Kenya

A version of this story was first published at www.unicef.org  

Actress Lupita Nyong'o in a scene from the Kenyan TV drama ‘Shuga’.
Credit: UNICEF

At its New York headquarters, UNICEF highlighted a recent collaboration with MTV through a screening of ‘Shuga’, a three-part TV drama about a group of young friends living in Nairobi, Kenya. As they explore the complexities of love, the characters confront the risk of HIV infection – and learn that a positive test result is not a death sentence.

MTV produced the programme in collaboration with UNICEF and other partners, including the US President’s Emergency Plan for AIDS Relief, or PEPFAR.

MTV has a long standing commitment to the AIDS response and has been partner of UNAIDS and its co-sponsors since 1996.

Partnerships like this one play a vital role in UN’s efforts to halt and reverse the AIDS pandemic. When it comes to delivering messages about HIV prevention, working with media and entertainment partners such as MTV provides a valuable – and credible – connection to young audiences.

‘Meaningful engagement’

“It’s fast, it’s furious, it’s cool – and that’s exactly how we filmed it,” said actress Lupita Nyong’o, who plays a lead role in ‘Shuga’ as Ayira, a college student who finds herself torn between a boyfriend her own age and an older man. Ms. Nyong’o attended the screening and a panel discussion that followed, along with representatives of key partners in the project.

UNICEF collaborated with MTV to create ‘Shuga’, a TV drama set in Nairobi, Kenya. It includes messages about HIV prevention for young people.
Credit: UNICEF

The series shows how behaviours – including sexual involvement with multiple partners, sexual exploitation and alcohol abuse – can make young people more vulnerable to HIV.

During the panel discussion, PEPFAR Senior HIV/AIDS Prevention Advisor Tijuana A. James-Traore noted the programme’s power to speak effectively to young viewers.

“This is really what we mean when we talk about the meaningful engagement of young people in issues that impact their own lives,” she said. “No other person or persons, I think, could have communicated the messages in the way these young people have done.”

A regional priority

Messages about AIDS prevention are especially crucial in eastern and southern Africa, the heart of the global epidemic.

Lupita Nyong'o, a star of the Kenyan TV drama ‘Shuga’, attended a screening of the programme at UNICEF headquarters and took part in a panel discussion that followed.
Credit: UNICEF

“Young women in eastern and southern Africa are particularly severely affected by HIV,” said the Senior Specialist in HIV Prevention with UNICEF’s Unite for Children, Unite against AIDS campaign, Susan Kasedde. “In some countries, as many as three young women to each young man are infected,” she added.

Starting a dialogue

While popular dramas like ‘Shuga’ will not end the epidemic on their own, they can lead to dialogue about the risks of HIV infection. They can also help to combat the stigma that people living with HIV sometimes face.

“We’re not the silver bullet,” said MTV International’s Vice President for Social Responsibility, John Jackson. “We’re not going to solve this problem. But we’re a critical player in getting a certain section of our community to think, to have a conversation they might not have otherwise.”

The Bill and Melinda Gates Foundation is assessing the effectiveness of ‘Shuga’ in changing behaviour within its target audience. For some members of the cast, that change has already begun.

“Especially where we were doing the scenes where we were doing the HIV testing,” said Lupita Nyong’o, “there was a hush on the set. It was a heavy time for us, and a lot of the actors said, ‘This is real. Yeah, this is real – and I need to make a change in my life.”

Cultural structures and systems can facilitate or inhibit the success of HIV programs such as voluntary male circumcision, PMTCT and social protection. Thus science and culture must work in tandem to enable adoption of innovations. To promote voluntary male circumcision, the government programme has recognized the importance of working with social structures to catalyze behavioral transformation among non-circumcising communities.

Michel Sidibé, UNAIDS Executive Director, had an opportunity to visit the Luo Council of Elders in the western part of Kenya to discuss their role in social transformation. As guardians of traditions in the region, the Elders guide communities in many aspects of health and sexual practices.

Among their many achievements, the Elders have been instrumental in reinstatement of widows who had been disinherited following the death of their husbands from AIDS related illness. By speaking out against ingrained stigma, the Elders have facilitated community acceptance for more than 198 widows who would have been considered outcasts.

“I am very impressed with the work that the Luo Council of Elders has done to lead their communities. As agents of change, these leaders are paving the way on how communities can address challenges in the AIDS response while still retaining the positive cultural values and practices that hold communities together”, said Michel Sidibe.

