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With PrEP, I am Covered

July 25, 2017

Geoffrey Njenga and Catherine Ndungu

Cynthia, 25, a sex worker in Nairobi’s Kengemi informal settlement, with her first dose of PrEP, an HIV-prevention medication. Photo: Juozas Cernius.

Photo: Juozas Cernius.

Pre-exposure prophylaxis offers peace of mind to people at continuous risk of HIV infection

Nairobi, Kenya—In the outskirts of Nairobi is the sprawling Kangemi informal settlements. The slum is bustling with people; some cooking outside their shacks, others burning charcoal to sell or busying themselves with their food stalls. The sky is overcast and the air is cold. At the hall hired for the day’s outreach, bedsheets serve as makeshift partitions. This outreach is unique: Here, for the first time in Kenya, eligible clients will have access to pre-exposure prophylaxis (PrEP).

PrEP is a pill taken once daily by HIV-negative people who are at continuous risk for HIV infection. In Kenya, Jhpiego—through the Jilinde project—is scaling up the use of PrEP into a large-scale public health response. Over 20,000 people at continuous risk of HIV infection will receive oral PrEP, which will be integrated within existing HIV combination prevention services.

Today’s outreach gives clients access to HIV testing and counseling services, anti-retroviral therapy and PrEP. Among those getting their first dose of PrEp is Cynthia, a warm and candid 25-year-old sex worker.

Born and raised in Nairobi, Cynthia was introduced to sex work as a teen, after the birth of her daughter. “My father deserted us and my mother struggled to take care of my siblings and I,” she explains. At 15, she dropped out of school to look for a job so she could feed her baby. When no opportunities arose, her cousin, a sex worker, told her how she could earn earn between 2,000-3,000 KES per night (the equivalent of about $20 to $30), and $5,000 KES ($50) on weekends. Most of the clients are men 35 and older, from wealthy neighborhoods surrounding Kangemi slum.

Too good to be true?

Conventional protection isn’t always easy or even possible, Cynthia says: “Sometimes, clients pay extra for condom-less sex and sometimes a condom bursts.” She has also been forced to have sex with policemen to buy her freedom when arrested.

When Cynthia first heard about PrEP from a Jilinde-trained peer educator, it sounded like a scam, too good to be true. “My first thought was, there is no cure for HIV, so how could there then be a pill that prevents HIV?” Only when she saw PrEP in the media did she begin to believe it was a real drug and seek more information.

The Jilinde project is scaling up the use of PrEP in Kenya within existing combination prevention services to people like Cynthia who are at high risk of HIV. More than two million people acquire HIV infection globally every year. In Kenya, in 2015, 71,034 people aged above 15 years and 6,613 aged 0-14 years got infected with HIV. This translates to 77, 648 Kenyans requiring lifelong antiretroviral treatment to keep them alive and prevent further transmission of HIV.

The Jilinde project is set to demonstrate the incredible potential of PrEP by generating evidence that population-level PrEP interventions are feasible and effective in low-and middle-income countries which bear the brunt of the world’s HIV burden.

For Cynthia and so many others like her, the time for PrEP is now.

“I don’t like the sex work and hope that one day I can start my own food business,” she says. “But for now, PrEP gives me peace of mind because I know that I can keep HIV at bay.”

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Taking Control of my health

By Geoffrey Njenga

Kwale, Kenya – As darkness sets in, the coastal town of Ukunda becomes alive as music blares from the clubs announcing the start of another colorful night. Scantily dressed young women and men are on the prowl looking for men and women who will pay for sex. Among them is 23 year old Duncan Thomas or Dan as he is fondly called by family and friends. He is a male sex worker  and his ultimate price is white men who will pay twice as much as his local clients. He sleeps with 4 men a day each paying Ksh 4,000 about $40 on a good day. Some men refuse to use a condom however Dan is at peace as he knows he is protected thanks to the Pre-Exposure Prophylaxis (PrEP) pill he is taking daily.

 

In the early days of the HIV epidemic in Kenya, there were few ways of preventing an individual from contracting HIV.  However Kenya has come a long way in HIV prevention with the latest addition being Oral PrEP- a pill prescribed to HIV-negative individuals at high-risk of infection. Jhpiego—through the Jilinde project —is ensuring PrEP is integrated within current HIV prevention services by creating demand for PrEP, identifying eligible users through HIV testing, enrolling new users, and supporting continued use as long as individuals remain at risk.

Stolen childhood

Dan was just 3 years old when he was orphaned. He was brought up by his sister in Ukunda and life was not easy. At the age of 13, Dan was taken in by a well-off family but little did he know that this would be the start of his journey as a man who has sex with men commonly referred to as MSM.

