AIDSTAR-One | CASE STUDY SERIES                                                                                      Novem...
AIDSTAR-One | CASE STUDY SERIES                                        are unable to address the many interrelated needs o...
AIDSTAR-One | CASE STUDY SERIESGender and HIV in Kenya                                                       and STD Contr...
AIDSTAR-One | CASE STUDY SERIES                                                            police, health, and legal assis...
AIDSTAR-One | CASE STUDY SERIESMaanisha provides them with training on new                             communities should ...
AIDSTAR-One | CASE STUDY SERIES       training and support. Capacity building               messages and approaches to cha...
AIDSTAR-One | CASE STUDY SERIESa Gender Analysis Tool for CSOs to assess their level of gendersensitivity.                ...
AIDSTAR-One | CASE STUDY SERIES                                                                             widows and hel...
AIDSTAR-One | CASE STUDY SERIES                                                                       so silenced that the...
AIDSTAR-One | CASE STUDY SERIESWAFNET’s experience is typical of many Maanisha        coupled with other GBV services so t...
AIDSTAR-One | CASE STUDY SERIES                                                                        Addressing gender a...
AIDSTAR-One | CASE STUDY SERIESREFERENCES                                           Violence Prevention and Response in PE...
AIDSTAR-One | CASE STUDY SERIESof the Kenya National HIV and AIDS Response.                           Dr. David Ojakaa, Pr...
AIDSTAR-One | CASE STUDY SERIESfrom Encompass, LLC; John Snow, Inc.; and theInternational Center for Research on Women for...
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AIDSTAR-One Case Study: Addressing HIV and Gender from the Ground Up in Kenya


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In Kenya, the government's work against HIV is supplemented frequently by civil society organizations. These organizations, however, are often faced with a lack of available funding and knowledge. The Maanisha Community Focused Initiative, a program that works in many of Kenya's provinces, works to provide CSOs with both grants and capacity building in all HIV program areas while simultaneously addressing multiple gender-related issues.

This case study covers one of the 31 programs from the Africa Gender Compendium, an AIDSTAR-One gender and HIV integration resource. A series of five Africa Gender Compendium case studies is accompanied by a findings report, which describes lessons learned, gaps, and common experiences across the programs.

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AIDSTAR-One Case Study: Addressing HIV and Gender from the Ground Up in Kenya

  1. 1. AIDSTAR-One | CASE STUDY SERIES November 2011Addressing HIV and Genderfrom the Ground UpMaanisha Community Focused Initiative to Control HIV:A Program to Build the Capacity of Civil SocietyOrganizations in Kenya1 T he fishing villages situated on Lake Victoria in Kenya paint a peaceful picture with boats dotting the water and the quiet of rural life. But looking closer, the scene is less than idyllic. The Lake Victoria Basin is one of the poorest regions in the country, and HIV prevalence is high in communities where there is little access to information or prevention programs. In fishing villages, poverty contributes to practices such as “fish for sex,” where women trade sex for fish they can later sell in ICRWBoats along the coast of Lake the market, or consume. Many people living with HIV do notVictoria (Bondo, Nyanza Province, know that they are infected because they have not been tested;Kenya). as a result, many do not access care and treatment. Although the Lake Victoria Basin has some of the highest rates of poverty and HIV in Kenya, it is hardly atypical. Thousands of local nongovernment organizations (NGOs) are working to help Kenyans better protect themselves and change practices that contribute to the HIV epidemic, including sexual and gender-based violence (GBV)2, early marriage, cross-generational, and transactional sex, in addition to poor health-seeking behavior. Yet NGOs often lackBy Saranga Jain, the know-how and resources to be effective in preventing HIV. TheyMargaret Greene, An AIDSTAR-One compendium and additional case studies of programs in sub-Saharan Africa thatZayid Douglas, 1 integrate multiple PEPFAR gender strategies into their work can be found at Betron, and focus_areas/gender/resources/compendium_africa?tab=findings. 2 In the broadest terms, “gender-based violence” is violence that is directed at an individual based onKatherine Fritz his or her biological sex, gender identity, or his or her perceived adherence to socially defined norms of masculinity and femininity. It includes physical, sexual, and psychological abuse; threats; coercion; arbitrary deprivation of liberty; and economic deprivation, whether occurring in public or private life (Khan 2011, 7).AIDSTAR-OneJohn Snow, Inc.1616 North Ft. Myer Drive, 11th Floor This publication was produced by the AIDS Support and Technical Assistance ResourcesArlington, VA 22209 USA (AIDSTAR-One) Project, Sector 1, Task Order 1.Tel.: +1 703-528-7474 USAID Contract # GHH-I-00-07-00059-00, funded January 31, 2008.Fax: +1 703-528-7480 Disclaimer: The author’s views expressed in this publication do not necessarily reflect the views of the United Agency for International Development or the United States Government.
