Seif + Michael

- a PWID / addiction recovery story -

In a real sense, we were in a very bad condition - not only me, but everyone around me who are addicts... This program has had a very, very big impact... I came here looking different than the way I am today, and this is all because of PEPFAR.

(Seif Ashraf)

"PEPFAR gives second chances"

PEPFAR Kenya gives hope and second chances through....

helping people who inject drugs (PWID) realize freedom from addiction

An Added Risk for At-Risk Populations


According to the UNODC World Drug Report of 2020, an estimated 15.6 million people inject drugs globally. People who inject drugs (PWID) often experience challenges related to stigma, rejection, imprisonment, and many other mental health issues. While pockets of negative public perceptions to people who inject drugs or PWIDs still exist, Kenyans increasingly acknowledge the growing problem of drug addiction in the country (especially among the youth)—and that this group needs help and friendly health services.


In addition to their other aspects of compromised health, PWID are also among the most vulnerable populations in the battle against HIV, due to the high risk of HIV transmission associated with injection drug use. HIV prevalence rates are elevated among PWID in all parts of the world, and in Kenya the documented prevalence is 18.7% - even higher than regional estimates. Because of the stigma they encounter, this population also often finds it difficult to access essential health services and support, including antiretroviral therapy (ART).


Improved Outcomes


PEPFAR and Kenyan health authorities have taken action to prevent HIV and other adverse effects from injection opioid use among PWID through an impactful medically assisted therapy (MAT) program. MAT provision has shown to be a highly effective treatment for opioid dependence, reducing injecting behaviors that put PWID at risk for HIV – thus preventing HIV transmission while also improving retention on HIV treatment for those who are already HIV positive. Individuals are initiated on MAT upon going through a long-term preparation process, where they then receive the MAT through primary healthcare settings or specialized outpatient clinics.


In 2013, Kenya adopted the use of Methadone to aid individuals who are addicted to injecting opioids, and through PEPFAR’s support, these services have been linked and integrated into HIV-specific services, including HIV testing and treatment. The first MAT clinic to support PWID in Kenya was established in Nairobi in 2014, and today, PEPFAR supports 10 clinics across 5 counties in the country. The therapy model centers on harm reduction – which acknowledges that people face challenges in freeing themselves from drug use – and it comprises a range of services that mitigate the adverse consequences of drug use to protect both personal and public health. 


Despite the known benefits, provision of MAT can often pose a challenge to clients, as they have to understand and commit that, once enrolled, they will take the methadone drug every day at a given time for at least one year, and even up to two years, until successful treatment of addiction.


Seif and Michael each represent a PWID success story: as friends who met through the Kisauni MAT Clinic in Mombasa, they have both been on MAT for over one year; in the process, they have supported one another in their recovery journeys, they have regained their health, and they are once again able to support themselves and re-establish relationships with family and friends. 


The Kisauni MAT clinic – funded by PEPFAR through USAID’s Stawisha Pwani project – provides people like Seif and Michael with myriad integrated treatment, including: opioid replacement therapy (methadone); HIV testing, counseling and linkage to care; ART; vaccinations; triage for other health issues; diagnosis and management of viral hepatitis; prevention and treatment of tuberculosis; psychosocial counseling; behavior change and community and family re-integration programs. These interventions are all provided free of charge to people like Seif and Michael and their peers, to reduce their risk of contracting and transmitting HIV. 


The moving success stories of MAT program participants who have overcome addiction and are now leading healthier, freer lives, like Seif and Michael, demonstrate the program’s effectiveness…


Seif’s story


In 2011, Seif Ashraf Regge was struggling. His wife had left him and he felt like he was at rock bottom. “I lost everything,” Seif recalls; “My family – my own family – they were still there, but my wife, my kids – they had to stay away from me. It was so sad, but I couldn’t do anything.”


One day his friend told him “something good is coming,” and he introduced him to the MAT clinic. Reluctantly, Seif joined. Things did not go smoothly right away; there were ups and downs, and because addition is powerful, Seif relapsed back into old habits. However, he did not give up. His friend encouraged him to return to the MAT clinic, even though he was afraid and embarrassed. Seif was doing well, and traveled to Dubai for work, but the COVID-19 pandemic hit him hard; he was struggling, and turned to drugs again. His friend encouraged him to go back to treatment. Seif was ashamed that he had once again “defaulted”, but with his friend’s encouragement, Seif sought help once more at the MAT clinic. After his last time defaulting, Seif returned home to his mother’s house while undergoing treatment; She told him he was changing while he was in treatment – she could see a difference.


Seif has now spent 12 months in recovery and is doing well; he says he owes his success to the PEPFAR MAT program and its dedicated staff – who he sees daily – for their continued encouragement and support. Seif is determined to continue his journey towards health, and with the support of friends like Michael, he is working toward completing his two years in the program and being completely free from addition. Reflecting on where he has been and where he is heading, Seif says of addition: “That’s not a good life. We have kids, we have parents, we have friends who are depending on us. We have a lot of people who are looking at us. We have to show them a good example.”


