Edition III – May 2010

It is always a time of joy when Ms Wanjiku (left) More than a sister visits Ms Moi at her home.

Were it not for the APHIA II -supported community her condition. Wanjiku is part of an APHIA II Nairobi-supported team of health worker (CHW) Margaret Wanjiku, 39-year-old CHWs attached to the health center. Monica Moi from says that she would probably The facility is also supported by APHIA II. Wanjiku is responsible for 36 people not be alive today. Since the year 2000, the two have had a living with HIV. She has managed friendship that has transcended any blood relationship. to bring these clients together in a support group, a strategy which makes hen Ms Moi was diagnosed with tuberculosis and malnutrition. it possible for her to see all of them HIV positive in 1998, she every week in the vast Kangemi slums. Wmoved back to Ms Moi says that Wanjiku, who is a from Kangemi in search of solace and housewife and a volunteer at the “I derive great satisfaction from being support from her close relatives. But Kangemi Health Center, is like a a CHW, particularly when I see a the shock that she encountered was mother to her. The CHW ensures that bedridden person start walking after beyond her worst nightmare. the client under her care has all the the initiation of care and treatment,” necessary drugs and food to manage says Wanjiku, adding that her vocation “I suffered stigma not just from close cont. on pg.8. relatives and friends but from my own children after they discovered that I New task for APHIA II Nairobi > 2 was ailing with HIV,” recalls the mother Creating HIV friendly workplaces > 3 of two children aged 21 and 18, saying Profile of a partnership with private hospital > 4 at that time she was extremely down Following up on HIV care > 5

inside... Making V C&T part of family planning > 6 Transport Workers take to change > 7 APHIA II Nairobi recently embarked on implementation of the USAID funded Women’s New task Justice and Empowerment Initiative (WJEI). This U.S. government initiative aims at preventing sexual and gender based violence (SGBV) for APHIA II primarily through raising awareness about SGBV, improving law enforcement against the Nairobi vice, and giving assistance to survivors of SGBV.

Secondary school girls from participate in a Girls Speak Out forum in April 2010 at the Salvation Army Hall.

enya is among four African understand and combat gender above those reported. There are over countries that were selected to based criminal conduct. 16,000 rape incidences in Kimplement WJEI. The pilot project is annually, with the largest percentage being piloted in Kibera slums. Specifically, iii) Providing victims with medical involving women and children. The the three WJEI components include: and psychosocial support to 2003 Kenya Demographic Health enhance their re-integration into Survey found that one out of every i) Helping to raise awareness of their respective societies two girls and women aged between gender based violence This component seeks to strengthen 15 and 49 years had experienced some This element seeks to increase the capacity of health, legal, and form of physical, verbal/psychological, awareness of the following: prevalence social organizations that provide or sexual violence. of GBV; care and support/resources assistance to survivors of GBV. This available to survivors of the crime; component will be focused on It is reported that there has been an public policy and laws regarding enhancing services offered by the increase in the number of reported women’s rights under the Sexual GBV Recovery Centre based at the cases of rape, attempted rape, Offences Act (2006). The component Kenyatta National Hospital. defilement, incest, and assault against also aims at assisting communities to girls and women. These numbers have overcome the barriers to recognizing The APHIA II Nairobi mandate increased steadily from 7,930 in 2000 GBV as a problem. is to support implementation of to 12,311 in 2005, with rape being the components i) and iii), while legal most prevalent GBV crime in 2005. ii) Improving the ability to assistance is supported separately The Gender Violence Recovery Centre investigate, prosecute and through the US Department of Justice. of the Nairobi Women’s Hospital has adjudicate GBV cases similarly recorded an increase in similar This component seeks to strengthen Situation analysis of SGBV in cases. However, it is still not clear what the capacity of Kenyan legal to attribute to the rising cases as there systems to protect women from Kibera have been numerous sensitization violence and to punish violators SGBV is characterised by underreporting campaigns on the crime by civil society by increasing the capacity of the to the extent that the actual number organizations in recent years. police, prosecutors, and judges to of cases are estimated to be five times cont. on pg.8.

2 Edition III • May 2010 Creating HIV friendly workplaces

Enterprises, employees, and employers alike are increasingly bearing the impact of the HIV epidemic. Further, the situation is worsened by the fact that there is still significant fear, stigma, and discrimination of people living with HIV, posing a major challenge to an effective response to HIV and AIDS.

s a response to this set of challenges, the Federation of AKenya Employers (FKE) has initiated several measures to address HIV/AIDS in the workplace. Since 1988 when it issued its first guidelines on managing HIV/AIDS at the workplace, many companies and organizations have adopted similar workplace programs.