  2. 2. AIDSTAR-One | CASE STUDY SERIES are unable to address the many interrelated needs of women and men, PEPFAR GENDER and lack the capacity or funding to address difficult issues such as STRATEGIES engaging men in program activities, reducing GBV and other human ADDRESSED BY rights violations, and alleviating poverty. THE MAANISHA COMMUNITY FOCUSED In 2004, the African Medical and Research Foundation (AMREF) INITIATIVE began the Maanisha Community Focused Initiative to Control HIV and AIDS (hereafter referred to as Maanisha). The program works • Reducing violence and coercion in Western, Nyanza, Rift Valley, and Eastern provinces to reduce • Engaging men and boys to the incidence and impact of HIV by providing grants and capacity address norms and behaviors building to civil society organizations (CSOs) to help them design and implement high-quality HIV prevention, care, and support • Increasing women’s and girls’ interventions. It builds the capacity of CSOs to promote behavior legal protection change among vulnerable groups, promote safe sexual behaviors, • Increasing women’s and and facilitate access to home-based care and referral services girls’ access to income and for people living with HIV. Through close linkages with CSOs productive resources, including and government structures, Maanisha also strengthens the HIV education. programming knowledge base to influence policy and promote the adoption of best practices. The Swedish International Development Cooperation Agency (SIDA) funded the program from 2004 to 2007, and in October 2007 Maanisha was scaled up with funding from SIDA and the U.K. Department for International Development, extending the life of the program through 2012. This case study describes how the Maanisha program addresses multiple gender-related issues while working with diverse CSOs on a range of interventions and approaches. For this case study, AIDSTAR- One conducted in-depth interviews with key informants at the UN Development Fund for Women, the National AIDS Control Council, Liverpool VCT Care and Treatment, and the National Empowerment Network of People Living with HIV and AIDS in Kenya. They also conducted group and individual interviews with program managers in Nairobi; field staff from the Western, Rift Valley, North Nyanza, and South Nyanza regions; and program staff at Women Action Forum for Networking (WAFNET) and the Women in the Fishing Industry Project (WIFIP), both Maanisha implementing partners. Additionally, AIDSTAR-One held focus group discussions with community members accessing the Maanisha program through six CSOs to hear their perspectives on how Maanisha was addressing gender in the context of HIV. These focus group discussions comprised groups of women—some of whom are living with HIV—as well as male youth and mixed groups of men and women.2 AIDSTAR-One | November 2011
  3. 3. AIDSTAR-One | CASE STUDY SERIESGender and HIV in Kenya and STD Control Program, established in 1987, and the NACC, established in 1999, to specificallyIn Kenya, HIV prevalence among adults is 7.4 coordinate the country’s HIV prevention strategies.percent. However, prevalence among women is 1.5 NACC designed and implemented three Kenyatimes greater than men—8.7 percent compared to National AIDS Strategic Plans from 2000 to 20055.6 percent (Kenya AIDS Indicator Survey 2007)— (KNASP I), 2005 to 2009 (KNASP II), and 2009 toand females aged 15 to 24 are five times more 2013 (KNASP III)5 that embody the “Three Ones”likely to be infected than their male peers (Ministry principle in addressing HIV across multiple sectors.of Health 2003; National AIDS Control Council Recognizing the interconnectedness between[NACC] 2005). gender and HIV, NACC created the multi-sectoralWomen’s and girls’ relatively higher vulnerability Technical Sub-Committee on Gender and HIV andcan be tied to social, cultural, and economic risk AIDS Task Force in 2001 to develop a strategyfactors, including practices such as female genital for mainstreaming gender activities into KNASPcutting, widow cleansing,3 wife inheritance,4 (NACC 2002). However, while the governmenttransactional and cross-generational sex, and is currently putting in considerable effort toearly marriage (NACC 2009). A practice common address gender and HIV, some gaps still Kenya’s fishing villages—as well as in similar In 2008, a gender audit of the KNASP II foundcommunities in other countries—is “fish for sex.” that most implementers and stakeholders in theAt issue is the scarcity of fish, which has forced national HIV response lack an understanding ofsome women to provide sexual favors to fishermen gender concepts and the role that gender playsin exchange for obtaining fish that can be later sold in HIV vulnerability, and that this can stymieby the women. GBV between intimate partners is mainstreaming efforts. Further, the sex andcommon throughout Kenya and condoned by men age disaggregation of data collected under theand women alike. This kind of GBV was found KNASP’s priority areas has been planned butto be strongly associated with an HIV-positive is not yet fully operationalized (NACC and UNstatus among women participating in a study Population Fund 2009).in Nairobi (Fonck et al. 2005). The 2008–2009 The Kenyan government has attempted to addressDemographic and Health Survey found that nearly gender-related vulnerability to HIV. In response to47 percent of ever-married women aged 15 to 49 high rates of GBV among children, particularly girls,had experienced domestic violence, and over 20 in 2001 the government passed the Children’s Act,percent of women aged 15 to 40 had experienced which criminalizes GBV against children