Appreciating differences and building on similarities

The stigma against drugs makes it difficult to be open about drug use, especially for people who do not consider themselves a ‘drug user’. Among people who face stigma because of their sex work, or their same-sex sexuality, the additional burden of stigma against drugs might prevent open discussion of their drug use, and thus prevent them from accessing important services and information. Bridging the Gaps partners MSMGF, North Star Alliance and Mainline all work with different key populations in Kenya, respectively MSM, Sex Workers and People who use Drugs. During a webinar they discussed the cross-linkages & challenges and discussed the best harm reduction approaches.

Human rights approach

Central to harm reduction as practiced by Mainline is to work from a human rights approach; not judging the person for his/her drug using behaviour but being open-minded about the reasons why someone is using drugs. Among both men who have sex with men and sex workers in Kenya, drug use is practised. North Star Alliance mentioned that sex workers often choose to use substances (mainly alcohol) to feel more confident and to cope with harassment by clients. MSMGF noted the link between drugs and sexual pleasure and performance. Hence, the reasons for using drugs and the expected and desired affects can be quite different.

During the webinar, the partners addressed three questions:

Does substance-use have an effect on risk-taking sexual behaviour?

There may be a relation between substance-use and risk-taking sexual behaviour. People under the influence of drugs might perform sexual acts which they would normally refuse or not use condoms as frequently as when they are not under influence.

How should drug use be addressed in programs serving sex workers or men who have sex with men?

It is important to build a trustful relationship with the target group and to break taboos by asking the right questions and providing comprehensive information about preventing HIV and Hepatitis B and C. Outreach workers should have basic knowledge about the effects of drugs, harm reduction interventions and services facilities for referral. It is important that any person using drugs does this in an informed way, reducing possible harm to their health and preventing HIV and Hepatitis infections.

Are there tools that can help community-run programs to identify problematic drug use?

If a person expresses having no problems related to his or her drug use, we should accept this. Central in the harm reduction approach is that we take individuals’ understanding of their drug use seriously. This is a first step in building trust and opens the discussion on how to reduce risks and health-related harms. Once a person considers his or her drug use as problematic, then it is possible to improve individual and public health by providing information on safer drug use and access to clean needles and/or methadone.

Appreciating differences and building on similarities

Despite the differences between the three key populations, there is a considerable overlap which calls for sharing knowledge and experiences. The webinar was a first step towards more in-depth collaboration between the three partners in Kenya. In the coming period, further information sharing will take place and Mainline has offered to train outreach workers reaching out to MSM and sex workers on harm reduction approaches upon request. Stay informed at www.hivgaps.org.