Another example on how the Elders are forwarding the response to HIV is in the process of rolling out male circumcision. Male circumcision is now recognized as an important HIV prevention strategy, and the government began offering the service in December 2007. HIV prevalence among uncircumcised men in 2007 was found to be three times higher (13.2%) than among men who were circumcised (3.9%).

Male circumcision is not traditionally practiced in some parts of western Kenya, but with recent efforts there has been an upsurge of demand. Over 20,000 men have undergone voluntary medical male circumcision over the past few months. The Elders have been instrumental in promoting and generating this demand.

Hon. Minister of Special Programmes, Dr. Naomi Shabaan, UNAIDS Executive Director, Mr Michel Sidibé and Hon. Prime Minister Raila Odinga with the first copies of Kenya’s third National AIDS Strategic Plan in Nairobi, Kenya. 12 January 2009

Kenya has seen great success in their HIV response. AIDS related deaths have fallen by one third since 2002 and HIV prevalence has consistently declined over the past few years.

In order to strengthen the national response to HIV and AIDS, Kenya’s third National AIDS Strategic Plan, running from 2010-2013, was launched today by the country’s Prime Minister Hon. Raila Odinga in Nairobi. The country has delivered a plan which uses the best available evidence to guide its response. Built on the recently undertaken Modes of Transmission analysis, the plan responds to the need to rethink some of the priorities of the HIV response to align with the evidence now on hand.

While gains have been made, recent epidemiological modeling estimated that the total number of people living with HIV in the country is 1.2 million. And with an estimated 76,300 new HIV infections in the last year, the Prime Minister in his address committed to face HIV and AIDS head-on stressing the importance to “turn off the tap” on new infections. “I encourage Kenyans to stop the silence and speak out on AIDS,” said Mr Odinga.

Men and women in committed relationships now account for 44% of new infections in Kenya. Mr Michel Sidibé, UNAIDS Executive Director, building on Mr Odinga’s argument stressed that “Clearly a new approach is needed to reach those traditionally considered not at high risk. This plan offers just that”

“By pursuing a prevention revolution, we can reduce sexual transmission of HIV,” said Mr Sidibé. “Let 2010 be the year when change begins and universal access to HIV prevention, treatment, care and support moves from rhetoric to reality.”

This third National AIDS Strategic Plan also sets the stage for a stronger National AIDS Control Council, which will guide an inclusive and broad coalition of advocates and stakeholders from different sectors of society in a more cohesive way.

Mr Sidibé’s attendance at the launch concluded his official country visit to Kenya. During the past five days, the UNAIDS Executive Director has met with key leaders in the country. He also took the opportunity to visit the Kibera slum where he met with women’s organization delivering HIV services under very difficult conditions. Inspired by their strength and resilience, Mr Sidibé saluted these powerful community members in his remarks at the launch of the strategic plan.

Participating in the launch in Nairobi were also Hon. Naomi Shaban, Minister of State for Special Programmers, Hon. Beth Mugo, Minister of Public Health and Sanitation as well as Ambassadors and heads of UN agencies.

Reducing sexual transmission of HIV is one of the nine priority areas in the UNAIDS Outcome Framework

Credit: WHO

According to a new study led by the World Health Organization (WHO), if HIV-positive pregnant women are given a combination of antiretroviral (ARV) drugs from late in pregnancy until six months into breastfeeding, rather than a short course of drugs that ends at delivery, their babies are over 40% less likely to become infected with HIV.

The initial findings of the study, named Kesho Bora, which means ‘a better future’ in Swahili, were presented at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention taking place in Cape Town, South Africa, 19-22 July. WHO worked in partnership with the French National Agency for Research on AIDS and Viral Hepatitis (ANRS), the US Centers for Disease Control and Prevention (CDC) and Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the US National Institutes of Health.

Carried out between June 2005 and August 2008, involving 1,140 women at five sites across Africa (in Burkina Faso, Kenya and South Africa), the purpose of Kesho Bora was to assess whether the risk of passing on HIV during breastfeeding could be reduced.

It shows that a significant reduction in infant infection can be achieved when pregnant women with a CD4 immune cell count of 200-500 cells/ mm3 are given a combination of three ARVs to prevent transmission: starting in their last trimester of pregnancy, continuing through birth and six months of breastfeeding. This was shown to reduce the risk of transmitting HIV to the baby and improved survival compared with babies of mothers with HIV who are given the current WHO-recommended short-course ARV regimen in late pregnancy and around the time of delivery.

