Peer educators promoting oral pre-exposure prophylaxis (PrEP)

 Peer educators promoting oral pre-exposure prophylaxis (PrEP)

By Daniel Kyalo and Geoffrey Njenga

Nairobi, Kenya – You cannot talk about the successful implementation of PrEP in Riruta Health Centre without mentioning Julia, Mary, Diana, and Magdalene. The four have a lot in common, they are single mothers, active sex workers and are peer educators linked to Riruta.

Harassment by customers, condom bursts and contracting STI’s was the order of the day for the four. PrEP couldn’t come at a better time as they were constantly worried of getting HIV and they were tired of being on PEP due to condom bursts.

Having been on PrEP for the last two years, they have seen the benefits and were motivated to become strong advocates of PrEP as they desired to see their fellow sex workers healthy and worry-free from the fear of contracting HIV and leaving behind their children.  “I have seen many people infected with HIV, others have died as a result of it and many children orphaned, it makes me sad knowing they could have taken PrEP to prevent HIV. This motivated me greatly to become a peer educator” says Magdalene.

The number of sex workers in Nairobi County is estimated to be 29,494 and they are among key populations that contribute a third of all new HIV infections in Kenya. The HIV prevalence rates among sex workers is 29.3% yet they have the least access to prevention, care, and treatment services because their behaviors are often stigmatized. By using peer educators to reach out to hot spots with information on HIV prevention a positive attitude by service providers at Riruta and a combination of services such as family planning, cervical cancer screening, STI treatment, condom, lubricant supply and counselling, female sex workers feel at ease going for PrEP services at Riruta, a public health facility.

The four are among 428 peer educators sensitized by Jilinde on HIV prevention methods including PrEP, condom negotiation/use and how to identify those at risk and in need of PrEP. They create awareness of PrEP at the hotspots and in the community linking those at risk of HIV infection to Jilinde supported sites for PrEP services. They have reached 9,256 female sex workers with PrEP messages.

Reaching sex workers is not always easy, the four peer educators confess. Most sex workers don’t want to take a daily pill they would prefer to take just one pill that protects them for an extended period of time. “Sometimes we get abused during outreaches and following up clients on PrEP for refills is not easy as most of them are mobile” says Julia. These challenges have been addressed by correcting the myths with correct information and ensuring a strong referral system.

“PrEP is not for sex workers only, it’s for anybody who is at risk of HIV infection. “Anybody can take it as long as they are at ongoing risk. “says Mary

Riruta Health Centre is a shining example that, if sex workers are trained as peer educators, facilitated to do their work and a nice rapport between them and the health workers is ensured, public health facilities can increase PrEP uptake and reduce HIV transmission.


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Reducing Stigma by Health Providers

Reducing Stigma by Health Providers

By Geoffrey Njenga

Nairobi,Kenya – It was a bright Wednesday morning; the sky was clear and the sun was slowly baking the grounds of Kenyatta University which was dotted with tents from different organisations. The students were marking International Condom Day on February 13th 2018. HIV services were being offered by different organisations in a bid to avert the increasing numbers of new HIV infections among youth and encourage condom use. Approximately 29% of all new HIV infections in Kenya are among adolescents and youth. Thirty percent of new HIV infections in adults are among youth below 24 years. Young women aged 15 – 24 years post the highest number of HIV infections and contribute 21% of all new infections in Kenya. Jilinde a Jhpiego led project is rolling out PrEP in Kenya as part of the combination prevention package and on this day, Jilinde was on site offering HIV testing and PrEP services.


For Elizabeth, a clinician at Mathare North Health Centre in Nairobi, this day was different than the ones she had done before as it involved students. As she was busy offering HIV testing and PrEP services a group of young men aged 19 came to the tent set up by Jilinde requesting for PrEP services. PrEP, a pill taken daily has proven to be an effective way of preventing HIV. It is used in combination with other HIV prevention strategies.


The young men were referred to Elizabeth who was more than happy to offer the services until her colleague mentioned that they are Men who have sex with Men (MSM).


