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Kenya has a severe, generalized HIV epidemic, but in recent years the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavior change and increased access to ART.
UNAIDS estimated Kenya’s adult HIV prevalence rate at 6.14 percent in 2013, with some 1.6 million people living with the virus. The country is currently home to about 1 million children who have been orphaned by the AIDS epidemic.
With support from PEPFAR and CDC/Kenya, AIHA has been working with the Kenya Conference of Catholic Bishops in Nairobi to implement a national HIV prevention program targeting youth since 2005 through our HIV/AIDS Twinning Center.
DREAMS Initiative Project – Siaya and Homa Bay, Western Kenya
(2015 – Present)
In late 2015, the US Centers for Disease Control and Prevention (CDC) in Kenya selected AIHA as an implementing partner of the DREAMS Initiative in Kenya. Working closely with our long-time partners at the Kenya Conference of Catholic Bishops (KCCB) General Secretariat, we are supporting girls between the ages of 10-14 in the Nyanza Province counties of Siaya and Homa Bay.
Nestled on the shores of Lake Victoria in Western Kenya, both of these counties have adult HIV prevalence rates around 25 percent, which makes the adolescent girls and young women in the area some of the most vulnerable in the country.
Together, AIHA and KCCB are implementing a multi-pronged school-based intervention that focuses on HIV and gender-based violence prevention, post-violence care, parent/caregiver support, HIV testing and counseling referrals, educational subsidies, and social asset building. We’re also working closely with Impact Research and Development Organization (IRDO) and
International Medical Corps (IMC), which are both implementing CDC/Kenya-supported DREAMS projects targeting young women aged 15-24 in Siaya and Homa Bay, respectively.
While considerable progress in the overall response to the global HIV/AIDS pandemic has been achieved over the past 30 years, gender and age disparities in high-HIV burden countries in sub-Saharan Africa remain as a critical challenge. The reality for many adolescent girls and young women is that they are often more than twice as likely to contract HIV than boys and young men in the same age group.
Every year, around 380,000 adolescent girls and young women are infected with HIV – that’s the equivalent of more than 1,000 girls every day.
There are a plethora of reasons for this heightened risk, including gender bias that devalues women and girls and greatly hinders access to a full range basic opportunities and support that can help ensure they grow and thrive. In some parts of the world, girls and women are seen as unworthy of investment or protection. They experience discriminatory cultural norms, social isolation, and economic disadvantages that all too often contribute to a lifetime of vulnerability to poverty, abuse, and poor health.
DREAMS — an ambitious $385 million partnership to reduce HIV infections among adolescent girls and young women in 10 sub-Saharan African countries — has the potential to change how we work together to ensure an AIDS-free future for girls and women. The goal of DREAMS is to help girls develop into Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women.
In sub-Saharan Africa, girls and young women account for 71 percent of new HIV infections among adolescents. The DREAMS countries of Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe accounted for nearly half of all the new HIV infections that occurred among adolescent girls and young women globally in 2014.
With support from the US President’s Emergency Plan for AIDS Relief (PEPFAR), the Bill & Melinda Gates Foundation, Girl Effect, Johnson & Johnson, Gilead Sciences, and ViiV Healthcare, the DREAMS initiative was launched that same year to change things by providing multiple, comprehensive solutions to this problem.
Selected Program Results through March 2016
- AIHA and KCCB conducted a mapping of primary schools in the two target counties, linking a total of 79 in Rarieda (23), Bondo (24), Mbita (15) and Homa-Bay (17) to our school-based HIV & violence prevention program, Making Life’s Responsible Choices (MLRC).
- AIHA conducted MLRC sensitization workshops for a total of 150 head teachers, village elders, religious leaders, and other stakeholders in Bondo.
- In Homa Bay County, AIHA and KCCB have initiated MLRC in 32 schools, enrolling a total of 702 adolescents in the program; 491 girls are participating in our DREAMS social asset building intervention within 17 previously identified “safe spaces.”
- In Homa Bay County, AIHA has launched MLRC at 17 schools in Kaksingiri West Ward, with 425 girls enrolled, along with 15 schools in Gembe Ward, reaching 277 girls there. In Siaya County, we’ve registered 2,350 adolescents for MLRC, enrolling some 881 adolescent girls in DREAMS and linking them to safe spaces in eight wards through our DREAMS social asset building intervention.
- Based on analysis of county-specific girl rosters — a census-like mapping tool — AIHA conducted a first screening of vulnerable adolescent girls and is currently planning to implement a ward-based level-2 screening to identify those who are most vulnerable for inclusion in our education subsidy program.
- AIHA identified and trained a total of 28 facilitators, who are set to initiate the Families Matter! Program (FMP) in both target counties. All required materials have been procured and the first phase of mobilization and participant recruitment is being finalized for this intervention, which targets parents and caregivers, as girls are enrolled in DREAMS.
- AIHA and KCCB conducted SASA sensitization trainings for some 500 community stakeholders, including teachers, chiefs and assistant chiefs, religious leaders, and others as a way to encourage expanded community-based efforts to challenge harmful gender norms.
- Through outreach and screening efforts, AIHA identified three cases of girls who are facing gender-based violence. Social workers provided these girls with counselling services and referred their cases to relevant authorities for follow up.
