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Jaguga F, Kiburi SK, Temet E, Barasa J, Karanja S, Kinyua L, Kwobah EK. A systematic review of substance use and substance use disorder research in Kenya. PLoS One 2022; 17:e0269340. [PMID: 35679248 PMCID: PMC9186181 DOI: 10.1371/journal.pone.0269340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The burden of substance use in Kenya is significant. The objective of this
study was to systematically summarize existing literature on substance use
in Kenya, identify research gaps, and provide directions for future
research. Methods This systematic review was conducted in line with the PRISMA guidelines. We
conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of
Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and
Cochrane Library) from inception until 20 August 2020. In addition, we
searched all the volumes of the official journal of the National Authority
for the Campaign Against Alcohol & Drug Abuse (the African Journal of
Alcohol and Drug Abuse). The results of eligible studies have been
summarized descriptively and organized by three broad categories including:
studies evaluating the epidemiology of substance use, studies evaluating
interventions and programs, and qualitative studies exploring various themes
on substance use other than interventions. The quality of the included
studies was assessed with the Quality Assessment Tool for Studies with
Diverse Designs. Results Of the 185 studies that were eligible for inclusion, 144 investigated the
epidemiology of substance use, 23 qualitatively explored various substance
use related themes, and 18 evaluated substance use interventions and
programs. Key evidence gaps emerged. Few studies had explored the
epidemiology of hallucinogen, prescription medication, ecstasy, injecting
drug use, and emerging substance use. Vulnerable populations such as
pregnant women, and persons with physical disability had been
under-represented within the epidemiological and qualitative work. No
intervention study had been conducted among children and adolescents. Most
interventions had focused on alcohol to the exclusion of other prevalent
substances such as tobacco and cannabis. Little had been done to evaluate
digital and population-level interventions. Conclusion The results of this systematic review provide important directions for future
substance use research in Kenya. Systematic review registration PROSPERO: CRD42020203717.
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Affiliation(s)
- Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
- * E-mail:
| | | | - Eunice Temet
- Department of Mental Health & Behavioral Sciences, Moi University
School of Medicine, Eldoret, Kenya
| | - Julius Barasa
- Population Health, Academic Model Providing Access to Healthcare,
Eldoret, Kenya
| | - Serah Karanja
- Department of Mental Health, Gilgil Sub-County Hospital, Gilgil,
Kenya
| | - Lizz Kinyua
- Intensive Care Unit, Aga Khan University Hospital, Nairobi,
Kenya
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
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Nelson EUE, Abikoye GE. Syringe Sharing and the Risk of Viral Transmission Among People Who Inject Drugs in Nigeria: Structural, Relational, and Subjective Influences on Behaviors. JOURNAL OF DRUG ISSUES 2018. [DOI: 10.1177/0022042618811654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, we report findings of a qualitative study on structural, relational, and subjective determinants of injecting risks. Forty-one current people who inject drugs (PWIDs) were recruited through snowball sampling in Uyo, Nigeria. They were interviewed with a loosely structured interview guide. We employed inductive and thematic analysis of interview transcripts. PWIDs recognize the risk of viral transmission through sharing of syringes. As countermeasures, they inject with sterile syringes, refuse to borrow syringes, and disinfect borrowed syringes. Risk reduction efforts are undermined by withdrawal, pleasure seeking, public injecting settings, policing, social networks, and intimate relationships. These factors create a risk environment for viral transmission. Pleasure-seeking and risk reduction practices show agency and subjectivity, counterbalancing current emphasis on structural determinants of injecting risks. Findings indicate the need for policy reforms, needle and syringe provision, oral drug substitution, safe injecting environments, and peer education. Interventions should build on PWIDs’ agency and risk management practices.
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Affiliation(s)
| | - Gboyega E. Abikoye
- Centre for Research and Information on Substance Abuse, Akwa Ibom State, Nigeria
- Department of Psychology, University of Uyo, Nigeria
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Ahmed N. Most at-risk populations: contextualising HIV prevention programmes targeting marginalised groups in Zanzibar, Tanzania. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 13:205-13. [PMID: 25388975 DOI: 10.2989/16085906.2014.952645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
According to a 2009 UNAIDS report the HIV/AIDS prevalence rate in Zanzibar, Tanzania, is low in the general population (0.6%), but high among vulnerable groups, specifically sex workers (10.8%), injecting drug users (15.1%), and men who have sex with men (12.3%). In response to this concentrated epidemic, the Government of Zanzibar, international and local non-profit organisations have focused their prevention activities on these marginal populations. Although these efforts are beneficial in terms of disseminating information about HIV/AIDS and referring clients to health clinics, they fail to address how the socio-economic status of these groups places them at a greater risk for contracting and dying from the virus. Furthermore, there is an absence of qualitative research on these populations which is needed to understand the challenges these groups face and to improve the effectiveness of interventions. Through interviews with employees of government agencies and non-profit organisations, medical professionals, vulnerable populations and HIV/AIDS patients, this paper used a political economy of health and syndemic framework to examine how local realities inform and challenge HIV/AIDS programmes in Zanzibar.