For the first 10 seconds her face stuck in an incredulous expression, unblinking stare, she was desperately trying to make sense of it all, she was rendered speechless unable to comprehend what she had just been told. She sat there with the client as if paralyzed from the neck up. It was Elizabeth’s first encounter with MSM’s in her 8-year career in providing health services. “My thoughts were blocked. I dint know where to start or how to talk to the clients, since I was not prepared how to handle them. It was tough for me to handle them at first.” says Elizabeth.


The young men quickly noticed the shock in Elizabeth’s face and felt uneasy and were not willing to disclose why they were at high risk of HIV infection and in need of PrEP. “I judged them based on their sexual orientation because I did not understand why they had to be MSM at that young age”. Says Elizabeth.


Instead of focusing on offering PrEP services, Elizabeth was hard at work convincing them to reconsider their sexual orientation and asked inappropriate questions. For the young men they felt stigmatized by a health worker who should be helping them.  Finally, the MSM’s were able to get the services they came for however they felt they did not receive quality services.


Many key populations  who will potentially benefit from PrEP face barriers to healthcare through discrimination and stigmatisation. Healthcare providers, including clinical staff, and counsellors should be provided with the competencies to provide quality PrEP services.


Jilinde organized a PrEP sensitization training on key population sensitivity, clinical guidelines, counselling, and attitudes to promote uptake and retention of PrEP by creating a non-stigmatizing and supportive environment for key populations. Elizabeth together with other health care workers went through this training and were equipped with the knowledge, attitude, and skills to provide effective PrEP services to different people.


For Elizabeth, the training has enabled her provide better PrEP quality services and even helped her reach out to more key populations at high risk and in need of PrEP. “The training has enabled me to be better prepared and more relaxed even if it’s key population coming for services. I am confident of handling them respectfully.” says Elizabeth.


Since the incident she has offered PrEP services to an older MSM couple and was able to handle them well and follow up with them during their monthly revisits. She is now able to reach out to key populations at risk and encourage them to take up PrEP as part of combination prevention package to ensure holistic care.

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Bridge to Scale Project at IAS

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Jhpiego’s Daniel Were represented the Kenyan oral PrEP scale-up project at a WHO-sponsored satellite session during the 9th International AIDS Society Conference on HIV Science in Paris. Co-presenters included U.S. Global AIDS Coordinator Ambassador Deborah Birx; Rachel Baggaley of the HIV department at WHO; Yogan Pillay of the National Department of Health, South Africa; South African epidemiologist Quarraisha Abdool Karim; Sheena McCormack, a clinical epidemiologist at UCL; and Jean-Michelle Molina, an infectious disease specialist at the University of Paris Diderot. Moderating the session was Dr. Wafaa El-Sadr, founder and director of ICAP.

Oral Pre-Exposure Prophylaxis (PrEP) for an AIDS-Free Generation

A single pill taken daily to prevent HIV

Oral PrEP Works!

A daily dose is more than 90% effective in preventing HIV.

The World Health Organization (WHO) recommends oral PrEP to anyone at substantial risk for becoming infected with HIV and includes PrEP on the Essential Medicines List. A dozen clinical trials have proven that taking oral PrEP as prescribed prevents HIV.

*Fonner VA, Dalglish SL, Kennedy CE, et al. 2016. Effectiveness and safety of oral HIV pre-exposure prophylaxis for all populations. AIDS. 30(12):1973–1983. doi: 10.1097/QAD.0000000000001145.


Who Needs Oral PrEP?

Anyone who is HIV-negative and at substantial risk of becoming infected with HIV

Examples of those who may particularly benefit from PrEP include:

  • adolescent girls and young women in areas where HIV is common
  • HIV-negative men or women in a relationship with an HIV-positive person
  • men who have sex with men
  • sex workers
  • those with behavioral risks that make it easier to get HIV

Bridge-to-Scale in Kenya

One of the largest national oral PrEP programs

Scale-up of routine oral PrEP services to over 22,000 people at risk for HIV

A global learning laboratory for governments and stakeholders considering oral PrEP policy and programs

Support from the Bill & Melinda Gates Foundation

The Jhpiego Difference

Trusted relationships with governments and international stakeholders

Close collaboration with WHO to make oral PrEP web-based training available to clinicians and pharmacists

Proven experience scaling up large and challenging interventions

Prior experience translating science to public health practice that is affordable, effective and sustainable.

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