“We only trust each other”

A qualitative study exploring the overdose risk environment among persons who inject drugs living with HIV in Nairobi, Kenya

Bibliographic Data

ID19592815
AuthorsMegan Maurano (0000-0003-1013-7572, University of Washington, corresponding author), David Bukusi (0000-0003-1910-4179, Kenyatta National Hospital, corresponding author), Sarah Masyuko (0000-0002-9836-4616, University of Washington, corresponding author), Rose Bosire (0000-0001-5777-7329, Kenya Medical Research Institute, corresponding author), Esther Gitau (Partners for Health and Development in Africa, corresponding author), Brandon L Guthrie (0000-0002-2059-3291, University of Washington, corresponding author), Aliza Monroe‐Wise (0000-0002-8843-3462, University of Washington, corresponding author), Aliza Monroe-Wise, Helgar Musyoki (0000-0002-0972-6065, Ministry of Health, corresponding author), Mercy Owuor (0000-0002-2517-3798, United States International University Africa, corresponding author), Mercy Apiyo Owuor, Betsy Sambai (0000-0003-2100-4943, United States International University Africa, corresponding author), William Sinkele (Partners for Health and Development in Africa, corresponding author), Hanley Kingston (0000-0003-1181-5507, University of Washington, corresponding author), Carey Farquhar (0000-0001-8575-3439, University of Washington, corresponding author), Loice Mbogo (0000-0001-5916-7188, United States International University Africa, corresponding author), Natasha Ludwig-Barron (0000-0002-0981-1550, University of Washington, corresponding author), Natasha T Ludwig-Barron
EditorsPadmasayee Papineni (0009-0007-7196-0454)
Year2024
Volume4
Issue7
Pagese0003435
Publication date2024-07-02
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0003435
PMID38954694
OpenAlexW4400230576
LanguageEN
Citations received2
References cited30

In Kenya, overdose remains a major public health concern with approximately 40% of persons who inject drugs (PWID) reporting personal overdoses. PWID living with HIV (PWID-LH) are particularly vulnerable to experiencing fatal and non-fatal overdoses because of the surrounding physical, social, economic, and political environments, which are not fully understood in Kenya. Through qualitative inquiry, this study characterizes Kenya’s overdose risk environment. Participants were purposively recruited from a larger cohort study from September to December 2018 using the following inclusion criteria: HIV-positive, age ≥18 years, injected drugs in the last year, and completed cohort study visits. Semi-structured interviews explored experiences of personal and observed overdoses, including injection settings, sequence of events (e.g., pre-, during, and post-overdose), safety strategies, and treatment. Interviews were transcribed, translated (Swahili to English), reviewed, and analyzed thematically, applying a risk environment framework. Nearly all participants described personal and/or observed overdose experiences (96%) and heroin was the most frequently reported substance (79%). Overdose precursors included increased consumption, polysubstance use, recent incarceration, and rushed injections. There were also indications of female-specific precursors, including violence and accessing prefilled syringes within occupational settings. Overdose safety strategies included avoiding injecting alone, injecting drugs incrementally, assessing drug quality, and avoiding polysubstance use. Basic first-aid techniques and naloxone use were common treatment strategies; however, naloxone awareness was low (25%). Barriers to treatment included social network abandonment, police discrimination, medical stigma, fatalism/religiosity, medical and transportation costs, and limited access to treatment services. In Kenya, the overdose risk environment highlights the need for comprehensive overdose strategies that address the physical, social, economic, and political environments. Morbidity and mortality from overdose among PWID-LH could be reduced through overdose prevention initiatives that support harm reduction education, naloxone awareness, and access, destigmatization of PWID, and reforming punitive policies that criminalize PWID-LH

Drug · Environmental health · Family medicine · Harm reduction · Heroin · Opioid · Opioid overdose · Polysubstance dependence · Psychiatry · Public health · Substance abuse · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Nursing · Opioid Use Disorder Treatment