Most at Risk Populations (marps)
HIV in Kenya
Kenya is experiencing a mixed and geographically heterogeneous HIV epidemic with characteristics of both a ‘generalised' epidemic among the mainstream population, and a ‘concentrated' epidemic among specific most-at-risk populations.
Who are MARPS?
MARPs are groups of people who are disproportionately at higher risk for acquiring or transmitting HIV. This is because they engage in behaviors that predispose them to acquiring HIV.The primary MARPs in Kenya include Sex workers and their clients, Men who have sex with men (MSM), Prisoners, People who Inject drugs (IDUs). Others include truckers, fishing and beach communities.
Why focus on MARPS?
MARPs have the highest risk of transmitting and acquiring HIV/STI due to increased frequency of high risk sex (unprotected anal and vaginal sex, multiple partners, frequency of partners) and drug-related HIV risk behaviors (e.g. sharing of needles, flashblooding , vipointing etc).
MARPs experience barriers to accessing services because their behaviors are criminalized and stigmatized making them marginalized and hard to reach.
MARPs account for one third of new HIV infections in Kenya which is estimated to be about 100,000 per year. (KAIS 2008)
Sources of new HIV infections in Kenya (Kenya Mode of transmission study - KMOT, 2008)
Why a National program?
To effectively reach and address the particular needs of most-at-risk populations there is need to develop customized HIV/STI prevention, care and treatment programs. This is envisioned in the 2009-2013 Kenya National HIV/AIDS Strategic Plan (KNASP III).
The mandate of the MARPs program is to provide technical leadership in the development of policy, strategies, service delivery package and guidelines for high risk groups. The national program works closely with stakeholders such as government agencies, donor community, research institutions, civil society and MARPs networks.
The HIV/STI Package of Services for MARPs and Their Sex Partners has 3 components:
Peer Education and Outreach
Risk Assessment, Risk Reduction Counseling and Skills Building
Screening and Treatment for Drug and Alcohol Abuse
HIV Testing and Counseling
STI Screening and Treatment
TB Screening and Referral to Treatment
HIV Care and Treatment
Promotion, Demonstration and Distribution of Male and Female Condoms and Water-Based Lubricants
Family Planning, Sexual and Reproductive Health Services
Post-Abortion Care Services
Cervical Cancer Screening
Post rape care
Screening and management of hepatitis B
Opiates substitution Therapy
Needle exchange program
Ensuring 100% Condom Use
Mitigate and manage sexual Violence
Mitigating violation of human rights
Expand choices beyond sex work
Family and Social Services
Access to micro credit and other financial products
What have we achieved?
Existing coordination structure through the national program
Formation of multi-sectoral technical working group
Mapping of hotspots
Estimating population sizes of MARPs – ongoing
Integrated bio-behavioral surveillance
Development of service guidelines and other programming tools
HIV/STI guidelines for Sex workers programs
QA standards for MARPs peer education programs
Health workers training curriculum for MARPs – on going
National peer educators training manual – in print
Setting minimum package for MARPs care
Creating and enabling policy environment
Policy dialogue involving MARPs stakeholders
Soliciting political support from lawmakers
Strategic involvement and capacity building MARPs
Training of MARPs as peer educators and health workers (onsite/online)
Supporting MARPs to form organized groups
Mobilization of MARPs to create service demand
Establishing service delivery models
Drop in centres
Truckers wellness centres
Specialized MARPs friendly clinics
Development of referral networks – ongoing
Piloting new interventions eg opioid substitution therapy
Financing and sustainability
Global Fund support for biomedical interventions for IDUs
Global Fund support for MARPs friendly centres
PEPFAR support for MARPs programming
Population is highly mobile
Immigration status of some sex workers
Stigma and social discrimination towards MARPs
Violence due to cultural insensitivity
Addressing the challenges
Implementation of peer led interventions
Introduction of Online training for health care workers
Sensitization of health care workers on MARPs issues
Media engagement for advocacy
Mapping of MARPs hotspots
Taking the services to MARPs eg through outreach programs
Engaging UN agencies to address challenges facing migrant sex workers
Consideration for replication
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