as well assexual violence (Kenya National Bureau of harmful traditional practices such as early marriageStatistics and ICF Macro 2010). and female genital cutting (Government of Kenya,The Kenyan government’s response to the epidemic Office of the Vice President and Ministry of Homeis led by the Ministry of Health’s National AIDS 5 The Kenya National AIDS Strategic Plan 2009–2012 (KNASP III) re-3 A practice whereby a woman who has lost her husband subsequently sponds to new evidence from the Kenya AIDS Indicator survey signalinghas sex with a man in the community, or relative of her husband, to fulfill that the decline in the epidemic had stalled and incidence was concen-a ritual cleansing. trated in specific groups: discordant couples, sex workers, and people4 A practice whereby a woman who has lost her husband marries a male who inject drugs. KNASP III strengthens new approaches to prevention,relative of the deceased, typically ensuring the deceased husband’s care, and treatment and rearticulates the commitment to effective andproperty stays within the family. sustainable programming. Maanisha Community Focused Initiative to Control HIV: A Program to Build the Capacity of Civil Society Organizations in Kenya 3
  4. 4. AIDSTAR-One | CASE STUDY SERIES police, health, and legal assistance (Government of Kenya, Kenya Police 2006). However, the quality of services varies depending on the gender desk officer’s availability and assessment of the victim upon arrival at the police post. Kenya’s laws on women’s rights to property and inheritance at the present time are not clearly operationalized. The new constitution, passed in August 2010, guarantees freedom from gender discrimination with respect to property and ICRW inheritance, but guidance has yet to be releasedVictoria Women Group participants. on how to ensure this freedom. Most customary laws prevent women from owning or inheriting assets, including property, and traditionallyAffairs, Heritage and Sports, Children’s Department these have taken precedence over national laws.2002). However, punishment is minimal, with However, the government has drafted a land policyincarceration of less than one year or a monetary that prohibits gender discrimination in propertyfine. To further strengthen the response to HIV and ownership, including customary law (Barasa 2009).GBV, in 2005 the Ministry of Health developed a Another bill under consideration, the Kenyanpolicy framework (including standards of care) for Matrimonial Property Bill, outlines division ofpost-rape care. Training materials for counseling marital property between a couple, including thosevictims of GBV and clinical care for victims of residing in polygamous households, althoughrape were developed in 2006. Also in 2006, the inherited assets or assets held in trust are notgovernment passed the Sexual Offenses Act, which included in the bill (Mathenge 2009). Though thisissues penalties including imprisonment for rape, is a step toward gender equality, this propertyattempted rape, sexual harassment, sexual assault, bill does not address gender discriminationsex or attempted sex with a child, and deliberate in inheritance, which is now mandated to beinfection of HIV. The act also provides for the medical addressed under the new of GBV and of both victim and perpetratorin cases of HIV infection (Kenya Law Reportsand Government of Kenya 2009, 3). However, The Maanisha Approachenforcement of this act has been a challengebecause of fear among victims and of perceived Maanisha is Swahili for “giving meaning to,” whichstigma and discrimination from service providers and captures the program’s philosophy that involvingthe broader community. Furthermore, the act also communities in their own health and in thedoes not recognize marital rape. In general, domestic design, implementation, and evaluation of healthviolence is not formally recognized by law. programs is crucial to addressing HIV. Accordingly, Maanisha addresses multiple gender-relatedThe establishment of a gender desk at all police vulnerabilities to HIV infection by fostering thestations in the country is another government effort capacity of CSOs to provide integrated servicesto address GBV. This desk uses a referral process in in three ways. First, when CSOs identify gender-which a female officer with experience in dealing with related challenges to the delivery of their services,GBV is an entry point for victims of GBV to receive interconnected with those they already address,4 AIDSTAR-One | November 2011
  5. 5. AIDSTAR-One | CASE STUDY SERIESMaanisha provides them with training on new communities should not be passive recipients ofapproaches that address these challenges that services but rather active contributors to solvingcan be incorporated into their existing activities. health problems. Maanisha targets CSOs thatFor example, in response to CSO concerns about address HIV in conjunction with cross-cuttingthe challenge of involving men in behavior change issues such as human rights violations, stigma,efforts around safe sex and GBV, Maanisha staff gender inequality, and poverty. Examples of CSOprovides training on male engagement using interventions include educating youth on HIVguides drafted by AMREF. prevention, providing home-based care to people living with HIV, addressing the needs of widowsSecond, Maanisha develops networks for CSOs and orphans, and changing harmful practices andand government structures to encourage sharing behaviors such as widow cleansing and violenceof lessons, approaches, and practices to address against women and children.complex, interrelated gender factors that drivethe epidemic. For