1. Comprehensive HIV/AIDS Programming for Refugee/Mobile populations Turkana District Experience Dr. Dan Koros - IRC

2. Objectives Briefly describe components, structure and implementation of a comprehensive HIV/AIDS program amongst Refugees and pastoralist communities residing in Turkana District. Reflect on the lessons learnt, challenges and how they can be adopted in other settings.

3. Context Kakuma Refugee Camp –A population of 63,000 people. –Established in 1992. –Diverse cultures with people from 9 different nationalities. –Free interaction with members of the local community and across the borders.

4. Context ctd.. Turkana Community –Covers an area of 477,000 sq. km. and a population of 517,000 people. –We cover 4 main areas in Turkana District namely, Lodwar town, Kakuma Division, Kalokol Division and Lokichogio Division (estimated population of 200,000). –Nomadic pastoralists’ community. –Harsh weather conditions. –Long standing conflict with neighbours.

5. Unique features of the targeted population Highly mobile Always in some forms of conflict with neighbouring communities. High levels of poverty Adverse weather conditions. Vast geographical locations. Poor or absent government infrastructures.

6. Program Goal To increase the capacity of the health system, communities and partners to prevent HIV transmission and to provide high quality care and support services for people infected with HIV/AIDS in Turkana District.

7. Programming areas HIV prevention education services Counselling and Testing TB/HIV co-infection and STI control services Blood and injection safety program Prevention of Mother-to-Child Transmission (PMTCT) services Comprehensive HIV/AIDS care including ARV provision Home Based Care

8. Programming strategies – General Holistic approach Working through local partners and MOH Evidence–based approaches through regular assessments, KAP surveys and PRA

9. Programming strategies - prevention IRC BCC strategy “Families matter” approach for teenage children. HIV prevention activities targeting school and out-of school children.

10. Programming strategies - CT Client Initiated Counselling and Testing (CICT ) –Facility –based CICT –Mobile VCT –Home-level VCT Provider-Initiated Counselling and Testing

11. Programming strategies - PMTCT Integrated in to the routine ANC Utilizes the existing MOH protocols (Niverapine single therapy, dual therapy and triple therapy). Provision of infant feeding options.

12. Strategies – Comprehensive Clinical care Provision of Basic Care Package (BCP) Provision of ARVs Procurement and Installation of a CD4 machine to serve the entire district.

13. Selected results - PMTCT 200420052006 Women enrolled in ANC (1 st consultation) 2,8613,2333,585 Number of pregnant women tested 3,8673,7623,585 Number of positive tests604918 HIV prevalence among ANC mothers 1.6%1.3%0.52%

14. VCT data (Jan – July 07) Number of Persons Accessing Mobile VCTs Percentage of VCT Clients Reached through Mobile VCTs Lokichoggio1,03678.2% (1,036 of 1,324) Kalokol43566.4% (435 of 655)

17. Conclusion It is possible to successfully implement a comprehensive HIV/AIDS programming among mobile and conflict affected populations. Need to use evidence-based approaches to yield better results. Benefits from partnerships with local organizations. THANK YOU