Why a National program?

To effectively reach and address the particular needs of key 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 key populations 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 KP networks.

Key Populations Interventions

The HIV/STI Package of Services for MARPs and their sex partners has 3 components:
Behavioural Components

These are a range of sexual behaviour change communication programmes that use various communication channels (mass media, community level or inter personal) to disseminate behavioural messages designed to encourage people to reduce behaviours that increase risk of HIV and increase protective behaviours (reduction in multiple partnerships, correct and consistent condom use). Behavioural interventions are also aimed to increase acceptability and demand for biomedical interventions

Biomedical components – These directly influence the biological systems through which the virus infects a new host such as blocking infection (e.g., male and female condoms), decreasing infectiousness, anti-retroviral theraphy (ART) as prevention) and reducing acquisition/infection risk (e.g., voluntary medical male circumcision).

Structural Components – These are iinterventions that aims to address and changes root causes or structures like social, economic, political and environmental factors that determine or affect individual or community’s HIV risk and vulnerability in specific context. These interventions attempt to reduce an individual’s HIV related vulnerability by creating the conditions in which people can adopt safe behaviours (and fulfil their human rights). Structural approaches are part of overall HIV prevention strategy and must be complemented by other prevention options (Merson MH, Lancet, 2008).

Behavioral components

  • Peer Education and Outreach
  • Risk Assessment, Risk Reduction Counseling and Skills Building
  • Screening and Treatment for Drug and Alcohol Abuse

Biomedical components

  • 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
  • Emergency Contraception
  • Post-Exposure Prophylaxis
  • Post rape care
  • Screening and management of hepatitis B
  • Opiates substitution Therapy
  • Needle exchange program
  • Male Circumcision

Structural components

  • Ensuring 100% Condom Use
  • Mitigate and manage sexual Violence
  • Mitigating violation of human rights
  • Expand choices beyond sex work
  • Psychosocial support
  • Family and Social Services
  • Access to micro credit and other financial products

What have we achieved?

  • Coordination
  • Existing coordination structure through the national program
  • Formation of multi-sectoral technical working group
  • Situation analysis
  • Mapping of hotspots
  • Estimating population sizes of MARPs – ongoing
  • Integrated bio-behavioral surveillance
  • Stakeholder analysis
  • 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 – ongoing
  • 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

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