The best results in the study were recorded in the group of mothers enrolled with a CD4 count between 200 and 350 cells/mm3. There is no increased risk to the health of the mother or the infant associated with this triple-ARV regimen, consisting of zidovudine, lamivudine and lopinavir/ritonavir. The study did not randomize women with CD4 counts below 200 cells/ mm3 as these women require treatment for their own health. That treatment also substantially reduces the risk of transmitting HIV during breastfeeding.

The issue of breastfeeding is a crucial one for pregnant women living with HIV. In many developing nations they have a tough choice: either breastfeed their babies and risk transmitting the virus through their milk, or give them formula. The latter deprives infants of the natural immunity passed on through breast milk which helps protect against diarrhoea, malnutrition and other potentially deadly diseases. Sanitation can also be an issue, with a scarcity of clean water with which to mix the formula and, in any case, many may not be able to afford to buy it in the first place.

Preventing mothers from dying and babies becoming infected with HIV is one of the nine priority focus areas for UNAIDS and its Cosponsors under the Joint action for results: UNAIDS outcome framework 2009-2011.

Michel Sidibé, UNAIDS Executive Director, has championed this priority and said during a recent visit to Lesotho in Southern Africa, “Strengthened services for maternal health, for reproductive health and for paediatric health will mean we can prevent mothers from dying and babies from becoming infected with HIV in Lesotho and around the world.”

The findings from the Kesho Bora study will now be considered by WHO experts, along with other recent data, and the 2006 WHO recommendations on the use of ARVs in pregnant women and on infant feeding and the prevention of mother-to-child transmission will be reviewed in the context of this new evidence. Updated guidelines are expected to be published before the end of the year.

It is clear that this research increases the range of treatment options available to mothers living with the virus and offers them hope that, if they so wish, they have a greater chance of breastfeeding their babies without passing on HIV.

Additional funds for the Kesho Bora study were provided by the European and Developing Countries Clinical Trials Partnership, the Thrasher Foundation, the UK Department for International Development, UNICEF and the Belgian Government.

Credit: The World Bank

Transport corridors in sub-Saharan Africa, as elsewhere, enable movement of people and goods, increasing economic activity and spreading wealth. But they also facilitate the spread of HIV. In response, the Africa Transport Sector of the World Bank has published a practical new booklet on how to implement HIV prevention activities as part of road construction projects.

The booklet, The route to good living: An overview of roles and responsibilities for HIV prevention strategies in transport sector projects, shows just why this matters. Numerous studies find relatively high HIV prevalence in this sector, especially among long-distance truck drivers. Several have shown that truckers in Kenya, Rwanda and Uganda were more than twice as likely to be living with HIV as the general population.

Many transport workers spend weeks or months away from their families, and often have multiple sexual partners, which can facilitate the spread of HIV. In Nigeria, for example, one study documented each driver having more than six sexual partners at various stops along his route. This means that people living in and around major transport hubs also have increased vulnerability. In Kenya, along the Trans-Africa Highway, high risk behaviour has been reported among boys and girls visiting truck stops and incidence of sexually transmitted infections was documented in 50 percent of the girls and 30 percent of the boys.

Credit: The World Bank

The route to good living highlights practical steps that can be taken to prevent new infections among transport workers and roadside communities, with special emphasis on road construction works. It summarizes ‘do and don’ts’ for transport ministries, World Bank teams, contractors, consultants, country project units, donors and NGOs when designing and implementing such projects. An overview of the roles and responsibilities of each set of actors within the project cycle is provided: from identification to preparation to implementation and, finally, completion. An HIV prevention strategy should be not an afterthought but an integral part of the undertaking.

The booklet is the latest addition to the information and tools available on the World Bank Africa Transport Sector's AIDS web site.

Promoting HIV prevention in the transport sector is a key component of the overall AIDS response
Credit: The World Bank

It is the result of the sub-Saharan Africa Transport Policy Programme (SSATP) encouraging discussions and collaboration among a range of partners, including the Bank, to provide concrete support in dealing with HIV. The SSATP, a unique partnership of 35 countries, eight regional economic communities, three African institutions (including the African Union/New Partnership for Africa's Development) and international partners recognizes the importance of the transport sector in achieving its goals of reducing poverty and promoting economic growth and regional integration.

