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The Omari Project has been working with heroin users in the Kenyan towns of Watamu, Malindi and Mombasa for the past five years. The paper reports on the piloting, adaptation and evaluation of motivational interviewing carried out with 20 heroin users living in coastal Kenya, a cultural context in which participatory approaches and counselling in general, and motivational interviewing in particular, are not familiar. The findings indicate that motivational interviewing was nevertheless acceptable and useful to the study participants.

Heroin has been a street drug along the East African coast for 25 years (Beckerleg, 1995) but it has only recently been recognised and documented (Kilonzo et al, 2001; Jones & Needle, 2005). Heroin use is risky and HIV transmission an increasing problem (McCurdy et al, 2005). Susan Beckerleg and colleagues uncover high rates of unprotected sex, excessive needle sharing and continued re‐use of old and dirty needles often kept in old tins, pockets, or as most do, hidden under rocks.

This paper reports on a questionnaire survey of 300 heroin users in Zanzibar town, in Tanzania. It was found that about 13% of respondents were current injectors of heroin, but that 38% of respondents reported have ‘ever injected’ heroin. Many injectors reported hiding their needles and syringes and almost half of them had shared their equipment during the past four weeks. Most of the respondents reported that they had not had sexual intercourse during the past four weeks. Of those who were sexually active most reported not having used a condom the last time they had intercourse. These findings highlight the need for a wider recognition of the extent of heroin use in East Africa as well as the urgent need to provide harm reduction and treatment services.

Catha edulis, known in the drugs literature as khat and in Kenya as gat, miraa, murungi, veve, gomba, abounds with paradoxes. One of the curious features of khat is that it has become so closely associated with Somalis, both at home and in the diaspora, that consumption of twigs and leaves of miraa are widely assumed to be part of Somali culture and tradition. Yet, khat consumption by Somalis only gained wide popularity in the second half of the twentieth century (Goldsmith, 1997). So, how did miraa use and distribution in Kenya come to be a marker of Somali identity?