Scaling up Voluntary HIV Counseling and Testing services for Deaf Persons through capacity building in Ministry of Health sites in Kenya Presented by Victoria Kisaakye Kanobe, Regional AIDS Training Network, Nairobi, Kenya 10/21/20151 Developing Capacity for HIV & AIDS Response in East & Southern Africa –

Background Information to RATN Established in 1997 as a project funded by CIDA under the University of Nairobi RATN’s status changed in 2003 from a project to an International NGO 30 Member Institutions (MIs) and three (3) associate members in 11 countries: Kenya, Uganda, Tanzania, Zambia, Rwanda, Malawi, Zimbabwe, Lesotho, Swaziland, Botswana and South Africa 10/21/20152 Developing Capacity for HIV & AIDS Response in East & Southern Africa –

Focus of Training & Capacity Development Strengthened capacity for training institutions (under RATN membership) to develop and deliver training and/or manage quality gender sensitive HIV and AIDS prevention, care, support and mitigation programs. 10/21/20153 Developing Capacity for HIV & AIDS Response in East & Southern Africa –

Background to scaling up PWD HCT Services PWDs in Kenya are estimated at about 600, % of Kenya's total population where almost 11% are deaf/Hearing impairment (Kenya National Survey for Persons with Disabilities, 2008), They also experience barriers to accessing health information and services arising from restrictive cultural norms, stigma and prejudice This situation is compounded further with high levels of poverty, low literacy (about 3% globally), lows levels of education and low self esteem among PWDs & lack of mainstream HCT services targeting PWDs. RATN in conjunction with the Kenya Association of Professional (KAPC) counselors – one if its member institutions, chose to implement a project that aimed at: – scaling up access and increasing the involvement of PWDs towards accessing HIV/AIDS services, specifically the deaf through training for MOH staff and Deaf HCT counsellors. Developing Capacity for HIV & AIDS Response in East & Southern Africa – 10/21/20154

Training Focus Phase 1: HCT for the Deaf counselors (4wks) – Module 1: Introduction To Counseling And Disability (37 Hours) – Module 2: HIV And AIDS Information (5 Hours) – Module 3: HIV Care And Support (4 Hours) – Module 4: HIV Testing And Counseling Protocols (7 Hours) – Module 4: HIV Testing In HTC Programmes (21 Hours) – Module 6: Psychosocial & Contextual Issues In HTC For The Hearing Impaired (10 Hours) – Module 7: Legal, Ethical And Professional Issues In HTC Services For PWDS (7 Hours) – Module 8: Data Management In HTC Services (6 Hours) – Module 9: Group Counseling (6 Hours ) Phase 2: Training In Sign Language For HCT Counsellors (2 weeks) Developing Capacity for HIV & AIDS Response in East & Southern Africa – 10/21/20155

Intervention Design and Targets Training & Placement Ten (10) health workers (Male: 4, Female: 6) and Ten (10) HCT deaf counselors trained (Male:5 Female: 5) Placement in four health centres of Kariobangi North, Kayole 2, Dandora 2, and Umoja health Centres Disability friendly desks were established within the health care facilities, no PWDs had ever been counseled at the facilities Services were announced in the communities and mobilisation through peers Numbers Reached 4,187 people went through the VCTs in all four sites. – 432 (10.3% of the total clients attended to within the facilities) were Deaf clients of whom – 12 were HIV positive. The distribution was as follows: Kayole 2 Health Center Deaf clients of which 1 was HIV positive Dandora 2 Health Center Deaf clients of whom 7 were HIV positive Kariobangi North Health Center Deaf clients of whom 4 were HIV positive, Umoja Health Center tested 61 Deaf clients of whom none was HIV positive 10/21/2015 Developing Capacity for HIV & AIDS Response in East & Southern Africa – 6

