Access and utilisation of reproductive, maternal, neonatal and child health services among women who inject drugs in coastal Kenya: Findings from a qualitative study

Ndimbii, James; Ayón, S Milder; Abdulrahman, Taib; Mahinda, Samantha; Jeneby, Fatma; Armstrong, Gregory; Mburu, Gitau

doi:10.1016/j.srhc.2018.10.002

Cited by 12 publications

(31 citation statements)

References 42 publications

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“…The characteristics of the study sample is summarized in Table 1, and is reported in more detail elsewhere (Ayon et al, 2017, Mburu et al, 2018b, Ndimbii et al, 2018. In brief, the average age of the 45 women was 28.5 (range 19 -56) years (Mburu et al, 2018b).…”

Section: Primary Study Samplementioning

confidence: 99%

Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya

Mburu

Limmer

Holland

2019

Addictive Behaviors

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Introduction: Gender dynamics and interpersonal relations within intimate partnerships are known to determine health behaviors, including substance use, within couples. In addition, influence from intimate partners may occur in the context of wider social ecological determinants of health behavior. The aim of this study was to document the role of intimate partners in influencing injecting drug use among women in Kenya, where injecting drug use is on the rise. Methods: We performed secondary data analysis of an existing dataset from a 2015 qualitative study involving 45 women who inject drugs and 5 key stakeholders in coastal Kenya. Primary data had been collected via a combination of in-depth interviews and focus group discussions exploring sexual, reproductive, drug use, and other social contexts of women who inject drugs. The process by which intimate partners influenced women's initiation of drug use, transition to injecting practices, and maintenance of injecting drug use were identified using thematic analysis. Results: Boyfriends and intimate either facilitated or restrained women's drug-injecting. On the one hand, young women's entry into drug use was prompted by relationship problems or a need to acquiesce with their drug-using boyfriends. Once women started injecting, intimate partners facilitated ongoing drug-injecting by financing the acquisition of drugs, peddling drugs to their women, or sharing their drugs with their women. The social capital that peddlers held insulated women from police arrests, and encouraged women to seek and sustain intimate relations with well-connected peddlers. Men's influences over women were driven by an underlying patriarchal drug acquisition and economic power. On the other hand, boyfriends and intimate partners who were non-injectors or non-drug users sought to moderate women's injecting drug use by encouraging them to inject less, to smoke or snort instead of injecting, or to enroll into rehabilitation. These moderating influences were most prominent when couples were pregnant. Despite men being a source of practical and emotional support, women were frequently unable limit or alter their injecting drug use, due to its addictive nature. Men's disagreement with women's ongoing injecting strained relationships, and occasionally led to separation. Conclusions: Some boyfriends facilitated women's injecting drug use, while others moderated it, supporting assertions that intimate relationships can both be a site of injecting risks or protection. At the micro-level, these findings highlight an opportunity for couplebased interventions, leveraging on non-drug injecting males as a resource to support women adopt safer injecting practices. At a macro level, incorporating livelihood interventions into harm reduction programs is required in order to mitigate economic-based influence of male intimate partners on women's injecting drug use. At both levels, gender transformative approaches are essential. To gain a comprehensive understanding of women's injecting drug use, future stu...

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Section: Primary Study Samplementioning

confidence: 99%

Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya

Mburu

Limmer

Holland

2019

Addictive Behaviors

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“…In addition, IDIs and FGDs were audio-recorded and lasted between 45 and 60 min. Additional details regarding the primary data collection and analysis have been reported in a series of several primary manuscripts [16,[25][26][27].…”

Section: Aims Setting and Methodology Of Primary Data Collectionmentioning

confidence: 99%

“…This paper reports information generated through a secondary analysis of pre-existing qualitative data. The primary study [25,26] was a qualitative study conducted in 2015 with aim of exploring the needs, barrier, and determinants of sexual and reproductive health (SRH) of women who inject drugs in the Kenyan coastal towns of Mombasa and Kilifi.…”

Section: Primary Study Aims and Designmentioning

confidence: 99%

“…The social demographic profile of the sample has been published the above primary papers [16,[25][26][27]. In brief, the sample was relatively young (mean age 28.5 years), and poorly educated, with a fifth (18%) not having had formal education.…”

