International Conference on AIDS and STIs in Africa ICASA ‘ Patients Not Criminals’ - Harm Reduction Responses and Policy Reform in Kenya By Dr. Sobbie Mulindi Deputy Director-Coordination & Support National AIDS Control Council Tuesday 6 th December, 2011, 17:30 – 19:00 ADDIS ABABA, ETHIOPIA

International Conference on AIDS and STIs in Africa ICASA What Does Kenya’s Epidemic Look Like? 1/3 new infections – MARPS KNASP III prioritizes interventions for MARPS, incl. IDUs Unknown whether IDU epidemic is growing but is perceived to be increasing New cases every month(program data) 60% injectors started last 6 months Lack national estimates for IDUs, no denominator data

International Conference on AIDS and STIs in Africa ICASA Kenya Context: Restrictive laws – criminalization of drug use High stigma and discrimination Perceived increase in female IDUs and youth Lower socio-economic status of most users High mobility among users Kenya Coast entry/transit point for drug trafficking

International Conference on AIDS and STIs in Africa ICASA Indirect needle-sharing Female users more vulnerable to sexual transmission with higher STI prevalence Overlap of sex work and drug use Front-loading and back-loading HIV Profile: Contextual & Risk Factors

International Conference on AIDS and STIs in Africa ICASA Data Sources National Surveys, sentinel surveillance, Size estimation exercises, research studies, etc. Routine HIS IBBS Special studies – PLACE study

International Conference on AIDS and STIs in Africa ICASA Achievements March 2005 – April 2011 Total Outreach 76,996 New contacts 38,718 Repeat contacts 38,278 VCT Referral46,040 VCT Tested26,831 HIV Care1,203 ARV560 Drug Treatment8,486 Out Patient5,513 In PatienT2,973 New Contacts breakdown DU31,308 PWID6,745 SW608 SW (Drug using)2,094 MSM154 Alcoholics299 Previous PWID336

International Conference on AIDS and STIs in Africa ICASA Gaps NSP Commodities Other commodities (bleach??, syringes, needles) MAT Review of policies and guidelines Implementation manuals, SOPs Enlisting buy-in into annual operational plans by Counties Capacity-strengthening – social services, health sector, media.... Community engagement and sustainable livelihoods

International Conference on AIDS and STIs in Africa ICASA Needs Expand the scope of interventions –NSP complement GFATM and PEPFAR Review regulations, Policies and guidelines to make them more friendly to IDU programs Strengthening community-preparedness for harm-reduction programs Need funds for outreach services (GFATM only covers training )

International Conference on AIDS and STIs in Africa ICASA Needs (2) Training police and law enforcement agencies Consolidate data to better inform programs Strengthening TB/HIV/IDU collaboration Provide IDU/MAT training Re-establish treatment centres – Mathare and Coast? Establish centres of excellence PWID-appropriate IEC materials Sensitize DHMT on IDU, harm-reduction …

International Conference on AIDS and STIs in Africa ICASA Response to Epidemic Country preparedness for sustained nationally-owned programs Program data available on current uptake of services Centers of excellence to be established

International Conference on AIDS and STIs in Africa ICASA Monitoring and Evaluation Strengthening M&E – National M&E database for IDUs Strengthen surveillance in the region for MARPS Mapping IDU sites Conduct surveys Operations research Size estimation – national protocol submitted to ERC Need output data to demonstrate program effectiveness

International Conference on AIDS and STIs in Africa ICASA Monitoring and Evaluation Review indicators, data collection, reporting tools and procedures for service delivery (facility-based and outreach) commodity management Include indicator to report on migrant MARPS and human rights Annual IDU review meetings Scientific conference Exchange programs

International Conference on AIDS and STIs in Africa CONCRETE ACTIONS ADVOCACY? ICASA New constitution promulgated August 27, 2010 First symposium on MARPs September 2010 All Members of Parliament sensitized on key populations Media, Faith Based Organizations, Judiciary and Criminal Justice Systems have been sensitized High Level Government delegation sent to Spain, UK, Vietnam and India – Best Practices Recent visit UNAIDS PCB to the country Cabinet Paper being developed

International Conference on AIDS and STIs in Africa ICASA