Tackling HIV on Kenya's transport corridors

The Kenyan government has launched a strategic plan to help revitalize HIV prevention programmes for mobile populations working along country's transport corridors. Kenya's mobile populations have long been regarded as highly vulnerable to HIV.

"Mobile populations face the severe challenge of accessing services at appropriate locations and times. Targeted HIV services for the transport corridors are poorly coordinated, inadequately resourced, operate under out-dated policies, and experience severe structural barriers such as infrastructure, service availability and accessibility that limit the appropriate provision of services or inhibit proper access of the key population," says the strategic plan.

Forty-one-year-old Kenyan truck driver Mwaniki* knows about HIV - how it's transmitted, how to prevent it and where to get tested for it - but says he doesn't use the available services because they don't suit his hours.

"As truck drivers, we are most active at night, but when you visit some of the available voluntary counselling centres during that time, they are closed," Mwaniki told IRIN at the Mlolongo truck stop, on the outskirts of the capital, Nairobi. "During the day, we are busy dealing with clearance of our documents with government officials. We have very little time for anything else during this time."

Angela, who runs a food kiosk in Mlolongo during the day and is a sex worker at night, said she, too, misses out on HIV counselling and testing targeted towards sex workers due to her unusual hours.

"It is easier to get us at night because then you can tell this is a [sex worker], but during the day, it is hard to tell. So if you have HIV messages targeted at us [sex workers], night is good," she said.

Coordination needed

"Several different organizations have been working along the transport corridors for some time now, with the aim of ceasing the spread of HIV along these corridors. Unfortunately, these efforts lack the necessary coordination and harmonization that is needed if an impact is to be made," Paola Pace, regional health programme officer at IOM, told IRIN.

According to Lucy Waweru, a psychology lecturer and communication-for-development specialist at the University of Nairobi, "Understanding the behavioural characteristics and lifestyles of the target population is a key determinant of the success of HIV prevention [strategies] targeting mobile populations.

"Truck drivers for instance, have fatalistic attitude[s] which must first be dealt with. Sex workers along transport corridors are, on the other hand, never static, and many more are illegal immigrants who might fear coming out to seek services. Interventions must be tailored with these in mind," Waweru said.

The National Strategy on HIV/AIDS and STI (sexually transmitted infection) Programming along Transport Corridors in Kenya - developed by the International Organization for Migration (IOM), the UN Joint Programme on HIV/AIDS in Kenya and the National AIDS Control Council - aims to consolidate and streamline efforts to improve the prevention and control of HIV along the country's transport corridors.

The strategy calls for engaging with countries within the East Africa region to allow mobile populations to access services within any country. This would entail regional governments harmonizing their HIV policies, which would, for instance, allow a truck driver from Kenya to access antiretroviral therapy (ART) in Uganda.

It also urges the "analysis of existing behavioural and biological data to obtain more in-depth understanding of HIV and AIDS dynamics among MARP [most at-risk populations] along the transport corridor", and calls for intensive advocacy to promote measures like consistent condom use.

"As truck drivers, we are most active at night, but when you visit some of the available voluntary counselling centres during that time, they are closed." Regional governments will also be engaged to reduce bureaucracy that creates delays at border checkpoints. These delays lead many truck drivers to engage in risky behaviours, such as alcohol abuse and sex with multiple partners.

"If it is able to address the various existing challenges to access among mobile populations, then it will definitely work. But advocacy will need to happen, too, if buy-in among various stakeholders is to happen," Waweru said.

Paul Davis, director of global campaigns for US-based advocacy group Health Global Access Project, told IRIN that "while the strategy is welcome", the government will also need to emphasize "routine HIV testing and early initiation of ART for migrant workers, sex workers and truckers" working along transport corridors.

Mobile populations at risk

According to the 2008 Kenya Demographic and Health Survey, mobile populations - including truck drivers, sex workers and fishing communities - are among the key drivers of the HIV epidemic in Kenya.

These groups have infection rates higher than the national average. Together with the other most at-risk populations, such as men who have sex with men and drug users, they account for a third of all new infections.

For instance, sex workers and their clients are responsible for an estimated 15 percent of new HIV infections nationally each year.

Experts say initiatives to address HIV along the transport corridors have not achieved much; it is hoped the strategy will provide a platform to coordinate these initiatives and improve their efficacy.

"We expect that there will be a well-structured planning and implementation of HIV services along the transport corridor [that], once implemented, will lead to a measurable reduction of HIV risk for the truckers and the communities living along the transport corridors," George Githuka, from the National AIDS/STI Control Programme, told IRIN.

Gaps and shortcomings

The 2010 Response Analysis of Combination Prevention along the Northern Transport Corridor in Kenya, done by IOM and the Kenya National AIDS Control Council, revealed serious gaps in the response to HIV/AIDS at the truck stops covered under the study.

It revealed, among other things, funding restrictions, limited resources, poor commodity management, a lack of targeted messaging for key populations and unsustainability of HIV programmes.

The strategic plan notes shortcomings within existing programmes, including failure to fit into the schedules of mobile populations.

Experts say that in order for the strategy to deliver results, it must be fully implemented.

"Dissemination of the strategy, more concerted efforts to mobilize adequate resources, development and dissemination of the accompanying documents such as the communication and [scaling-up of] resource mobilization strategies will be necessary," Steven Oyugi, head of regional initiatives at the National AIDS Control Council, told IRIN.