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
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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
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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
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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?
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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
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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
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Financing..
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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
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LVCT response?
Our mission
Peer- led programming– with a funded programme, coordinator,– providers are persons with disabilities (15 LVCT staff)
Willing to invest
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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
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Services
HTC services by genderHTC services by gender
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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???
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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: [email protected]
Building Partnerships, transforming Building Partnerships, transforming liveslives18