Presented by Tim Rhodes, Professor of Public Health Sociology at the London School of Hygiene and Tropical Medicine (UK)
Drawing on analyses of qualitative interview accounts of people who inject heroin in Kenya, Tim will describe the narration of addiction treatment access and recovery desire in conditions characterised by a ‘poverty of drug treatment opportunity’, in the face of heavy social constraints limiting access to care.
"Up until December 2014, fee-based residential rehabilitation (‘rehab’) was the only addiction treatment locally available and inaccessible to most. Its recovery potential is doubted, given normative expectations of relapse. Treating drug use is a product of tightly bounded agency. Individuals enact strategies to maximise their slim chances of treatment access (‘access work’), develop self-care alternatives when these fail to materialise, and ration their care expectations. The use of rehab as a primary means of respite and harm reduction rather than recovery, and the individuation of care in the absence of an enabling recovery environment, are key characteristics of drug treatment experience. It is in this context of ‘rationed recovery expectation’, that the promise of methadone substitution treatment is imbued with meaning. Introduced in December 2014, after two years of planning, we find that methadone is narrated as a symbol of hope – both for individuals and community – especially regarding recovery from addiction. This narrative of hope for recovery coexists with policy narratives drawing on global evidence which position methadone primarily as HIV prevention. While the primacy of recovery narrative in relation to addiction in Kenya is potentially troubled by the incorporation of a ‘harm reduction’ discourse, and by the limits of rehab to realise its recovery potential, these findings show addiction recovery desires are reinforced among PWID by their sense of immediate HIV risk concern, which frame how the meaning of methadone is made."
Tim Rhodes is Professor of Public Health Sociology at the London School of Hygiene and Tropical Medicine (UK). He uses qualitative methods to explore narratives of HIV care, citizenship, and risk environment. Current research focuses on the social relations of access to HIV prevention and treatment, including among people who inject drugs in Kenya, among people living with HIV and hepatitis C in the UK, and among young people living with HIV in Uganda and the UK. He is Editor-In-Chief of the International Journal of Drug Policy.