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Reaching the hard to reach along the northern transport corridor

Reaching the hard to reach along the northern transport corridor

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Reaching the hard to reach along the northern transport corridor

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  1. Reaching the hard to reach along the northern transport corridor Haron Njiru, HelgarMusyoki Ministry of Public Health & Sanitation Kenya December 2011 16TH ICASA: ADDIS ABABA - ETHIOPIA

  2. Presentation outline • HIV in Kenya • The Northern corridor • HTC strategies / Interventions • Some successes • Challenges

  3. HIV PREVALENCE IN KENYA • National prevalence: 6.3% • Rural: 7% • Urban: 8.9% • 1.4 Million PLWHA • Nyanza & Rift Valley: >50% of all HIV-infected adults • HIV Incidence: 100,000 pa • Kenya Popln: 40 million

  4. Sources of new HIV infections in Kenya 1/5 of all the new HIV infections are attributable to FSW KNASP III (2009); Kenya Modes of Transmission Survey (2009)

  5. THE NORTHERN CORRIDOR 6,700 km http://www.ttcanc.org/maps/roads.html

  6. Why the Northern corridor? • Strategic commercial & humanitarian route in Africa • Links landlocked countries of East and Central Africa • Uganda, Rwanda, Burundi & DRC through Mombasa seaport • Northern Tanzania, Southern Sudan, Ethiopia and Somalia • Busiest corridor in East and Central Africa • 10 million tons of import/export cargo per year • 4,000 light vehicles, 1,250 trucks, 400 buses daily • Combination of land/water transport modes http://www.ttcanc.org/mnrdnetwork.html ; http://www.eastafricancorridors.org/

  7. Affected populations • Truck drivers and loaders • Sex workers along transport corridor • Clients of sex workers • Spouse/girlfriends of truckers • ‘Spaces of vulnerability’

  8. Truckers’ vulnerability • Continuously on the road • Long waiting at customs points &weighbridges • Long periods away from home • Hotspots for female sex workers (FSW: Truckers, 5:1) • Male sex workers • Unprotected sex, multiple sex partners en route • Inadequate skills on correct condom use Diallo BL (2011); Bal B et al (2007); Muraguri N (2011); Mbugua GG (1995)

  9. INTERVENTIONS • Prioritization of transport corridors: KNASP III • Coordinated national program • Mapping hotspots along the Northern corridor • Estimating the size of FSWs populations • Friendly and standardized services • Prevention • Diagnosis (HTC) • Care & Treatment NASCOP

  10. Friendly services: Prevention Rebranding of the commodity and using peers Condom distribution in social places

  11. Identifying with the beneficiaries “ Zip it” trucks: Enhancing commodity distribution

  12. Friendly services: HTC • Truckers / FSW friendly HTC strategies • Moonlight HTC in truckers & FSW at hotspots • Stop over towns, weigh bridges • Door to door HTC by visiting brothels • Truckers wellness centers (24/7) • Stand alone FSW clinics • Peer led HTC NASCOP

  13. HTC successes (2011) 70% Source: Program reports

  14. Benefits of HTC • Entry point to HIV prevention and care • Early initiation of ARVs • Chemoprophylaxis for opportunistic infections • Informed choices on pregnancy and contraception

  15. Care and treatment • Strategic location of sites • Drop in centers • Truckers’ wellness centers • MARPs friendly clinics • Public private partnerships NASCOP

  16. National MARPs Guidelines Guidelines & Tools http://nascop.or.ke/marps/

  17. Standardized services • Minimum package • Information on safer sex practices • Condom demonstration and provision • HIV testing and counseling (PITC) • STI screening and treatment • Risk reduction counseling services NASCOP

  18. Standardized services • Minimum package • FP information and services • TB screening and referral • PEP & emergency contraceptive provision • Psychosocial support and referral • ARV and HIV basic care NASCOP

  19. Challenges • Mobility: Loose peer networks • Sex work is illegal in Kenya • Attitude of healthcare workers • Referring mobile populations for care • Stigma and social discrimination against SW • No national denominator for SWs &Truckers Schneider JA (2011);

  20. Considerations for replication • Define a standard package • Generate/build evidence for policy • Meaningful involvement of beneficiary organizations • Consult, be innovative • Start small: Pilot to demonstrate efficacy National strategic plan + implementation framework Surveillance activities

  21. Acknowledgements THE TASK FORCE GoK / NASCOP Civil society & Truckers organizations Implementing partners & Funding agencies Beneficiary populations Other stakeholders

  22. Haron Njiru Email:haron.njiru@gmail.com Skype:haronjiru December 2011 16TH ICASA: ADDIS ABABA - ETHIOPIA