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Reducing Vulnerability Of Marginalized Drug Dependent Communities In Nairobi

Kenya Through Socio-economic Opportunities

Hezron Ogembo1, Calleb Angira1, Beth Mbugua2, Reychad Abdool2, Saade Abdallah2

1. Nairobi Outreach Services Trust (NOSET)

2. United Nations Office on Drugs and Crime, Regional Office for Eastern Africa (UNODC ROEA)

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Introduction

• People who use drugs in Kenya, including PWID suffer from socio-economic marginalization due to crime and HIV risk-related behaviour

• There are an estimated 18,327 PWIDs in Kenya

• HIV prevalence rate 18.3% among IDUS, versus 6.3% among general adult population

• HIV prevalence is 44.5% among female IDUs and16% among males

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Nairobi Outreach Services Trust

• Located in Ngara, Nairobi• Offers HIV prevention, care & treatment

for PWUD since 2005• Operates in 2 broad districts of Westlands

and Eastlands• Covers 23 IDU drug use hot spots • Through UNODC, implements OFID-

funded Sustainable Livelihood Project since 2011

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Vulnerability ContextDecrease in

protective factors: health hazardous

behavior

Drug dependence,imprisonment

and related HIV infection

Stigmatization,discrimination

Exclusion from development process and socio-economic

services

Poverty,Marginalization,

deprivation

Vicious circle

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Interventions

HIV and Drug Use Prevention & Treatment:• Drop-in-Centre: HTC, • Nursing, addiction

counseling;• Outreaches: IEC, NSEP• Referral: ART for HIV-

positive clients,

Sustainable Livelihood Interventions• Daily meals and showers• Shelter for women with

children• Microcredit training with

loan provision• Vocational training in IGAs

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Methods

• Simple Excel cohort monitoring tool used to extract data for beneficiaries of SLP

• Inclusion criteria: at least two documented encounters for SLP interventions; Jan to Dec 2013

• Total enrolled: 160 recovering PWUDs in cohort• Retrospective review of service coverage and

effects of basic socio-economic support and other PWUD interventions

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Baseline Status

Got Basic support

Living alone Unemployed Injecting Drugs

Sharing Needles

020406080

100120140160180 158

127 127

62 54

98.8%

79.4% 79.4%

38.8% 87.1%

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Immediate Outputs

Basic Socio-Economic Support:

• 936 DUs, 624 IDU’s and 421 Females received daily meals

• 40 FWUDs received shelter

• 822 DUs, 1023 IDUs and 533 Females got Psychosocial and life skills support:

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Medium/Long term Support

• 56 trained on basic entrepreneurship skills• Micro credit groups:5 (30 DUs, 25 IDUs, 10

Females)• Issued loans:42 (22 DUs, 12 IDUs, 8 Females)• Servicing loans: 24 (10 DUs, 7 IDUs, 7 Females)• Fully repaid :10 (8 DUs and 2 IDUs),defaulters:7• New enterprises:34(shoe selling, water

containers, transportation using trolleys among others)

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Behavioral Outcomes

0

20

40

60

80

100

120

140

160

180158

62

8462

3624

12798.8%

38.8%52.5%

38.8%

58.1%15.0%

79.4%

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Conclusion

Socioeconomic interventions for PWUDs can lead to:• Reduced risky sexual and drug use

behavior.• Reduced criminality• Reduced vulnerability to HIV infection• Increased potential to self reliance • Improved general health

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IGA Training by Jamii Bora Bank Staff

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Beneficiary FWUD with Children

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Lessons learnt

• Lunches, bathing & washing services attracted more clients to DIC services, including mothers with young children.

• A viable enterprise can sustain feeding programme.

• Recovering PWUD can successfully service loans and accrue small savings.

• As Kenya embarks on methadone maintenance treatment (MMT), socio-economic empowerment is vital to assure retention of female heroin users.

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Acknowledgements

• OPEC Fund for International Development (OFID)

• Kenya’s Ministry of Health: NASCOP and Mental Health Directorate

• United Nations Office on Drugs and Crime (UNODC ROEA and HQ)

• Nairobi Outreach Services Trust (NOSET)• Project Beneficiaries