Reducing HIV STI risk and improving
treatment for Men who have sex with
Men in Mombasa, Kenya
Prepared by
Agnes Rinyiru
(I...
Presentation Outline
• Formative Study Background
• Sexual health risks identified
• Issues and barriers to treatment
• Ba...
Introduction
• Formative research (2002) by Population Council and ICRH
indicated MSW existed in Mombasa and surrounding a...
Sexual Health Risks Identified
• Low risk perception of HIV/STI infection
• Poor knowledge base of HIV/AIDS
• Multiple sex...
Issues and Barriers to treatment
• Lack of MSM sensitive health providers and services
• MSM reluctance to use existing he...
Barriers to program Response
• Denial of MSW existence
• Social marginalization
• Lack of Prevention and care programs dir...
Intervention Objectives
• To increase knowledge and skills in HIV/AIDS prevention, care
and support, and support behavior ...
Pre-intervention Activities
• Mapping - 77 MSW hotspots
• Formation of Project Advisory Committee
• MSW enumeration using ...
Intervention
• Based on formative research and feedback from
baseline assessment intervention activities were
implemented ...
1. Drop in Centre
To serve the following:
• Friendly Resource centre to receive health related
information
• On-site MSM f...
2. Peer Education Training
Using interpersonal approaches to BCC - 40 MSW
peer leaders were trained in PE to:
• Increase K...
3. Condom Distribution
• Drop-in centre is distribution point
• Peer educators distribute condoms to peers
• Regular condo...
4. Lubricant Promotion
• Baseline study indicated MSWs little knowledge about
water-based lubricants
• Most used oil-based...
5. Training of Health Providers
• Health providers (n=20) were trained on MSM specific STI related
needs - anal and oral S...
7. Alcohol and drug addiction
training
• The 40 PE were undertaken through intensive
‘Alcohol/Drug/HIV/AIDS Harm Reduction...
8. Psychosocial Support
• PE (n=40) were trained in basic counseling skills to
provide counseling to peers and host regula...
Project status
Due to successful intervention around Mombasa district
• Program has seen major expansion - Kwale, Malindi ...
Intervention Sites
Ukunda
Lessons Learned
• Collaboration with government (MOH) and stakeholder
engagement contributed to the success of the interve...
Challenges
• MSWs are a hidden and highly mobile population thus difficulty
to reach
• High cost and limited availability ...
Final Thought
• The programs issues raised and lessons learnt from this
study/intervention are not exhaustive. Innovative ...
Acknowledgement
• MOH
• Population council
• FHI/USAID/APHIA II
• KEMRI
• Support For Addiction Prevention and Treatment I...
THANK YOU
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Reducing hiv sti risk and improving treatment for men who have sex with men in mombasa, kenya icrh

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Reducing hiv sti risk and improving treatment for men who have sex with men in mombasa, kenya icrh