example, a project addressing In 2006, AMREF conducted a capacity assessmentbehavior change around sexual practices in fishing in Nyanza and Western provinces and found thatvillages added an income-generation component the thousands of CSOs working to address HIVfor women and began targeting men on risky (including those supported and not supportedsexual behavior to discourage the practice of “fish by Maanisha) were having little impact in theirfor sex.” This project’s staff members learned communities and required more experience, skills,about these approaches in exchanges with other and resources to be effective. They also foundCSOs and during network meetings that were there was duplication in efforts, that CSOs wereorganized by Maanisha. not following national guidelines on addressing HIV, and that coordination with and support fromThird, in working with hundreds of CSOs to address government were limited. Further, Maanisha founda wide variety of community needs, many of which that existing HIV programming did not align withinclude addressing gender-related barriers to HIV the Paris Declaration6 nor did much evidence existprevention, the program coordinates efforts across regarding the extent to which HIV actors embracedCSOs to avoid duplication and provide communities the “Three Ones” approach7 in their programmaticwith complementary services that address efforts. Maanisha therefore began to strengthen theinterconnected needs. capacity of CSOs and private sector organizations to improve their interventions.Development and The Maanisha program consists of five components:Implementation 1. The capacity building component toProject start-up and activities: The improve the ability of CSOs to designMaanisha program started in 2004 in Nyanza and implement interventions throughand Western provinces with the aim of reducing 6 The Paris Declaration on Aid Effectiveness is about program implemen-HIV incidence and improving the quality of life for tation measures improving the effectiveness of foreign aid and stressespeople living with and affected by the disease. five principles: ownership, alignment, harmonization, mutual accountabil-In particular, the program supports communities ity, and managing for results. 7 Kenya is a signatory to the “Three Ones” principle—one agreed AIDSto develop and implement HIV interventions action framework, one national AIDS coordinating authority, and onethrough more than 730 CSOs, believing that country level monitoring and evaluation system. Maanisha Community Focused Initiative to Control HIV: A Program to Build the Capacity of Civil Society Organizations in Kenya 5
  6. 6. AIDSTAR-One | CASE STUDY SERIES training and support. Capacity building messages and approaches to change risky needs are identified in collaboration behaviors and practices among CSO target with local stakeholders, and training and communities. support are operationalized using an organizational development and systems 4. The care and support component helps strengthening approach, which uses one- CSOs improve health care access and on-one mentoring with CSOs on eight referrals for people living with HIV, and topics ranging from vision and strategy provides care and support to orphans and development to administrative topics vulnerable children, as well as widows such as budgeting and human resources and widowers who lost a spouse to an management. HIV-related illness. Through this program component, Maanisha coordinates with 2. The grants component for CSOs to relevant government agencies to close undertake HIV interventions. Prior to gaps between community care and the 2007, Maanisha solicited grant proposals formal health system. The program also using a “reactive” approach, where CSOs encourages health care workers to support, submitted proposals based on their own supervise, and train CSO staff members. identification of local needs and solutions to these needs. However, a review showed 5. The knowledge management component that this approach missed marginalized documents Maanisha’s activities and results, groups, such as mobile populations, men and identifies CSO strengths and needs who have sex with men, drug users, and related to their ability to document and share prisoners, because these groups lacked the lessons learned, which guides Maanisha’s capacity to compete for grants. In response, continued training and mentorship to each Maanisha now also uses a “proactive” CSO. By building the capacity of CSOs to approach to grant-making, wherein exchange lessons learned with each other Maanisha selects priority areas to be and with Kenyan policymakers, the program addressed and limits competition for these and its partner organizations have been funding opportunities by targeting recipients able to transfer skills to communities and that have not participated in past “reactive” influence policy and practices. funding opportunities in order to build these organizations’ capacity in developing Integrating gender: In 2006, the Maanisha programming. project developed a Gender Mainstreaming Strategy to identify gender gaps in CSO activities 3. The behavior change communication and address them by developing program component promotes safer sexual behavior priorities, guidelines and strategies, and plans among youth, teachers, parents, people for resource allocation. The strategy calls for the living with HIV, caregivers, widows, people development of a gender-sensitive monitoring who inject drugs, sex workers, men who and evaluation framework and gender-sensitive have sex with men, people with disabilities, HIV programming among all civil society and and mobile populations. Maanisha works government service providers. (This strategy intensively with CSOs to develop their was under review for a three-year period and capacity to design and deliver tailored was rolled out in 2010.) Maanisha also developed6 AIDSTAR-One | November 2011