In order for the transport sector to fulfill its pivotal role, the potentially devastating effects of the AIDS epidemic must be effectively challenged. The route to good living provides a concrete guide to help achieve this goal

Participants at Global Citizens Summit to End AIDS which took place in Nairobi, Kenya from 27 to 29 May 2009. Credit: Global Citizen Summit 2009

Leonard is the father of five daughters, one of whom, recently turned 14, was born HIV positive. In addition to juggling with the responsibility of raising a family of girls, Leonard is becoming very concerned about the new challenges he’s facing with having a positive teenage girl at home. “She is growing and as a father, I must help her grow into a mature and responsible woman. How should I talk to her about sex given her HIV positive status without instilling a sense of guilt? I do not find the guidance to help me respond to her needs,” he said.

This question was one of many others at the core of the Global Citizens Summit to End AIDS which took place in Nairobi, Kenya from 27 to 29 May.

The Citizen’s Summit was organized by a determined group of civil society, including Africa CSO Coalition against HIV&AIDS, Asia People’s Alliance for combating HIV&AIDS, Africaso, Eanaso, Heard, Cegaa, OXFAM, ActionAid, the UN Millennium Campaign, Healthlink World Wide, Panos and Pamoja. The idea stemmed from the observation that there is a growing gap between the needs of the people at the forefront of the epidemic and the response that is offered at the global level.

(from left) Leonard Okello of ActionAid, Salil Shetty, and Alloyce Orago of NACC during the official opening of the 2009 Citizens Summit Credit: Global Citizen Summit 2009

Addressing an audience of over 250 front line practitioners, Leonard Okello, who heads ActionAid’s HIV and AIDS unit, said: “We are meeting here at a time when the world is witnessing an increasing sense of AIDS fatigue, and witnessing serious global crises: food, climate, financial and emerging epidemics. A time when there is a big global debate on AIDS funding versus health funding and we, the people at the frontline of the AIDS response, are not on the debating table”.

During the three days meeting, the participants from grass root communities, networks of people living with HIV, faith based groups and other civil society groups came together under the umbrella of the Summit’s title “Reclaiming our Role in Universal Access” to share their experience at the front line of the response to AIDS. Their objective was to learn from their peers how they can better support people living and affected by HIV in their communities and where they can find support and guidance. The Summit was also an opportunity for them to consolidate in a roadmap the challenges that communities are facing on the road to universal access and how they could contribute to overcome them.

Representing UNAIDS at the Summit, Elhadj Amadou Sy, Deputy Executive Director ad interim, spoke of the importance of the communities’ role in scaling up towards universal access and reaffirmed UNAIDS commitment to support them in their constant and tireless efforts in the AIDS response. Referring to UNAIDS Outcome Framework for 2009-2011, he reiterated UNAIDS commitment to stand by people living and affected by HIV and to enable them to demand change in governance, legislation and policy to support a response that works for them.

Building on their previous advocacy experience in 2005 which led to the G8 commitment made in Gleneagles to move as close as possible to universal access to HIV prevention, treatment, care and support by 2010, ActionAid is planning to use the Summit’s roadmap to create a new impetus for demanding the right to universal access to prevention, treatment, care and support. At the Summit, ActionAid also launched STAR, a human rights based social mobilization methodology aiming at enabling and empowering communities to protect themselves from HIV infection and to demand their rights to prevention, treatment and care.

The Joint Annual Programme Review process is a vital tool in the global effort by governments and development organizations to ‘make the money work’ Credit: UNAIDS/P.Virot

HIV prevalence in Kenya has halved in a decade – a dramatic and sustained decline rarely seen elsewhere in Africa. The Government aims to continue this level of progress by ensuring that the national response to the epidemic is as coordinated and collaborative as possible, and that funding is spent effectively.

In recent years, as national responses to and funding for AIDS in many countries have become more complex – with more activities, stakeholders and donors than a few years ago – coordination has become an even bigger challenge.

Kenya decided to support coordination by conducting Joint Annual Programme Reviews, which bring together a wide range of people working on AIDS to take a comprehensive look at the overall national response. The Joint Review process is led by the national Government and involves participation at all government levels, as well as by civil society organizations, networks of people living with HIV, local and district authorities, and international donors and organizations.

“Joint Reviews of National AIDS Responses: A Guidance Paper”.

