Strategies to ensure vulnerable populations in Kenya’s poor Urban Settlements stay HIV free

Background

According to projections by the United Nations Population Fund (UNFPA), more people in the developing world will live in urban than rural areas by 2030. This demographic transformation is set to have profound implications especially for health. Urban slum populations are characterized by poverty, deprivations, lack of political participation and generally lack of basic infrastructure and services (health, education, housing, security and water). Due to rapid urbanization and a deep rift between the rich and the poor, 60 percent of residents now live in over 100 slums and squatter settlements. According to the United Nations Human Settlements Programme (UN-HABITAT), Nairobi is home to some of the most dense, unsanitary and insecure slum settlements in the world. And, “urban poverty is set to be Kenya’s defining crisis over the next decade” Oxfam adds.

Nairobi

Vulnerability dimensions of the poor urban dwellers include:

• Higher risk of HIV infection
• Poor health of children (in Nairobi’s slums: over half suffer acute respiratory infection, stunting and majority are prone to diarrhoea and fever)
• High population densities
• Weak social support networks and insecurity

According to UNFPA, about half of all new HIV infections worldwide happen in young people aged 15 to 24. In 2007, approximately 6,000 young people became HIV infected on a daily basis. According to the Kenya AIDS Indicator Survey (KAIS, 2007), of the 7.4 percent HIV prevalence among the population aged15-64, young people aged 15-24 contributed 4.1 percent with girls and young women bearing the brunt with 6.1 percent.

Target Audience

42 percent of Kenya’s population is below 15 years (PRB, 2009). This population requires nurturing and especially in a way that will prevent further HIV spread and incidence considering that the country has a 7.4 percent HIV prevalence. Early sexual initiation (by age 17), more than one sexual partners and at times early marriages among girls below 19 years including lack of correct information on HIV and life skills, lack of use of contraceptives (including condoms) have played in concert to increase HIV risk among young people aged 15-24.

Most programmes target youth aged 19-24 leaving out the majority (below 15 years) yet these are the most vulnerable and the right starting point. Due to mis-targeting, young boys and girls, especially in slum dwellings initiate sex as early as age 9-12! Then there is the issue of young girls’ susceptibility/exposure to rape, incest and sex work. According to a study by the Population Council, girls are most vulnerable between ages 12 and 16 years.

To be able to implement a sustainable HIV-free programme, there will be need to target school children, youth, teachers and parents as well as communities and their leaders. Teachers, parents and community leaders are gate keepers in programming concerning young people and their involvement is critical for behaviour change and the successful implementation of a HIV project.

In summary, the target audience topology could look like:

• Young people aged 9-14 (in and out of school)
• Youth aged 15-19 (in and out of school)
• Youth aged 20-24 (in and out of school) – women in this age group report highest HIV infection (in Kenya, women aged 20-24 have five times higher HIV infection compared to men of the same age category)
• Married youth aged 15-24 (in and out of school)
• Youth living with HIV

as the primary audience while the secondary audience could involve:

• parents/guardians, teachers, health workers, the media, community leaders and community(including Civil Society Organisations)

Strategies

The following strategies can be employed for a HIV-free youth population:

1. Behaviour change communication and provision of information on HIV and AIDS, PMTCT (Prevention of Mother to Child HIV Transmission), ART (AntiRetroviral Therapy), HCT (HIV Counselling and Testing), nutrition, contraception, prevention with positives, sexuality and life skills using Information, Education and Communication (through print, internet-based, mobile telephony, other Information and Communication Technologies (ICTs), sports, mentorship projects, dialogue, edutainment)
2. Provision of services such as HIV counseling and  testing, treatment of sexually transmitted infections, prevention of mother to child HIV infection, prevention, care and management of HIV/TB co-infection, AntiRetroviral Therapy, Male circumcision, integration of contraceptives and family planning services
3. Prevention with positives: working with people living with HIV to prevent new infections and further spread of HIV. This strategy also helps strengthen social support networks
4. Establish HIV “High Flyer” clubs in schools and youth friendly centres in communities (partnership projects with schools and Civil Society Organisations (CSOs)) where target audiences can access information and services.
5. In partnership with CSOs, establish and strengthen socio-economic support systems and increased reporting
6. Work in partnership with medical facilities/health workers to support diagnosis and treatment of chronic illnesses on site (e.g. youth friendly centre) instead of referring clients to a medical facility. This helps with confidentiality issues
7. Synergize with other development partners and key government institutions in the area in order to support a comprehensive programme.
8. Support a rights-based approach

It is crucial that the youth (primary audience) are involved in the comprehensive programming right from programme design to monitoring, evaluation and reporting. For this to happen, young people need to be empowered with required skills.

Information Sources

UNFPA

NACC/NASCOP

Oxfam

UN-HABITAT

SAFAIDS/KIT

PRB

Population Council