The FKE HIV/AIDS Workplace Program was started in 1990. In August, Workers in Nairobi’s industrial area 2006 APHIA II Nairobi launched a listen to an APHIA II Nairobi Advocate partnership with the federation at the company’s premises during lunch time. to scale up implementation of the workplace program. According to the APHIA II Nairobi Outreach Program and practice (baseline) survey in Other components of the APHIA II Specialist, Ms Margaret Lubaale, APHIA workplaces to identify the existing Nairobi partnership with FKE include: II’s role involves assisting workplaces information gaps and assess what Training of facilitators/coordinators and to develop HIV related policies and practices predispose the workers to peer educators within organizations implement programs that help people HIV,” says Lubaale. on behavior change so they can either infected or affected with the virus. influence their colleagues to avoid risky She notes that the program also behavior; Training of management The program exists to improve involves undertaking surveys in organizations on adopting and awareness and understanding of HIV on human resources within FKE implementing HIV workplace policies; and AIDS for purposes of prevention membership in order to determine Development and publishing and increasing access to relevant organizations with HIV workplace of information, education, and clinical and community-based policies, and those currently communication materials, including services. It is also aimed at ensuring rolling out the programs. She says training manuals on the workplace that employers develop and apply HIV APHIA II supported FKE in drafting policy. workplace policies in order to create and adopting a code of conduct an enabling environment for the HIV (guidelines) on HIV/AIDS in the “We also network organizations with positive worker. workplace. These guidelines, which various service providers for care and are constantly under monitoring and treatment, sensitization campaigns, “Together with the federation, we evaluation, are reviewed in line with and voluntary, counseling and testing first undertake a knowledge, attitude emerging trends in HIV. services,” says Lubaale.

Edition III • May 2010 3 New York Congresswoman Ms Nita Lowey (center), during her visit to the Gender Violence Recovery Centre at Nairobi Women’s Hospital. Looking on is the NWH CEO Dr Sam Thenya (second right), and Dr Sheila Macharia (second left), Senior Health Manager, USAID/Kenya, Profile of a among other NWH staff. partnership with private hospital

The popular Nairobi Women’s Hospital (NWH) is a gem. testing and counselling, voluntary counselling and testing, prevention-of- Established in March 2001, the aim of the hospital is to provide mother-to-child-transmission (PMTCT), holistic care to women and children, though men also benefit and TB treatment.

from the health services. Although the hospital is based in the NWH also receives support from upmarket Hurlingham area, the facility services attract patients the Government through the Kenya across the socio-economic spectrum of the capital city, catering Medical Supplies Agency, National AIDS and Sexually Transmitted Infections for both needy and paying patients. Control Program, and the National Tuberculosis Control Program for HIV and TB drugs and commodities. he partnership between APHIA APHIA II Nairobi provided a grant to II Nairobi and NWH started NWH to improve access and strengthen The Gender Violence Recovery Centre Tin 2006 with the support of provision of comprehensive care for (GVRC) at NWH provides free medical a comprehensive care program for people living with HIV and TB. NWH treatment and counseling to men, the hospital’s HIV positive clients and has seen an increase in the number of women, and children who survive incorporation of comprehensive PMTCT CCC clients attended to at the facility sexual and gender based violence services at the maternity and the which today stands at 800. The clinic (SGBV). The treatment helps to antenatal clinic. The project facilitated operates three days a week and offers prevent the spread of HIV, Hepatitis NWH in accessing anti TB drugs supplied the CCC services free-of-charge. B, and unwanted pregnancies. APHIA by the National TB, Leprosy and Lung II Nairobi’s support for the GVRC Diseases (NTLLD) Control Program. APHIA II Nairobi also supports out- started in March 2008. Between patient services offered at the hospital, December 2008 and September 2009, As the hospital’s new services developed, which serve as entry points to the CCC. 2,348 clients received post exposure it needed more resources to meet the These services include provider initiated prophylaxis for sexual assault while challenges of expansion. In May 2008, testing and counselling, diagnostic cont. on pg.8.

4 Edition III • May 2010 “The major objective of M&E is to record all patients who are on HIV care from Following up their initial visit and all subsequent visits to a facility,” explained Ms Alice Kimani, the Nairobi Deputy Provincial Health Records and Information Officer on HIV in a recent workshop held in Nairobi. Ms Kimani said that numerous facilities care have lost many patients without a trace of their records. Ms Kimani noted that lack of documentation hampers planning for budgets (especially for drugs) and decision making for policy makers.

In addition, she observed that lack of clients’ details is also a major hindrance to researchers searching for information on the state of HIV, for instance prevalence rates, in the country. Most importantly, loss or incomplete data has a grave impact on a patient whose prognosis diminishes since the healthcare provider does not have the full set of information necessary for management.

“It is only through keeping proper (accurate) and up-to-date records that facilities can effectively follow up their clients and identify those who are defaulting on their treatment Participants from APHIA II Nairobi partners at a past workshop held in a Nairobi hotel. schedules,” said Ms Kimani.