With the lessons learned from the Joint Review processes in Kenya and other countries, UNAIDS has developed a new publication entitled “Joint Reviews of National AIDS Responses: A Guidance Paper”. It aims to help countries conduct Joint Reviews and improve coordination, implementation and funding effectiveness among the many stakeholders involved in national responses.

Well carried out Joint Reviews provide a truly nationally-led forum for sharing information, achievements, shortfalls, challenges and emerging issues, and assessing how well efforts and spending are aligned in meeting the goals of the national AIDS strategy.

Kenya has undertaken in 2007 the 6th consecutive Joint Review of its national response and the process has become a valued method for building bridges and coalitions among the many groups involved in the AIDS response.

With the lessons learned from the Joint Review processes in Kenya and other countries, UNAIDS has developed a new publication entitled “Joint Reviews of National AIDS Responses: A Guidance Paper”.

Kenya’s 2007 Joint Review lasted two and a half months and involved hundreds of participants – not a quick or easy process, but well worth the effort. The Review is widely recognized by those working on AIDS as a platform for bringing together data from a range of sectors and levels, including surveillance and service delivery data, as well as qualitative data collected at the community level. The 2007 Review was more inclusive than ever, with participants from all 71 districts and nine regions of the country. The findings and recommendations were used to revise the way the country measures the results of AIDS programmes, and also to inform planning at district and regional levels. The effort of doing regular participatory joint reviews has resulted in more alignment, collaboration and commitment among the many organizations involved in the Kenyan AIDS response.

Anatomy of a Joint Review

The new Guidance Paper gives specific advice for conducting a successful Joint Review. However, just as every country’s AIDS epidemic and response is different, the Joint Review process in each country will differ according to the national political environment, health and social policies, infrastructure, economic development and other factors. Nonetheless, the Guidance Paper lays out several principles which should help build a strong Joint Review process in any country, including:

1. national ownership
2. inclusion and participation
3. commitment to results – participants must agree from the outset to subscribe to the recommendations of the Review
4. impartiality
5. evidence informed
6. enhancing national planning
7. sensitivity to gender and human rights.

The Joint Annual Programme Review process is a vital tool in the global effort by governments and development organizations to ‘make the money work’ – ensuring that all AIDS funds are linked to national objectives and simplifying aid structures. In Kenya, for example, the Joint Review process has helped to strengthen donors’ confidence in the quality and effectiveness of national programmes.

The new Guidance Paper on Joint Reviews, along with other related tools, is designed to help countries unite the many stakeholders involved in the AIDS response, in order to increase understanding of the epidemic and work collectively to achieve results.

Yvonne Awuor, a volunteer home-based
care provider with Women Fighting AIDS in
Kenya (WOFAK) takes a bicycle taxi to visit
her clients in remote villages.
Credit: WOFAK

Before she sets out to visit her client Ms. Heluda in Kisian, Yvonne prepares a bag with a towel, multivitamin tablets, over-the-counter painkiller tablets, a packet of porridge flour, liquid detergent, hand gloves and soap. Then, she takes a bicycle taxi to Kisian village, 12 km away.

On her arrival at Ms. Heluda’s home Yvonne is met by three young children who are not in school today because their mother was too sick to get up this morning and has been too weak to cook for them, she is HIV-positive.

Yvonne Awuor is a volunteer home-based care provider in Kenya with WOFAK (Women Fighting AIDS in Kenya) an organization founded by women to give support and reach out to other women experiencing discrimination as a result of being affected by or infected by HIV.

Yvonne talks with Ms. Heluda and makes the fire to prepare porridge for her and the children. She then helps her to take the cup of porridge, perhaps her only food intake that day and bathes her face, hands, feet and body. She applies massage oil and massages her feet, hands and shoulders. After chatting with her about the importance of taking care of herself and the need to take her HIV medications so that she will get stronger, Yvonne later returns to town by bicycle taxi, promising to visit again in three days time.

Home-based care ensures a continuum of care for people living with HIV who have left hospital and returned home. It offers a holistic approach often including palliative and spiritual care. However, in most areas, providing care for people living with HIV would be far more difficult and in many cases impossible without a bicycle.

“We use bicycles in Kisumu because it is the cheapest means of transport for our caregivers. We also use the bicycle as it offers a more convenient way of reaching remote places within our area”, says Dorothy Onyango, Director of WOFAK. “In many cases, our caregivers are one of the best sources of hope and inspiration for the sick person and the family members. Such visits are therefore received with joy,” she added.

