Utilizing HIV combination prevention interventions in reaching sexually exploited children in slums in Kenya (3)
1. 1
Utilizing HIV Combination Prevention Interventions in Reaching
Sexually Exploited Children in Slums in Kenya.
Karoki, H., Thiomi, J. Jeckonia, P., Otiso, L.
Presented by
Hellen Karoki
10th
Annual HIV Prevention, Care and Treatment Consultative Forum.
Nairobi, Ole Sereni Hotel 3rd to 5th June 2015
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• Background
• Rationale
• Objectives
• Methodology
• Reasons for engaging in sex work
• Results
• Conclusion
• Recommendations
• Acknowledgements
OVERVIEW
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Children should be the first to benefit from our successes in defeating HIV, and
the last to suffer from our failures
(Anthony Lake, Executive Director, UNICEF)
She deserves a future
free of HIV/AIDS
Can we provide it!
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• Young girls joining sex work are desirable because they are thought to be “safe”
and uninfected with HIV (UNAIDS, 1999)
• Globally 1 million children are forced into prostitution every year. (US.CDC,
2002)
• In Kenya more than 30,000 children are exploited in the sex industry.
(UNICEF, 2006)
• Children do not join sex work by free choice; only through Manipulation,
coercion, violence, trafficking, poverty, debt bondage, and through being
orphaned. (UNAIDS, 2010)
• Increased sexual exploitation, vulnerability to HIV infection and negative
Sexual Reproductive Health (SRH) outcomes among girls and young women
aged 10 to 24 years in Korogocho slum, Kenya (LVCT Health 2009).
BACKGROUND
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BACKGROUND CONT’D
• In 2009, LVCT Health carried out a study in
Korogocho slum in Nairobi
• The aim was to gather evidence to inform
HIV/AIDS, sexual and reproductive health
(SRH) interventions and services targeting girls
in the urban slums.
• Study established that young girls below age of
11 were exploited through sex work and the
community has ‘normalized’ having sex with
children.
• Many of the study participants were;
• Orphaned (as a result of their parents
succumbing to HIV AIDS)
• Dropped out of school
• Abused alcohol
• They also did not have alternative means to
fend for themselves and their siblings other
than through sex work.
Lost Innocence: Stories of
children exploited through sex
work in Korogocho, Nairobi
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• Nearly 14% of women reported sexual debut before 15 years (KMOT 2009).
• Sex workers and their clients contributed 14.1 % of the national HIV
incidence by 2006. (KMOT 2009)
• 74% of respondents in a national situational analysis of sex workers and their
clients knew a child sex worker. (KMOT 2009)
• Kenya’s HIV prevalence has reduced from 7.2 % to 5.6% in the last 4 years
(KAIS 2012) .
• Young women (15-24 years) are four times more likely to be HIV infected
(5.6 %) than their male peers (1.4%) and stays consistently higher than that of
male counterparts. (KAIS 2012)
• Women account for 49% of all new HIV infections with young women and
girls aged 15 to 24 contributing up to 21% of the same (Kenya HIV Estimates
2014).
• Young women are often willing to participate in transactional relationships
for emotional reasons; perceived educational, work, or marriage
opportunities; monetary and material gifts; or basic survival (KDHS 2008-9).
RATIONALE
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• In response to the evidence of the burden of HIV among girls and young women
in Kenya and the vulnerability of the children in the slums, LVCT Health
through funding from CDC implemented a program known as One Child at a
Time (OCaT) in 2013 with the following objectives:
– To respond to the HIV risks and the negative Sexual Reproductive Health
(SRH) outcomes among children aged 17 and below.
– To provide combination prevention interventions aimed at reducing
vulnerability to HIV infection, sexual exploitation and negative SRH
outcomes.
– To provide evidence to inform HIV, SRH interventions targeted at young
girls exploited through sex.
– To understand the HIV and SRH practices, access to services and needs of
young girls exploited through sex.
OBJECTIVE(S).
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• Three implementation sites were identified for implementation of OCaT;
Korogocho, Kibera and Kibagare slums in Nairobi
• Stakeholders including; Government offices, community leaders (Chief, village
elders) and other implementing partners were sensitized on the program and
sought for buy-in and partnership.
• Community Health Workers (CHWs) and HIV Testing and Counselling service
providers were identified and sensitized on program objectives and criteria for
selecting participants.
• A risk screening tool was developed and was applied to recruit participants who
reported sexual exploitation.
• Consent was then obtained from participants, their parents or guardians during
recruitment for enrollment in the program.
• Participants were then enrolled into OCAT program where they received HIV
combination prevention interventions.