Data collection and reporting are a very important means of APHIA II Nairobi supports facilities with data collection and reporting monitoring and evaluating progress being made in addressing tools like patient cards, registers, tally sheets, and stationery. Ms Kimani also the HIV and AIDS epidemic, particularly in health centers. acknowledges more APHIA II support This system is aimed at capturing all patients who are on has been provided to the Nairobi Provincial Medical Office through HIV care and treatment right from the day of enrolling at a provision of furniture, computerization, comprehensive care center (CCC). funding of supportive supervision, and capacity building through hiring of health records and information officers. n order to improve the quality of health facility data and ensure The APHIA II Nairobi Data Officer, Ms Ithat it is used for management Caren Oburu, says computerization of decisions, APHIA II Nairobi has data collection would eventually solve organized and supported workshops many of the challenges currently faced aimed at streamlining and enhancing by health facilities ensuring proper CCC the monitoring and evaluation (M&E) records keeping. She notes that APHIA component in CCCs. The target II is currently offering both technical staff for such workshops include and material assistance to the good clinicians, health records officers, management of the paper-based M&E and information officers working at system in Kenya. APHIA II supported public, private and faith-based sites. Workshops Says Caren: “Ultimately, national level have been held both to build computerization of medical records technical skills and to serve as forums and data will help to ensure complete for participants analyze district-level and accurate data management, both data and trends. Ms Alice Kimani, the Nairobi DPHRIO for patient and for M&E”.

Edition III • May 2010 5 Making HIV C&T part of family planning

With the limited resources in our public healthcare The first is facility integration which system, the need for creativity in the provision of services entails the co-location of HIV and FP services within the same facility. The cannot be overemphasized. The fact that demand for second is room integration which health services far outstrips their supply urgently calls involves offering HIV and FP services for integration of most of these services if Kenya is to in the same room, while the third is service provider integration which is meet the sixth goal of the United Nations Millennium offering these services using the same Development Goals. Integration also improves the quality service provider in one consultation. and comprehensiveness of services provided to clients. Maweu observes that most, if not all clients for FP and HIV counselling and testing (HCT) are within reproductive age. And, since pregnancy and HIV are acquired through sexual intercourse, all sexuality related issues can be discussed and dealt with in a one-stop shop offering both HCT and FP services.

States Maweu: “Integration not only saves time for the client but also ensures privacy and confidentiality as he or she is served by one service provider.”

He adds that integration also saves time for the health worker through the “balanced counselling strategy” approach. This approach involves the use of job aids, which significantly reduces time taken in the protocols A participant from Jericho Health Center, Ms for both FP and C&T without Emily Nyaberi (left), is taken through a practical compromising the quality of services. session during a C&T workshop in Nairobi. After the eight-day training session ut in order for integration to be of Nairobi, targeting FP clinics at both participants drafted their own action successful, service providers public and private APHIA II Nairobi plans for implementation of services Bmust have the necessary skills supported sites. in their respective stations over a four- and knowledge. In partnership with week period. APHIA II Nairobi supports the Ministry of Health, APHIA II Nairobi “With integration, FP clients are able post-training follow up supervision has supported trainings for health to know their HIV status and they get by trainers to the participants work providers on the integration of HIV appropriate counselling. For those stations to assess progress, share counselling and testing (HCT) into who test HIV positive, they are referred experiences and challenges, and family planning (FP). to a comprehensive care centre for come up with interventions that can care and treatment and are linked to streamline integration. In addition to enhancing the skills, the other services available at both facility training is also aimed at changing the and community level” explains the Besides the integration of HCT and FP attitude of the service providers to provincial training coordinator at the services, the project has also supported view integration positively rather than Ministry of Public Health & Sanitation contraceptive updates for PMTCT as extra work. Nairobi, Mr Richard Maweu. service providers in Nairobi province in order to strengthen FP counselling Participants for the trainings have Integration at the health facility level can and service provision within antenatal, been drawn from all the nine districts be categorized into three approaches. maternity, and postnatal services.

6 Edition III • May 2010 Matatu industry crew take time out for some life skills training from an APHIA II Nairobi Advocate. Transport Workers take to change

