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HIV Prevention in Migrant Population_IRC's Experience_IAS2012_peter mutanda
- 1. HIV Prevention in Migrant Population IRC’s Experience AIDS2012 IAS Conference Washington DC, July 2012
- 2. Life in Turkana 2
- 3. Life in Turkana Kenya’s HIV prevalence at 6.4% (KDHS, 2008/9) Turkana hosting refugees from Somalia, S/Sudan, Ethiopia and ALL Great Lakes countries Refugee camps in existence since 1992 Estimated Turkana population: >850,000 (KNBS, 2009) Refugee population > 85,000 (UNHCR PHHIV Report, 2011) Community reliant on food aid, mostly by external donors Community in denial – “HIV problem of the urban” (2005) 3
- 4. HIV Prevalence: Sentinel Surveillance – Turkana (Nascop, 2011). IRC started program in 2005 11.3 12 10 9 7.4 8 6 5.1 4.8 4 2 0 2006 2007 2008 2009 2010 4
- 5. IRC in Kenya Started work in refugee programs in 1997 Host population programs started in 2005 – HIV Prevention, WASH Refugee programs – direct implementation Inevitable interactions, assimilation over time among refugees and their hosts at Kakuma Host Population Programs- mainly with partners through enhancing capacity of Community Based Organization 5
- 6. Through the Path… 2004/5 – HIV Program limited to small part of Turkana, no public disclosure in the region, denial of HIV at community, first HIV sentinel surveillance – 18% (Nascop) 2006 – HTC services through mobile programs, mass awareness in the community/schools, HIV Care and Treatment at three facilities 2007 – Decentralization of HIV care, treatment more facilities, trainings of health care workers and community health workers, first public disclosure 6
- 7. …the Path 2008/9 – Rapid results campaigns, support CBOs on MIPA initiatives, complimentary programs 2010 – Emphasis on Evidence Based Intervention,, decentralized supply commodity mechanism, target new HIV testing 2011 – Severe drought slows down community activities, focusing on EBI – relevance, efficiency and sustainability 7
- 8. Targeted HIV Prevention Approaches Families Matter! Program: Targets 9-12 year-olds through parent/child communication. Healthy Choices: Targets 13-17 year olds Community HIV Testing: Home or family-based HIV testing Community Prevention with Positives: From clinical settings to the community 8
- 9. Hard Lessons Program priority not community priority! Very key: Program linkages, active community participation Agreement on what constitutes evidence since many factors influence its acceptance 9
- 10. Taking services to the community 10
- 11. Participation 11
- 13. Leadership 13
- 14. Standards, Standards 14
- 15. Acknowledgements Centers for Disease Control and Prevention (CDC) Kenya Government through the Ministry of Public Health and Sanitation Turkana Community and their leadership Other donors for supporting other health programs 15
- 16. Thank You16
Notas do Editor
- Largest County in Kenya, mostly nomadic, pastoralist community Area covers 77,000 sq kilometers; pop density ranges from 1 to 16 people/sq km (Turkana Strategic Plan, Arid Land Resource Management Project, 2009) Borders three countries; Uganda, Ethiopia and South Sudan Drought stricken, 2007 and 2011 some of the worst years in memory Historical conflicts over resources (pasture, water, land) with national and international neighbors, leading to clashes, loss of property, displacements and loss of lives Poverty levels very high; Kenya at 46%, Turkana at 86% (KNBS) One of the worst illiteracy levels in Kenya – almost 84% of entire population (KNBS, Open Data)
- ANC based Sentinel surveillance has been conducted in Kenya by the national program on STI/HIV control (NASCOP) since 1990, but only started in Turkana from 2005 Findings from ANC SS provide important data on trends in HIV prevalence among pregnant women in Kenya and in combination with national population‐based HIV surveys (done every five years in Kenya), are used to project national HIV estimates for the general population of Kenya and inform programming for government and non-state actors like IRC While decreases in HIV prevalence among young pregnant women are indicative of positive trends in the HIV response, sub‐populations of pregnant women continue to be at high risk for HIV infection. This is so across the countryResults presented in the ANC SS represent univariate and bivariate analysis which are not adjusted for potential confounders (e.g., age) so caution should be taken in the analysis. Further multi-variate analysis needed to determine independent corelates to HIV infection. IRC has used the SS for community feedback and program adjustments with CDC
- IRC has managed to expand its programs over the last six year to respond to the community needs; peace building, sexual and gender based violence, nutrition and water, hygiene and sanitation
