Building Partnerships, Building Partnerships, Transforming LivesTransforming Lives

Increasing Access to HIV Services – Case of Increasing Access to HIV Services – Case of LVCTLVCT

Nduku Kilonzo, PhDNduku Kilonzo, PhD

Executive DirectorExecutive Director

Acknowledgements: Acknowledgements:

Stephen Lewis Foundation; CDC; Stephen Lewis Foundation; CDC;

LVCT colleagues; disability programmeLVCT colleagues; disability programme

2

LVCT – LVCT – an indigenous Kenyan NGOan indigenous Kenyan NGOcountry led, country managed, country country led, country managed, country

prioritiespriorities

Quality assured HTCQuality assured HTC

VCT; home-based, mobile, workplace, VCT; home-based, mobile, workplace, couple HTC; 526,000 tested in 2011 couple HTC; 526,000 tested in 2011

Linking testing to care/ART /SRHLinking testing to care/ART /SRH

models for effective linkages & retention models for effective linkages & retention

Vulnerable & at risk populationsVulnerable & at risk populations

MSM/Prisons (MSM/Prisons (since 2006)since 2006) - 26,000 tested ; - 26,000 tested ; DisabilityDisability - 25,000 tested through award - 25,000 tested through award winning Deaf VCT; winning Deaf VCT; YouthYouth - one2one - one2one youth hotline - youth hotline - PPP with Safaricom PPP with Safaricom (Kenya’s largest telcoms co. – (Kenya’s largest telcoms co. – 3,000 3,000 monthly calls); 1.6M youth tested; monthly calls); 1.6M youth tested; GBV/Post Rape CareGBV/Post Rape Care:: 15,000 survivors 15,000 survivors seenseen

LVCT - inputs

3

Facilita-Facilita-ting scale ting scale upup

Systems Systems streng-streng-theningthening

TA for TA for policy policy reforms reforms (GoK)(GoK)

Research/Research/Piloting Piloting

-innovation-innovation-new service delivery models-new service delivery models

Evidence-based policy reforms:Evidence-based policy reforms:-national strategies, standards -national strategies, standards for processes, personnel, for processes, personnel, commodities, scale up with commodities, scale up with costs, performance indicatorscosts, performance indicators

-sustainable human resource -sustainable human resource (training)(training)-quality assurance & -quality assurance & supervision mechanismssupervision mechanisms-M&E, data & reporting-M&E, data & reporting-CSO coordination frameworks-CSO coordination frameworks

--South to South TA: South to South TA: sub-granting sub-granting & capacity building for & capacity building for implementers, special needs gpsimplementers, special needs gps-direct service delivery-direct service delivery-demand creation & advocacy-demand creation & advocacy

outcomesoutputs

The relationship between HIV and

disability has not received due attention;

persons with disabilities are found

among all key populations at higher risk of

exposure to HIV

Where are we in the HIV response in KenyaWhere is disability? Persons With Disability?

The LVCT response

What do we need to do differently4

5

Setting the context – HIV in Kenya

• Population – 40M • 52% female• 60% youth i.e <35yrs60% youth i.e <35yrs• Mixed epidemicMixed epidemic• Generalized (concurrent Generalized (concurrent

relationships, couple relationships, couple discordance)discordance)

• Most at risk (sex Most at risk (sex workers, workers,

• Geographical disparitiesGeographical disparities• Gender disparities e.g. Gender disparities e.g.

females aged 15-24yrs - females aged 15-24yrs - 4x of male prevalence4x of male prevalence

• No disability dataKenya 7.4%

KAIS 2007

HIV testing and counselling services?HIV testing and counselling services?

