributor to the solution to the national HIV response.”
In an effort to support the development of networks for people who use drugs across the world, INPUD has been working in East Africa, where we have been delivering capacity building workshops in Kenya and Tanzania, since June 2012.Tinga leading a peer led workshop
The seeding of new networks comes under INPUD’s programming remit and so is supported by the Community Action on Harm Reduction (CAHR), and Bridging the Gaps projects, funded by the Dutch of Foreign Affairs. This has allowed INPUD to provide technical and limited financial support to INPUD’s sister network in Kenya, KeNPUD. The Community Action on Harm Reduction (CAHR) project is led by the International HIV/Aids Alliance, TaNPUD in Tanzania is funded by M
It has been important for KeNPUD and TaNPUD to draw strength and experience from each other and by linking both networks together, they are able to share valuable information. Tinga from KeNPUD has been instrumental in the initial mobilisation of the networks, and both he and Peter from KeNPUD, have crossed borders to jointly facilitate workshops with their peers in Tanzania.
TaNPUD experienced a high profile launch with national TV and radio coverage, but it had yet to fully develop its internal structures. However, the April/May workshops in Kenya and Tanzania this year have clarified the aims and objectives of both activist and advocacy drug user organisations and have helped to strengthen their internal structures. Time was also spent focussing on human rights advocacy, project planning and implementation and documentation.
In countries where there is minimal OST and high levels of stigmatisation, criminalisation and discrimination, our duty of care to members’ increases in necessity and complexity and INPUD has recently revisited this issue in East Africa. INPUD has a duty of care to ensure adequate attention is given to the health and wellbeing of INPUD members while they travel and we will need to unpack this complex ethical issue further as we evolve as an international organisation.
As with our duty of care when travelling with members, our duty of care towards
Tinga Kilimanjaro (Interestingly, Tinga is the name of a tribespeople famous for their artwork, and mainly coming from the Tanzanian region -I’m yet to ask Tinga if he has any Tinga blood. It is really magnificent artwork which evokes the flora and fauna of the region. )
seedling networks and their development is paramount. The temperature of local politics, the history of police abuse towards drug users (and human rights defenders), and the deep stigmatisation and discrimination that drug users still face in the region, must all factor into our planning. INPUD must offer support to budding networks when needed, facilitating and encouraging full independence as the seeded network flourishes and begins to work effectively in its region.
KeNPUD, TaNPUD and INPUD are organising the first East African Drug User Activist Conference planned for November 2013 in Mombasa. This is intended to mark the official launch of the regional networks and is an exciting development for both the people and the politics of the regions.
Working with the community of people using drugs in East Africa is one of the most exciting and challenging aspects of our programming work; central to this is our commitment that strong peer based organisations are the foundation to reducing HIV infection and drug related harms.
*KANCO is the Kenya AIDS NGOs Consortium
INPUD is part of Community Action on Harm Reduction (CAHR), an ambitious project that aims to expand harm reduction services to more than 180,000 injecting drug users, their partners and children in China, India, Indonesia, Kenya, and Malaysia. You can visit the CAHR project website here: www.cahrproject.org
INPUD is part of ‘Bridging the Gaps – health and rights for key populations’. This unique programme addresses the common challenges faced by sex workers, people who use drugs, men who have sex with men, and transgender people in terms of human rights violations and accessing much needed HIV and health services. Go to http://www.hivgaps.org for more information.
Contacts in East Africa: Tanzania: email@example.com, Kenya: firstname.lastname@example.org and