‘Sometimes I feel like the other life on heroin was better’: transitioning experiences towards methadone, and HIV prevention implications in Urban Kenya

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.