Access to Quality Preventive Comprehensive Services for Key Populations in Meru County.

1. Access to Quality Preventive Comprehensive Services for Key Populations in Meru County. By Prof. E. Ngugi,DirectorUNIVERSITY OF NAIROBI, CENTRE FOR HIV PREVENTION & RESEARCHPrincipal Investigator Most at risk populations (MARPS) PROJECT UNIVERSITY OF NAIROBI MINISTRY OF HEALTH

2. First and foremost let me take this opportunity to thank and appreciate (GOK) MOH staff for their collaboration and commitment • MOH has seconded 3 staff to Meru Drop In Centre(DICE).

3. STRENGTHENING STD/HIV/AIDS CONTROL PROJECT • AIDS was first reported in Kenya in 1984 and since then has grown into an epidemic of devastating magnitude and has not yet stabilized. • The Centre for HIV Prevention and Research which was then called Strengthening STD/HIV/AIDS Control Project in Kenya in the 90s. • The Centre started working in Meru in August 2002 when the HIV prevalence was 28%. • In 2003, the prevalence was 8% in 2003 and at the time of Exit in March 2006, the HIV prevalence had dramatic fallen to 4% as measured by Ministry of Health Surveillance data (2004).

4. ACHIEVEMENT • Worked with over 12000 FSWs and over 2500 clients e.g.(touts, Jua kali artisans) of FSWs. • Providing holistic services including STI Management EXPENDITURE ANALYSIS FOR STRENGTHENING STD/HIV/AIDS PROJECT

5. UoN CHIVPR- MERU DICE • UoN -CHIVPRis implementing a programme on Access to Quality Preventive Comprehensive Services for Key Populations in Eastern and Central Provinces of Kenya since the year 2010. • This was to build on what UoN had done since August, 2002 to March, 2006 in the same area. • Subsequently, the Meru DICE was established in March, 2011. • The DICE is supported by the Ministry of Health, UON and CDC.

6. COVERAGEMERU county AND IT’SSUB-COUNTIES • Imenti North • Imenti South • Meru Central • Igembe South • Central &North • Tigania East • Tigania West • Buuri

7. MERU DICE

8. Target Population • The targeted groups are Key populations: Female Sex Workers (FSW), Male Sex Workers (MSW), Men who have Sex with Men (MSM), People who Inject Drugs (PWID) & Long Distance truck drivers (TKR). • Out of School Children (Healthy Choices II) • Continuously abused children (OCaT) • Family Matter Project (FMP)

9. Meru DICE after renovation by UON [interior view]

10. Why Key Population interventions? • In the 2012 Kenya AIDS Indicator Survey (KAIS), HIV prevalence among adults aged 15-64 years was 5.6%. • The Kenya Analysis of HIV Prevention Response and Modes of HIV Transmission Study of 2009 reported that about 33% of new HIV transmissions were attributed to Key Populations (KPs) where by; • Sex workers and their clients (14.1%), • men who have sex with men (15.2%), • people who inject drugs (3.8%).

11. Continued • They are at higher risk of acquiring or transmitting HIV due to their lifestyle (Multiple sexual partners and unprotected anal and vaginal sex, Intravenous drug use and sharing of needles.) • They form the bridge through which the HIV virus is transmitted to the same larger community that stigmatizes them since this is where the clients come from. • Due to self and community stigma there are health care and other social services access barriers. • Their interventions are few and far in between. The nearest MARPS DICEs in upper Eastern are Chuka and Embu.

12. SERVICES OFFERED IN THE DICE • Male & Female condom and lubes education and distribution, Health communication • HTC and Linking to care, HIV care and treatment; Clinical and community Positive Health Dignity Prevention (PHDP); Post Exposure prophylaxis • STI screening and treatment; Cancer of cervix screening and referral; TB screening and referral. Screening for alcohol and drug abuse • Family planning including Emergency contraceptives. • Gender based violence • Health Choices II (youth out of school) • Linked referral services.

13. MARPS reached with interventions by Typology since 2011.

14. Quarterly Prevalence

15. NUMBER ON CARE (ART)

16. Support and Peer led Groups Peer led Groups

17. Choices Beyond Sex Work

18. Sex workers prepare Aloe bathing soap to supplement their income

19. CONTINOUSLY ABUSED CHILDREN • The DICE started working with Continuously Abused children from October 2012 and up to September 2013, • Mobilized 56 children and out of these; 14 are aged 12-15 years, and 42 are aged 16-17years. • Of these, 15 (27%) are still active and continue to visit the DICE, while the other 41(73%) are lost to follow but the DICE is closely working with the peer leaders to trace them. • Given this experience, University of Nairobi is now involved in the CDC One Child at a Time (OCaT) Program for one year. The Program will reach 1,000children of whom 99% will be those sexually abused.

20. Continuously abused children with Project staff

21. EXPENDITURE ANALYSIS FOR MARPS

22. Challenges • Slow behaviour change • Poverty – serves as a push factor to risky sexual behaviour • Drug and substance abuse- inhibits anticipated risk to HIV infection drug / medication adherence failure. • Many dysfunctional families – leading to many vulnerable mature minors to sex abuse. • Low HIV zero status disclosure to partners. • Less resources comparable to the size of the health problem

23. Challenges continued • Children not wanting to be known thus making it difficult to identify them. • The children being very mobile thus making it challenging to form peer-led groups. • Being illegal to employ children limits the options. • Some of the girl child have a baby or two.

24. Priority Areas and way-forward. • Strong county and community leadership for a multisectoral HIV response. This is application of what is scientifically known as programme intelligent • Mobilizing additional local resources to increase and sustain the HIV response. • Expanding HIV treatment programmes and increasing community involvement in driving demand for increased uptake and adherence among both adults and children. • Increasing social welfare services to HIV-positive persons and others affected by HIV.

25. Continued It is possible and credible mobilizing and working with Continuously Abused Children and providing them with: • Comprehensive care package which is essential • Educational support for those who can go to school is mandatory • Vocational Training and subsequently Economic Empowerment is a feasible option • Linkage with the family kinship system works well with support counseling

26. continued • Meru County has made great progress since When UoN established a programme aimed at reducing HIV prevalence from 38% (19) to a level nearer the National HIV prevalence which was 12% • Together your able team • Mobilisers, FSW clients

27. Conclusion • The Meru County Government has the mandate and power to intertwine this programme in their plans. • Therefore, we are seeking greater collaboration & subsequently transfer of the DICE to the County. • This programme intelligent aspect can bring the county to: • No new infections by 2020. • Near zero death by the same year. • Thus boosting county Growth and Development.

28. Thank you!Asante!