  7. 7. AIDSTAR-One | CASE STUDY SERIESa Gender Analysis Tool for CSOs to assess their level of gendersensitivity. PROGRAM INNOVATIONSFormative research conducted by AMREF shows that men’s behaviorsand practices often put them and their partners at risk of HIV, that • Building the capacity ofthey are significantly less likely than women to seek health care, and hundreds of CSOs working onthat their involvement in HIV mitigation, including caregiving or serving diverse, locally targeted issuesas community health workers, is minimal. In response, in June 2008 allows the program to addressMaanisha developed Male Involvement Guidelines. The guidelines a range of gender-relatedreview the current situation of male engagement in HIV efforts and barriers within and acrossoutline male-related determinants of vulnerability. They also suggest communities.strategies for increasing male involvement, some of which include • Targeting funding and capacitygreater investment in CSOs that work with men, building the capacity building to marginalized groupsof CSOs to increase male involvement and promote male behavior allow the program to focus onchange, and disseminating lessons and best practices on male vulnerable populations.involvement to influence programs and policies. • Building the capacity of CSOs and private sector organizations, as wellWhat Worked Well as creating coordination mechanisms between CSOsAccording to project staff and participants, Maanisha has been and with government, cansuccessful in improving the HIV-related activities of CSOs, including help increase programthe quality of care for people living with HIV and access of people effectiveness, relevance, andliving with HIV to microcredit. It has also increased the capacity of sustainability (Wafula andCSOs to address gender-related HIV vulnerabilities and to reach more Ndirangu 2009).people, including marginalized groups such as prisoners, men who • Coordination efforts to buildhave sex with men, and sex workers. networks among CSOs, and between CSOs andAccording to a client satisfaction survey, the Maanisha program has government structures, allowssuccessfully connected communities to health systems. District-level service providers to sharegovernment structures are also increasingly working with CSOs in lessons, approaches, and bestimproving health systems as well as mentoring CSOs (Kombo 2007). practices on addressing oftenMaanisha program staff, in interviews for this case study, reported challenging gender-relatedthat community knowledge of services has increased, as has the barriers to HIV prevention andway women and girls are valued, because of CSOs’ community mitigation.sensitization activities. Community members now know that post- • The program has flexibilityexposure prophylaxis is available in cases of rape, for example. They to add in new training topicsalso recognize that investing in women improves the entire family’s based on issues identified bywelfare. CSOs, allowing organizations to address a multitude ofAmong Maanisha’s successes is its ability to respond to specific related issues needs as they arise. In response to CSO feedback that peopleliving with HIV were left out of community programs and that prevention Maanisha Community Focused Initiative to Control HIV: A Program to Build the Capacity of Civil Society Organizations in Kenya 7
  8. 8. AIDSTAR-One | CASE STUDY SERIES widows and helping women retain property. To address the challenge of engaging men, Maanisha partners with the Movement of Men against AIDS in Kenya and the Network of Positive Men in Kenya, who train CSOs in male involvement and changing harmful male behaviors such as multiple partnerships and gender-based violence. The program also uses the One Man Can campaign (Sonke Gender Justice Network 2006) module for engaging men and plans to adapt it for local use. CSOs interviewed as part of this case study explained how the Maanisha program has helped them address multiple, interrelated gender barriers to HIV prevention and mitigation. For example, through Maanisha’s technical support, WIFIP now ICRW works to end the practice of “fish for sex” through Support group meeting attendees. community sensitization on the links between “fish for sex” and HIV, and provides training formessages ignored their sexual and reproductive alternative livelihoods such as fishing, farming,health needs and rights, in 2008 and 2009, Maanisha and income-generating activities. Maanisha hasparticipated in a Ministry of Health–led technical worked with WIFIP staff on designing messagesworking group to develop Prevention with Positives and approaches to address sociocultural factors(PWP)8 training manuals. These manuals, now associated with this practice, including poverty andavailable to HIV service providers, aim to meet the traditional gender needs of people living with HIV and scale upHIV prevention. Maanisha is currently training CSOs Through WIFIP, Maanisha supports the Victoriato disseminate community PWP messages to people Women Group, a small group of women livingliving with HIV and community members. In addition to with HIV in a village outside Kisumu, to addresspromoting PWP interventions, Maanisha also reviews a range of HIV-related issues in their community.and restructures the budgets of a selected number of The Victoria Women Group provides HIVtarget CSOs in order to enhance the roll-out of this