METHODOLOGY
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• The combination prevention interventions that were offered include:
– Biomedical interventions that include quarterly HIV testing and counselling,
condoms dispensing, Sexual Reproductive Health information and services,
Voluntary Medical Male Circumcision (VMMC), family planning and
cervical cancer screening offered.
– Evidence based behavioral interventions (Sister to Sister, Respect-K and
Healthy Choices II) and health education.
– Structural interventions which include financial and material support for
those out of school and need reintegration.
– Linkage to legal services and social support
• Peer educators were trained from among the participants who run health forums
known as OCAT clubs formed of about 30 children with support from the service
providers.
• Mentorship forums were conducted to the parents and teachers on a quarterly
basis.
METHODOLOGY
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1. Poverty, unemployment, insecurity, burden of HIV
‘..When I was young I had to take care of my ailing parents who were infected
with the HIV. I spent most of my time preparing uji [porridge] for them.
This denied me the opportunity to go to school completely. My parents, my
younger brother and one of my aunties later died from complications
caused by the disease. My auntie left 3 children who are now under my
care.….. in view of the burden of bringing up my little cousins, I
considered engaging in sex work...’
16 years old girl
2. Peer Pressure- from peers/friends in school & neighbourhood.
“…When I turned 11 years my friends introduced me to a male friend who
introduced me to sex and rewarded me with food or twenty shillings. On a
good day I make about five hundred shillings ($5) and on a bad day I
manage to get a soda for myself and cake for my child…’’
11 years old girl
– Parental influence
‘..My mother asked me where I had gotten money from and I told her that I had
done ‘bad manners’ with a man who gave me money. She was happy and
encouraged me to continue with that so that I can provide for the family…’
14 years old girl
REASONS FOR ENGAGING IN SEX WORK
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5. Gifts and presents offers
‘…There is one who used to lie to me that he would give me 50 shillings and then
after we have sex, he gives me 5 shillings or 10 shillings…‘
11 years old girls
6. Lack of HIV information; Some of the OCaT participants have never seen a
condom neither do they know its purpose especially in the prevention of HIV.
‘….I have never used a condom with anyone …I have never even touched one, I
only see them lying on the roads here in Korogocho...’
13 years old boy
7. Drugs, alcohol and substance abuse; Some of the children especially boys
consume alcohol and drugs to be able to engage in sex work.
‘….I had to take alcohol so that I can be able to ‘sleep’ with women in charge of
the dump site in exchange for a scavenging space at the dump site...’
14years old boy
REASONS FOR ENGAGING IN SEX WORK
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• From February 2014 to January 2015, 201 boys and 920 girls have been enrolled
in OCaT.
• All children have been tested for HIV, with 98% (1099) receiving quarterly HIV
testing and counselling. Twenty two children (2%) tested positive for HIV and
were successfully enrolled to care and treatment.
• Eighty percent (896) of the children were trained on Healthy Choices II, 38%
(348) girls underwent through Sister to Sister, and 70% (786) Respect-K.
• Thirteen peer educators were trained to facilitate OCaT clubs consisting of 30
members each.
• Nineteen boys and 82 girls were re - integrated into school (61 primary, 32
secondary and 13 tertiary (A total of 106)).
• In collaboration with the children’s offices at sub county level, 20 orphaned
children experiencing sexual violence were supported with legal aid and 6 of
those rescued and placed in shelters/orphanages.
RESULTS
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• OCaT program demonstrates positive effects of an adolescent tailored HIV
combination prevention approach in resource-limited settings.
• There is need to invest and scale up targeted interventions that respond to HIV
prevention and SRH needs of adolescents in order to reduce new HIV infections.
• Community inclusivity is key for success in programming and continuity of HIV
community focused interventions
CONCLUSION
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• There is need to invest and scale up targeted interventions that respond to HIV
prevention and SRH needs of adolescents in order to reduce new HIV infections.
• Pre Exposure Prophylaxis (PrEP), will be useful in reducing the risk of acquiring
HIV if and when used correctly and consistently.
• There is need for continuous sensitization to the adolescents, girls and young
women on:
– Correct HIV information; empowerment on condom negotiation; SRH and
need for HIV testing & counselling.
– Post Rape Care services
– Drugs and substance abuse
RECOMMENDATIONS
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•CDC Kenya
•MOH – Kasarani, Langata and Westlands
•Children's Department
•National youth service
•The Senior chiefs of Korogocho, Kibera and Kibagare
•OCaT Participants
•OCaT implementing staff
•Other sponsors:
– Kenya Commercial Bank
– Pendekezo letu
– Miss Koch
– SHOFCO
– UNDUGU Society
– LVCT staff
ACKNOWLEDGEMENT
