KENYA: Walking 26km for a condom

Photo: Kenneth Odiwuor/IRIN

People in rural areas struggle to access condoms

NAROK, 2 December 2010 (PlusNews) – Correct and consistent condom use is one of the bedrocks of Kenya’s HIV/AIDS prevention programme but many people in rural areas have limited access to condoms.

“Condoms are good and I use them with girls – they have taught us how to use them… but here in the rural area there is a problem because we walk very far to get the condoms,” said Lemeo Ntalel, a 21-year-old Maasai moran – warrior – in rural Narok, in Kenya’s Rift Valley. “At times you want to use one and you don’t have it near so you just do it with a girl without it; it is hard to tell a girl ‘wait for me I am going to get a condom’, because she will lose interest and go.”

Ntalel has to walk to Narok sub-district hospital, 26km away, to fetch condoms.

Jactone Lelei – a peer educator who trains his fellow morans on the need to use condoms – says the demand is so high that he and his colleagues have started stocking condoms along with their education materials as they go around the community spreading the word about HIV.

“We have to walk with them so that as we sensitize people to use them, we also give the condoms out. I also keep some in my house so if they want, they just call me and I give them,” he told IRIN/PlusNews. “At least it helps a little… the lack of easy access gives people an opportunity to give excuses for not using them.”

He noted that many rural residents could not afford to or chose not to buy condoms – not considered a necessity – so stocking them in local shops did not really improve access.

More awareness than use

Nicholas Muraguri, head of the National AIDS and Sexually transmitted infections Control Programme, NASCOP, said intense condom education by both the government and NGOs had seen awareness outpace access.

“We can now say knowledge and awareness about condoms both in rural and urban areas could be in the region of above 90 percent. However, access to these condoms has been hampered by procurement and funding challenges. KEMSA [the Kenya Medical Supplies Agency] which procures, can only distribute to provincial- and district-level health facilities and not many people have access to these levels of facilities so yes, this hampers access,” he said.

Erratic funding and supply chain problems have led to fluctuations in condom distribution over the years; in 2008, the government distributed 15.3 million condoms nationally, against a demand from 21.6 million people. According to the UNAIDS Modes of Transmission Analysis 2008, condom distribution is very low generally and very unequal, ranging from almost negligible in remote northeastern Kenya to a high of 1.65 condoms per person per year in Western Province.

Poor placement

Ineffective condom placement can also hinder access, according to Mary Leshore, coordinator of Pastoralist Health Network, a local NGO based in Narok. “There is awareness about condom use but people still fear going to where the condom dispensers are [health centres] to pick them because they think people will think they are immoral or because they believe the culture does not allow condom use.”

If you can determine demand by how many people pick the condoms from here, then it is good – but then picking and using are two different things

According to Dofa Abdi, AIDS and sexually transmitted infections control officer in the rural northern district of Samburu, government condoms are often kept at the chief’s camp, to which many young men are reluctant to venture.

“So other than promoting awareness and increasing availability, it is good to reduce the stigma associated with the condom,” Leshore added.

Despite shyness, condoms in health centres do go fast. “If you can determine demand by how many people pick the condoms from here, then it is good – but then picking and using are two different things… if they are picking and using then we are doing well,” said Linnet Kerubo, a nursing officer at Narok District Hospital.

NASCOP’s Muraguri says high levels of awareness and demand for condoms mean the government must increase access.

“People are ready now more than they were a few years ago to use condoms and the government must and will put efforts into ensuring they are made available to those who need them because it is their right to have them,” he said. “We don’t want people to say we want them and we can’t get them.”

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source. http://www.irinnews.org

KENYA: Mother-baby packs to reduce HIV transmission

Photo: UN/Eric Kanalstein

KISUMU, 29 October 2010 (PlusNews) – A new, easy-to-use pack for pregnant, HIV-positive women could significantly reduce rates of mother-to-child HIV transmission (MTCT) in Kenya.

The “mother-baby pack” contains antiretroviral drugs (ARVs) and antibiotics that women can easily administer themselves at home to reduce the risk of infecting their babies and is colour-coded to make it easy to use even for illiterate mothers; each colour shows which drugs are to be taken during pregnancy, during labour and after delivery.

The packs form part of the “Maisha MTCT-free Zone Initiative”, launched in the western city of Kisumu by the Kenyan government and the UN Children’s Fund (UNICEF), which aims to eliminate paediatric HIV from the country by 2015.

“This initiative has the potential to save many lives and I believe it is [an important] component towards the realization of our goal,” Anthony Lake, UNICEF executive director, said at the launch on 29 October.

Health workers will distribute the mother-baby packs to pregnant women living with HIV who do not yet need ARV treatment for their own health. It is hoped the programme will reach HIV-positive pregnant women who might not return to the clinic following an initial diagnosis.

The packs will be available at antenatal clinics in four districts in the western provinces of Nyanza and Rift Valley with the aim of virtually eliminating paediatric HIV from both provinces by 2013; the two provinces account for about 50 percent of all children living with HIV/AIDS nationally.

Currently 4,000 out of 4,500 antenatal clinics in Kenya provide HIV treatment for mothers and children. While many mothers make at least one antenatal visit during their pregnancy, most do not have their babies at hospitals and clinics.

