Draft:IRC Kenya Turkana HIV/AIDS Program
IRC Kenya Turkana HIV/AIDS Program
The BCC Strategy Review
By Rose Wahome, BCC Advisor
- 1. Introduction and Background:
The IRC started implementation of HIV/AIDS prevention and care in Turkana District in September 2001, in Lokichoggio in 2004 and in Kalokol in 2005. The program targets three divisions in Turkana District namely, Kakuma, Lockichoggio and Kalokol. Kakuma is the site of the refugee Camp (KRC) which has roughly 72,000 refugees of none different nationalities presents the IRC’s largest target beneficiary population. The IRC also targets approximately 7,000 beneficiaries from the host population in Kakuma and works with the Kakuma Mission Hospital (KMH).
The IRC’s HIV/AIDS services in Lockichoggio and Kalokol are run directly by the African Inland Church (AIC) as IRC-Kenya partner. The beneficiary population in Lochichoggio is roughly 17,000 local population and 1,000 humanitarian aid workers. In Kalokol, IRC targets the local community estimated at 18,000. At the three sites, the IRC HIV/AIDS program provides the following services:
- Voluntary counseling and Testing (VCT)
- Treatment of Sexually Transmitted Infections (STIs)
- Blood and injection safety (Universal precautions)
- Home based care (HBC)
- TB treatment and control
- Prophylaxis and early management of opportunistic infections
- Behavior change and communication (BCC)
- Prevention of mother to child transmission (PMTCT)
- Provision of antiretroviral drugs (ARVs
Behavior Change and Communication (BCC) Activities
BCC materials are used in the IRC program as part of the outreach activities and as a parallel means of encouraging behavior change.
- 2. HIV/AIDS’ status at KRC RE: Desk Review.
- 1. Kakuma Knowledge, Attitude, Practice and behavior (KAPB) survey of May 2007 (draft)
- 2. Kenya Demographic and Health Survey 2003
- 3. HIV/AIDS Behavioral Surveillance Survey (BSS) July 2002
The KAPB survey revealed that on the whole, the HIV/AIDS knowledge, attitude and behavior among Kakuma residents is varied. There is a general lack of targeted information regarding HIV/AIDS among the population sub-groups represented in the Kakuma Refugee Camp. Similarly, the HIV/AIDS Behavioral Surveillance Survey (BSS) conducted in 2002 had made closely related observations. Below is a summary of the findings from the three reports as follows:
- The 2004 Behavioral Surveillance Survey (BSS) and the May 2007 KAPB (draft) point out the low HIV?AIDS risk perception especially among the youth. Generally a partner is trusted after two or three sexual intercourse encounters where the condom is no longer considered necessary.
- Both surveys noted generalized negative attitude towards the use of condoms by all refugee subgroups with the most negative attitude having been observed among the Somali community. The Somali community purports to adhere to the teachings of Islam on sexual responsibility and therefore would not consider use of the condom a necessary undertaking for the community.
- The Kenya Demographic and Health Survey (KDHS) 2003 also had reported low risk perception of infection with HIV/AIDS related to sexual involvement with one partner. The responses between men and women (both young and adults) were closely similar.
- Among the host communities, the Turkanas were found to lack adequate knowledge of HIV/AIDS to facilitate change in behavior to ensure adoption of known HIV/AIDS preventive measures.
- High levels of knowledge of existence of HIV/AIDS service/centers (for example VCT, CCC and PMTCT) among all population sub-groups in Kakuma did not translate into adequate utilization of the services, a trend that is nationally reflected through the KDHS.
- The 2003 KDHS reported 48% women and 62% men having heard about VCT but only 15% of women and 16% of men reported to have ever been tested.
- The youth and commercial sex workers (CSWs) are the most commonly mentioned in both surveys as perceived to be at the most risk of contracting HIV. Early sex debut was a problem identified with the youth from most communities living within the Kakuma area.
