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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. 2. www.aids2014.org Nairobi Outreach Services Trust (NOSET) United Nations Office on Drugs and Crime, Regional Office for Eastern Africa (UNODC ROEA) 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 www.aids2014.org 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 OFIDfunded Sustainable Livelihood Project since 2011 www.aids2014.org Vulnerability Context Decrease in protective factors: health hazardous behavior Poverty, Marginalization, deprivation Vicious circle Exclusion from development process and socio-economic services www.aids2014.org Drug dependence, imprisonment and related HIV infection Stigmatization, discrimination Interventions HIV and Drug Use Prevention & Treatment: • Drop-in-Centre: HTC, • Nursing, addiction counseling; • Outreaches: IEC, NSEP • Referral: ART for HIVpositive clients, www.aids2014.org Sustainable Livelihood Interventions • Daily meals and showers • Shelter for women with children • Microcredit training with loan provision • Vocational training in IGAs 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 www.aids2014.org Baseline Status 180 160 140 120 100 80 60 40 20 0 158 98.8% 127 79.4% Got Basic support www.aids2014.org 127 79.4% Living alone Unemployed 62 38.8% 54 87.1% Injecting Drugs Sharing Needles 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: www.aids2014.org 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) www.aids2014.org Behavioral Outcomes 180 160 158 98.8% 127 79.4% 140 120 100 80 60 40 20 0 www.aids2014.org 62 38.8% 84 52.5% 62 38.8% 36 58.1% 24 15.0% 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 www.aids2014.org IGA Training by Jamii Bora Bank Staff www.aids2014.org Beneficiary FWUD with Children www.aids2014.org 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), socioeconomic empowerment is vital to assure retention of female heroin users. www.aids2014.org 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 www.aids2014.org