Section: Social Demographic Profile Of Primary Participantsmentioning

confidence: 99%

“…Over a quarter (27%) were homeless and over half (53%) had a history of being imprisoned. Most had at least one child, and did not use contraception, nor attend antenatal care when they got pregnant [25,26]. Their access to sexual and reproductive health services was prevented by user fees, transport costs, and stigma [16,25].…”

Section: Social Demographic Profile Of Primary Participantsmentioning

confidence: 99%

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HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data

2019

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Background: Injecting drug users are at high risk of HIV infection globally. Research related to female drug users is rare in Kenya, yet it is required to inform the development of gender-sensitive HIV prevention and harm reduction services in East Africa, where injecting drug use is on the rise. Methods: This study aimed to document the nature of HIV risks encountered by women who inject drugs in the Mombasa and Kilifi, Kenya. Secondary data analysis was conducted on an existing dataset from a 2015 primary qualitative study involving 24 interviews and 3 focus group discussions with 45 women who inject drugs. These were complemented with five interviews with key stakeholders involved in the provision of services to women who inject drugs. Guided by the social ecology theory, a thematic analysis was conducted to identify the nature of HIV risks and their underlying determinants.Results: HIV risk behaviours fell into two broad categories: unsafe injecting and unprotected sex. These risks occurred in the form of sharing of needles, unprotected oral, anal, and vaginal sex, sexual assaults, injecting drug use during sex, sex work, and other types of transactional sex. The primary determinants underlying these risks were a low-risk perception, inequitable gender power, economic pressures, and poor availability of needles and condoms. These social-ecological determinants did not exist in isolation, but intersected with each other to create powerful influences which exposed women to HIV. Social-ecological determinants exerted constant influence and created a persistent 'HIV risk environment' that was involuntarily experienced by women.Conclusion: Individual, interpersonal, and societal-structural factors intersect to produce HIV risk behaviours. As a minimum, these risks will require a combination of multifaceted micro-level interventions including self-efficacy training, risk assessment skills, couple counselling, and universal access to the recommended harm reduction package. In addition, the current focus on micro-level interventions in Kenya needs to shift to incorporate macro-level interventions, including livelihood, employability, and gender norms-transforming interventions, to mitigate economic and gender-related drivers of HIV risks. In the Kenyan context, injecting drug use during sex work is emerging as an increasingly important HIV risk behaviour needing to be addressed.

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Determinants of Women’s Drug Use During Pregnancy: Perspectives from a Qualitative Study

Mburu

Ayón

Mahinda

et al. 2020

Matern Child Health J

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Introduction Drug use during pregnancy can have negative effects on maternal and child health. However, there is a dearth of data regarding drug use among pregnant women in Kenya, where illicit drug use is on the rise. In this paper, we report factors influencing women's decisions to use drugs during pregnancy. Methods In 2015, we conducted in-depth interviews and focus group discussions with 45 women who inject drugs and five key stakeholders involved in provision of services to people who use drugs in coastal Kenya. Inductive thematic analysis was conducted to draw out themes related to key determinants of drug use during pregnancy. Results Four key themes emerged outlining determinants of drug use during pregnancy: (i) the use of drugs to cope with the stress of unexpected pregnancy, (ii) the continued drug use during pregnancy to manage withdrawal, (iii) the dual effect of pregnancy on drug use either as a facilitator or as a moderator of drug use, and (iv) the role of male intimate partner in influencing women's drug use during pregnancy. Conclusion Our paper reports women's drug use during pregnancy and the factors influencing this phenomenon. To safeguard the health and well-being of pregnant women and their unborn children, there is a need for education and awareness raising, implementing couple-based harm reduction approaches to leverage on positive male influences, improving availability of drug treatment, and provision of family planning interventions for women who use drugs.

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Access and utilisation of reproductive, maternal, neonatal and child health services among women who inject drugs in coastal Kenya: Findings from a qualitative study

Cited by 12 publications

References 42 publications

Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya

Role of boyfriends and intimate sexual partners in the initiation and maintenance of injecting drug use among women in coastal Kenya

HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data

Determinants of Women’s Drug Use During Pregnancy: Perspectives from a Qualitative Study

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