ICRH Kenya

Risk Reduction with MARPS – APHIA+

Reducing the Risk to HIV/STI for MARPs in Coast Province (APHIA PLUS)

ICRH-Kenya in partnership with the Ministry of Health and support from APHIA PLUS aimed to contribute to increased access to quality reproductive health (RH) services among female sex workers(FSW) and men who have sex with men (MSM) in Coast province. The intervention components were implemented in line with National guidelines for HIV/STI programs for MARP groups; Behavioral component, biomedical component and structural component.

The interventions were primarily implemented through drop-in ser- vice centers that are MARPS friendly, venue based and moonlight outreaches and through door to door services. The services provid- ed to clients at the DISCs and outreaches included HIV Testing and Counseling, STI screening and treatment and FP services. During the year under review, cervical cancer screening was also intro- duced to the FSW DISCs. The other activities carried out included peer education sessions under both the FSW and MSM/MSW com- ponent and condom and lubricant promotion and distribution.

Clients were referred for RH services not provided in the program to Ministry of Health and private facilities and other stake holders in the community. All the peer educator groups were registered as

Community Based Organizations and some have been able to carry out activities in the community as well as start income generating projects.

Key Achievements
  • Drop-in services centers in activities: The DISCs are each managed by 2 HTC counselors who provide services on a daily basis. The DISCs also have a clinical officer who comes on a locum basis to provide screening and treatment of STIs, family planning services and cervical cancer screening services.
  • The FSW activities were carried out at Kisauni drop-in service center and Likoni drop-in service center. At both Kisauni and Likoni DISCs, 5,708 (2,477 male; 3,231 Female) were provided with HTC services; 116 tested positive (46 male; 70 female); (2 %). The clients who accessed STI treatment were 628 (108 male; 520 female) while those provided with family planning services were 603 FSWs. A total of 563 FSW were provided with cervical cancer screening services
  • The MSM/MSW activities were carried out at Mombasa and Ukunda drop-in service centers. At the two centers, 7,538 (3,977 male; 3,561 Female) were provided with HTC services; 248 tested positive (88 male; 160 female); (3%).
  • The number of clients who accessed STI treatment were 949 (458 male; 491 female) while those provided with family planning services were 523 FSWs and 26 male clients.
  • The clients who tested HIV positive were referred to comprehensive care centers for care and treatment.
  • A total of 25,075 IEC materials containing HIV/STI/TB and other reproductive health information were distributed to FSW and their clients to reinforce the peer education sessions. Under the MSM/ MSW component, a total of 14,794 IEC materials containing HIV/ STI/TB and other reproductive health information were distributed to MSM/MSWs and their clients to reinforce the peer education sessions.
  • Condom promotion and distribution: During the period under review, 4,324,126 male condoms and 27,438 female condoms were distributed to female sex workers, their clients and FSW hotspots while 2,373,139 male condoms were distributed to MSM, MSW and their clients and MSM hotspots. All the male condoms distributed were procured from MOH-KEMSA whereas female condoms were provided by NASCOP. The water based lubricants distributed to MSM/MSW were 7,833 while those distributed to FSW were 3,318.
  • Peer Education: The FSW and MSM/MSW peer educators carried out several activities throughout the year. These activities included recruitment of peers to attend peer education sessions, participatory peer education sessions, referrals for reproductive health services to the FSW and MSM/MSW DISCs, MOH facilities and other partners in the community, condom promotion and distribution, and mobili- zation during outreaches .Under the FSW component ,5,757 peer education sessions were conducted reaching 7,642 new FSWs. In the MSM/MSW program, 2,859 peer education sessions were con- ducted reaching 4,692 new MSM/MSWs. In all the sites, bi-monthly supervisory meetings were held with the peer educators (320) under the supervision of the project officers and field coordinators. One hundred and ninety two (192) supervision meetings were held at the FSW sites while seventy two (72) were held at the MSM/ MSW sites in 2012.
  • Moonlight HTC: The activity aimed at reinforcing the Strategic Behaviour Change campaign being implemented through Peer Education, providing HTC services to sex workers and clients as they socialize at venues (hotspots), providing STI treatment and family planning services to sex workers and clients outside hotspots and promotion and distribution of both male and female condoms.
