Most at Risk Populations (marps)

HIV in Kenya

Kenya is experiencing a mixed and geographically heterogeneous HIV epidemic with characteristics of both a ‘generalised' epidemic among the mainstream population, and a ‘concentrated' epidemic among specific most-at-risk populations.

Who are MARPS?

MARPs are groups of people who are disproportionately at higher risk for acquiring or transmitting HIV. This is because they engage in behaviors that predispose them to acquiring HIV.The primary MARPs in Kenya include Sex workers and their clients, Men who have sex with men (MSM), Prisoners, People who Inject drugs (IDUs). Others include truckers, fishing and beach communities.

Why focus on MARPS?

MARPs have the highest risk of transmitting and acquiring HIV/STI due to increased frequency of high risk sex (unprotected anal and vaginal sex, multiple partners, frequency of partners) and drug-related HIV risk behaviors (e.g. sharing of needles, flashblooding , vipointing etc).
MARPs experience barriers to accessing services because their behaviors are criminalized and stigmatized making them marginalized and hard to reach.

MARPs account for one third of new HIV infections in Kenya which is estimated to be about 100,000 per year. (KAIS 2008)

Sources of new HIV infections in Kenya (Kenya Mode of transmission study - KMOT, 2008)

Why a National program?

  • To effectively reach and address the particular needs of most-at-risk populations there is need to develop customized HIV/STI prevention, care and treatment programs. This is envisioned in the 2009-2013 Kenya National HIV/AIDS Strategic Plan (KNASP III).

    The mandate of the MARPs program is to provide technical leadership in the development of policy, strategies, service delivery package and guidelines for high risk groups. The national program works closely with stakeholders such as government agencies, donor community, research institutions, civil society and MARPs networks.

  • MARPs Interventions
    The HIV/STI Package of Services for MARPs and Their Sex Partners has 3 components:
    Behavioural Components
    Biomedical components
    Structural Components
    Behavioral components
    Peer Education and Outreach
    Risk Assessment, Risk Reduction Counseling and Skills Building
    Screening and Treatment for Drug and Alcohol Abuse
    Biomedical components
    HIV Testing and Counseling
    STI Screening and Treatment
    TB Screening and Referral to Treatment
    HIV Care and Treatment
    Promotion, Demonstration and Distribution of Male and Female Condoms and Water-Based Lubricants
    Family Planning, Sexual and Reproductive Health Services
    Post-Abortion Care Services
    Cervical Cancer Screening
    Emergency Contraception
    Post-Exposure Prophylaxis
    Post rape care
    Screening and management of hepatitis B
    Opiates substitution Therapy
    Needle exchange program
    Male Circumcision  
    Structural components
    Ensuring 100% Condom Use
    Mitigate and manage sexual Violence
    Mitigating violation of human rights
    Expand choices beyond sex work
    Psychosocial support
    Family and Social Services
    Access to micro credit and other financial products

What have we achieved?

  • Coordination
    Existing coordination structure through the national program
    Formation of multi-sectoral technical working group
    Situation analysis
    Mapping of hotspots
    Estimating population sizes of MARPs – ongoing
    Integrated bio-behavioral surveillance
    Stakeholder analysis
    Development of service guidelines and other programming tools
    HIV/STI guidelines for Sex workers programs
    QA standards for MARPs peer education programs
    Health workers training curriculum for MARPs – on going
    National peer educators training manual – in print
    Setting minimum package for MARPs care
    Creating and enabling policy environment
    Policy dialogue involving MARPs stakeholders
    Soliciting political support from lawmakers
    Strategic involvement and capacity building MARPs
    Training of MARPs as peer educators and health workers (onsite/online)
    Supporting MARPs to form organized groups
    Mobilization of MARPs to create service demand
    Establishing service delivery models
    Drop in centres
    Truckers wellness centres
    Specialized MARPs friendly clinics
    Development of referral networks – ongoing
    Piloting new interventions eg opioid substitution therapy
    Financing and sustainability
    Global Fund support for biomedical interventions for IDUs
    Global Fund support for MARPs friendly centres

What have we achieved?

  • Population is highly mobile
    Immigration status of some sex workers
    Stigma and social discrimination towards MARPs
    Violence due to cultural insensitivity
    Limited funding
     
    Addressing the challenges
    Implementation of peer led interventions
    Introduction of Online training for health care workers
    Sensitization of health care workers on MARPs issues
    Media engagement for advocacy
    Mapping of MARPs hotspots
    Taking the services to MARPs eg through outreach programs
    Engaging UN agencies to address challenges facing migrant sex workers
    Consideration for replication
    Define a standard package of services for the respective MARPs groups
    Generate/build evidence for policy and environment change
    Start small: Pilot to demonstrate the efficacy of interventions - what works best
    Garner international support: Resources, best practices, and technical assistance

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