ICRH Kenya

Alternative Means of Livelihood for MARPS – UNFPA

Promoting Alternative Means of Livelihood to Reduce STI/HIV among Vulnerable Groups in Kilifi, Coast Province

ICRH-K is implementing evidence-based interventions to  address the sexual and reproductive health needs, and promoting behavior change, among female sex workers (FSW) in the Kilifi District, Coast Province. The programme contributes to UNFPA country programme annual plan (CPAP) and aims at comprehen- sive condom programming, scaling up of HIV and STI prevention skills and services, strategic behavior change communication, increasing counselling and testing for HIV uptake among sex workers and reducing vulnerability in the context of sex work.

During the year, we included a youth and sexual and gender based violence component. We recruited and trained 40 youth peer educators to reach out to the youth in Kilifi District and under the SGBV component we concentrated on capacity development and advocacy of SGBV to health care providers, religious leaders and the community targeting men and the youth.


•             Comprehensive Condom Programming

This is another lead activity that is part of the package under the national guidelines for HIV/STI programs for sex workers

developed by NASCOP. A total of 479,126 male condoms 22,162 female condoms and 3,488 water based lubricants were distrib- uted from the DISCS over the period. This is in aim of achieving our 100% condom programming. Condoms were also distributed to hotspots with a total of 1,236,144 male condoms distributed. Female condoms are now readily available from NASCOP enabling us to meet the demand from FSW.

•             In-reach Services at Drop in Service Centers

Two DICs were established (one in Kilifi town and another in Mtwa- pa) to enable FSW access services in a convenient and friendly space for them. The drop-in Centers have been equipped to provide access to information on HIV, AIDS, STIs, FP, condoms, counseling and referrals to health facilities. ICRHK in collaboration with MOH and support from UNFPA have enhanced service delivery to MARP groups in line with the national guidelines for HIV/STI programs for sex workers developed by NASCOP.

A total of 4,495 (2007 male; 2488 female) accessed full HTC ser- vices with 25 males and 61 females testing positive for the period January to December 2012.  A total of 1292 (360 male; 932 female) accessed STI treatment during the year. A total of 825 females ac- cessed FP methods at the DISCs during the same period. Cervical cancer screening was started during the year 2012 and a total of 665 FSW were screened with 4 testing positive and being referred appropriately. The results show that these centers are proving to be user friendly for FSW and their clients and they will help in achiev- ing increased utilization of equitable, efficient and effective health services especially by vulnerable populations.

•             Provision of HIV/STI/ FP Information through IEC Materials IEC materials with information on HIV/STI/FP were distributed from the DISC. This is an important component as through these materi- als, a wider audience is reached. They also provide basic facts and referrals for this services enabling anyone who reads them know where to go for more information. A total of 33,032 IEC materials were distributed from the two DISCS over the period January-De- cember 2012.

•             Provision of HIV/STI Prevention Information, Skills and Services for sex workers

Several trainings have been carried out for FSW all with the aim of reducing vulnerability in the context of sex work. From the trainings, FSW were provided with skills and knowledge about HIV, STIs, FP, Gender-based violence and the importance of seeking treatment and protecting themselves. Provision of HIV/STI prevention infor- mation is done through Participatory peer education and facilitative supervisory bi-monthly meetings. Skills provided through trainings, mentorship and activities such as creative space and services for sex workers done through moonlight, community education and house to house HIV/STI/FP outreaches.

•             Creative Space

Creative space is an event which brings sex workers together in a safe environment to discuss issues that affect them in sex work, share experiences and the challenges they face and also to learn from one another. During this event they also learn about the human, health and legal rights issues that affect them, issues to do with SGBV, how to care for their children and income generation including saving of money. They also develop an action plan and the way forward from the issues learnt. This event was first carried out in 2011 and we saw a positive impact with peers understanding about their health rights and with others learning from role models who had changed their lives. We had three peers requesting to go back to school to finish their education with 8 others requesting  to loans to set up their small businesses. In January 2012, we also included services for HTC, STI treatment and FP services. A total of 37 FSWs were tested with only one turning positive and this shows the decreasing trends of HIV amongst this group.


•             Alcohol and Drug Harm Reduction Training

It is widely documented that sex workers abuse alcohol and drugs and this puts them at risk of contracting HIV/STIs and unplanned pregnancies. Peer educators in Kilifi were also noted to use a lot  of alcohol (more than four bottles) a night including usage of the local brew mnazi. It is based on this that this training was conduct- ed so as to sensitize the peer educators on the harm they cause themselves and how they could counsel their fellow peers in the

community. A total of 30 peer educators and 4 staff were trained in March 2012 and through this they acquired skills on how to counsel on alcohol and drug reduction therefore will lead to an increase in the number of peers identified and counseled on alcohol and drug reduction.

