Reaching Key Populations With A Comprehensive Package of Services in Homa Bay, Kenya

US Ambassador to Kenya, Robert Godec, visiting the EGPAF-supported health facility in Homa Bay.

Recently, The United States Ambassador to Kenya, Ambassador Robert Godec, visited an EGPAF-supported health facility on the outskirts of Homa Bay – a town with the highest rate of new HIV infections in the country.

One in every four people in Homa Bay, Kenya lives with HIV. The area contributes the highest number of new infections in the country, recording 15,000 new HIV infections in 2013 alone, according to the Kenya HIV Prevention Revolution Road Map 2014.

With funding from PEPFAR through CDC, USAID and other partners, EGPAF in Kenya supports the Ministry of Health and 27 county governments to provide high quality HIV prevention and care and treatment services in over 600 health facilities in support of the mission to end AIDS in children.

The facility in Homa Bay is different than others though -- it also provides a comprehensive package of HIV prevention, care and treatment services for often-stigmatized groups, referred to as key populations.

Key populations (or most-at-risk populations) are small groups that have a significant impact on the transmission of HIV/AIDS. They are also disproportionately infected with HIV compared to the general population. According to Kenya’s 2009 Mode of Transmission report, although these populations represent less than 2% of the general population, they contribute to a third of all new HIV infections. These populations include sex workers, men who have sex with men (MSM), intravenous drug users, and in Homa Bay, those who take part in the “Sex for Fish” trade (in which female traders engage in sexual relationships with fishermen to secure their supply of fish).

Because these key populations are stigmatized, discriminated against, and often are victims of hostility (because of their HIV status and/or their lifestyle choices), as a rule, in many places around the world, they have found it difficult to access health services.

In April 2015, Homa Bay’s EGPAF-supported health care facility (which already offered health services such as maternal, child and neonatal health (MNCH), tuberculosis screening and treatment, family planning and treatment for other medical conditions) opened its doors to key populations. The site is the first in Kenya to provide fully integrated, safe, and friendly access to HIV care and treatment, sexually transmitted infections (STIs) screening and treatment, cervical cancer screening, risk reduction, drug and alcohol abuse assessment and counseling, and voluntary medical male circumcision.

Just a few months after opening and establishing proper training for health care workers, the facility had enrolled more than 400 female sex workers – 40 percent of the estimated sex workers in Homa May.

Upon arrival at the facility, members of these key populations are met by a social worker to determine whether or not they should see one of the facility’s clinicians. In addition to counseling, the facility provides essential services to these key populations, many of whom are receiving these medical care for the first time. For example, the comprehensive package of care for female sex workers includes screening for STIs, HIV testing and treatment, prophylactics and counseling for risk reduction.

Given Homa Bay’s high rate of HIV and the facility’s potential impact on the community, United States ambassador to Kenya, Robert Godec, recently visited the area to speak with local government, staff at the EGPAF-supported health clinic, and members of the key population.

During the visit, the Homa Bay County Governor, Mr. Cyprian Awiti restated his government’s commitment to serve this vulnerable group and promised to engage with the law enforcement system to stop harassment and violence toward the key population and other high-risk groups.

While delivering his own remarks, Ambassador Godec reiterated the US government’s commitment to forging sustainable partnerships to address challenges in bringing key populations the vital treatment and services they need to live safe, healthy and productive lives.

“HIV undermines other opportunities Homa Bay should have, that is why we are pouring more resources [into the area], so more can be done,” he said. “We also know that it is difficult to be open and honest about these things [referring to commercial sex work, homosexuality and drug use] -- we must find way to end stigma and discrimination to reach this group”.

Stigma toward people living with HIV is just one of the reasons that classify a person into being in an key population.. Poverty, political upheaval, lack of education and lifestyle choices, are other factors that might identify someone as being also part of a key population.

While the overall rate of new HIV infections appears to be on the decline, the epidemic among key populations, like those in Homa Bay, Kenya, continue to grow. UNAIDS’s 2014 Gap Report analyzed the reasons for the widening gap between people gaining access to HIV prevention, treatment, care, and support, and people being left behind. It shows how focusing on populations that are underserved and at higher risk for HIV will be key to ending the AIDS epidemic.

The overall HIV prevalence among female sex workers in sub-Saharan Africa is about 14 times the overall HIV prevalence among the general population of women ages 15 to 49. The relative global burden among men who have sex with men, compared to men in the general population, shows a 19-fold difference. Rates among transgender persons and injecting drug users also are disproportionately high. Key populations, their partners and clients of sex workers face alarmingly low access to services as persistent societal barriers stand in the way. ("Key Populations: Targeted Approaches Toward an AIDS-Free Generation." USAID.)

Collaborative partnerships and health outreach, like those at the EGPAF-facility in Homa Bay, Kenya, are proven methods of reaching those most and risk, providing them with prevention and treatment services.

Ending the AIDS epidemic will not be possible without greatly increased efforts to reduce new infections and prevent AIDS-related deaths among high-risk key populations.

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) began working in Kenya in 2000. The program started as a small, privately-funded prevention of mother-to-child HIV transmission (PMTCT) program and has since grown into one of the largest HIV prevention, care and treatment programs in the country. EGPAF supports sustainable programs that move the government of Kenya closer toward its mission to end pediatric AIDS. EGPAF collaborates with multiple partners, including Kenya’s Ministry of Health, to support the provision of PMTCT and HIV care and treatment services. In addition, EGPAF provides essential technical and organizational capacity-building assistance to community-based organizations throughout supported regions.