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Affiliation(s)
- Naheed Ahmed
- a Department of Anthropology , University of South Florida , 4202 E. Fowler Avenue, SOC 107 Tampa , Florida Author's
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Otieno FO, Ndivo R, Oswago S, Pals S, Chen R, Thomas T, Kunneke E, Mills LA, McLellan-Lemal E. Correlates of prevalent sexually transmitted infections among participants screened for an HIV incidence cohort study in Kisumu, Kenya. Int J STD AIDS 2014; 26:225-37. [PMID: 24810218 DOI: 10.1177/0956462414532447] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We determined the prevalence of four sexually transmitted infections and the demographic and behavioural correlates associated with having one or more sexually transmitted infections among participants in an HIV incidence cohort study in Kisumu, western Kenya. Participants were enrolled from a convenience sample and underwent aetiologic sexually transmitted infection investigation. Demographic and behavioural information were collected and basic clinical evaluation performed. Multiple regression analysis was done to determine variables associated with having one or more sexually transmitted infections. We screened 846, 18- to 34-year-olds. One-third had at least one sexually transmitted infection with specific prevalence being: syphilis, 1.6%; gonorrhoea, 2.4%; herpes simplex virus type-2, 29.1%; chlamydia, 2.8%; and HIV, 14.8%. Odds of having any sexually transmitted infection were higher among participants who were women, were aged 20-24 or 30-34 years compared to 18-19 years, had secondary or lower education compared to tertiary education, were divorced, widowed or separated compared to singles, reported having unprotected sex compared to those who did not, reported previous sexually transmitted infection treatment, and tested HIV-positive. Multiple strategies are needed to address the overall high prevalence of sexually transmitted infections as well as the gender disparity found in this Kenyan population. Structural interventions may be beneficial in addressing educational and socio-economic barriers, and increasing the uptake of health-promoting practices.
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Affiliation(s)
- Fredrick Odhiambo Otieno
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI)/CDC Program, Kisumu, Kenya
| | - Richard Ndivo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI)/CDC Program, Kisumu, Kenya
| | - Simon Oswago
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI)/CDC Program, Kisumu, Kenya
| | - Sherri Pals
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Robert Chen
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Timothy Thomas
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Ernesta Kunneke
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Lisa A Mills
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Eleanor McLellan-Lemal
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
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Dar-Nimrod I, Hansen IG, Proulx T, Lehman DR, Chapman BP, Duberstein PR. Coolness: An Empirical Investigation. JOURNAL OF INDIVIDUAL DIFFERENCES 2012. [DOI: 10.1027/1614-0001/a000088] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Some people are routinely described as “cool,” but it is unknown whether this descriptor conveys trait-like information beyond mere likability or popularity. This is the first systematic quantitative investigation of coolness from a trait perspective. Three studies of North Americans (N = 918) converged to identify personality markers for coolness. Study 1 participants described coolness largely by referring to socially desirable attributes (e.g., social, popular, talented). Study 2 provided further evidence of the relationship between coolness and social desirability, yet also identified systematic discrepancies between valuations of coolness and social desirability. Factor analyses (Studies 2 and 3) indicated that coolness was primarily conceptualized in terms of active, status-promoting, socially desirable characteristics (“Cachet coolness”), though a second orthogonal factor (“Contrarian coolness”) portrayed cool as rebellious, rough, and emotionally controlled. Study 3, which examined peer valuations of coolness, showed considerable overlap with abstract evaluations of the construct. We conclude that coolness is reducible to two conceptually coherent and distinct personality orientations: one outward focused and attuned to external valuations, the other more independent, rebellious, and countercultural. These results have implications for both basic and applied research and theory in personality and social psychology.
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Affiliation(s)
- Ilan Dar-Nimrod
- Department of Psychiatry and Laboratory of Personality and Development, University of Rochester Medical Center, Rochester, NY, USA
| | - I. G. Hansen
- Department of Psychology, York College, City University of New York, USA
| | - T. Proulx
- Department of Psychology, Tilburg University, Tilburg, The Netherlands
| | - D. R. Lehman
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - B. P. Chapman
- Department of Psychiatry and Laboratory of Personality and Development, University of Rochester Medical Center, Rochester, NY, USA
| | - P. R. Duberstein
- Department of Psychiatry and Laboratory of Personality and Development, University of Rochester Medical Center, Rochester, NY, USA
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Beckerleg S. East African discourses on khat and sex. JOURNAL OF ETHNOPHARMACOLOGY 2010; 132:600-606. [PMID: 20832464 DOI: 10.1016/j.jep.2010.08.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 06/14/2010] [Accepted: 08/28/2010] [Indexed: 05/29/2023]
Abstract
AIM OF THE STUDY The study aims to review and analyse the varied East African discourses on the effects of khat use on libido, fertility, transmission of HIV, prostitution and rape. MATERIALS AND METHODS The data were gathered between 2004 and 2009 in Kenya and Uganda. Between 2004 and 2005 across Kenya and Uganda a broad survey approach was adopted, involving identification of and travel to production areas, interviews with producers and consumers in rural and urban settings. In addition, a survey of 300 Ugandan consumers was carried out in late 2004. Between 2007 and 2009, an in-depth study of khat production, trade and consumption was conducted in Uganda. This study also employed a mixture of methods, including key informant interviews participant-observation and a questionnaire survey administered to 210 khat consumers. RESULTS Khat is associated, by consumers and its detractors alike, with changes in libido and sexual performance. Although there is no evidence to support their claims, detractors of khat use argue that khat causes sexual violence, causes women to enter sex work, and that chewing causes the spread of sexually transmitted diseases, including the HIV virus. CONCLUSIONS In East Africa the discourse on khat and sex has led to consumption of the substances being associated by many people with uncontrolled sexual behaviour. There is no evidence that khat use fuels promiscuity, commercial sex, sexually transmitted diseases or rape. The current discourse on khat and sex touches on all these topics. Local religious and political leaders invoke khat use as a cause of what they argue is a breakdown of morals and social order. In Kenya and Uganda it is women khat consumers who are seen as sexually uncontrolled. In Uganda, the argument is extended even to men: with male khat chewers labelled as prone to commit rape.
