Juliana Odindo

PHDP: A new way of thinking A broader, more holistic, human rights-based approach Emphasizes policies and programs that are designed and implemented with the meaningful involvement of PLHIV; treat PLHIV humanely and with dignity; Provide people with knowledge, skills, social and legal support; and focus on the holistic health and related needs of PLHIV, Have a higher chance of being accepted, implemented, likely to be more effective than “ Positive Prevention”.

Operational Research Need for tangible evidence to inform policy and programmes to respond to evolving needs of YPLHIV, Need to explore the implications of the PHDP within the framework of Access, Services & Knowledge ( ASK) as they relate to SRHR of young people living with HIV Findings will help advance the understanding of the YPLHIV networks of PHDP, improve interventions, advocacy for policy change and improved services Empower YPLHIV, build their confidence and empowerment for better engagement, prevention, care and support..

Background to the Survey Complex conventional challenges facing young ppl with Prenatally acquired HIV, YPLHIV have reproductive and sexual health needs Need to exercise their freedom of choice on matters of SRH Need to identify gaps and opportunities in the current policy and programmatic interventions targeting YPLHIV

PHDP Components Health promotion and access Sexual and reproductive health and rights Prevention of transmission Human rights, including stigma and discrimination reduction Gender equality Empowerment Social and economic support Measuring impact

Study Aims Assess extent to which PHDP features in the lives of YPHLIV in Kenya Determine whether YPLHIV treated with dignity and respect report higher satisfaction in adherence to treatment, care and support, reduced stigma and knowledge of rights to access relevant services, Provide baseline information for measuring effect of future advocacy interventions to promote a PHDP approach ( information to empower YPLHIV to be at the centre of the response.

Data Collected From … Three regions: Nairobi, Western and Mombasa) Target Counties: Kisumu, Kakamega, Mombasa, Kilifi, Nairobi counties, 270 YPLHIV aged aware of their HIV sero-status diagnosed at least 6 months prior to interview willing, able to participate + parental consent when necessary

Respondents were mainly … Urban-based (77%) Heterosexual (76%) Christian (72%) Single – never married (82%) Primary school educated only (48%) In school (47% - vs. 24% in employment) Orphaned at an early age (37%)

Health Promotion and Access The good news ( ) Strong perceptions about personal health improvement since diagnosis + improvement of health services High levels of knowledge about, access to, and use of treatment

The bad news (  ) Only 67% got both pre- + post-HIV counseling at first HIV test 20% either didn’t know CD4 count or didn’t get results – Of these, 15% refused to indicate why 8% had shared their ARVs with someone else 24% would rather only visit CCC when they feel sick

Barriers to Accessing Treatment

Sexual and Reproductive Health and Rights The Good News ( ) Largely positive SRHR messages being conveyed to YPLHIV by health providers – sex life, partner choice, right to sex, vaginal deliveries, contraceptive choice beyond condom, etc. Some conversation on less conventional topics – dating, pleasurable sex, sexual problems, pregnancy termination, etc.

The bad news (  ) High unintended pregnancy rate among YPHIV in Kenya, yet: 38% heard no msgs about pregnancy prevention 81% heard no msgs about pregnancy termination 45% heard no msgs about use of substances and sexual intercourse

Prevention of Transmission The good news ( ) Encouraging condom use at last penetrative sex (72%) High sense of personal responsibility in regard to sexual encounters and prevention 77% had not acquired any STIs since HIV diagnosis

The bad news (  ) Sense of ‘shared responsibility’ for prevention low (18%) No condom use at last sex (non-use or couldn’t remember): 22%  STIs (15%) Disclosure to last sexual partner – ‘No’ (36%) – ‘Don’t remember’ (18%) – 55% concerned partner will leave them if they disclose, or aren’t sure partner won’t leave 47% used substances in the last year – Of these, 36% had access to drug rehab program

Human Rights (including stigma & discrimination reduction) The good news ( ) Majority are convinced they would receive support if they disclosed their status (76%) YPLHIV are most likely to disclose to health providers, family, and partners 42% report having access to free legal services 50% know their rights as PLHIV

The bad news (  ) 16% experienced discrimination in last 12 mo Of these 72% took no action despite high reported access to free legal services 72% don’t know of any law in Kenya protecting PLHIV from discrimination 50% don’t know their rights as PLHIV

Gender Equality The good news ( ) Openness by both sexes to report on the sensitive issue of intimate partner violence (IPV): 60% 39% took some form of action – mainly just talking to someone (13%)

The bad news (  ) Female YPLHIV much more likely to experience various forms of IPV than male counterparts (so, not so ‘equal’) Older YPLHIV (20-24) more likely to experience IPV than younger peers (12-19) 83% took no action 2% took legal action, sought social protection, sought help from civil society

Empowerment The good news ( ) 71% see networks of PLHIV as very important About half belong to a group/association, with 52% of these providing support to other PLHIV Moderate knowledge of organizations/groups providing support to PLHIV (67%)

The bad news (  ) No single YPLHIV knew about departmental or national HIV and AIDS committees or councils in Kenya  poor access to this important level of decision-making among YPHIV

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