This presentation discusses Kenya's key populations program. It defines key populations as female sex workers, injecting drug users, and men who have sex with men. It notes that these groups account for 1/3 of new HIV infections in Kenya and have much higher HIV prevalence than the general population. The presentation outlines Kenya's combination prevention approach, which includes biomedical, behavioral, and structural interventions. It discusses challenges like stigma, violence, and political opposition faced by key populations. It also presents strategies to address challenges, considerations for replicating the program, and the need to scale up comprehensive interventions to reduce new HIV infections.

1. NOPE Conférence
June 2014
MINISTRY OF HEALTH
National AIDS &STI Control
Program(NASCOP)
KENYA
Helgar Musyoki
Key Populations
Program Manager

2. Presentation outline
• Who are the key populations?
• HIV Prevalence in Kenya
• Why focus on MARPs
• Strategies and interventions
• Challenges
• Addressing challenges
• Considerations for replication
2

3. Who are key populations??
3

4. HIV prevalence
ranged from
1% to 15%
across regions in
2012
.
National
prevalence 5.6%
Nyanza home to
nearly 40% of all
HIV-infected adults
(15-64 years)
National HIV
Prevalence

5. Sources of new HIV infections
5Source: Kenya Mode of Transmission Study, 2008

6. Why focus on MARPs
• 1/3 of all new HIV infections are
attributable to MARPs
• Bridge population for HIV to general public
• HIV prevalence higher than general
population. (Ranges 20-50% prevalence)
• Estimating the size of MARPs population
FSWs :140,000 countrywide
IDUs: 18,000
MSMs: 30,000
• 33,000 new HIV Infections out of 100,000
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7. HIV PREVALENCE BY MARP TYPE

8. HIV Status by Age Group-MSM
HIV incidence of 10.9% (95% CI 7.4, 19.3)HIV incidence of 10.9% (95% CI 7.4, 19.3)

9. HIV Status by Age Group- FSWs
NB: Total positive across all age groups 27.8%
HIV incidence of 2.2% (95% CI 1.6, 3.1)HIV incidence of 2.2% (95% CI 1.6, 3.1)

10. •
Our Approach
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11. Elements of Combination
Prevention Approach
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12. Conceptual Framework
Negative social norms – S&D, homophobia, gender inequities
Creating a supportive environment for prevention, knowledge of HIV status and increasing access and
use of MARP-friendly health and social support services
Factors increasing risk behavior
•Inaccurate perception of risk
•Peer pressure
•Low self-esteem/isolation
•Past history of abuse
•Economic vulnerability
•Social vulnerability
•Gender
•Sexual and gender-based violence
•Multiple concurrent partners
•Inter-generational sex
Risk increased
Risk reduced
Interventions to reduce risk/vulnerability
•Increasing risk awareness
•Self-efficacy
•Knowledge of HIV status
•Treatment seeking behaviors
•Addressing depression/mental health
•Economic vulnerability
•Peer support
•Developing a life plan
•Safe spaces to address history of
abuse/violence
At risk individual

13. • Government led National MARPs program
• Multisectoral Technical working group
formed
• Gathering strategic information for decision
making
• Development of program tools
• Setting standards for HIV prevention
• Enabling policy environment
• Strategic involvement of MARPs
• Establishing service delivery models
• Capacity building
• Innovation and pilot programs
Strategies

14. Prevention Revolution-Prevention
of HIV.. Everyones business!!!!
6 key features to achieve the combination prevention approach:
• A combination of biomedical, behavioural and structural elements—
to reduce both the immediate risks and the underlying vulnerabilities.
• A meaningful engagement of affected communities, promoting
human rights and addressing gender issues.
• Operating synergistically, consistently over time, on multiple levels—
individual, family and society.
• Investing in decentralized and community responses and enhance
coordination and management.
• A flexible and continuous learning—can adapt to changing epidemic
patterns and can rapidly adjust and deploy new tools and innovations
• Tailoring the process to national and local needs and contexts.

15. Some Prevention options and their limitations
• Abstinence – efficacy 100%, effectiveness is virtually nil
• Condoms – effective but use must be correct & consistent
• Female condoms – women do not like them
• Be faithful – the spirit is willing but the flesh is weak
• VC and HIV testing – can be effective, but may not be
• Behaviour change communication – may be effective but
of itself is not enough
There is no magic bullet – “combination prevention”

16. •
Do we know where our
populations are???
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17. National FSW mapping

18. National MSW mapping

19. 19

20. •
Do we have the
right info?....
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21. Guidelines for MARPs
21
Others
coming
soon

22. NASCOP
webpage
provides link to
page

23. •
Are we taking
services to the
people??
23

24. Service delivery
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25. •
Challenges………..
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26. • Conflict with law
• Attitude of healthcare workers
• Mobility of the population
• Stigma and social discrimination-housing
• Being MSM is a taboo subject in Kenya
• Violence due to cultural insensitivity-incl
politicians.
• Commodity supply management
• Programming challenges- persistent refusal
to register organizations openly dealing
with MSM issues
• Occasional negative media publicity
Challenges
26

27. Gambian President Yahya Jammeh's threat to
behead homosexuals.
Last week he told a political rally that gay people
had 24 hours to leave the country. He promised
"stricter laws than Iran" on homosexuality and
said he would "cut off the head" of any gay
person found in The Gambia. BBC 2008
‘[Homosexuals are] repugnant to my
human conscience...immoral and
repulsive, lower than pigs or dogs.
Zimbabwe President, Robert Mugabe, 1993
Harsh political climate
27

28. "It is against African tradition and
biblical teachings, I will not shy
from warning Kenyans against this
scourge.“
Daniel Arap Moi 1999
Kenyan Prime Minister orders
that gays should be arrested. He
withdraws the statement days
later” Raila Odinga
Harsh political climate
28

29. Barriers and Challenges …
• In Feb 2010, mobs in Mtwapa attacked men they
suspected of being gay, and 1 project staff
‘arrested’.(A documentary has been done on
how it was addressed)
• Nobel laureate archbishop Desmond Tutu:
“Kenyan religious leaders … threatened the HIV
clinic in Mtwapa [Kenyan coast], because the
clerics wanted gay men excluded.” 12Mar2010 29

30. Barriers and Challenges …
“Churches demand the sacking of the minister after
she made remarks that Kenyans should accept
gays and respect their rights”
Example of Backlash
30
“MARPs are Kenyans and
they have rights like
anyone else”.
Ministers’ Remarks-
Esther Murugi
Photograph of the Minister
special Programmes and
Representatives of the MSM
communities on a Daily
newspaper papers draws public
outcry: 30th
Sept 2010

31. • Online training of health workers on MARPs
programming.
• Media engagement for advocacy
• Continuous Surveillance / sentinel sites
• Periodic Mapping of MARPs Hotspots
• Peer led interventions
• Adapting the best Service delivery models
• Integration of MARPs services to existing
systems
• Engaging National and county governments
with support from UN agencies.
Addressing the challenges
31

32. • Define a standard package of services for
the respective MARPs groups
• Generate/build evidence for policy and
environment change
• Start small: Pilot to demonstrate the
efficacy of interventions - what works best
• Garner international support: Resources,
best practices, and technical assistance
• Use a combination prevention approach to
HIV interventions
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Considerations for replication

33. 33

34. We are unlikely to achieve policy
objectives of reducing new HIV
infections unless we scale up
the delivery of comprehensive
and evidence based HIV control
interventions
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35. Thank you!
Ahsante sana
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Email: helgar@nascop.or.ke
Website: www.nascop.or.ke