- The BSS revealed that 60% of the youth at the camp have had sexual intercourse at 15 years of age, most of these youth may be in Primary School in Turkana District or in the Refugee camp where children start schooling rather late. A minority will be in secondary school.
- Stigma and discrimination is evident among most of the sub groups in the Kakuma refugee camp, however, among the minorities i.e. Ethiopians, Congolese and Burudians, stigma is less pronounced as these subgroups show acceptance to their infected kin.
- The 2003 KDHS showed 27% females and 40% males as having a more accepting attitude towards people with HIV/AIDS. Education was noted as an important factor in stigma reduction as the surveys showed that the lower the education level the higher the misconception level. It was surprising though that men were reported to be more accommodating to the HIV positive people than their female counterparts.
The three surveys provided background information on the Kakuma Refugee Camp, after reading the survey reports, the BCC Advisor had a good understanding of the situation at the refugee Camp. This understanding is necessary for making decisions regarding way forward for the IRC BCC Strategy.
Kakuma BCC activities after the Limuru workshop
- Dissemination and staff orientation to the BCC Strategy
Participants at the July 2007 Limuru IRC BCC Strategy workshop organized and conducted a dissemination workshop for program and Implementing Partner (IP) staff in Kakuma. The purpose of this activity was to share the new BCC approach to enable staff to move together to implement the BCC strategy. The orientation workshop ended up with the formation of a BCC committee to oversee planned BCC activities and further disseminate the BCC strategy to community supervisors and leaders.
2. Problem Description and prioritization (IRC BCC Strategy step 1)
The IRC Kakuma HIV/ADS staff conducted a needs assessment exercise that consisted of individual interviews and focus group discussions with a cross-section of camp residents from most community subgroups living there. The needs assessment was conducted for all IRC programs at the IRC Kakuma Refugee Camp.
IRC facilitated formation of five groups at KRC representing both youth and adults among the participants for the focus group discussions (FGDs). The groups identified the main issues/problems related to HIV/AIDS around the Kakuma Refugee Camp as follows:
Low or non-use of the condom
- Low self Risk perception, the “trusted partner concept”
- Early sex debut
- High rate of STIs
- Commercial sex (sexual exploitation due to poverty)
- Lack of disclosure of HIV status due to stigma and discrimination
- Poor nutrition for PLWHAs
- Limited HIV/AIDS awareness
- Rape and forced marriages
- Not testing for HIV
A report on the above mentioned activity identified IRC BCC Strategy’s Step 1, “Describe the Problem”. The formative assessment that followed immediately included all IRC Kenya programs for the exercise. Due to the many problems facing the Refugee Community, they may not have identified HIV/AIDS as their priority problem when some of them struggle to meet their basic needs. I would recommend applying the BCC Strategy to the HIV/AIDS program separately while being available to assist other programs in applying the BCC strategy in other IRC programs as need arises.
The formative assessment needs priority matrix
The priority matrix rankings identified problems/needs were ranked in order of priority. High priority needs received more points (in the range of one to five) in the matrix. The report is however silent on specific problems/needs identified by the HIV program as priority ones to address.
The “But Why” problem analysis
The HIV/AIDS program team mentioned having worked on a problem tree and objectives for the BCC strategy, the HIV/AIDS and BCC teams will be review the problem tree findings alongside the SWOT analysis to chart the way forward for the BCC Strategy..
Through my review of the KAPB and BSS reports, I came to the conclusion that early sex debut is a problem among the youth in Kakuma. This was later confirmed by the BCC Officer as a priority problem for the program. The HIV/AIDS team is currently working to address abstinence as a behavior change goal.
2. Identification of Stakeholders (IRC BCC Strategy Step 2)
The IRC BCC team in Kakuma has identified stakeholders to participate in addressing identified needs, the stakeholders were invited to a one day dissemination workshop. The stakeholders are Kakuma Mission hospital (KMH), National Christian Council of Kenya (NCCK), Film Aid International, GTZ, Handcapp International, Lutheran world Federation (LWF), Constituency AIDS Coordinating Committee and the Provincial Administration (GOK).