“In Nyanza, 92 percent of HIV-positive pregnant women know their HIV status but only 24 percent deliver in health facilities,” said Ojuang Lusi, director of medical services in Nyanza Province.

An estimated 22,000 Kenyan children are infected with HIV annually through mother-to-child transmission. The country has around 81,000 pregnant women living with HIV; according to UNICEF, 72 percent of them received ARVs for PMTCT in 2009.

“We must strengthen other components like reproductive health and also give women a reason to deliver in health facilities for good outcomes,” Lusi added.

Lessons from southern Africa

The mother-baby pack was launched in Lesotho and Zambia earlier this year and according to Charles Lyons, president of the Elizabeth Glaser Paediatric AIDS Foundation, a key partner in Lesotho, the southern African experience could provide valuable lessons for the programme in Kenya.

“Our experience in Lesotho is that focus should be on strengthening the capacity of health workers by training and thus increasing acceptability by them… Also community participation – which involves male participation – is critical in the success of the programme,” he said.

The rollout of the mother-baby pack will run until mid-2011, during which time its acceptance by women, as well as the management of supply and distribution will be monitored. UNICEF’s Lake noted that operational research would help determine gaps in the programme and how best to close those gaps.

According to Jacqueline Odongo, an HIV-positive mother, reduction in stigma will be key to the success of the mother-baby pack.

“We must continue with efforts… that would make mothers not afraid of taking the packs – continuous persuasion of mothers that this is important for the health of their children and themselves is very important,” she said.

The “Maisha MTCT-free Zone Initiative” will also involve the use of “mentor mothers” to support pregnant women living with HIV; a strategy for early infant diagnosis that includes the use of mobile phone short message service (SMS) technology; and encouraging pregnant women’s male partners to get more involved.

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source. http://www.irinnews.org

KENYA: HIV prevention jeopardized by PM’s call for arrest of gays

Photo: Obinna Anyadike/IRIN

Homophobia is widespread in Kenya

NAIROBI, 30 November 2010 (PlusNews) – Gay Kenyans will be driven further underground and away from HIV prevention, treatment and care services following a recent call by Prime Minister Raila Odinga for a nationwide crackdown on homosexuals, activists say.

Addressing a rally in Nairobi on 28 November, Odinga ordered the police to arrest and bring criminal charges against anyone found engaging in sex with someone of the same gender. He added that the country’s constitution made it clear that homosexual activity was not tolerated.

David Kuria, chair of the Gay and Lesbian Coalition of Kenya, said the prime minister’s remarks will negatively impact the government’s efforts to include the country’s gay population in HIV prevention programmes. For example, activists warned that few would be willing to participate in a government survey – due to start in December – that aims to draw on responses from the country’s gay population to inform HIV programming for men who have sex with men (MSM). Activists said potential respondents would be too fearful of being targeted by the authorities.

Prevention

“Kenya has made tremendous headway in terms of involving men who have sex with men in HIV and AIDS prevention and such remarks coming from the prime minister will erode the gains already made,” said Kuria. “These remarks not only increase the possibility of [homophobic] attacks but will also interrupt treatment programmes – how do you go for treatment when you are a marked man?”

“We cannot put a dent in HIV spread by segregating one group,” he added.

Following the release last week of positive results from a clinical trial that tested the efficacy of taking a daily dose of antiretroviral drugs to prevent HIV in MSM, Kuria told IRIN/PlusNews he feared that in countries like Kenya, where homosexuality is criminalized, MSM may not benefit from the new HIV prevention method.

Kenya has made tremendous headway in terms of involving MSM in HIV prevention and such remarks…will erode the gains already made

MSM are considered one of Kenya’s most at-risk populations in terms of HIV risk. According to the Kenya HIV Prevention Response and Modes of Transmission Analysis, 2008, MSM and prisoners account for 15.2 percent of all new HIV infections annually.

Peter Cherutich, head of prevention programmes at the National AIDS and Sexually Transmitted Infections Control Programme (NASCOP), said Odinga’s remarks would not affect plans to involve gay people in their programmes.

“What he said has nothing to do with what we do and we will continue offering HIV prevention services,” he told IRIN/PlusNews.

Stigma

Homophobia is widespread in Kenya, but this is the first time such a senior political figure has openly called for legal action against homosexuals. In October, a cabinet minister who called for tolerance towards gays was urged to resign for promoting “un-African” culture.

Joseph Musili, a local pastor, said he fully backed the prime minister. “I am happy, but it took him too long; this is something he should have ordered a long time ago because you can’t allow things like homosexuality under the pretext of human rights and expect to have a moral society,” he said.

Kenya’s National HIV/AIDS Strategic Plan for 2010/2013 begin_of_the_skype_highlighting              2010/2013      end_of_the_skype_highlighting recognizes that stigma is a limitation to service provision to groups like MSM. “Many service providers find it difficult to provide non-stigmatizing services to clients perceived to be practicing illegal behavior,” it states.

Dedan Warui, a 24-year-old Nairobi resident said Odinga’s statements would only worsen stigma.

“The problem is people will pretend they are not [gay] and it is that pretence which is most dangerous because it is stigma by another name, and what has dragged HIV prevention back has always been stigma,” Warui said. “When it comes to saving lives, the law must take a back seat.”

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source. http://www.irinnews.org