Home-based care volunteers from Okathitu
Parish, part of the Anglican AIDS
programme in the country (2006).
Credit: BEN Namibia

In Namibia, the non-governmental organization Bicycling Empowerment Network (BEN) was set up to respond to the need for affordable transport by providing bicycles and maintenance training to home-based care volunteers. Through field research they found that in this vast country rural Namibians have extremely poor access to emergency medical transport and that the cost and non-availability of transport has a particularly negative impact on adherence to antiretroviral treatment for people living with HIV.

“Bicycles benefit the caregivers, clients and their families,” says Michael Linke, Director, BEN Namibia.

In urban settings with good roads, bicycles can increase the range and carrying capacity of people by four or five times compared with walking. Even on un-tarred rural tracks a bicycle carries up to four times the weight, goes twice as far and travels twice as fast as a person walking.

However according to Linke a bicycle is much more than a practical mode of transport.

“Both volunteers and clients have told us that their sense of pride in the home-based care service increases when the volunteer has a bicycle to make her visits. We didn’t expect that a bicycle would also affect the clients’ perception of the services.”

In addition to bikes for delivering home-based care, BEN Namibia has also purchased 93 bicycle ambulances to take people over what are often long distances to the nearest health clinics and so improving access to healthcare for people living with HIV.

In countries like Kenya and Namibia the volunteers who bring home-based care services to people living with HIV form the backbone of the response to AIDS. Bicycles are playing an important role enabling them to visit clients more often, spend longer with them, deliver more supplies including antiretroviral treatment, and reach more distant locations.

Research in many African countries
indicates higher HIV prevalence among
men who have sex with men and higher
incidence rates from male to male sexual
activity compared to the general
population.

“Like many gay men in Kenya I am married,” said Peter (not his real name) a taxi driver in Nairobi who was busy ferrying partygoers to and from the third party attended by several hundred gay-identifying men and their friends to be held in the Kenyan capital in the last six months.

“We have to hide our sexuality from the rest of society. It’s not like in Europe. But I have a good life, good family, and good friends and really I cannot complain.”

Peter, who has two young children and has always lived in Nairobi, decided to work rather than attend the party held just outside the city centre: “I would have liked to be at the party but we have had fewer visitors to Kenya this year and I need the money. It is fun to be in an environment when you can relax knowing that everyone is the same. There is no way that people can be themselves like that in the bars in town”.

“Sometimes a bar does become popular with a gay crowd but then, a point will come that the bar owner will ask them not to come back because he is afraid of the law and afraid that people might think he is also gay.”

The latest party in the fledgling Nairobi scene was organized on the eve of the International Day against Homophobia. In addition to providing an opportunity for dancing and socializing it also provided space for support groups to distribute HIV prevention information and safer sex packs including condoms and lubricants to a group of men often described by public health officials as ‘hard to reach’.

The following day, the Kenya Human Rights Commission, the International Gay and Lesbian Human Rights Commission and the Gay and Lesbian Community of Kenya booked a half page advertisement in a leading national newspaper promoting the International Day against Homophobia and rights for gay and lesbian people in Kenya.

Despite signs that gay and other men who have sex with men (MSM) are better organized and more visible than ever before in both Kenya and the rest of the continent the words ‘overlooked’ and ‘sidelined’ are currently being used to describe the HIV epidemics that are thriving unchecked among men who have sex with men across sub Saharan Africa.

Research in many African countries indicates higher HIV prevalence among men who have sex with men and higher incidence rates from male to male sexual activity compared to the general population. Furthermore consistently higher levels of infection among men who have sex with men and formidable cultural, social and legal barriers, combined with high levels of stigma and discrimination and the need to address AIDS within the general population, have inhibited the provision of MSM-targeted HIV prevention, care and treatment services.

Various African research projects and
initiatives indicate that many men who
have sex with men in Africa also have
female sexual partners and do not
necessarily identify themselves as gay.

In order to address this situation, the Kenya National AIDS Control Council co-hosted a meeting with the Population Council in May 2008 to bring together researchers, advocates and national AIDS programme managers from other African countries to review the status of research and evidence around HIV and men who have sex with men in Africa.

