An exchange visit to improve the quality of services for people who use drugs

In Pakistan, people generally have limited knowledge on sexual transmission of HIV, because the virus is concentrated among most-at-risk populations. In Kenya, the epidemic is generalised and, therefore, know-how on the issue is more widespread. Valuable experiences were exchanged during a four-day visit to Pakistan organised by Mainline under the Bridging the Gaps initiative, in November 2013.

Mainline’s Kenyan partners Omari, Reach Out, and MEWA (Muslim Education and Welfare Association), together with Dutch delegates, visited the organisation Nai Zindagi in Pakistan. They observed, discussed, asked questions, clarified, and also encouraged one another to better understand different contexts of drug use related HIV prevention, treatment, and delivery of services.

Reducing infection risks

Three very different sites were visited, to observe diverse ways of service delivery to people who use drugs, and to talk to people on the ground. The first site was a spot where Nai Zindagi’s outreach workers provide clients with clean syringes and needles, and counselling focusing on safe injecting practices. One of them, a trained paramedic, provides abscess and wound management openly in the street. We noticed that Nai Zindagi and the people who use drugs had jointly cleaned the site of used needles, thus reducing infection risks for people who use drugs and the community.

Psychosocial care

The second site was a sort of shooting gallery in the house of a local drug dealer, who allowed people to buy and use drugs on his property. This motivated some discussion about whether or not working with drug dealers. The third field visit was a ladies-only trip, as we were invited in the house of a wife who got HIV from her husband, who injected drugs. We were all impressed and touched by the commitment of the mother-in-law, taking care of her and her children. This old woman was part of a group of mothers, who not only support each other, but are also role models for others to embrace psychosocial care for people who use drugs and their families.

Working in a religious setting

On the last day of the visit, tips and tricks were exchanged to enable the Kenyan partners to work on their organisational capacity, which in the end might give them easier access to new types of funding. Throughout the visit, a red line in the discussion was the difficulty of working in a religious setting and trying to set up progressive services like harm reduction. The Kenyan organisations struggle with their Muslim constituents and communities, which are sometimes opposing programmes like needle and syringe exchange. Seeing harm reduction services in Pakistan helped a lot to create a common language that can be used during local advocacy efforts in Kenya.