1. HIV Risk Behavior, Risk Perception and Experiences
in Accessing HIV and Sexual Reproductive Health
(SRH) Services among Adolescent Key Populations
in Kenya. A Situational Analysis
Presented by:
Annrita Ikahu
LVCT Health, Kenya
, 13:00-14:00
Getting on with #Adolescents“ IAS 2017

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Background
Adolescent deaths resulting from HIV continue to rise
17% of all AIDS related deaths in Kenya are among adolescents and youth (HIV Estimates 2014)
29% of all new HIV infections were among adolescents & youth (HIV Estimates 2014)
Low levels of HIV knowledge (17.4% for adolescents aged 10-14yrs) (KAIS 2012)
Low condom use among 15–24yrs (11% among female & 43% among males) (KAIS 2012)
Sexual debut among young women generally occurs in the age group 15 to 19 years (KAIS 2012)
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Question
What are the perceptions of adolescent key populations on their HIV risk and what are their experiences as they seek HIV and SRH service?
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Methodology
Primary data collection: IDIs, KII and FGDs
Sites: 3 counties- Kisumu, Nairobi, Mombasa
Sampling: Purposive sampling of counties and participants
Study populations:
Adolescents (10 – 19yrs) reporting; same sex intercourse among boys, adolescents injecting drugs and females engaged in sex work
National and county level policy makers
Health service providers
Key populations programme implementers
Ethical clearance was provided by AMREF Africa Ethics Review Committee (ESRC P212/2015)
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5. Profile of participants
Demographic characteristics
Adolescent boys who have sex with boys and men
Adolescent female sex workers
Adolescents who inject drugs- female
Adolescents who inject drugs- Male
Age
10-14 years 2
15-19 years 36 35 14 21
Mean age (Yrs) 17 18
Current level of Education
Primary 6 20 10 12
Secondary 15 4
Tertiary 9
Number of children 8 16 1 5
Marital status
Single 33
Married
Separated 3
Mean age of all participants was 17 years
Participants were identified in collaboration with KP organizations and snowballing used to reach additional participants
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6. Reasons for entry into risk behaviour
Results
Reasons for entry into risk behaviour
Entry into injecting drugs: parental influence, peer pressure, involvement in drug business, idleness, unemployment and poverty, one time ‘tasting’.
Reported age of entry: 14 to 17 years of age
Drug use made them drop out of school
Engaged in sex work to finance addiction
Female Sex work: peer pressure, poverty, history of sexual abuse, dropping out of school, pregnancy
Reported age of entry: 10 to 17 years of age
Male sex work (among boys engaging in same sex): poverty, school drop out, escape from home
Reported age of entry 10 to 14 years
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7. Risks and fears of adolescent KPs
Results
Risks and fears of adolescent KPs
Fears of SW: pregnancy, HIV/STI, SGBV from clients & police
“I fear getting a client who can mistreat me or physically abuse me”. NAI.ASW.FGD.001
Fears of boys engaging in same sex behavior:
arrest by police, condom bursts and getting infected with HIV, Hepatitis and STI infections.
Those whose family members did not know of their practice mentioned that being discovered was their main fear.
Factors affecting condom use:
SW: Monetary, lack of access to condoms, violence & inability to negotiate condom use
MSM: monetary benefits, being in love with sexual partner and knowledge of partner status, violence
IDUs: duration of knowledge of sexual partner, soberness
“Money can make you use or not use condoms because some client may come with a lot of cash and when you look at your life you are poor, so it forces you to have sex” MSA.ADU.IDI.002.
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8. Adolescent KP perspectives on their
multi-sectoral needs
Adolescents PWID
Adolescent MSMs
Adolescent sex workers
Health services
Rehabilitation
Access to clean needles and Syringes
Access to methadone
Health talks
HTS and treatment
Prevention of HIV and STI
Prevention of HIV and STI 
Education
Being taken back to school
Nutrition
Food for them and their children
Economic empowerment
Income Generating activities (IGAs)
IGAs
Security
Protection from harassment by general public
Protection from harassment by police
Protection from harassment and arrest by police
Stigma and discrimination
Protection from stigma and discrimination
Information on dating and relationships
Social networking
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9. Recommendations for programming
priorities
Address legal and policy environment that limit the adolescent KPs human rights and access to services
Promote legal protection from abuse, violence & sexual exploitation including by law enforcement
Reduce barriers to accessing heath services e.g. age
Increase access to legal information & services
Increase access to adolescent KP programs & service delivery , ensuring their accessibility and affordability.
Adolescent friendly services with input from adolescents
Train providers to reduce judgement, stigma & discrimination
Update and provide services as per KP guidelines
Deliver prevention interventions in communities, schools to minimize risk
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10. Recommendations for programming
priorities
3. Strengthening strategic information and research
Develop systems for collecting & utilizing routine and surveillance data on adolescent KPs
Advocate for and include adolescents in research that affects them
4. Investment and funding for Adolescent KP programs and research
Increase funding from govt & donors for advocacy, research and programs for adolescent KPs
Investment in critical enablers to address structural inequalities and factors that increase vulnerability
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11. Recommendations for programming
priorities
5. Cross cutting elements
Multi-sectoral engagement
Education, police and legal, community, tourism, children’s department, agriculture, local administration, NACADA, religious leaders etc
Role of counties and national government
Involvement of adolescents
Empowerment and involvement in research and programs
Continuous community consultations
Advocacy
By adolescent KPs, KP organizations, CSOs, govt etc
For improvement of legal and policy environment & service delivery
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Acknowledgements
Ministry of Health (NASCOP)
KNBS (Kenya National Bureau of Statistics)
County governments of Nairobi, Mombasa, and Kisumu
The UN Joint Team on HIV/AIDS including UNICEF, UNAIDS,UNFPA, UNODC, WHO, UNDP
LVCT Health, Reachout Center Trust (RCT), MEWA, AHF-Kenya, ICRH, KASH, PEMA, Hapa Kenya,
DSW, NYARWEK, NACADA, GALCK, BHESP, Ishtar MSM, and SWOP
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