Opening the meeting Professor Miriam Were, Chairperson of the Kenya National AIDS Control Council, recognized the many social and cultural challenges involved in addressing the increased HIV risk of male to male sex and encouraged participants to face facts and develop constructive responses to address HIV among men who have sex with men.

Evidence on HIV prevalence, risk and behavior within groups of men who have sex with men was presented from several studies in Kenya and studies from Namibia, Uganda, Tanzania, Nigeria, Malawi and South Africa.

Meeting organizer and Associate with the Population Council, Scott Geibel, said: “In recent years there has been an increase of research focusing on the HIV needs of African men who have sex with men. The research is helping stimulate an increase in programmatic responses. In Kenya we particularly appreciate that the National AIDS Control Council has considered our research results and allowed it to inform their decision and policy making”.

“Through sharing lessons learned with other African National AIDS Programmes we hope to see an acceleration of targeted HIV responses for men who have sex with men in the region.”

In April 2008, the Open Society Institute in Southern Africa (OSISA), OSI’s Sexual Health and Rights Project (SHARP) and John’s Hopkins Bloomberg School of Public Health, hosted a meeting in Cape Town, South Africa, of organizations working on research and advocacy on HIV prevalence among men who have sex with men in Botswana, Namibia, Malawi and South Africa.  

The OSISA/SHARP research partnership was initiated in response to the lack of funding and programmes addressing access to HIV prevention and AIDS treatment services targeting MSM despite overwhelming anecdotal evidence that MSM are a high risk community within the region. 

The meeting was intended to evaluate community based studies, managed by national organizations of men who have sex with men, assessing HIV-related risk behaviors and describing the epidemiology of HIV infection among black MSM in urban sites in the four focus countries.

“Stigma and discrimination, even among
AIDS programmers and policy makers,
remains a real barrier to scale-up,” said
Andy Seale, Senior Regional Adviser for
UNAIDS Regional Support Team East
and Southern Africa.

In addition to revealing higher levels of HIV, other key themes emerging from the various African research projects and initiatives indicate that many men who have sex with men in Africa also have female sexual partners and do not necessarily identify themselves as gay.

In all studies, unprotected receptive anal sex was reported as highest risk for HIV transmission. Reported condom use, although often higher than sexually active heterosexuals, was often inconsistent and remains relatively low.

Andy Seale, Senior Regional Adviser for UNAIDS Regional Support Team East and Southern Africa, said: “Despite strengthening evidence that men who have sex with men are disproportionately affected within the generalized and hyper endemic HIV epidemics of Africa there is still poor targeting within national strategic AIDS plans and through programmes and services.

“Stigma and discrimination, even among AIDS programmers and policy makers, remains a real barrier to scale-up.”

Health Development Networks and SAFAIDS (the Southern Africa AIDS Information Dissemination Service) have been hosting an e-forum among AIDS practitioners in Southern Africa entitled ‘Sidelined in Prevention’ to identify barriers to scale-up.

“The discussion so far has been illuminating – during the first few weeks several postings were made anonymously by people fearful of being associated with work focused on men who have sex with men and those who feel unable to engage with the issue on religious and moral grounds,” said Seale.

The e-forum has mobilized a useful exchange between AIDS practitioners and LGBTI organizations (lesbian, gay, bisexual, transgender and intersex) with the sharing of tools, resources, strategies and approaches including to scaling up targeted prevention at a community level.

“Clearly we still have a long way to go – we need to put aside tensions between public health and rights based approaches and any personal issues around morality. All of us in the region working on AIDS should ensure that all people – regardless of their sexual preferences - are able to access the prevention, care and treatment services they need,” said Seale.

In the run-up to the International Women's Summit on Women's Leadership on AIDS, the Global Coalition of Women and AIDS's (GCWA) leadership council convenes its third meeting in Nairobi on 3rd July 2007 to examine evidence of what is happening at country level for women and AIDS.

The GCWA leadership council is made up of AIDS activists with a wide range of personal experience and professional expertise from 25 countries around the world. Advocates for the need to develop and implement AIDS programmes specially tailored to respond to the needs and challenges faced by women all over the world, the leadership council memebers will exchange information and experience on strategies that are working for women and areas where increased action is needed. The meeting will also lay out a vision for the GCWA as it moves forward.

The UNAIDS-led Global Coalition on Women and AIDS was established in 2004 to respond to the increasing feminization of the AIDS epidemic and a growing concern that existing AIDS strategies did not adequately address women’s needs.