    During the year under review, there was a lot of focus on emerging hotspot, ensuring that the FSW operating in these areas had access to RH services. A total of 6,486 (3,902 male; 2,584 Female) were provided with HTC services; 134 tested positive (68 male; 66 female) (2%). The clients who accessed STI treatment were 554 (215 male; 339 female) while those provided with family planning services were 123 FSW and 3 male clients. A total of 16,717 IEC materials were distributed.
  • Stakeholders Meetings: There was a community stakeholders meeting and a Project Advisory Committee Meeting (PACM) held at Royal Court Hotel during the fourth quarter. The meetings were aimed at updating various stakeholders in Mombasa on the progress of APHIA PLUS program activities and on SGBV issues in the community and among sex workers. There were thirty stakeholders attending each meeting who were able to share their insight on issues relating to provision of services to MARPS.
  • Peer Educators Community Based Organizations: Peer educators from all the FSW and MSM/MSW sites were able  to register their groups as CBOs. Bombolulu CBOs received funds from organizations like UHAI and ACTION AID to carry out com- munity education forums on HIV prevention. Bangladesh/Mapor- omokoni CBO received funds from NACC to implement TOWA project (couple counseling and testing) and they also initiated in- come generating activities such as soap making for sale. Mombasa Island is also currently involved in soap and bleach making as their IGA projects. Likoni CBO held a fund raising to initiate HIV preven- tion education forums for their peers as well as mobilize them to seek RH services at Likoni DISC and other MOH facilities in Likoni. All the CBOs held regular meetings throughout the year to update members on the CBO schedules.
  • Paralegal Activities: Ten peer educators (9 FSW and I MSM/MSW) underwent a paralegal training under the HAKI YENU project. The paralegals also underwent one week training in Basic counseling skills to enable them carry out counseling sessions with victims of SGBV in the community. There were several follow up meetings with the paralegals throughout the year under the HAKIN YENU project as well as consistent cross coordination of activities with the APHIA PLUS program. The paralegals from Kisauni organized a forum aimed at creating awareness on Sexual and Gender Based Violence amongst FSW and MSM/MSW, as well as the community at large. The activity was during the 16 days of activism held on the 13/12/12 at the Kisauni drop in center.
  • MSM/MSW Peer Education Curriculum Development and Pre-test: One coordinator from ICRHK attended a forum aimed at developing the new MSM/MSW peer education curriculum.Ten peer educators from Mombasa and nine from Ukunda were also selected to attend a pre-test for the new MSM/MSW peer education curriculum under development by NASCOP and NOPE in collaboration with other partners. The forums were organized by NOPE and held on 12th to 16th November 2012 at Central Park Hotel in Machakos and on 21st to 26th November 2012 at Titanic Hotel in Kilifi consecutively.
  • NACC TOT Training: Ten peer educators from ICRHK (5 FSW and 5 MSM/MSW) were invited to attend a TOT training in peer education for key affected population. The one week training that was held from 19th/11/12 to 23rd/11/12 at Kilifi Bay Hotel was organized by National AIDS Control Council. The trained peer educators worked closely with the project coordinators to improve facilitation skills of other peer educators by attending their sessions and helping them work on their weaknesses.

There was inadequate supply of female condoms and water based lubricants during the year under review, hence we were unable to meet the demand for these commodities by the subpopulation. Weather changes with flush floods sometimes made it difficult or led to postponement of moonlight HTC leading to a backlog of out- reaches to be done. FSW and MSM/MSW commonly experience SGBV, sometimes leading to severe health implications or death.

All the planned activities were carried out successfully; the team was able to reach all the targets set for the various components of the program with the support of APHIA PLUS, MOH, partners, and other stakeholders. Peer educators from Kisauni, Mombasa Island and Chaani underwent computer and business management trainings organized by Digital Opportunity Trust. There was a peer educator (MSM) from Mombasa employed by CAPACITY and posted to Kilifi District Hospital. The trained paralegals were quite significant in ensuring that survivors of SGBV were linked to the much needed health and legal services. One FSW peer educator from Kisauni was recruited in August to join Kenya Armed Forces while another peer educator from Chaani joined Administrative Police and is currently undergoing training. There was an increase  in uptake of HTC services by the target population and their clients at the DISCs. Cervical cancer screening was introduced at the FSW DISCs in April and has been picking up well over the subsequent month.