UN Integrated Regional Information Networks - November 21, 2007

However, the rapid spread of HIV through needle sharing put paid to the popularity of mainlining, and by 2004 most heroin users had switched to mixing the drug with marijuana and tobacco and smoking it.

Health officials breathed a sigh of relief at the drastic drop in intravenous drug use, but the staff of The Omari Project (TOP), a local non-governmental organisation (NGO) working to prevent heroin use and HIV, warned that sustained vigilance was necessary.

"We know that many people who stopped injecting are still addicted to heroin through smoking, and if the urge for a fix is bad enough, they will reach for the needle without thinking about the possible consequences," said Shosi Mohammed, coordinator of the project.

"TOP is involved in community outreach; we go to the drug dens and let them know that they must always use a new needle and must never share," he stressed. "We let them know that they must use condoms when they have sex, but we are aware that careless behaviour always creeps in when they are high."

Mohammed said regardless of whether the drugs were smoked, inhaled or injected, the chances of risky behaviour, like unprotected sex and commercial sex work, were always higher when people were using them.

Vicious cycle

"Heroin tends to lower one's libido, and so when you're an addict you don't really have as much sex as most other people," said Lion Ludovic, a former drug addict who is now a counsellor at TOP's rehabilitation centre in the neighbouring town of Watamu.

"When you quit and the urge for sex returns, people find that they are able to have more sex, and often have sex carelessly and compulsively, the same way they once took drugs carelessly and compulsively." He said premature ejaculation was common among men coming off drugs and dissatisfaction with sexual performance sometimes drove people back into addiction.

The main issue for Fatma Wangechi*, who became hooked on heroin when she was persuaded by a Nigerian businessman to become a dealer, is how to make a living now that she no longer sells it.

"I used to earn some good money, but when I was arrested and spent nearly one year in jail, I knew I had to stop selling and using it," she said. "But now that I'm out I sell jewellery to tourists at the beach - it's very little compared with what I used to make."

Wangechi said many female dealers turned to commercial sex work to make ends meet once they stopped selling, but often returned to taking drugs to be able to facing having to have sex with strangers.

Another factor that pulled people back to heroin, said Abdul Aziz*, who is also in recovery at TOP's centre in Malindi, was that 'normal' people were so reluctant to trust or welcome former junkies into society.

"When I returned from TOP the first time, I went back home but no one would do business with me; no one trusted me and no one wanted to be my friend," he said. "But my old friends, the junkies, were always warm and welcoming, so I continued to hang with them and eventually I was persuaded to take the drug again - I went right back to the old life."

Aziz knows that if his recovery is to be permanent, he must move away from his old neighbourhood and the friends he grew up with. He worries that he may not be able to earn a living, but understands that staying clean is a priority.

If drug use was to be controlled in Malindi, alternative sources of income would have to be provided to prevent former drug users from being sucked back into 'the life', said TOP's Ludovic.

"What they need is to learn a skill, to be given the chance to earn a decent living that will boost their self esteem and income, to the point where they have no incentive to take drugs," he said. "A former drug user who becomes a carpenter has money, pride in his work and the respect of his peers - he will not go back to the drugs or take unnecessary risks with his life."

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