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May Wilkerson May Wilkerson

Photos: Harm Reduction in a Kenyan Coastal Town

Malindi is a small tourist city where heroin addiction and HIV are widespread. But local harm reduction efforts are making a big impact.

3 Substance

Malindi, Kenya is a resort town on the east coast of Africa, where a booming tourism industry has coincided with—and contributed to—widespread heroin addiction and an HIV epidemic among the local population. Photographer Mia Collis captures the daily lives of heroin addicts living in the town, in a photo essay for PBS Newshour, ”Sex and drugs in an HIV-infected paradise.”

For decades, the city has attracted throngs of European visitors looking to cash in on its known abundance of extra-cheap heroin. In the past few decades, more locals have become addicted. The Kenyan government estimates that about one in four drug users on the Kenyan coast have contracted HIV (about five times the rate of infection among the general population).

But in the past few years, various harm reduction efforts have been set up in the area, to help reduce the spread of HIV and provide drug users with education on safer practices, and access to treatment and health services.


Buska Ismail, 32, is a “beach boy” who works to support his drug habit. When business is good, he can afford to shoot up five-or-six times a day. But between April and July, when tourism is slow, he often can’t afford the drug and is forced to go through withdrawal. Above, he waits to receive medical treatment at a drop-in center.


Ahmed Mohamed, above right, is known as “the doctor” because he teaches heroin addicts safer injection practices and discusses the health risks associated with sharing needles. Mohamed has been injecting drugs since he was 14, and recently tested positive for HIV. “I don’t want anybody else to get in this trap,” he says. “If my brothers and sisters are going to inject, I want to teach them how to do it safely.”


The local Watamu drop-in center—affectionately dubbed “the Junky House”—was established two years ago by the Kenya Red Cross to help reduce HIV rates in the area. The center offers ”fast and friendly” treatment for addicts, as well as counseling and evidence-based education on safer drug use, in addition to general medical care. Above, a man named Hajji Fadhil Mohammed is taken through “the steps of a typical injecting session” with a counselor named Tengia. The No. 1 rule Tengia tells all his patients: “Use a clean needle with each injection. Don’t share. No excuses.”


The Omari Project is another harm reduction group in Malindi, who now send dozens of volunteers throughout the city daily to hand-deliver clean syringe packets, and to help connect users with treatment, counseling and health services. Above, Hassan Abdul, receives emergency treatment at an Omari Project drop-in center, for a wound caused by accidentally missing a vein in his leg while shooting up.

There is recovery in Malindi, as well. Monica Wanja, above, cries as she recalls her past addiction to heroin. She finally kicked the drug after her tenth stay in the Omari Project rehab center (below). She now works as a paralegal for the Omari Project, and is seven years clean.

Drug use is still widespread in Malindi. But local health officials say, ever since harm reduction outreach projects began in the city, disease rates seem to have leveled off.