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Affiliation(s)
- Susan Beckerleg
- School of Health and Social Studies, University of Warwick, Coventry CV47AL, UK.
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McCurdy SA, Williams ML, Kilonzo GP, Ross MW, Leshabari MT. Heroin and HIV risk in Dar es Salaam, Tanzania: Youth hangouts, mageto and injecting practices. AIDS Care 2006; 17 Suppl 1:S65-76. [PMID: 16096119 DOI: 10.1080/09540120500120930] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HIV risk through needle sharing is now an emerging phenomenon in Africa. This article describes the practices that heroin users are producing as they establish the rules and organization surrounding their drug use. Their practices and interactions reveal the ways that they become initiated into its use, how they progress to injecting, and the important role of local neighbourhood hangouts in facilitating this process. Their practices, interactions and narratives also provide insights into what may be the most appropriate HIV-prevention interventions. Semi-structured interviews were conducted during the months of February and July 2003 with 51 male and female injectors residing in 8 neighbourhoods in the Dar es Salaam, Tanzania. Interviews were content coded and codes were collapsed into emergent themes around hangout places, initiation of heroin use, and progression to injecting. Interviews reveal that Dar es Salaam injectors begin smoking heroin in hangout areas with their friends, either because of peer pressure, desire, or trickery. One hangout place in particular, referred to as the 'geto' (ghetto) is the main place where the organization and rules governing heroin use are produced. Three main types of heroin 'ghettoes' are operating in Dar es Salaam. As users build a tolerance for the drug they move along a continuum of practices until they begin to inject. Injecting heroin is a comparatively recent practice in Africa and coincides with: (1) Tanzania transitioning to becoming a heroin consuming community; (2) the growing importance of youth culture; (3) the technical innovation of injecting practices and the introduction and ease of use of white heroin; and (4) heroin smokers, sniffers, and inhalers perceived need to escalate their use through a more effective and satisfying form of heroin ingestion.
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Affiliation(s)
- S A McCurdy
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX 77030, USA.
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Abstract
This article reports on a rapid assessment (RA) carried out in the city port of Mombasa, Kenya in March 2004 by the Omari Project to inform the scaling up of their services to heroin users. Heroin has been a street drug in Mombasa for over 25 years. From 1998, white crest, probably from Thailand, started to replace brown sugar, and there was a major shift from inhalation of the vapor ("chasing the dragon") to injecting. The Omari Project has been monitoring the heroin situation in Mombasa and treating heroin users from Mombasa since 1997. In the course of the RA, 496 heroin users were interviewed of whom 95% were men and 5% were women. A range of methods were used, including mapping of the Mombasa region, work with a key informant/guide who was a heroin user, administration of a brief questionnaire and informal interviews, and feedback of findings to other local agencies working with drug users. Respondents were from a wide range of cultural/ethnic groups, the two largest being Mijikenda and Swahili, who are indigenous to the Kenya coast. Overall, 15% of respondents had "ever injected" heroin, and 7% were current injectors (n = 37). These data indicate a shift away from injecting but also reflect the death of many established injectors, either through overdose or AIDS or hepatitis. The figure of 7% of the sample reporting being current injectors is likely to be an underestimate. Syringes were available from a number of pharmacies and most injectors reported using a syringe for 1-3 days. The majority reported injecting in a group of three or more and described risk behaviors for HIV transmission. The results of the assessment highlight the need for a range of services, including needle exchange, counseling, and referral to residential treatment programs. However, progress toward responding to the findings of the RA by establishing effective services are hampered because of legal impediments to operating needle exchange programs in Kenya.
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Affiliation(s)
- Susan Beckerleg
- Policy and Environmental Health Research Unit, London School of Hygiene & Tropical Medicine, UK.
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Beckerleg S, Hundt GL. Women heroin users: Exploring the limitations of the structural violence approach. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2005. [DOI: 10.1016/j.drugpo.2005.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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