Needle exchange for injection drug users in Kenya

Public health initiatives are vulnerable to being beaten down by political and religious opposition if they do not cohere with what a moral majority deems acceptable or conflict with the sensibilities of influential faith communities. Such was the case with HPV vaccine in Texas. So it is surprising to see that in Kenya, public health authorities are moving forward with needle exchange programs (as part of comprehensive care services) for injection drug users in the country, despite the vocal opposition heard in the media over the summer.

If it were a purely evidence-driven issue, public health priorities would surely prevail: there is ample data about the (cost- and other) effectiveness of such programs in other parts of the world, and there is little to no evidence that they perversely lead to increased intravenous drug use. The opposition arguments tend to have little more behind them than the 'yuck' factor: those who inject drugs are debauched, unclean, frightening and doing something illegal. Why devote scarce health resources to those who have obviously lost their way?

There are responses to that question, of course, in terms of disease control (a third of injection drug users in Kenya are HIV-positive) and the human right to health. But generally arguments go out the window when the rambunctious public health/politics/religion machine starts going. It will be interesting to see what happens with this initiative in the coming months, and to discern whether it is part of a general trend: public health flexing its muscles in Sub-Saharan Africa.