Malindi, Kenya, sits on the Indian Ocean coast, hugged by pristine beaches and a history that is charming and rich in diversity. The town of more than 100,000 residents is popularly known as “Little Milano,” thanks to booming tourism and the Italians who never left. Here you are guaranteed to find the best pasta in the country.
In this same town, however, you will find some of the most invisible women in Kenya. In Malindi is where Halima, for one, started using heroin. “There is something about this place,” she says. “It’s a curse.” Halima wants to stop. On the morning we spoke, Halima had spent more than two thousand shillings ($20) to relieve her withdrawal symptoms. Now she was looking for a mere 20 shillings to fend for food for her empty stomach.
Halima is not alone. In recent months, my colleagues and I have regularly met with ten women who use drugs in Malindi. Our interviews were conducted in order to gather information on how to improve access to services specifically aimed at women drug users, including health, legal and social assistance—all services to which we as Kenyans are entitled. These conversations have yielded a close look into the world these women live in, and it is imperative to share their stories.
Four of the ten women we spoke with never anticipated they’d end up using heroin—they’d started off using marijuana but at some point it was not just marijuana, it had been intentionally laced with heroin either by a male friend or a dealer. Then they suffered withdrawal, leading them to use again. Others started using heroin, not knowing the side effects. Unfortunately, the law—and society—does not distinguish.
Drug criminalization and drug-related crime means Kenya’s prisons are filled with people who use drugs, and the majority of the women we spoke to who had spent time in prison spoke of having access to drugs in prison. Police extortion is rampant, while legal representation is in short supply if not nonexistent. In many cases, police even advise defendants to plead guilty to cases of needle possession, something not even illegal. “The police are out to facilitate life sentences to drug users,” one woman, Amina, told us.
There is also the issue of being locked out of a national identity. Kenya, for instance, did not recognize mother-to-child transfer of citizenship until our new constitution in 2010. Another of our interviewees, Njeri, moved to Kenya from Tanzania and has lived in Malindi for more than a decade yet still has no identification papers. Her child was born here but is not recognized as Kenyan because the father is not present. As both mother and child are stateless, Njeri’s child might not be able to sit for national high school entrance exams, leaving her future in peril as well.
Good medical care is likewise hard to find. Women who use drugs are often in the hands of health care providers who do not understand the complexity of addiction. Where other patients receive care, they receive judgment and scrutiny. As a result, many of them only go to the hospital as a last resort, even in child birth. Consider the harrowing story one woman, Monica, told us:
I pushed so hard I thought I was going to die. Nothing was coming out. I explained to the doctor that there was no way I was going to be able to deliver without getting a fix. I called my boyfriend, went downstairs and he gave me a shot. Right there I felt as if the baby was leaking out of me. I rushed back upstairs and gave birth.
All of the women we spoke report knowing about safe practices: using a condom to prevent HIV and other sexually transmitted diseases, sharing needles is dangerous. They also know they can get condoms, HIV testing and counseling at the local NGO Omari Project. Still, for sex workers, some clients will pay more for sex without a condom. And more than 25 percent of drug users on the coast of Kenya report sharing needles. An anecdote we heard from one user, Betty, is not unfamiliar:
I now live in Majengo with my boyfriend. He is also a user. We sleep together with no protection. He does not know that I am a sex worker. I have never gotten pregnant and I don’t use any family planning.
People who inject drugs do so in the shadows of shame because of the stigma and legal repercussions—a dilemma that these conversations show to lead more towards retaliation than it does maintenance or rehabilitation. Consequently, our mothers, our sisters and daughters have been left in the fringes of an already marginalized population. And we must acknowledge that our own neighbors are sometimes the most brutal police.
Consider again the words of Betty:
This is not a life of choice. The stigma towards drug users here is at another level – no one trusts us, everyone thinks that we are all thieves. I have been beaten on several occasions by youth that call themselves community police, about fifty of them; they beat me with electric cables.
So something must be done. Let harm reduction initiatives, however, not end up like the anti-malaria campaign in Kenya that handed out mosquito nets. Without guidance on a community level or local ownership, the nets didn’t go to preventing malaria but instead were used to catch fish.
To avoid this fate, we must intervene through the community collective to ensure the rights of women who use drugs are not violated. Needle exchange and medically-assisted drug treatments such as methadone and buprenorphine should be available through community mechanisms, but we have to also ensure the voices of women themselves are heard in determining what interventions will best help them. Indeed, these community voices must be the strongest component of the equation—or else we might as well all pack up our bags and go fishing.