Abstract

In 2014 methadone as part of Medically Assisted Therapy (MAT) was introduced in Kenyan public health facilities as part of a comprehensive approach to HIV prevention and treatment. This paper explores the transition experiences for people moving from the use of heroin to MAT. The paper reports on a qualitative study conducted in an urban setting in Kenya in 2015. Findings show that transitioning from the use of heroin to methadone can both be a liberating and disempowering experience. While study participants were reportedly pleased with the life changes brought about by methadone, they struggled with negotiating the transition from an ‘old life’ of heroin use to methadone. Tensions were navigating the 'new life' on methadone and the 'old life' on heroin. These tensions generate new forms of social exclusion, as well as feelings of uncertainty and ambivalence. A particular effect of this challenging transition is how new forms of risk and vulnerability for HIV are created even whilst others are attended to. MAT programs need to attend to the dynamics described to address the risk of HIV posed by a ‘new life’ and the broader tensions involved in transitioning from the use of heroin to methadone.

摘要

2014年，美沙酮作为医学辅助疗法（MAT）的一部分被引入肯尼亚的公共卫生机构，作为艾滋病毒预防和治疗综合方法的一部分。本文探讨了从使用海洛因到MAT的人们的过渡经历。该论文报道了2015年在肯尼亚城市环境中进行的定性研究。研究结果表明，从使用海洛因到美沙酮的过渡既可以解放也可以削弱他们的能力。据报道，虽然研究参与者对美沙酮所带来的生活变化感到满意，但他们仍在努力协商从海洛因使用的“旧生活”向美沙酮的过渡。紧张局势使美沙酮的“新生活”和海洛因的“旧生活”泛滥。这些紧张关系产生了新的社会排斥形式，以及不确定和矛盾的感觉。这一具有挑战性的过渡的特殊效果是，即使在照顾其他人的情况下，如何为艾滋病毒创造新的风险和脆弱性。MAT计划需要关注所描述的动态，以应对“新生活”带来的HIV风险以及从使用海洛因向美沙酮过渡所涉及的更广泛的紧张局势。