On Zero Discrimination Day, UNAIDS calls on countries to examine discriminatory provisions in their laws, policies, and practices and make positive changes to ensure equality, inclusion, and protection for those populations most at risk. To learn more about this annual campaign, click here.
Experiences of violence are common among key populations (KPs) in Kenya. In a polling booth survey conducted in 2018, 48% of female sex workers and 21% of men who have sex with men reported having been arrested or beaten by police or city askaris (county law enforcement officers) in the preceding six months. Additionally, 22% of female sex workers and 13% of men who have sex with men reported being physically forced into sexual encounters in the preceding six months. Discrimination and violence can make it very difficult for members of these groups to access health care, including HIV prevention, care, and treatment services. With support from the Key Populations Investment Fund (KPIF), the FHI 360-led Meeting Targets and Maintaining Epidemic Control (EpiC) project is working with nine local partners – seven KP-led civil society organizations (CSO), one KP-competent CSO, and the national technical support unit – to address structural barriers hindering KPs’ access to comprehensive health care services. The program is working with female sex workers, men who have sex with men, and transgender people in five counties – Nairobi, Nakuru, Kisumu, Busia, and Kilifi.
KPIF activities under EpiC include strengthening capacity of and collaboration between county health ministries in providing quality, comprehensive health care for members of KPs; advocating for the reduction of stigma and discrimination against KPs at the community level; and enhancing the capacity of partners to prevent and respond to violence. EpiC also provides technical assistance on use of social network-based testing strategies to reach and diagnose KP members living with HIV. And, once diagnosed, the team uses enhanced peer navigation and case management to link individuals to care and treatment, all while strengthening partners’ crisis response systems; sensitizing healthcare workers, law enforcers, judicial officers, and religious leaders; and participating in county advocacy forums. The structural work under KPIF is allowing for a more effective response to the epidemic among KPs in Kenya.
“Before we embarked on advocacy activities targeting law enforcers and healthcare workers, we used to be treated as secondary citizens. This led to some of our cases being dismissed and for the sex workers living with HIV, frequent arrests and detention resulted in an interruption of HIV treatment. We are glad that the sessions we’ve had with the law enforcers and healthcare workers have borne fruits where they now see us as part of the society, treat us with respect, appreciate the role we play in the fight against HIV and violence, and acknowledge that we are also human and respect our rights. We have also identified key persons to work with who have been sensitized and our members are comfortable working with.” – Mary, paralegal and female sex worker, Bar Hostess Empowerment & Support Programme
At the county level, EpiC has conducted entry level meetings with county health departments and health management teams to cement future collaboration and support. Several health facilities in Nairobi received sensitization trainings in an effort to integrate health care services specifically for KPs into existing service provision. Continuous engagement with each county has fostered an environment that is more KP-friendly and KP-competent than ever before.
“I really learnt a lot from the healthcare workers sensitization. I noticed that at times we unknowingly stigmatize key population members when offering clinical services. The sensitization has really opened our eyes and we will use the knowledge gained to change the way we offer our services and avoid judging people based on their appearance or behaviors. We will be happy to have more of these sensitizations in the future to build the capacities of our staff.” – Jane, nursing officer, Nairobi
“Through working with the county health department and the county health management team, efforts have been made to address stigma and discrimination hindering access to healthcare services through setting up structures at the county level. The structures enshrined under the county technical working group and the advocacy subcommittee, are mandated to coordinate violence prevention and response, ensure survivors of violence access post GBV services at the organizational level and at the public health facilities, coordinate the sensitization of powerholders and ensure services offered are key population friendly. Working with the counties has greatly assisted in increasing acceptance, reducing discrimination, creation of friendly environments, addressing violence and providing key populations with a platform where they can freely voice out their views and opinions.” Daisy, Director, Smart Ladies
KPIF investments in structural HIV response interventions continue to generate real impact in Kenya, especially for those who regularly face issues related to service access, stigma and discrimination, and violence. On March 1st, we celebrate the advocacy and action that is bringing communities – and the world – closer to zero discrimination.