- AIHA used girl roster data to initiate phased identification of adolescent girls and young women for referral to HIV counseling and testing services. Phase I covered three wards in Siaya and two wards in Homa Bay, resulting in the referral of 231 girls.
Safe Spaces for Girls
Kenya Conference of Catholic Bishops – General Secretariat
(2005 – Present)
From 2005 until 2013, partners at the Kenya Conference of of Catholic Bishops (KCCB) worked with counterparts from DePaul University in Chicago to develop and implement a faith-based behavior change program targeting youth in primary schools — many Catholic-sponsored, but also a number of public schools or private schools sponsored by other religious denominations — throughout Kenya. Partners also developed and implemented complementary programs including a radio social marketing campaign and a health education program for parents to support the school-based program.
By working within the partnership infrastructure, partnering with public sector organizations such as Ministry of Education and the Teachers Service Commission, and utilizing a training-of-trainers approach, this AIHA partnership consistently leveraged more than 400,000 volunteer hours a year prior to the graduation of DePaul in 2013.
Based on the success of this long-standing partnership, AIHA began providing direct funding and technical support to KCCB’s efforts to carry out their prevention programming targeting young people in Kenya.
AIHA partners at the Kenyan Conference of Catholic Bishops – General Secretariat’s Commission for Education and Religious Education in Nairobi are successfully implementing a multifaceted HIV prevention intervention that has to date reached more than 720,000 Kenyan youth across the country.
The intervention was developed in partnership with DePaul University in Chicago, Illinois, and encompasses a three-pronged approach that includes a:
- School-based program targeting primary school pupils largely between the ages of 11-14;
- Complementary program for parents or caregivers of children enrolled in the school intervention; and
- Community-based radio programming that reinforces the behavior change lessons using interviews, music, skits, and other dynamic and engaging messaging techniques.
These complementary programs work together to target youth with important HIV prevention education individually in their primary school classrooms, through their families and caregivers at home, and through mass media in the larger community.
The initial focus of the partnership targeted curriculum development for a school-based program for Kenyan primary school pupils aged 11-14. The program includes various characteristics of evidence-based interventions and is rooted in health behavior change theories, including Social Cognitive Theory and the Theory of Reasoned Action. It builds on standard HIV prevention information and activities included in the Kenyan Ministry of Education, Science, and Technology’s National AIDS Education Syllabus and CDC curricula. Furthermore, the holistic learning modules and accompanying resources incorporate Christian and traditional Kenyan and African values, drawing on these rich and varied teachings to better arm children with the tools they need to safeguard their health and well-being.
Throughout this process, the Kenyan partners led the curriculum development efforts with experts from DePaul providing guidance and technical assistance, largely on evidence-based behavior change interventions, programming, and monitoring and evaluation.
The curriculum for “Making Life’s Responsible Choices” (MLRC) is a six-module school-based intervention designed to be implemented across one academic year. The curriculum was drafted and approved for implementation by the KCCB Bishop’s Council in May 2006 and initial training-of-trainers workshops for selected school teachers ensued that summer. Partners launched the program in 15 Catholic Dioceses in September 2006 and have since expanded its reach to 25 of Kenya’s 26 Catholic dioceses. The MLRC curriculum was approved by the Vatican, the central governing body of the Catholic Church, in 2009.
MLRC has also been fully embraced by the Muslim community and other denominations because the curriculum focuses on children rather than a specific religious affiliation. Since its launch, the program has enjoyed the strong support of pupils, teachers, parents, and policymakers alike. The program is currently being delivered in more than 1,673 Catholic and public-sponsored primary schools across the country. Partners have trained 3,732 teachers to deliver MLRC lessons and more than 722,153 pupils have participated in the school-based program since its launch.
The MLRC curriculum is in the final stages of approval as a nationally-recognized curriculum for youth after which it will be eligible for public funding.
What the MLRC Program Teaches
The Families Matter! Program — which was piloted in Machakos Diocese in 2009 and in Meru Diocese in 2010 — is desinged to increase family involvement in promoting healthy living and behavior change by training parents how to talk with their children about human sexuality, STIs, and HIV/AIDS.
Adapted from the Parents Matter! program developed by CDC, Families Matter! It equips adult caregivers with the communication and parenting skills they need to successfully support behavior change for children and young adults. As of September 2014, partners and the facilitators they have trained had delivered Families Matter! to 8,799 parents and caregivers whose children participate in MLRC.
In addition, partners work closely with Radio Waumini, a national Catholic radio station, to deliver youth and family-friendly radio messages that reinforce HIV prevention messaging.
The 15-minute radio show — called Love Life, Talk, and Live — airs several times a week and often features children enrolled in MLRC, who act out various lessons and role play activities. Guest speakers are also invited to talk about topical issues, such as peer pressure, HIV-related stigma and discrimination, substance abuse, and other challenges young people face in their daily lives.
In 2011, partners conducted an outcome evaluation of Making Life’s Responsible Choices to assess changes in the HIV-related knowledge, intentions, attitudes, and behaviors of youth enrolled in the program. The study was carried out at over 200 primary schools across Kenya and included over 1,800 pupils. The evaluation provided useful baseline data, built the capacity for future monitoring and evaluation activities, and helped inform the direction of interventions.