6

2003 – KDHS 2003 – KDHS

2007 – KAIS*2007 – KAIS*New HTC guidelines, New HTC guidelines, Focus on routine HTC Focus on routine HTC at all service pointsat all service points

2009 – KDHS2009 – KDHSHTC roadmap - focus HTC roadmap - focus on outreach serviceson outreach servicesData dissagregation Data dissagregation not inclusive of not inclusive of disability disability

7

HIV care and treatmentHIV care and treatment-KAIS data – 2007 KAIS data – 2007 -Currently 70% coverage (of Currently 70% coverage (of needed 500,000 individuals)needed 500,000 individuals)-PMTCT – 73% coveragePMTCT – 73% coverage

No data on disabilityNo data on disability

2%

16%

26%56%

Never Tested

Believed themselves uninfected based on last test

Correctly reported HIV positive

Did Not Report Status

82% of those HIV+ did not know their HIV status

8

Financing..

9

LVCT response ? Responding to vulnerabilities rather than just ‘HIV risk’Responding to vulnerabilities rather than just ‘HIV risk’

Vulnerable groupsVulnerable groups– Ltd access to HIV information & servicesLtd access to HIV information & services– Challenge to identify & serveChallenge to identify & serve– Hard to reach – limited documented knowledgeHard to reach – limited documented knowledge– Face potential stigma and discriminationFace potential stigma and discrimination

Persons with disabilityPersons with disability– Less literacyLess literacy– Assumptions that they do not have sexAssumptions that they do not have sex– Exposure to sexual violence/coercion - younger girlsExposure to sexual violence/coercion - younger girls

10

LVCT response?

Our mission

Peer- led programming– with a funded programme, coordinator,– providers are persons with disabilities (15 LVCT staff)

Willing to invest

11

LVCT response – policy reforms action

The Kenya National AIDS Strategic Plan (KNASP) III 2009/10-2012/13 (NACC, 2009)

“I want to particularly acknowledge the work of the team from Liverpool VCT, which, as a voice for civil society, helped to

integrate the concerns of people most at risk, as well as importance of gender and human rights across the Plan’s

four pillars” Mr. Michel Sidibe, the Executive Director of the UNAIDS who was a

special state guest at the launch of the KNASP III by the Right Hon. Prime Minister, Raila Odinga on 12th January 2010

Disability task group of North-South on international advocacy for disability & HIV

LVCT response – systems strengthening

70 hearing HIV service providers trained on basic Kenya Sign Language (KSL)

Partnership with 20 organizations of persons with disability and built their capacity

Development & dissemination of “Signs for Sexuality and Reproductive Heath Manual”

Partnership with VSO, produced “A Handbook on the Best practice regarding HIV/AIDS for people with disabilities” to assist in advocacy, policy formulation and programming for PWDs. Copies are also available in Braille and audio for the blind.12

Services LVCT established the first deaf VCT sites in KenyaLVCT established the first deaf VCT sites in Kenya

Initiated a national Deaf (now disability) Mobile VCT Initiated a national Deaf (now disability) Mobile VCT campaign (2009)campaign (2009)– Over 300 Mobile VCT targeting persons with disabilitiesOver 300 Mobile VCT targeting persons with disabilities

HTC to over 24,000 disabled clients including over 12,000 HTC to over 24,000 disabled clients including over 12,000 deaf clientsdeaf clients

7 support groups established in 2 regions, for persons with 7 support groups established in 2 regions, for persons with disability living with HIVdisability living with HIV

Partnership with Kenya Institute of Special Education Partnership with Kenya Institute of Special Education (KISE) for a Disability friendly HTC site(KISE) for a Disability friendly HTC site13

14

Services

HTC services by genderHTC services by gender

15

HIV prevalence HIV prevalence – similar to – similar to national levels national levels from VCT data from VCT data (not national (not national survey data)survey data)

50 on 50 on treatment???treatment???

16

17

What do we need to be doing? Invest! Invest! Invest!

– Provider training– Service delivery processes– Outreach services

Respond to vulnerability before we have to respond to most at risk populations

Deliberately put in funds into material production in reachable format

Thank You!Thank You! Contacts

Website: www.liverpoolvct.org

Email:Email: enquiries@liverpoolvct.org

Building Partnerships, transforming Building Partnerships, transforming liveslives18