- Families Matter ProgramThis intervention targets parents, guardians or primary caregivers of pre-adolescents between the ages of 9 to 12 years through a parent–youth communication approach. The program is aimed at delaying sexual debut and promoting sexual and reproductive health among adolescents by addressing gender, reproductive health, HIV/STI preventive and protective behaviors, STIs, HIV/AIDS, abstinence, gender-based violence, decision-making, and communication skills. This is done through facilitating dialogue between parents, primary caregivers, and children on issues related to adolescent sexual reproductive health (ASRH) by trained male and female facilitators. Healthy Choices I and II (HCI and HCII)This EBI takes two slightly different forms, Healthy Choices I and Healthy Choices II, and is aimed at adolescents in and out-of-schools between the ages of 10 to 17 with messages aimed at preventing early sexual debut, unplanned pregnancies, STIs, and HIV. These messages empower the adolescents to adopt or change their behaviors in ways that will reduce their risk of exposure to contracting HIV, STIs, and unplanned pregnancies. The Healthy Choices I (HC I) program targets adolescents aged 10 to 14 years in school settings to delay their sexual debut and abstain through reinforcing the abstinence message and understanding the physical changes that come with adolescence. To reach adolescents in schools, the IRC approaches a school and introduces the HC I program. The Healthy Choices II (HC II) program targets both in and out-of-school youth aged 13 to 17 years to delay sexual debut and promote secondary abstinence or have protected sex through providing knowledge and skills on correct and consistent condom use and how to handle peer pressure.The out-of-school youth are reached at youth centers and in villages. The youth participating in both HC I and II are also presented with an opportunity to learn their HIV status. Both HC I and II consist of eight modules of approximately one hour each. The modules are delivered by a trained male and female facilitator in four sessions of two hours each targeting adolescents of mixed small groups ranging from 12 to 16 participants per session. Each module has a specific focus on the areas of discussion related to ASRH such as knowing your body, handling peer pressure, knowledge about pregnancy and STIs, as well as learning safer sex practices. A total of eight modules must be completed for the participant to have undergone the full Healthy Choices (either I or II) curriculum. There is integration of HC and FMP to ensure that children who have gone through FMP also benefit from HC package. SHUGAThisis a recently (2012)accepted intervention that uses activities, movies and video clips as prevention education strategy designed for young people. It is a three-part drama series that uses the appeal of television targeting the youth above 15-25 years of age and addresses the universal issues of relationships, aspirations, and sexual decision-making in the age of HIV. The objectives of the drama series are to i) increase the risk perception of the target group to HIV infection, ii) increase the uptake of HIV testing and counseling services, and iii) increase knowledge of HIV prevention strategies like partner reduction. Very few youths in Turkana have access to television and the Shuga video has entertaining cast and storylines. Community Prevention with PositivesPrevention of new infections is the hallmark in fighting the spread of HIV under the Kenya National AIDS Strategic Plan (III). Nationwide, over 40% of HIV-positive individuals with partners are in an HIV-discordant relationship. Only about one-third of people who are aware of their HIV-positive status consistently use condoms, while 40% of HIV-positive women who want to delay pregnancy use modern contraception. The minimum package of CPwP services addresses risk behaviors, importance of early initiation to care and adherence to ART, contraception and partner disclosure. The IRC hasbuiltthe capacity of community and support groups to deliver CPwP messages and provide counseling on partner notification with HIV-positive community members. HIV Testing and CounselingUsing the Community HIV Testingapproach, the IRC will provide mobile, outreach, and door-to-door Testing and Counseling services. Teams of HTC counselors are sent to villages (manyattas and kraals) in Turkana where members of the community are offered opportunities to know their HIV status. Teams of HTC counselors will be sent to the field to provide HTC services in appropriate situations per the communities’ preference. HIV testing is done either at the homestead (i.e. HTC counselors will visit clients in their homes and book appointments with clients where possible) or another place preferred by the client (e.g., under a tree or at a private area away from the homestead), at strategic central places in school, churches and social and social places. Appropriate counseling is offered to all persons opting to be tested. Clients who are HIV positive will be referred to care and treatment services at the facilities within their locations. To ensure that effective referrals are made, the IRC works closely with other partners implementing care and treatment programs to share information on access to care and treatment by sero-positive clients through regular updates on HTC activities and outcomes, and engage in discussions on how best to ensure access to a continuum of care and support for persons testing HIV positive.
- All IRC Kenya health programs are implemented under national guidelines and quality control and assurances mechanisms are in place to ensure quality service delivery