TY  - JOUR
PY  - 2024//
TI  - "We only trust each other": a qualitative study exploring the overdose risk environment among persons who inject drugs living with HIV in Nairobi, Kenya
JO  - PLOS global public health
A1  - Maurano, Megan
A1  - Bukusi, David
A1  - Masyuko, Sarah
A1  - Bosire, Rose
A1  - Gitau, Esther
A1  - Guthrie, Brandon L.
A1  - Monroe-Wise, Aliza
A1  - Musyoki, Helgar
A1  - Owuor, Mercy Apiyo
A1  - Sambai, Betsy
A1  - Sinkele, William
A1  - Kingston, Hanley
A1  - Farquhar, Carey
A1  - Mbogo, Loice
A1  - Ludwig-Barron, Natasha T.
SP  - e0003435
EP  - e0003435
VL  - 4
IS  - 7
N2  - In Kenya, overdose remains a major public health concern with approximately 40% of persons who inject drugs (PWID) reporting personal overdoses. PWID living with HIV (PWID-LH) are particularly vulnerable to experiencing fatal and non-fatal overdoses because of the surrounding physical, social, economic, and political environments, which are not fully understood in Kenya. Through qualitative inquiry, this study characterizes Kenya's overdose risk environment. Participants were purposively recruited from a larger cohort study from September to December 2018 using the following inclusion criteria: HIV-positive, age ≥18 years, injected drugs in the last year, and completed cohort study visits. Semi-structured interviews explored experiences of personal and observed overdoses, including injection settings, sequence of events (e.g., pre-, during, and post-overdose), safety strategies, and treatment. Interviews were transcribed, translated (Swahili to English), reviewed, and analyzed thematically, applying a risk environment framework. Nearly all participants described personal and/or observed overdose experiences (96%) and heroin was the most frequently reported substance (79%). Overdose precursors included increased consumption, polysubstance use, recent incarceration, and rushed injections. There were also indications of female-specific precursors, including violence and accessing prefilled syringes within occupational settings. Overdose safety strategies included avoiding injecting alone, injecting drugs incrementally, assessing drug quality, and avoiding polysubstance use. Basic first-aid techniques and naloxone use were common treatment strategies; however, naloxone awareness was low (25%). Barriers to treatment included social network abandonment, police discrimination, medical stigma, fatalism/religiosity, medical and transportation costs, and limited access to treatment services. In Kenya, the overdose risk environment highlights the need for comprehensive overdose strategies that address the physical, social, economic, and political environments. Morbidity and mortality from overdose among PWID-LH could be reduced through overdose prevention initiatives that support harm reduction education, naloxone awareness, and access, destigmatization of PWID, and reforming punitive policies that criminalize PWID-LH.<p />  <p>Language: en</p>
LA  - en
SN  - 2767-3375
UR  - http://dx.doi.org/10.1371/journal.pgph.0003435
ID  - ref1
ER  -