Experiences and Comments from Health Workers “We really need deaf counsellors here. With their departure, we are denying the deaf clients a service they are already used to and, I don’t know what will happen when deaf clients who are already used to these services come in and fail to get them”… Female HCW “Through the deaf HTC counsellors, I have realized that there are many deaf clients around Kayole and I recommend that if there is something that can be done to retain them- the better. I feel at loss. It has been through interacting with them that I have continued to improve my Sign Language skills. We had taken them to be part of us and we will really miss them as we normally interacted during break and received extra tutorials in Sign Language”… Female HCW “…And with its inclusiveness, the project has been an eye opener as the deaf community in Dandora is now very confident with our facility with the knowledge that there is somebody who can assist them”… Female HCW 10/21/2015 Developing Capacity for HIV & AIDS Response in East & Southern Africa – 7

Experiences and Comments from Deaf HTC counsellors’ Comments …As interpreted by the Project Coordinator at KAPC “We appreciate the work that KAPC and RATN have done for the deaf and we feel privileged to have been selected to work for the Deaf community. We are also happy with what we have been able to achieve. By working at the health centres and helping the Deaf clients and patients we have learnt a lot about health issues such as family planning, TB etc in the process and we are better able to advise, guide and refer Deaf clients and patients. It was an opportunity for us to serve our community and it has helped us grow as persons and made us feel important and useful in the society”.....Male, Deaf HTC counsellor, Dandora 2 Health Center “I am concerned about the many illiterate deaf people who don’t understand the Kenyan Sign Language and who only communicate in our ‘mother tongue deaf language’, a language that only the Deaf understand. With such clients and patients, we have been walking them from department to department to assist them to communicate with the health workers including those who had been trained in Sign Language”.... Female, Deaf HTC Counsellor, Kariobangi North Health Center 10/21/2015 Developing Capacity for HIV & AIDS Response in East & Southern Africa – 8

Challenges Experienced Lack of enough counselling rooms in some Health centres right from the onset. Leading to a switching the counselling process amongst the hearing and deaf HTC counsellors. Transfer of some trained health care workers to other facilities while others were given leave during the project period or abseentism Some health facilities lacked the necessary equipment for the HTC work and the counsellors had to wait for a few days before the new supplies were received. The challenge of HCT counsellors in understanding the Deaf “mother tongue” sign language given that they had been given training on the Kenya sign language. 10/21/2015 Developing Capacity for HIV & AIDS Response in East & Southern Africa – 9

Key Lessons Learnt Not all the deaf can utilise the Kenyan Sign Language, others use the ‘mother tongue’ sign language to communicate especially those who have not gone to school. HCW need some insights on this language too. Most health care workers are not aware of the existence of the Deaf and Hearing Impaired people within the coverage of their health facilities. With good training and patience, the Deaf and hearing Impaired can make good HTC counsellors and that it is possible to improve client confidentiality by training health care workers in sign language and sign language interpretation. Also identified is the need for training on adherence counselling among the deaf counsellors and the need of deaf community health workers to attend to the deaf community and post test support groups and nutrition for the Deaf & Hearing impaired clients. 10/21/2015 Developing Capacity for HIV & AIDS Response in East & Southern Africa – 10

Conclusions Integration of deaf HCT services can increase uptake of HCT services and improved client confidentiality The best mode of mobilization is peer to peer mobilization and through the networks of NGO for PWDS Need to establish post test support groups for the Deaf & Hearing Impaired HIV positive people HCT training must be in line with the national HCT policies and with a strong component on how this service can be main streamed in the existing health structures if the services are to be effective The aspects of integrating the services that are disability friendly is crucial as well as establishing disability friendly services The deaf and hearing impaired person still have a sense of false security among them where if one tests negative yet a number have multiple and concurrent sexual partners among them 10/21/2015 Developing Capacity for HIV & AIDS Response in East & Southern Africa – 11

ASANTE SANA | MERCI Thanks for listening! And to KAPC and the Health Care facilities in Kenya where the project was implemented 10/21/2015 Developing Capacity for HIV & AIDS Response in East & Southern Africa – 12