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.
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.