prevention, care, and treatment to communitytype of intervention. members, develops income-generation activities to discourage “fish for sex,” and sensitizesTo meet requests for assistance in addressing community members on gender-based violencethe legal protection of women, Maanisha has experienced by some women after disclosinglinked CSOs to other organizations providing their HIV test results to their partner or familylegal support and to the Council of Elders, which members. Their work on GBV has been soprovides training on the inheritance rights of effective that one Victoria Women Group member said, and others affirmed, “These days women8 PWP (also known as Positive Health, Dignity, and Prevention) is a (in our community) are so empowered that aconcept that recognizes that people living with HIV have a role to play in man wouldn’t dare slap us, because we knowHIV prevention activities based on basic epidemiological principles thatindicate that transmission of an infectious disease can only be brought to our rights.” This group also partners with anothera halt if prevention activities focus on infected individuals. Maanisha- and WIFIP-supported CSO in the8 AIDSTAR-One | November 2011
  9. 9. AIDSTAR-One | CASE STUDY SERIES so silenced that they need help finding a voice. EVALUATION The most vulnerable groups, including female sex workers, young girls, and young women, A 2006 assessment conducted by AMREF revealed must be actively brought into the grant proposal that the organizational development and systems development and implementation process through strengthening approach had significantly improved initial outreach and capacity building. In short, it the processes, systems, and technical capacity, is important to mix community-initiated projects including gender mainstreaming, of CSOs. An with targeted support of vulnerable groups, independent midterm evaluation by SIDA in 2007 including young girls and young women, to ensure documented that all CSOs had shown significant the needs and issues of all groups are being improvement in management, governance, finance, addressed. and resource allocation (Kireria, Muriithi, and Mbugua 2007). Engaging men is crucial to HIV prevention and mitigation, according to the CSOs interviewed for this case study. “Many men are the gatekeepers, so changing the mindset of men is very important.same community, the Super Victoria Youth Group. [Otherwise] they block the gates,” said oneThe Super Victoria Youth Group uses theater CSO member. Kenya currently has no nationalperformances to target messages to men around guidelines for engaging men, but some CSOsprevention, alcohol use, multiple sexual partners, have attempted to develop their own approachescondom use, and drug adherence. with varying levels of success. Among their lessons learned is to approach men differentlyMaanisha also funds an urban group in Kisumu than women and with a greater intensity of effort.called Women’s Concern, which began in 2002 “Men like being [sensitized] slowly. They reallyas a support group for women living with HIV. As need to be convinced…[but] when they accept,a result of training and linkages to other service they become more committed than women,” saidproviders facilitated by Maanisha, Women’s a member of the Society of Women and AIDS inConcern soon expanded to address related needs, Kenya (SWAK).including community sensitization on propertyinheritance, GBV, and early marriage. Women’sConcern also engages in income-generationactivities, and members are being trained asparalegals by Community Action on ViolenceAgainst Women, another Maanisha partner.Lessons LearnedCommunity-driven participatory approachesare not always sufficient to identify the mostvulnerable groups in a community. Manymarginalized groups may be left out of the grant- ICRWmaking process because they do not have thecapacity to prepare competitive proposals or are Maanisha poster. Maanisha Community Focused Initiative to Control HIV: A Program to Build the Capacity of Civil Society Organizations in Kenya 9
  10. 10. AIDSTAR-One | CASE STUDY SERIESWAFNET’s experience is typical of many Maanisha coupled with other GBV services so that womenimplementing partners’ efforts to address the can more easily obtain legal support.sociocultural factors associated with HIV preventionand mitigation. Program staff advised that on-the- Engaging men: CSO staff interviewed for thisground service providers have learned that gender case study reported that engaging men in HIVnorms—and the community attitudes, beliefs, prevention and mitigation activities is extremelyand traditions in which they are reflected—are difficult. Men’s health-seeking behavior is minimal,entrenched and often take a long time to change. often because they see disease as a woman’sA focus on short-term results or programs cannot issue and because there are few health facilitiesachieve sustained change in harmful behaviors providing services that address men’s healthand practices, they say. These lessons have concerns. At the same time, interventions oftentaught them the importance of ongoing funding target women and leave men out. “Telling a manand support for phased projects so that there is to accompany his wife [for prevention of mother-continuity in program activities. to-child transmission] is a serious joke [if facilities don’t welcome men],” explains a Maanisha staff member in the field.Challenges Finding appropriate ways to engage men inAddressing violence: In multiple interviews for HIV-related interventions has been challenging.this case study, Maanisha staff, program staff at Women’s Concern, for example, opened itsnetwork organizations, and