By Sylvia Chebet, of Kenya's Citizen TV, who attended an HIV/Aids workshop in Nairobi in November

The crack of dawn on Lamu island. Cultural festivities break the quiet at the sea front. The locals seem deeply immersed in the event that tourists flock to in droves.

Hussein Ramadhan, popularly known as Ramah, is a beach operator. His day usually begins at the jetty. Though he does not have a permit from the government, he jostles among a horde of other beach operators, commonly called beach boys, for a chance to take tourists round the island for a fee. His ability to speak English, French, Spanish and some German, is his selling point.

Walking side by side with an Irish tourist, Ramah appears composed, despite patches of blood stains on his blue shirt, its buttons opened revealing light-skinned hairy chest, sleeves rolled up to the elbow. He is excited about his early catch and finally honours our appointment after four days of waiting.

Residents on the island call him ‘mtu wa unga” (the man who uses powder), and he does not shy from revealing that to me. “ Me, I’m the junkie number one in Lamu,” he says. “Wale wengine walianza mbele yangu, wako udongoni walishakufa.(All those who started before me are all dead).”

He walks me to an isolated spot in Kashmiri’s sandy coast, laced with palm and mango trees about 10 minutes’ walk from Lamu town. He comes here to inject himself, away from the glare of the public and the anti-narcotics police. The cool shade and the breeze is refreshing, and once we are seated on a low branch, Ramah removes his shirt and says “tangu nianze 17 years ago, sijawahi kumiss hata siku moja ( since I started 17 years ago, I have never missed even a day).”

He takes out a syringe and a roll of cocaine powder in a cigarette foil wrap. He pours the contents into the syringe and sniffs the remaining particles, then licks the foil before throwing it away. The fingernail-sized serving costs about 150 shillings (USD $2.00) from his friends.

I ask him if he is aware of the effects of drug and substance abuse. “Ni risky sana, (its risky),” he says - “Mtu anaweza shoot the wrong place akufe instantly (if you shoot the wrong place, you die instantly.”

But that’s not all.Injecting drug users face a further threat because needles and syringes are difficult to find and therefore tend to be reused. He recalls the first time he took a dose of hard drugs in 1989 in the company of four friends. Unfortunately there were only two syringes, provided to him and one other friend. He didn’t want to share his one so his friends found used needles in a hospital dustbin, washed away traces of blood and injected with those. Three of those friends are now dead.

That injecting drug users are vulnerable to HIV infection is not in dispute. Peter Mutie, Kenya’s National Aids Control Programme Director, says this hidden, high risk population accounts for eight per cent of new HIV infections.

Ramah’s story exposes a loophole that the National Aids Control Council (NACC) needs to urgently address. A needle exchange programme, where injecting drug users exchange used needles for new ones, is an option used in other countries but is still controversial here, even among the authorities helping drug and substance abuse addicts.

Joseph Kaguthi, founder and former Director of Kenya’s National Agency for the Campaign Against Drug Abuse Authority (NACADAA), says: “Let us not pretend that giving them a needle for a shilling each and in the meantime encouraging the habit is okay;instead what we should do, is help them to squeeze it out.” Mutie, however, thinks it is the way to go. “If it can save a life, why not? Exchange needles for them as you help them to stop the habit, because you know, a single HIV infection can result in 1,000 infections and we must intervene as far as vulnerability is concerned.”

Ramah is now under the care of an outreach officer, Adam Lali, at the only drug rehabilitation facility in Lamu, known as the Omari Project. Lali deals with dozens of drug addicts and walks them through the tough journey of abandoning the habit. Looking back, Ramah is full of regrets for his addiction. His voice lowered to almost a whisper he says “nilifikiri itaniondolea shida, sasa imeniongezea (I thought it would take away my problems, it has just added).”

Ramah has been in and out of prison. Kaguthi says it is regrettable that the government seems to consider the drug addict to be more of a criminal than the drug baron. “Drug addicts are not criminals that the government should go arresting in a swoop," Kaguthi says. "They are sick, they need help, and the person to give them help is their government.”

Kaguthi says the government appears lax in its effort to ward off drug barons and, as Ramah says, the market is increasing every day. “If the government does not tighten its net along the coastline to stop the drugs from been trafficked into the country, then Lamu is an island in peril," Kaguthi says.

END