1. Building Partnerships, Transforming Lives Increasing Access to HIV Services – Case of LVCT Nduku Kilonzo, PhD Executive Director Acknowledgements: Stephen Lewis Foundation; CDC; LVCT colleagues; disability programme

2. 2 LVCT – an indigenous Kenyan NGO country led, country managed, country priorities Quality assured HTC VCT; home-based, mobile, workplace, couple HTC; 526,000 tested in 2011 Linking testing to care/ART /SRH models for effective linkages & retention Vulnerable & at risk populations MSM/Prisons (since 2006) - 26,000 tested ; Disability - 25,000 tested through award winning Deaf VCT; Youth - one2one youth hotline - PPP with Safaricom (Kenya’s largest telcoms co. – 3,000 monthly calls); 1.6M youth tested; GBV/Post Rape Care: 15,000 survivors seen

3. LVCT - inputs 3 Facilita- ting scale up Systems streng- thening TA for policy reforms (GoK) Research/ Piloting -innovation -new service delivery models Coverage - access, equity (in both delivery and uptake); Strengthened health systems; New knowledge; GOAL: UNIVERSAL ACCESS Evidence-based policy reforms: -national strategies, standards for processes, personnel, commodities, scale up with costs, performance indicators -sustainable human resource (training) -quality assurance & supervision mechanisms -M&E, data & reporting -CSO coordination frameworks HIV testing & counselling; linking testing to palliative care & ART; HIV/SRH to vulnerable/at risk populations -South to South TA: sub-granting & capacity building for implementers, special needs gps -direct service delivery -demand creation & advocacy Technical, financial and human resources; partnerships outcomes outputs

4. The relationship between HIV and disability has not received due attention; persons with disabilities are found among all key populations at higher risk of exposure to HIV Where are we in the HIV response in Kenya Where is disability? Persons With Disability? The LVCT response What do we need to do differently 4

5. 5 Setting the context – HIV in Kenya Population – 40M 52% female 60% youth i.e <35yrs60% youth i.e <35yrs Mixed epidemicMixed epidemic Generalized (concurrent relationships, couple discordance)Generalized (concurrent relationships, couple discordance) Most at risk (sex workers,Most at risk (sex workers, Geographical disparitiesGeographical disparities Gender disparities e.g. females aged 15-24yrs - 4x of male prevalenceGender disparities e.g. females aged 15-24yrs - 4x of male prevalence No disability data Kenya 7.4% KAIS 2007

6. HIV testing and counselling services? HIV testing and counselling services? 6 2003 – KDHS 2007 – KAIS* New HTC guidelines, Focus on routine HTC at all service points New HTC guidelines, Focus on routine HTC at all service points 2009 – KDHS HTC roadmap - focus on outreach services HTC roadmap - focus on outreach services Data dissagregation not inclusive of disability Data dissagregation not inclusive of disability

7. 7 HIV care and treatment -KAIS data – 2007 -Currently 70% coverage (of needed 500,000 individuals) -PMTCT – 73% coverage No data on disability Never Tested Believed themselves uninfected based on last test Correctly reported HIV positive Did Not Report Status 82% of those HIV+ did not know their HIV status

8. 8 Financing..

9. 9 LVCT response ? Responding to vulnerabilities rather than just ‘HIV risk’ Responding to vulnerabilities rather than just ‘HIV risk’ Vulnerable groups Vulnerable groups – Ltd access to HIV information & services – Challenge to identify & serve – Hard to reach – limited documented knowledge – Face potential stigma and discrimination Persons with disability Persons with disability – Less literacy – Assumptions that they do not have sex – Exposure to sexual violence/coercion - younger girls

10. 10 LVCT response? Our mission Peer- led programming – with a funded programme, coordinator, – providers are persons with disabilities (15 LVCT staff) Willing to invest

11. 11 LVCT response – policy reforms action The Kenya National AIDS Strategic Plan (KNASP) III 2009/10-2012/13 (NACC, 2009) “I want to particularly acknowledge the work of the team from Liverpool VCT, which, as a voice for civil society, helped to integrate the concerns of people most at risk, as well as importance of gender and human rights across the Plan’s four pillars” Mr. Michel Sidibe, the Executive Director of the UNAIDS who was a special state guest at the launch of the KNASP III by the Right Hon. Prime Minister, Raila Odinga on 12th January 2010 Disability task group of North-South on international advocacy for disability & HIV

12. LVCT response – systems strengthening 70 hearing HIV service providers trained on basic Kenya Sign Language (KSL) Partnership with 20 organizations of persons with disability and built their capacity Development & dissemination of “Signs for Sexuality and Reproductive Heath Manual” Partnership with VSO, produced “A Handbook on the Best practice regarding HIV/AIDS for people with disabilities” to assist in advocacy, policy formulation and programming for PWDs. Copies are also available in Braille and audio for the blind. 12

13. Services LVCT established the first deaf VCT sites in Kenya LVCT established the first deaf VCT sites in Kenya Initiated a national Deaf (now disability) Mobile VCT campaign (2009) Initiated a national Deaf (now disability) Mobile VCT campaign (2009) – Over 300 Mobile VCT targeting persons with disabilities HTC to over 24,000 disabled clients including over 12,000 deaf clients HTC to over 24,000 disabled clients including over 12,000 deaf clients 7 support groups established in 2 regions, for persons with disability living with HIV 7 support groups established in 2 regions, for persons with disability living with HIV Partnership with Kenya Institute of Special Education (KISE) for a Disability friendly HTC site Partnership with Kenya Institute of Special Education (KISE) for a Disability friendly HTC site 13

14. 14 Services

15. HTC services by gender 15

16. HIV prevalence – similar to national levels from VCT data (not national survey data) HIV prevalence – similar to national levels from VCT data (not national survey data) 50 on treatment??? 50 on treatment??? 16

17. 17 What do we need to be doing? Invest! Invest! Invest! – Provider training – Service delivery processes – Outreach services Respond to vulnerability before we have to respond to most at risk populations Deliberately put in funds into material production in reachable format

18. Thank You! Contacts Website: www.liverpoolvct.org Email: Email: enquiries@liverpoolvct.o rg Building Partnerships, transforming lives 18