1. Implementing a violence prevention and response strategy for key populations in Kenya
Parinita Bhattacharjee, Giuliana J. Morales, Timothy M. Kilonzo, Robyn L. Dayton, Reuben T. Musundi, Janet M. Mbole, Serah J. Malaba, Bernard E. Ogwang, Shajy K. Isac, Stephen Moses and Helgar K. Musyoki

2. HIV and Key Populations in Kenya
Kenya has a mixed HIV epidemic
Key Populations (KP) in Kenya include Female Sex Workers (FSW), Men who Have Sex with Men (MSM) and People who Inject Drugs (PWID)
KP contribute to 33% of all new infections
High estimation of KP
FSW – 133,675 (76, 654 – 208,711)
MSM – 18,460 (9,660-32,886)
PWID – 18,327 (12,617 – 23,978)
High HIV prevalence among KP
NASCOP Kenya Kenya Most At Risk Populations Size Estimate
Consensus. Final Report. Nairobi: MoH
Source: IBBS, 2010; IBBS, 2011 and KAIS 2012

3. Snap shot of the Kenya KP Programme
Led by Ministry of Health (MoH) – National AIDS and STI control Programe (NASCOP) and National AIDS Control Council (NACC)
93 Implementing Partners adopt a combination prevention approach (biomedical, behavioural and structural) to implement KP programme
Funding through PEPFAR and Global Fund
Technical support through a technical Support Unit within MoH implemented by University of Manitoba with support from BMGF and LINKAGES
    FSW MSM PWID Contractual Targets CDC   GF   USAID     Others     Contribution (%)   FSW MSM PWID   CDC   GF   USAID   Others               Coverage vs estimation (%)     CDC   GF   USAID   Others    

4. Violence against key populations in Kenya
Physical, sexual and emotional violence against KPs in Kenya is common and frequently perpetrated by sex work clients, police, religious leaders, intimate partners and strangers
22% of FSWs, 14% of MSM and 12% of PWID experienced physical or sexual violence
48% of FSWs, 20% of MSM and 44% of PWID experienced police violence
Across populations, violence is fueled by gender inequalities, stigma and discrimination against persons perceived to depart from conventional gender and sexual norms and identities
The Kenyan legal system and county by-laws that criminalize behaviours related to sex work, same-sex sexual practices and drug use also legitimize violence, stigma and discrimination against KPs

5. Two-pronged strategy to address violence against KPs in Kenya
Goal Reduce the incidence of violence against KPs
Objectives
Improve violence reporting by KPs
Improve the response to violence for KPs
Improve the attitudes of police towards KPs and their rights
Violence Response
Train IP teams on violence support and creation of a violence response mechanism
Create awareness on violence and rights among KPs
Develop a network of support services, medical, psychosocial, legal, safe spaces, etc.
Document incidents of violence and violence response
Violence Prevention
Train selected police officers from counties as trainers
Sensitize police at the county level regularly
Conduct regular advocacy meetings with senior police officers in counties to give updates and build rapport

6. Data sources and analysis
Quarterly program monitoring data reported to NASCOP between October 2013 and September 2017 by 81 implementing partners
Data was aggregated annually and analysed using simple trend analysis. Further a chi square test was used to determine whether changes in violence reports and responses were statistically significant
Report of violence : A KP disclosing violence — such as sexual assault, physical assault, verbal abuse, discrimination, and arbitrary arrest — to a violence response team member via helpline, to a peer educator during outreach, or to a clinician during a facility visit.
Response to violence: A violence response team member, peer educator, or clinician providing first-line support to a KP who reports violence within 24 hours of receiving the report.  

7. Results: Program reach, reports of violence, and responses to violence by FSWs in Kenya, October 2013 through September 2017
Indicator
Oct 2013-
Sept 2014
Oct 2014-
Sept 2015
Oct 2015-
Sept 2016
Oct 2016-
Sept 2017
P value
Number of FSWs reached
67432
88327
113096
139041
Number of FSW reports of violence
4171
5341
11707
13496
Rate of increase in number of FSWs reached
1.0
1.3
1.7
2.1
Rate of increase in number of FSW reports of violence
2.8
3.2
Percent of FSW reports of violence out of those who were reached
6.2
6.0
10.4
9.7
P<0.001
Percent of responses to FSW reports of violence 53 65 74 84
P<0.0001
Reference year: Oct 2013 – Sept 2014

8. Results: Program reach, reports of violence, and responses to violence by MSMs in Kenya, October 2013 through September 2017
Indicator
Oct 2013-
Sept 2014
Oct 2014-
Sept 2015
Oct 2015-
Sept 2016
Oct 2016-
Sept 2017
P Value
Number of MSM reached
9118
12106
16680
26972
Number of MSM reports of violence
910
849
1026
1122
Rate of increase in number of MSM reached
1.0
1.3
1.8
3.0
Rate of increase in number of MSM reports of violence
0.9
1.1
1.2
Percent of MSM reports of violence out of those who were reached
10.0
7.0
6.2
4.2
P<0.001
Percent of responses to MSM reports of violence 44 77 86 80
Reference year: Oct 2013 – Sept 2014

9. Results: Program reach, reports of violence, and responses to violence by PWIDs in Kenya, October 2013 through September 2017
Indicator
Oct 2013-
Sept 2014
Oct 2014-
Sept 2015
Oct 2015-
Sept 2016
Oct 2016-
Sept 2017
P Value
Number of PWID reached
5856
7001
10990
14527
Number of PWID reports of violence
121
533
839
873
Rate of increase in number of PWID reached
1.0
1.2
1.9
2.5
Rate of increase in number of PWID reports of violence
4.4
6.9
7.2
Percent of PWID reports of violence out of those who were reached
2.1
7.6
6.0
P<0.001
Percent of responses to PWID reports of violence 37 48 89 97
Reference year: Oct 2013 – Sept 2014

10. Conclusion
The programmatic data from the national KP programme show that
reports of violence relative to individuals reached increased among FSWs and PWID but decreased among MSM
proportion of reports of violence that received a response increased among all KP groups
Monitoring violence against key populations is important to understand and measure experience of violence and support received. This can facilitate strong violence prevention and response mechanisms and policies in KP programme
Even in an criminalised environment, national government can take leadership in successfully addressing violence against key populations in partnership with stakeholders

11. Thank You Acknowledgement KP programme Implementing Partners in Kenya
All the peer educators and outreach workers from KP communities who provide support to KP victims of violence and build their confidence to report violence
Key Populations Technical Support Unit (TSU)
Partners for Health and Development in Kenya (PHDA)
Bill & Melinda Gates Foundation (BMGF)
U.S. Agency for International Development (USAID)
LINKAGES project implemented by FHI 360
Thank You