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Kenya Sex Worker Program

Kenya Sex Worker Program. Programmatic Responses Mercy Muthui CDC Kenya. Outline. Context Gaps in meeting SW prevention needs Minimum package: Process & Elements Scaling up SW interventions Challenges/ Issues for consideration. Context.

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Kenya Sex Worker Program

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  1. Kenya Sex Worker Program Programmatic Responses Mercy Muthui CDC Kenya

  2. Outline • Context • Gaps in meeting SW prevention needs • Minimum package: Process & Elements • Scaling up SW interventions • Challenges/ Issues for consideration

  3. Context • Research work, social/advocacy programs for CSW in Nairobi linked them to HIV prevention, care and treatment services and other non-health services. • Limited access to existing CSW sites; majority of Nairobi CBD, environs. • Accelerated national campaign for HCT, a Prevention & Treatment.

  4. Gaps • Diverse range of CSW interventions - Advocacy and IGA activities, limited prevention & tx services • Many initiatives, lacking a continuum of services • High stigma e.g. ‘STD clinic’, HCP attitudes. • Affordability and poor health seeking behavior • High risk sexual behavior & vulnerability

  5. Minimum Package of SW Program Guidelines - process • Leadership by Ministry of Public Health/ NASCOP to provide guidance to SW programming • PEPFAR supports NASCOP through collaboration with University of Manitoba/Nairobi & other partners. • In-country TWG for broad representation, includes CSWs, police, GoK departments, NGOs, development partners. • Guidelines and tools - to guide scale up & QA of SW programs (SOPs, M&E, info packs) • Focus male and female sex workers and partners

  6. Minimum Package for SW program: Essential Elements • Peer Education and Outreach • Prevention Education • Condoms and Lubricants • STI screening and treatment • HIV counseling and testing • TB screening/treatment/referral • Family Planning (MOH leverage) • HIV Care and treatment (on-site/direct collaborative partnership)

  7. Minimum package: Enhanced Elements • Other Clinical elements: PEP, Cervical cancer screening • Other non-clinical elements: -psychological, legal, social services -other counseling - (mainly referrals/partnerships)

  8. Scale up • Support the national (KNASP) plan for scaling up MARPs programs. • National scale up led by GoK national coordinating agency (NACC) and MOPH/NASCOP • Regional capacity strengthening for Public and Private sector HCPs and NGOs • Accreditation system – assure quality and provide continuous program improvement

  9. Scale up (2) • Guidance on population size estimates where feasible (Toolkit) • Model clinic providing minimum package of services established for -training/orientation • developing/ using SOPs • Dedicated CSW clinic

  10. Challenges/Issues for Consideration: • ARVs: Initiate ARV CSWs at higher CD4? national adult ARV guidelines Vs SW population. Only 21% HIV+ CSW have CD4 below 250. • PEP: what is the guidance? Sexual violence. • HCT: Frequency of Retesting? Sero-conversion and highly infectious stage. HCT acceptance over 85%. Additional counseling. • Partners of SWs: Prevention strategies esp. for regular partner‘mdosi’? Feasibility for Positive Prevention?

  11. Challenges/Issues for Consideration:..2 • HPV: Regular Pap screening basic element? HPV screening/prevention cheaper than treatment. • Young Women: Increased vulnerability in CSW. Need for target mature minors, transactional sex work • Alcohol and drug use-related risk behavior: strengthening capacity. counseling & treatment.

  12. Putting Prevention First: ‘Turning off the tap on new infections ‘

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