We did cross-sectional surveys in Kwale District, Kenya to determine the epidemiology of bovine trypanosomosis and livestock owners' perceptions of the disease. The surveys involved relative importance of trypanosomosis, examination of the current disease constraints, current control practices and drug-use patterns. Informal meetings were held with farmers and cattle census undertaken. Tsetse-fly densities and trypanosomosis prevalences in cattle were determined. A total of 132 farmers were interviewed. Trypanosomosis, anaplasmosis, East Coast fever, foot-and-mouth diseases were reported to be the major constraints to livestock production. Trypanosomosis was the most important compared to other diseases. Chemotherapy was the most widely used method of controlling the disease. Farmer-based tsetse-control technologies were poorly adopted. Respondents were quite knowledgeable on the symptoms, causes and treatment of trypanosomosis. Glossina austeni, G. brevipalpis and G. pallidipes were found in the area; the latter was the most common (0.2-738 flies/trap). Trypanosoma congolense and T. vivax were found in cattle with the former more prevalent. Infection prevalences in cattle varied between 0 and 25% (median: 22%).

Background Injection drug use is increasingly contributing to the HIV epidemic across sub-Saharan Africa. This paper provides the first descriptive analysis of injection drug use in western Kenya, where HIV prevalence is already highest in the nation at 15.1%. Methods We draw on quantitative data from a study of injection drug use in Kisumu, Kenya. We generated descriptive statistics on socio-demographics, sexual characteristics, and drug-related behaviors. Logistic regression models were adjusted for sex to identify correlates of self-reported HIV positive status. Results Of 151 participants, mean age was 28.8 years, 84% (n=127) were male, and overall self-reported HIV prevalence reached 19.4%. Women had greater than four times the odds of being HIV positive relative to men (Odds Ratio [OR] 4.5, CI: 1.7, 11.8, p=.003). Controlling for sex, ever experiencing STI symptoms (Adjusted Odds ratio [AOR] 4.6, 95% CI 1.7, 12.0, p=.002) and sharing needles or syringes due to lack of access (AOR 3.6, 95% CI 1.2, 10.5, p=.02) were significantly associated with HIV positive status. Lower education (AOR 2.3, 95% CI 0.9, 5.6, p=.08), trading sex for drugs (AOR 2.8, 95% CI 0.9, 8.8, p=.08), being injected by a peddler (AOR 2.9, 95% CI 1.0, 8.5, p=.05), and injecting heroin (AOR 2.3, 95% CI 1.0, 5.7, p=.06), were marginally associated with HIV. Conclusions This exploratory study identified patterns of unsafe drug injection and concurrent sexual risk in western Kenya, yet few resources are currently available to address addiction or injection-related harm. Expanded research, surveillance, and gender sensitive programming are needed.

Introduction Female and male sex workers experience heightened vulnerability to HIV and other health harms that are compounded by substance use, physical and sexual violence, and limited access to health services. In Kisumu, Kenya, where sex work is widespread and substance use is a growing public health concern, offering pre‐exposure prophylaxis (Pr EP ) for HIV prevention could help curtail the HIV epidemic. Our study examines “syndemics,” or mutually reinforcing epidemics of substance use, violence and HIV , in relation to Pr EP acceptability and feasibility among female and male sex workers in Kenya, one of the first African countries to approve Pr EP for HIV prevention. Methods From 2016 to 2017, sex workers in Kisumu reporting recent alcohol or drug use and experiences of violence participated in qualitative interviews on HIV risk and perspectives on health service needs, including Pr EP programming. Content analysis identified themes relating to Pr EP knowledge, acceptability, access challenges and delivery preferences. Results Among 45 female and 28 male sex workers, median age was 28 and 25 respectively. All participants reported past‐month alcohol use and 91% of women and 82% of men reported past‐month drug use. Violence was pervasive, with most women and men reporting past‐year physical (96% women, 86% men) and sexual (93% women, 79% men) violence. Concerning Pr EP , interviews revealed: (1) low Pr EP knowledge, especially among women; (2) high Pr EP acceptability and perceived need, particularly within syndemic contexts of substance use and violence; and (3) preferences for accessible, non‐stigmatizing Pr EP delivery initiatives designed with input from sex workers. Conclusions Through a syndemic lens, substance use and violence interact to increase HIV vulnerability and perceived need for Pr EP among female and male sex workers in Kisumu. Although interest in Pr EP was high, most sex workers in our sample, particularly women, were not benefiting from it. Syndemic substance use and violence experienced by sex workers posed important barriers to Pr EP access for sex workers. Increasing Pr EP access for sex workers will require addressing substance use and violence through integrated programming.

Aims: Globally, women who use drugs often practice sex work and experience multiple health and social harms that complicate their drug treatment needs. In East Africa, understanding the emergence of heroin use among women is critical in efforts to build effective drug treatment programming, including the ongoing scale-up of medication-assisted treatment (MAT). We explored heroin use among women engaged in sex work in Kenya to inform services. Methods: In a qualitative study of 45 female sex workers reporting substance use in Kisumu, Kenya, 32 reported lifetime heroin use and comprise the focus of this analysis. Semi-structured interviews explored histories of substance use and sex work and health programming needs. Thematic analysis focused on the contexts and meanings of heroin use. Results: Among 32 women, median age was 28 (range: 18–37). Women commonly smoked cocktails containing heroin while using alcohol and other drugs prior to sex work. Most women perceived heroin to engender “morale” and “courage” to engage in sex work and “fight” potentially abusive clients. Sex work reinforced drug use in ways that both managed and created new risks. Conclusions: Drawing on the concept of “paradoxical autonomy,” we suggest that heroin use engenders new forms of autonomy allowing women to support themselves in conditions of uncertainty, yet does not enable them to entirely overcome their vulnerabilities. Drug treatment programs for sex workers should address the situated logics of substance use in contexts of sexual risk, including patterns of poly-substance use that may render MAT inappropriate for some women who use heroin.