3. Identification of the target audience (IRC BCC Strategy step 3)
Although BCC activities have taken off in Kakuma, the HIV/AIDS team has not clearly defined the target audience(s). There is a general feeling that some problems like low condom use and utilization of VCT services cuts a cross a number of target audiences. Segmenting the target audience will bring out each target group as an entity to work with to improve acceptance of the condom by the target group
Iidentification of the target audience as an important step in the BCC process has not clearly been applied as per BCC Strategy guidance in the Kakuma program.
4. Understanding the target audience (IRC BCC strategy step 4)
BCC activities outside the refugee Camp
IRC in conjunction with the Partner, Kakuma Mission Hospital (KMH), has been facilitating an essay writing competition for Primary School youths (currently one of the target audiences) around Kakuma Division. The schools have been selected to participate in an essay writing competition as part of BCC Strategy Step 4, understanding the target audience. The ages of the target audiences in Primary Schools in Trukana District vary widely due to late school enrollment for children in Primary school. This calls for proper segmentation of the pupils by age to ensure each age category have their needs identified and appropriately addressed through BCC. For the essay writing competition, class 5 to 8 (ages 11-18) will compete in writing either of the two essays titled:
Discuss the reasons why school going children should abstain from sex
“…….to this very day, I have come to learn that abstinence is the best way of preventing HIV/AIDS.
The topics for the essays were composed with the help of teachers from participating Primary Schools at a one day workshop organized by the Kakuma IRC BCC team. A marking scheme was also agreed upon at the one day work shop with the teachers. The teachers will initially mark the essays and later hand the essays over to IRC for ranking and determination of the winners. There will be prizes for individual winners and trophies for the winning schools.
IRC will also use the essays to assess pupils’ awareness levels and gaps in knowledge on HIV/AIDS and its prevention.
The rationale for organizing the essay writing competition is to:
- Gauge the knowledge and understanding the pupils have on prevention of HIV/AIDS.
- Set an agenda for discussion among pupils and teachers about abstinence and motivate teachers and pupils to see abstinence as a positive behavior.
- Conduct a formative assessment (FGDs, IDs and Key informant interviews on the target audience.
The essay writing competition among schools as a way of understanding the target audience is a commendable approach by the Kakuma HIV/AIDS team. Subsequent BCC strategy steps will be applied as per recommended schedule with BCC Advisor’s inputs.
Kakuma BCC Strategy Analysis:
- BCC strategy dissemination to key staff and implementing partners was a good decision to ensure a common understanding and support for the activity.
- The HIV/AIDS team has actively involved stakeholders and implementing partners in the BCC strategy and included them as team members in implementing the strategy.
- A formative research has been conducted in the camp where priority problems have been identified.
- The HIV/AIDS team has put in substantial effort to implement the BCC strategy where the BCC component of the youth in school as a target group is actually making good progress in applying the BCC strategy.
- Some BCC strategy steps have not been applied according to the IRC guidance.
- The BCC Officer is based in Lodwar and has to travel to Kakuma and Lokichoggio for activities on the BCC strategy.
- Some BCC strategy steps have not been exhaustively applied, there are gaps that require addressing.
3. Proposed future Activities:
- Discuss this assessment report with the BCC Program Officer and the HIV/AIDS team in Kakuma and agree on a way forward.
- Strengthen BCC strategy step 4 for Kakuma by segmenting the target audience and conducting individual segment informal assessments.
- BCC Advisor to make an assessment of on going activities on BCC in Kalokol and Lokichoggio.
- Jointly revise the existing work plan and prepare a Logical Framework to implement the IRC BCC Strategy in Kakuma, Kalokol and Lokichoggio.
- Work with the team to implement subsequent steps of the IRC BCC Strategy at the three sites.
- Share this report with the Medical and HIV/AIDS Coordinators for their information.