Meeting the Needs of Women & Young People Who Use Drugs in Kenya
“Our early interventions and 10 years of building trust were important … our organization gained resilience.”
– MEWA staff
When COVID-19 first hit Kenya in March 2020, the Muslim Education and Welfare Association (MEWA)—a CBO providing harm reduction and other services to people who use drugs in Mombasa and surrounding regions—moved quickly to design an inclusive, community-based COVID response that focused on those most vulnerable, including women and young people who use drugs.1 The organization effectively leveraged its long-standing trust, credibility, and relationships with community members and leaders in the healthcare system, government, and law enforcement. With its services shut down in the initial weeks of lockdown, MEWA focused on producing and distributing homemade woven masks for people who use drugs in the community and in the prison system, taking action well before any guidance was issued around mask-wearing by health authorities. It also worked with local Muslim religious leaders, doctors, and the health department to ensure that the bodies of people who had died of COVID were buried respectfully, in accordance with religious and cultural customs. This was an important entry point for MEWA’s subsequent work with the community around social distancing, mask-wearing, and other COVID-related safety measures.
Throughout the pandemic, MEWA has worked to meet the needs of its most vulnerable community members, including providing homemade meals, hygiene kits, and clean needles and syringes, increasing the hours of operation for its drop-in center for women who use drugs, accommodating an increased number of women in its shelter, and providing take-home doses of methadone for women with underlying conditions. During this time, MEWA also undertook community-based research—which was the first of its kind in Kenya—to assess the prevalence and lived experiences of GBV among women who use drugs and their children. Additionally, It sought to better understand the economic, social, sexual health, and mental health needs and coping strategies of women who use drugs and experience GBV; evaluate psychological and structural factors that perpetuate GBV among women who use drugs; and develop a model of interconnections between GBV and uptake of harm-reduction services.2
Based on this research and informed by its ongoing work in the community, MEWA developed additional GBV-related services, including face-to-face counseling for couples at its drop-in centers, which resulted in a 45% reduction in GBV during the pandemic. Due to its ongoing engagement with government, MEWA received funding from the Kenyan Ministry of Labor and Social Protection to open an additional shelter for young drug users—many of whom were coming in as couples—and provide entrepreneurship training and start-up capital for small businesses for young people and their families. Because government-run health facilities were apprehensive about providing services to people who use drugs, MEWA responded by scaling up HIV case management at its two accredited antiretroviral therapy (ART) drop-in sites during the pandemic. All HIV-positive clients were 100% adherent and achieved 96% viral suppression.
Prevention strategies were deployed with an increase in uptake of HIV testing through self-testing kits and enrollment into PrEP services. MEWA staff said, “Our early interventions and 10 years of building trust were important … our organization gained resilience” during the COVID-19 pandemic. However, they highlighted that greater investment is needed in community systems and response in order to meet the needs of people who use drugs and other vulnerable groups, particularly because government systems have limited capacity.
1 This case study was prepared based on an interview with MEWA staff, and accompanying materials that were shared.
2
Understanding Experiences of Gender-Based Violence Among Women Who Use Drugs (WWUD) And Developing a Prevention and Response Framework in Coast, Kenya. Dr. Habil Otanga, Fatma Jeneby, Muna Handulle, Machteld Busz, Prof. Harry Sumnall, Prof. Marie-Claire Van Hout, January 2021.