CSOs all reported that membership to men because they discoveredbecause GBV is common, and often considered that disclosure for women was difficult when menacceptable in Kenya, women experiencing GBV were left out of counseling and support groups.have very little social support and have little However, men who joined found it difficult to beaccess to GBV-related services. affiliated with the group, as they were scorned by men in the community who support practicesGBV presents a different challenge for women. such as wife inheritance. SWAK’s Male InitiativePolice must first determine that GBV has program, which seeks to train men in preventionoccurred before hospitals can provide services of mother-to-child transmission, has had lowto rape survivors. Women have reported that the participation. Program staff say that the tendencypolice stigmatize them and sometimes refuse to assume that gender is a women’s issue “hasto assist them entirely, which is demeaning jeopardized development work in Kenya.”for women in need of urgent medical care andtrauma counseling. Not surprisingly, community However, Maanisha staff report that youngerorganizations report that women often do not seek men are being socialized differently as a resultany assistance after being physically or sexually of sensitization efforts by NGOs and exposure toabused. In some cases, women turn to paralegals media messages. As a result, these men are morewho may be able to help them directly access open to rejecting harmful traditions, and therehealth services. CSO staff suggest that women is more of an opportunity to work with them toshould be able to seek care from hospitals first, change harmful male norms.and then have the option to work with the police toaddress the criminal aspects of their experience. Programmatic challenges: While theThey also said that legal services should be Maanisha program has demonstrated commitment10 AIDSTAR-One | November 2011
  11. 11. AIDSTAR-One | CASE STUDY SERIES Addressing gender at the national level: According to interviews with key experts in Kenya, addressing gender in the national response to HIV has achieved results in part because many gender experts are selected based on demonstrated interest and expertise, are well positioned within ministries and agencies, and are retained to ensure that activities promoting gender equity are ongoing. However, senior ministry officials often see gender as an issue to be addressed solely by gender experts, and because these experts are usually steering this process, these officials can fail to develop their own understanding of or ICRW commitment to gender. This can be a barrier toCommunity members attend a Women’s Concern programs like Maanisha as leadership is crucialmeeting. for addressing gender and its association with HIV across addressing gender-related barriers to HIVprevention and mitigation, gender is addressed Future Programmingonly within the behavior change communicationcomponent of the program. The program would Maanisha plans to expand efforts to address thebenefit by mainstreaming gender into all other prevention, care, and support needs of most-at-components and could achieve this through risk and vulnerable populations in four provincestraining all project component managers in gender, of Kenya, including their ability to address genderperhaps in the design of programmatic approaches inequalities, human rights violations, and harmfulthat are gender-responsive, although training social cultural practices. Maanisha will accelerateof this nature would require additional support. prevention efforts through a combination ofHaving in place a resident gender expert on staff interventions including enhancing access towho could train component managers on gender counseling and testing by youth, couples, and most-issues could be another measure to support such at-risk populations; PWP; and promoting greatergender mainstreaming efforts. uptake of voluntary medical male circumcision. The program will promote involvement of CSOs inAlso, Maanisha program staff and partners are local and national planning by supporting advocacystretched in efforts to maintain regular support to efforts, including those on gender-sensitiveall 730-plus CSO partners, particularly those in programming and effective capacity building ofremote communities. Rural CSOs interviewed for CSOs. Finally, the program is also planning tothis case study reported receiving less capacity support continuous learning among implementersbuilding support and less access to tools to through exchange of lessons and best practiceshelp them address community needs, and were and improving and developing tools and approachesless likely to be engaged in network activities, a to address challenges such as engaging men andvaluable resource for coordinating services. addressing GBV. g Maanisha Community Focused Initiative to Control HIV: A Program to Build the Capacity of Civil Society Organizations in Kenya 11