Due to the itinerant nature of notes that in addition to the risk of The association, which was registered in November 2008, has more than ten their work, matatu drivers and having multiple sex partners, the transport worker has very little or no branches countrywide. These include touts, who are predominantly information on HIV and AIDS. Nairobi, Nakuru, Nyeri, Naivasha, men, are perceived to be highly Mombasa, Kisii, Meru, Garissa, Kikuyu and Githunguri branches. In Nairobi, exposed to HIV infection. This “The consequence of this ignorance is that matatu drivers and touts are still in sensitization seminars have already is because they put in a lot of denial about the existence and impact been held for members who operate hours in their work and come of HIV, and their high risk of exposure in , Kangemi, Buruburu, to the virus,” observes Wainaina. Huruma, Madaraka, Githurai and the into contact with substantial central business district. amounts of cash from the Partnering with APHIA II Nairobi to thousands of passengers they educate members of this sector of “The seminars have significantly helped in initiating behavior change carry on a daily basis. public service vehicle employees in Nairobi is something the chairman in our members,” states Wainaina, says could make a difference in the adding that those who are selected to enerally, the lifestyle of matatu crew way they now behave not just sexually attend the seminars act as influencers after work tends to predispose but professionally. and subsequent mobilizers of their Gthem to risky sexual behavior due colleagues for voluntary counselling to their potential of having many sexual Says Wainaina, “Together with APHIA and testing. APHIA II Nairobi has also partners. II Nairobi, we have been carrying trained 23 peer educators who are very out sensitization seminars for our instrumental in encouraging their peers The Chairman of the Matatu Drivers members with the aim of raising to go for testing, gives them condoms and Conductors Welfare Association of awareness within the matatu industry as well as showing them the correct Kenya, Mr Samson Wakabu Wainaina, fraternity”. way of putting on the condoms.

Edition III • May 2010 7 by APHIA II Nairobi. She recently ventured into soap More than a sister making although she laments that she is still to cont. from page 1 penetrate the market. However, Ms Moi is able to make a decent living from her business. says Wanjiku, adding that her vocation calls for great sacrifice, sometimes using “Stigma still remains my greatest challenge,” states her personal resources to buy clients food Ms Moi, saying that even her church had isolated and cater for their transport needs. her from the rest of the congregation. Being part of a support group which accepts her unconditionally Ms Moi has been on anti-retroviral drugs and having a CHW that provides her with a shoulder since February 2003 and has undergone to lean on gives Ms Moi strength and hope for the treatment literacy training conducted future.

National Hospital, training of women’s forums and training of women’s medical officers on SGBV response, groups on economic empowerment as training of trauma counsellors, well as supporting community multi- Kibera is the largest informal settlement facilitating the meetings of support sector coordination activities. in East Africa and holds a population groups for survivors and perpetrators. of about one million people. The In addition, WJEI will settlement consists of 14 villages, most Awareness and prevention activities seek to identify and of which tend to be divided along within Kibera will involve sensitizing the support shelters in ethnic lines. Kibera is characterised by district administration and community Kibera for short term poor infrastructure and limited delivery members on the Sexual Offences Act support of survivors of social services such as health care, (2006) and advocacy against contributing in unsafe situations. law enforcement, water and sanitation, factors to SGBV such as alcohol and These activities will and ways of making a living. substance abuse and pornography. be implemented in collaboration with local Some of the key activities that APHIA Others include SGBV sensitization forums community groups in II Nairobi plans to implement include for children and youth in school and out Kibera. renovations and equipping of the of school, developing a “male champions GBV Recovery Centre of the Kenyatta against SGBV” network, supporting

• Creating awareness of SGBV through Profile of a partnership with sensitization of community opinion private hospital cont. from page 4 leaders, community members, and drama groups in post rape care 1,812 survivors of sexual assault and services. domestic violence received trauma • Design and development of SGBV and psychosocial support counseling IEC materials. at the center. • Training of health care providers in • Provision of food and meeting the public health facilities on SGBV. In summary, APHIA II Nairobi support costs of radiology tests for HIV and • Salary support for staff at both the for NWH has included: TB co-infected clients. CCC and GVRC. • Comprehensive care for people • Paediatric HIV outreach services • Training of staff in HIV care and living with HIV (PLHIV) - provision to the Abandoned Baby Centre treatment, TB management, HIV of treatment and prophylaxis for (ABC) in where treatment/ testing and counselling, PMTCT opportunistic infections, anti-retroviral prophylaxis of opportunistic diseases and, reproductive health and family therapy and psychosocial care. and ART is given. planning. • Meeting the costs of laboratory • Prevention of HIV infection for Support for equipment. tests for PLHIV. survivors of sexual violence. •

Editorial Board Stephen Ndegwa, Communication Officer, Pathfinder International-Kenya Ms Linda Casey, Country Director, Pathfinder International Dr Margaret Makumi, Deputy Project Director, Pathfinder International-Kenya Ms Margaret Lubaale, Deputy Project Director Dr Janet Muriuki, Quality Improvement Advisor Ms Nelly Maina, Gender Advisor Ms Irene Mwaponda, Home & Community Support Coordinator Building Healthier Communities

For more information please contact: Pathfinder International – Kenya, Tel: (020) 2224154/2222387/2222490/2222487 • Mobile: 0722 516275/ 0733 618359 International House, Nairobi • E-mail: [email protected] • Web: www.pathfind.org / www.aphia2kenya.org