“In any addiction,” he adds “it’s really hard to quit… but if you heart is stuck on it, you have to do it… PEPFAR supported me, and it’s supporting a lot of people, in fact, to achieve freedom from addiction… There are so many of us here, and we are really getting a very, very big help right here.” The methadone clinic has given Seif the power to prove to himself that he can overcome, and has helped him become himself again, and thus regain his family’s trust. Seif is grateful for the chance to recover his life and his dreams for the future. As he summarizes: “PEPFAR gave me a second chance.”


Michael’s story


As the youngest of six children, Michael Jackson Washo started doing drugs after his mother passed away, when he was still a boy. “When my mom died, actually everything stopped in my life,” he recalls; “No one was there – the whole family scattered.” Michael started selling drugs for income and to afford school fees. Eventually, Michael also started using the drugs he was selling, with his brothers’ encouragement – to help numb the pain of his mother’s death. Once he started using, he would do anything to continue smoking and selling; it felt as though “Someone has to cry, someone has to get injured, just so you can smoke.”


Michael found himself in prison for robbery when advocates for the Kisauni MAT Clinic came and asked if he was interested in joining treatment. At first, he declined. But the judge on his case told him that if he would agree to and adhere to treatment, she would clear his records. “I felt different from that day I started Methadone,” Michael recalls; “I felt some difference in my life, you know. The judge asked me, ‘Hey, yo, did you start methadone?’ and I said ‘Yeah I did, and it felt great.’ ” The judge made Michael promise he would never come to court again. “I told her, ‘I promise, Miss Judge, I do promise – I will never.’” Michael recounts; “And I thank God I have never gone back to that courtroom ever since I started methadone.”


With the support of the medical staff and counselors at Kisauni MAT clinic, Michael has been successful in adhering to his recovery journey, and he recognizes PEPFAR’s role in helping him and his PWID peers: “PEPFAR has been the thing right here, man, and we really thank God, and we are hoping for more from them… You know, this methadone thing has helped so much, for so many people outside and inside here.” Now that he is in the process of reclaiming his own life, Michael wants to help others start down the path to recovery as well; “I wish I had the strength to help everyone get off this thing… everyone deserves a good life, no one needs a bad, sad story... everyone – EVERYONE – wants a good life.”


Michael says that, together with their peers at Kisauni, Seif and has become like family to him: “The only people I call family nowadays are the people I live with every day, not my real biological family…  these guys are essentially the people I am doing life with every day. Nowadays I have a great family here; we don’t use drugs anymore; we just hang around together, writing music…”


Michael is a musician, and these days, with the return of his clarity and creativity, he is back to making music he loves, and Seif sometimes joins him in producing his videos. He also recognizes that talent is only as valuable as what you do with it, and he wants to realize his full potential. “Giving up is not an option,” Michael says. “I am talented, but the question is, what are you doing with your talent? I’m a musician, but all the music I made is from after my addition; MAT made me stronger and clearer minded to be able to make something like that.”


Michael exhorts Seif and their other friends to stay strong on their path to recovery by fixing their vision on their goals and dreams for the future. As he puts it: ““If you don’t have goals, then you don’t have dreams; and if you don’t have dreams, then you don’t have goals.” He also is sure that he has a bright path ahead of him: “You know I have a future – I really have a future. I want to be ambassador of something someday, and with my music, I really believe in myself… I know have huge things ahead of me in my music career because, even though people really like my music, I know I haven’t even really dug inside my head to write something truly great yet… There is even more greatness in me; I have bigger hopes and a bright future ahead of me.”


Second Chances


MAT clinics are an essential tool for HIV prevention and treatment among PWID and play an important role in Kenya’s HIV response. The PEPFAR-supported MAT program at clinics like Kisauni significantly advances the battle against HIV in Kenya, and has impacted thousands of people like Seif and Michael.  In addition to the quality of their health and lives improving significantly due to MAT, now that they are recovering from addition, Seif and Michael are also able to receive HIV prevention instruction and services; By giving PWID a safe and supportive environment, we can educate them on the significance of and methods for HIV prevention, and provide them with access to testing and treatment. The clinics’ effects are seen in every aspect of the community, and the number of people newly diagnosed with HIV in the region has significantly decreased since PEPFAR began providing MAT services.


PEPFAR continues to tailor HIV prevention programs for the key populations and priority populations it serves in Kenya, including for PWIDS; these prevention activities are evidence-based, for both preventing HIV risk before it occurs, and reducing ongoing risks. Through all of this, we aim to give many more people ‘second chances’ at pursing their bright futures – much like Seif and Michael. And with freedom from addition and knowledge about HIV prevention – thanks to the support of PEPFAR’s MAT program and the dedicated clinicians and staff that serve Michael and Seif and thousands more like them every day – that future is within reach.


- a pepfar Kenya story of hope -