  12. 12. AIDSTAR-One | CASE STUDY SERIESREFERENCES Violence Prevention and Response in PEPFAR Programs. Arlington, VA: USAID’s AIDS SupportBarasa, L. 2009. Draft Law to Set Pace for and Technical Assistance Resources, AIDSTAR-Land Reforms. The Nation, November 19 One, Task Order 1.2009. Accessed at: (accessed June 2011) Kireria, A., G. Muriithi, and K. Mbugua. 2007. Maanisha Community-Focused Initiatives toFonck, K., L. Elys, N. Kidula, J. Ndinya-Achola, Control HIV/AIDS in Lake Victoria Region,and M. Temmerman. 2005. Increased Risk of HIV Kenya. Nairobi, Kenya: Swedish Internationalin Women Experiencing Physical Partner Violence Development Cooperation Nairobi, Kenya. AIDS and Behavior 9(3):335–339. Kombo, A. 2007. “The Maanisha Programme: Closing the Gap between Communities and theGovernment of Kenya, Kenya Police. 2006. Rest of the Health System through Civil SocietyAllegations on Conspiracy of Silence. Available Participation: Experiences from Western Kenya.”at (accessed Paper Presented at the 2007 WAFNET ProvincialDecember 2009) Conference, October 24–26.Government of Kenya, Office of the Vice President Mathenge, O. 2009. Want To Kick Me Out of theand Ministry of Home Affairs, Heritage and Sports, House: Get a Court Order? The Nation, SeptemberChildren’s Department. 2002. The Children Act 28. Available at 8 of 2001: A Summary. Nairobi, Kenya: /1056/665030/-/unfpny/-/index.html (accessedGovernment of Kenya. December 2009)Kenya AIDS Indicator Survey. 2007. Kenya AIDS Ministry of Health. 2003. Kenya DemographicIndicator Survey (KAIS) 2007 Data Sheet. Nairobi, Health Survey. Nairobi, Kenya: Ministry of Health.Kenya: Kenya AIDS Indicator Survey. National AIDS Control Council. 2002.Kenya Law Reports and the Government of Mainstreaming Gender into the Kenya NationalKenya. 2009. The Sexual Offences Act (Number HIV/AIDS Strategic Plan 2000–2005. Nairobi,3 of 2006). Nairobi: The National Council for Kenya: National AIDS Control Council.Law Reporting with the Authority of the AttorneyGeneral. Available at National AIDS Control Council. 2005. Kenyafamily/statutes/download.php?file=Sexual%20 National AIDS Strategic Plan, 2005/06–2009/10.Offences%20Act.pdf (accessed June 2011) Nairobi, Kenya: National AIDS Control Council.Kenya National Bureau of Statistics and ICF National AIDS Control Council. 2009. KenyaMacro. 2010. Kenya Demographic and Health National AIDS Strategic Plan, 2009/10–2012/2013.Survey 2008–09. Calverton, MD: Kenya National (Work-in-Progress). Draft report. Nairobi, Kenya:Bureau of Statistics and ICF Macro. National AIDS Control Council.Khan, Alia. 2011. Gender-based Violence and HIV: National AIDS Control Council and UN PopulationA Program Guide for Integrating Gender-based Fund. 2009. Republic of Kenya- Gender Audit12 AIDSTAR-One | November 2011
  13. 13. AIDSTAR-One | CASE STUDY SERIESof the Kenya National HIV and AIDS Response. Dr. David Ojakaa, Programme Manager, HIV/AIDS(Final Draft Report). Nairobi, Kenya: National AIDS and Health Systems ResearchControl Council, Technical Sub-Committee on Email: David.Ojakaa@amref.orgGender and HIV and AIDS.Sonke Gender Justice Network. 2006. One Man ACKNOWLEDGMENTSCan Campaign. Available at (accessed The authors would like to thank Nelson OtwomaDecember 2009) (formerly of the African Medical and Research Foundation [AMREF]), Dr. Meshack Ndirangu, Dr.Wafula, S. W., and M. Ndirangu. 2009. Building David Ojakaa, Dr. Njeri Mwaura, Dr. Festus Ilako,Community Capacity in HIV/AIDS Response: The Mette Kjaer Yvonne Machira, and Sam Wangila atCase of Maanisha Project. AMREF Case Studies. the AMREF office in Nairobi for their gracious timeAvailable at and help in learning about the Maanisha The authors also appreciate the wonderful on-(accessed September 2010) the-ground insight gained from Susan Achieng Olang’o, Jane Okungu, Gideon Oswago, Ignatius (Baraza) Mutula, Steve Amolo, Milka Kiptoo,RESOURCES Nicholas Lungaho, and Vincent Kutai, who implement Maanisha in the Western, Rift Valley,Integrating Multiple Gender Strategies to Improve North Nyanza, and South Nyanza regions, andHIV and AIDS Interventions: A Compendium of to Titus Onyango at AMREF Kisumu. Thanks toPrograms in Africa. Maanisha (p. 53): www.aidstar- Ursula Sore-Bahati, Eunice Odongi, and Mwaniki, for helping with understanding of Kenya’sFinal.pdf gender and HIV story. The authors are grateful to the many local organizations that shared their workIntegrating Multiple PEPFAR Gender Strategies and challenges: Easter Achieng and Shadrackto Improve HIV Interventions: Recommendations Oyier at Women Action Forum for Networking;from Five Case Studies of Programs in Africa: Martin Siquda and Deo Odie at Women in Fishing Industry Project; Truewill Comedy Troupe;studies_recommendations Victoria Women’s Group; Super Victoria Youth Group; Honge Support Group, Orongo WidowsCONTACTS and Orphans Group; and Women’s Concern. The authors were deeply impressed by theAfrican Medical and Research Foundation commitment of the Society of Women and AIDS58 Langata Road, P.O Box 27691 – 00506, in Kenya and its members. Thanks to FlorenceNairobi, Kenya Riako, an esteemed translator and gender andTel: + 254 20 699 3000 / Fax: +254 20 609518 HIV extraordinaire. Thanks to the President’sWebsite: Emergency Plan for AIDS Relief Gender Technical Working Group for their support and careful reviewDr. Festus Ilako, Deputy Country Director of this case study. The authors would also like toEmail: thank the AIDSTAR-One project, including staff Maanisha Community Focused Initiative to Control HIV: A Program to Build the Capacity of Civil Society Organizations in Kenya 13
  14. 14. AIDSTAR-One | CASE STUDY SERIESfrom Encompass, LLC; John Snow, Inc.; and theInternational Center for Research on Women fortheir support of the development and publicationof these case studies that grew out of the GenderCompendium of Programs in Africa.RECOMMENDED CITATIONJain, Saranga, Margaret Greene, Zayid Douglas,Myra Betron, and Katherine Fritz. 2011.Addressing HIV and Gender from the GroundUp—Maanisha Community Focused Initiative toControl HIV: A Program to Build the Capacity ofCivil Society Organizations in Kenya. Case StudySeries. Arlington, VA: USAID’s AIDS Support andTechnical Assistance Resources, AIDSTAR-One,Task Order 1.14 AIDSTAR-One | November 2011
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