  1. 1. Reducing HIV STI risk and improving treatment for Men who have sex with Men in Mombasa, Kenya Prepared by Agnes Rinyiru (ICRH)
  2. 2. Presentation Outline • Formative Study Background • Sexual health risks identified • Issues and barriers to treatment • Barriers to program response • Research/Intervention
  3. 3. Introduction • Formative research (2002) by Population Council and ICRH indicated MSW existed in Mombasa and surrounding areas • Study defined MSW as ‘any man who regularly receives money or gift in exchange for sex with other men’ • Increasing in numbers and visibility (study estimated Mombasa had > 500 MSWs) • Self identified themselves as either street based, bar/club based and home based • Had both male and female sexual partners • Were at risk of transmitting or getting infected with HIV/STIs
  4. 4. Sexual Health Risks Identified • Low risk perception of HIV/STI infection • Poor knowledge base of HIV/AIDS • Multiple sexual partners • Inconsistent condom use • Unprotected anal sex • STI infections were common • Practiced self-medication for STIs • Hidden nature of male-male sexual relations - contributes to high HIV prevalence
  5. 5. Issues and Barriers to treatment • Lack of MSM sensitive health providers and services • MSM reluctance to use existing health services due to fear of stigmatization • Alcohol and Drug use • Harassment by law enforcement agents • Sexual abuse and economic exploitation
  6. 6. Barriers to program Response • Denial of MSW existence • Social marginalization • Lack of Prevention and care programs directed at men having sex with men • The above findings generated rationale for implementing a program to address HIV/AIDS and sexual health needs of men who sell sex to men in Mombasa
  7. 7. Intervention Objectives • To increase knowledge and skills in HIV/AIDS prevention, care and support, and support behavior change among MSW through peer education. • To promote adoption and continued use of safer sex practices among MSW through condom and lubricant promotion and distribution. • To enhance the Health seeking behavior among MSM and reduce obstacles to obtaining treatment and counseling for STIs and HIV through Capacity building health personnel to offer MSM friendly health care services with emphasis on counseling and testing for HIV and STI treatment. • Enhance access to CT for HIV and STI treatment through outreaches and service provision at an MSW friendly drop-in centre
  8. 8. Pre-intervention Activities • Mapping - 77 MSW hotspots • Formation of Project Advisory Committee • MSW enumeration using capture- recapture technique estimated 739 MSWs within Mombasa • Baseline quantitative and qualitative research to assess sexual risks behaviour and health seeking behaviour of MSWs (refer to Geibel et al;2007 in STI journal)
  9. 9. Intervention • Based on formative research and feedback from baseline assessment intervention activities were implemented in the following priority sites: – Mombasa
  10. 10. 1. Drop in Centre To serve the following: • Friendly Resource centre to receive health related information • On-site MSM friendly CT for HIV and STI screening and treatment at drop-in center • Drop-in centers serve as triaging centers for referring sex workers to clinic based services. • Peer Educators meetings
  11. 11. 2. Peer Education Training Using interpersonal approaches to BCC - 40 MSW peer leaders were trained in PE to: • Increase Knowledge on HIV and STI prevention • Effect behavior change - values, attitude, conduct e.t.c • Uplift self esteem and empowerment • Strengthening leadership Skills • Facilitation Skills • Stigma Reduction
  12. 12. 3. Condom Distribution • Drop-in centre is distribution point • Peer educators distribute condoms to peers • Regular condom distribution to selected MSWs hotpots – bars, lodgings, nightclubs • Peer educators select other areas of condom distribution e.g. guest houses, private massage parlors, private homes etc
  13. 13. 4. Lubricant Promotion • Baseline study indicated MSWs little knowledge about water-based lubricants • Most used oil-based lubricants thus many reported having experienced condom breakage Therefore To promote use water based lubricant among MSW group • Program has distributed over 12,000 sachets of water- based lubricant (Assegai) through peer educators
  14. 14. 5. Training of Health Providers • Health providers (n=20) were trained on MSM specific STI related needs - anal and oral STIs • Sensitized to offer a MSW-friendly services – non-judgmental, supportive and sensitive to MSM needs • Trained on stigma reduction and positive attitude change • Confidence building meeting held between MSW and service providers
  15. 15. 7. Alcohol and drug addiction training • The 40 PE were undertaken through intensive ‘Alcohol/Drug/HIV/AIDS Harm Reduction Training • This was conducted by ‘ Support For Addiction Prevention and Treatment In Africa (SAPTA) in 2007 • Follow up sessions were held to assess progress after 5 months
  16. 16. 8. Psychosocial Support • PE (n=40) were trained in basic counseling skills to provide counseling to peers and host regular support group meetings • 6 PE were trained as VCT counselors. • The 6 are providing VCT/counselling services at the drop-in centres and other MOH health facilities • ICRH counselors are providing psycho- social counseling support to MSW/MSM
  17. 17. Project status Due to successful intervention around Mombasa district • Program has seen major expansion - Kwale, Malindi and Lamu • Drop-in centre has been established in Malindi • A total of 140 PE have been trained with support of APHIA II program • 6 more MSW have been trained as VCT counsellor – in Malindi and Kwale • On-going monitoring and supervision of intervention activities • Data collection for post intervention evaluation concluded (March to April 2008)
  18. 18. Intervention Sites Ukunda
  19. 19. Lessons Learned • Collaboration with government (MOH) and stakeholder engagement contributed to the success of the intervention • Training health care providers has potential to enhance provision of friendly MSM specific STI treatment services • Nurturing and sustaining relationship with target population reduces the likelihood of resistance to the program. • Creating ‘safe space’ to discuss personal issues and access to HIV/STI referrals and CT services enhances uptake of the services • Use of interpersonal approach to BCC such as peer education and easy access to condoms, lubricants and MSM specific information materials enhances adoption of safer sex practices
  20. 20. Challenges • MSWs are a hidden and highly mobile population thus difficulty to reach • High cost and limited availability of water-based lubricants • Constant threat and hostility from community leaders • Constant demand for money and personalised attention from MSW • Inadequate localised MSM sensitive BCC/IEC materials.
  21. 21. Final Thought • The programs issues raised and lessons learnt from this study/intervention are not exhaustive. Innovative ideas, programmes and interventions need to be developed • More MSM aspects need to be studied and updated periodically since social- cultural and sexual environment constantly evolves • It is hoped that this program supports the process of learning, sharing and networking in Kenya and the African region and will continue to inspire MSM interventions in response to the HIV epidemic
  22. 22. Acknowledgement • MOH • Population council • FHI/USAID/APHIA II • KEMRI • Support For Addiction Prevention and Treatment In Africa (SAPTA) • MSW Peer educators • Project Steering Committee • Study participants • Project Staff/team
  23. 23. THANK YOU

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