An ethnographic exploration of drug markets in Kisumu, Kenya

Abstract

Background Illegal drug markets are shaped by multiple forces, including local actors and broader economic, political, social, and criminal justice systems that intertwine to impact health and social wellbeing. Ethnographic analyses that interrogate multiple dimensions of drug markets may offer both applied and theoretical insights into drug use, particularly in developing nations where new markets and local patterns of use traditionally have not been well understood. This paper explores the emergent drug market in Kisumu, western Kenya, where our research team recently documented evidence of injection drug use. Methods Our exploratory study of injection drug use was conducted in Kisumu from 2013-2014. We draw on 151 surveys, 29 in-depth interviews, and 8 months of ethnographic fieldwork to describe the drug market from the perspective of injectors, focusing on their perceptions of the market and reports of drug use therein. Results Injectors described a dynamic market in which the availability of drugs and proliferation of injection drug use have taken on growing importance in Kisumu. In addition to reports of white and brown forms of heroin and concerns about drug adulteration in the market, we unexpectedly documented widespread perceptions of cocaine availability and injection in Kisumu. Examining price data and socio-pharmacological experiences of cocaine injection left us with unconfirmed evidence of its existence, but opened further possibilities about how the chaos of new drug markets and diffusion of injection-related beliefs and practices may lend insight into the sociopolitical context of western Kenya. Conclusions We suggest a need for expanded drug surveillance, education and programming responsive to local conditions, and further ethnographic inquiry into the social meanings of emergent drug markets in Kenya and across sub-Saharan Africa.

A Qualitative Study of Substance use during Pregnancy: Implications for Reproductive Healthcare in Western Kenya

“…In western Kenya, gendered inequalities are rooted in women’s limited access to steady employment, education, and healthcare, which increase their exposure to various forms of gender-based and structural violence 4, 23–24,32 . In our larger survey with people who inject drugs, women were more likely than men to be HIV positive, have lower levels of education, and be the primary caregivers of all or most of their children 2,36 , findings which provided the impetus for us to undertake the qualitative interviews documented in this article. Women’s pregnancies, often unplanned, may be an additional burden as they contemplate how they will feed their children in light of limited support from their children’s fathers 40 .…”

“…Overall, our results suggest the importance of addressing alcohol and drug use in the broader context of reproductive healthcare provision and birth outcomes in western Kenya. The lack of awareness around drug use and its health effects is a broader public health issue in the region requiring a multidisciplinary response 36 .…”

“…These interrelated factors have serious implications for women’s reproductive health and birth outcomes, which may be exacerbated by newly emerging patterns of alcohol and drug use 2 . While alcohol has long been part of the culture in this region, injection drug use has more recently emerged in response to rapid socioeconomic changes in Kisumu amidst persistent inequalities and social stress 36 . For women, injection drug use is enmeshed within a broader context of gendered inequalities but presents additional unique challenges, as described below…”

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

“…In Kenya, women constitute a tenth of an estimated 18,000 injecting drug users nationally (UNODC andICHIRA, 2012, NACC, 2014). Although injecting drug use is increasingly being documented in Kenya, recent studies focus on acquisition of drugs, transition to injecting, evidence-based policy development, or general epidemiology among all injecting users, majority of whom are male (Guise et al, 2015, Syvertsen et al, 2016, Mital et al, 2016. As such, there is limited exploration of the contexts of women who inject drugs (Ayon et al, 2017).…”

Development of the Brazilian Drug Market Toward Africa: Myths, Evidence and Theoretical Questions

“…In a recent ethnographic exploration of heroin market in Kisumu, Kenya, researchers unexpectedly documented the development of a cocaine market which had been used by 76% of the individuals they surveyed on their use of heroin. Users were pooling to buy cocaine from Mombassa although it was seen as a powerful and expensive drug (Syvertsen et al 2016). Regarding production, some methamphetamine laboratories run by Colombians were dismantled in Lagos in 2013.…”