•             Family Planning Training

A total of 40 peer educators from Mtwapa and 30 peer educators from Kilifi attended a community based distributor’s Family planning training for 1 week at Pride inn hotel from 28th to 1st May 2012 and Titanic hotel from 11th to 15th June 2012 respectively. The aim of

the training was to increase their awareness on family planning and distribute pills and condoms to their peers and community at large with supervision and follow from the district reproductive health nurse. This training is aimed at revitalizing family planning in the community and to ensure easy access to commodities such as pills and condoms.


Considering the high risk of STI infection among sex workers, and also on the need to reach their clients with services, STI screening and treatment and testing for HIV is an important component of the intervention. In order to reach this target group, outreaches were conducted during the year 2012 and the graph below shows their results.

Considering the high risk of STI infection among sex workers, and also on the need to reach their clients with services, STI screening and treatment and testing for HIV is an important component of the intervention. In order to reach this target group, outreaches were conducted during the year 2012 and the graph below shows their results.

•             Door to Door FP Services

Seventy FSW peer educators were trained on FP methods and the essence of this training was to make them community distributors. The DRHN identified several of the peer educators as having un- derstood well how the FP methods worked and they were the ones to distribute the pills. In line with this, door to door FP distribution was carried out in the community targeting both the general public and the FSW. As a result of this activity, a total of 804 FSW were reached with various short term FP methods.

•             FSW Exchange Visit

10 FSW peer educators (5 Mtwapa and 5 Kilifi) attended an exchange learning visit to Naivasha, Gilgil and Nakuru from 26th  to 29th September 2012. This visit provided an opportunity for the FSW peer educators to learn about the programs targeting FSWs in other parts of the country, exchange ideas and learn from one another by discussing challenges they face and how can they take care and support themselves. Topics discussed included recruit- ment into the program, package of services to FSWs, alternative livelihood and issues around SGBV.


•             Training of Youth Peer Educators

A total of 40 (20 female; 20 male) youth were recruited from Mtwapa and Kilifi (20 from each site) on 10th march 2012 and 12th march 2012 respectively. Orientation was then conducted for Mtwapa then Kilifi on 17th March 2012 and 21st March 2012 respectively. They were oriented on the UNFPA program, its objectives, how they fit into them as the youth and what would be required of them.

•             In-reach Services at Youth Drop in Service Centre (DISC)

A youth DISC was established in Mtwapa to provide youth friendly services including HTC services, STI screening and treatment, FP services, provision of IEC materials, an educational centre for the youth and a venue where the youth would meet to hold sessions, practice for theatre, dance and get referral for other health related services not provided at the DISC.

A total of 1,028 clients (560 male; 468 female) accessed full HTC services with 2 males and 4 females testing positive.  STI treatment and FP services were started in September at the youth DISC and a total of 467 (236 male; 231female) youths accessed STI treatment and a total of 349 females accessed FP methods at the DISC.

•             Community Outreach through Football Matches

Football matches are innovative ways to reach the youth with services by incorporating the services with the matches. ICRHK peer educators and peers formed four teams

(2 for girls and 2 for boys) two in Kilifi and 2 in Mtwapa to participate in a tournament in Kilifi district. Services were also provided and the graph below shows how the services were accessed:

During the period July-September 2012, a total of 12 football matches were played reaching a total of 2,256 (1,420 boys and 836 girls) youths with health information covering HIV, STIs and FP topics and in the process enabling them access services and get to know their status. A total of 28,800 male condoms, 326 female condoms and 5,000 IEC materials were distributed.

•             Youth Exchange Learning Visit

Ten (10) peer educators (5 mtwapa and 5 kilifi) attended an exchange learning visit to Naivasha, Gilgil and Nakuru from 26th to 29th September 2012.The aim of the visit was to provide the youth a forum in which to exchange and learn from other youth in a different part of the country. It was an opportunity to see what other programs were doing, what could be adopted or adapted to the project in Kilifi. The youth managed to visit different DISCs that offer youth friendly services in Naivasha, Gilgil and Nakuru.  Some of the topics discussed included recruit- ment as YPEs, how they conduct sessions, services available to them as the youth and different challenges they face as the youth.


The partnership with key stakeholders and the Ministry of Health has facilitated smooth implementation of planned activities and achievement of most of the set targets. We therefore ensure that a stakeholders meeting is held every quarter to enable us give feedback on the progress of the program. This will also ensure sustainability of the program.