How 'cool' is heroin injection at the Kenya coast

Qualitative research methods were used to contact, observe and interview about 40 heroin users living in a Kenyan coastal town with a lively tourist industry. It was found that injecting practices were similar to those reported in other parts of the world. High status, or 'cool', among heroin users was associated with injecting alone and with personal autonomy. The sharing of injecting equipment, however, did occur. Most users were ill informed about the risk of transmission of HIV through injecting equipment. Injecting heroin can be status enhancing within this subculture. 'Cool' among these heroin users was associated with personal self-control, a key attribute of Swahili culture. Intervention measures should build on local values of the need to maintain individual self-control and discourage the sharing or communal use of equipment to inject heroin.