One of the family members was an MSM and he started enticing him and sleeping with him. He was only 14. “I only agreed to his advances because he was paying my secondary school fees and I was doing well in school.” Dan says. In 2013, Dan parted ways with his male partner and he started selling his body on the famed beaches and clubs of Diani to both tourists and locals to make ends meet. He was very afraid of contracting HIV as he did not have an alternative. “In order to make ends meet, I used to sleep with different men every day some without protection and I was very scared of getting HIV” Dan says

 Curious about PrEP

While surfing the web, Dan came across PrEP on MSM dating sites like Planet Romeo and Grinder. He got curious about this drug that could prevent him from contracting HIV. He researched more on it and he was yearning to know where he would get it in Ukunda. By chance he bumped into a Jilinde trained peer educator who gave him the correct information and referred him to a clinician at Ukunda Drop in Center who answered all his questions on PrEP.

For effective delivery of oral PrEP in Kenya, Jilinde has built the competence and confidence of health care providers to deliver PrEP and give correct information to counter the rumours and misinformation about PrEP. Whole site orientations conducted by the project has ensured health care workers and support staff are knowledgeable about PrEP and can provide appropriate referrals to clients.

Dan says he had received a lot of conflicting information on PrEP and he was glad he found someone who could give him accurate information. After his questions were satisfactorily answered, Dan enrolled on PrEP and he has been on it for three months.

“I am HIV negative and I love PrEP because it has helped me regain control of my health. I know I am safe and won’t be at risk of HIV infection” Duncan says.

According to the National HIV estimates, Kenya has seen a sharp decline in HIV incidence among adults aged 15-49 from 0.41% in 2010 to 0.27 in 2015 possibly due to the scale up of various prevention programmes. In terms of absolute numbers, the new HIV infections among all adults aged 15+ years declined from 83,097 in 2010 to 77, 648 in 2015, a 7% decline in the number of new annual HIV infections at national level. The government believes oral PrEP together with other HIV prevention methods will play a big role in reducing these numbers even further.

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Creating PrEP Demand

Urembo Wednesday: Creating Demand For PrEP

By Geoffrey Njenga

Nairobi, Kenya- Walking up the stairs to the 3rd floor of the wellness center run by Bar Hostess Empowerment and Support programme, my ears are tickled with the sound of warm music and my nostrils are hit with the scent of acetone and fingernail polish. I arrive at the reception and there are young beautiful ladies chatting and watching music videos as they wait for their turn to be pampered in an adjacent room.

Every Wednesday BHESP with support from Jilinde hosts Urembo Wednesday where sex workers get a chance to try something new with their nails, change their look and get pampered. However, there is a twist to this event. Not only do the girls get pampered they also get health talks on HIV prevention methods like condoms, Post Exposure Prophylaxis (PEP), and the latest HIV prevention method Pre-Exposure Prophylaxis (PrEP)- a pill taken daily to prevent HIV infection for those at high risk. This is one of the many events that Jilinde in partnership with Civil Society Organizations (CSO’s) is using to create demand for PrEP and health services in general.

The receptionist greets me with a friendly “hello” and a smile. “I am here to meet Mercy the Prevention Manager” I say with a smile. “Please have a seat” she tells me. She retreats into one of the offices and comes back to tell me Mercy will be with me shortly as she is wrapping up another meeting.

I decide to make new friends in the meantime and I started charting with Gladys a 23-year-old bubbly sex worker and an outreach worker at BHESP. “Why are you here today?” I inquire. “I am here to help with the event and to get myself pampered” she replies. “For you to be a successful sex worker you have to be attractive and be good looking” she continues. She invites me to the room where the action is happening and I am met with young women getting their nails done. In one corner of the room manicurists are busy tending to their clients, in another, there is a condom demonstration happening, there is also a station for snacks for the clients. I notice a health talk going on as they are being pampered. There are posters on the wall reminding clients the need to maintain a negative HIV status and use PrEP daily.

After 10 minutes, Mercy comes to where I am and pulls me aside. “Welcome to our Drop in Centre. This is a safe space for female sex workers where they not only get health services but also a space where they can come to catch up with their peers and relax” she says. As we continue talking I find out Urembo Wednesday came about after consultation with the sex workers as a way of creating demand for health services among sex workers and particularly PrEP.  “You see Wednesday is ladies’ night and what better way to get your mojo on than to pass by the wellness center and get pampered before proceeding to your hotspot” she says.

Urembo Wednesday is usually a hit with the sex workers and its one of the demand creation approach they are using together with Jilinde to ensure sex workers and those at high risk of HIV infection are reached with PrEP information and are able to take PrEP to prevent HIV infection.

After talking to Mercy, I walk back to Gladys who was getting her nails done. She had chosen different colors for each of her nails. “I have been on PrEP for 1 year 2 months now and I am satisfied with its protection. I can’t imagine living with HIV” she says. As I walk out of the wellness center I meet more ladies arriving at the facility to get their dose of beauty.

 

 

 

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