The Kenya PLHIV Stigma Index 2.0 Starts with Consultations of Communities
Participants at the Communities Consultative meeting on PLHIV Stigma Index 2.0 in Nairobi last week
The roll-out of the People living with HIV Stigma Index 2.0 in Kenya formally started last week with a consultative forum that brought together 60 participants drawn from the networks of people living with, at risk of and affected with HIV, including the representatives of adolescents and young people and key populations living with HIV. The roll-out shall be spearheaded by the NEPHAK under the guidance of a partnership led by an all-inclusive National Steering Committee with funding from the Global Fund to fight AIDS, TB and Malaria (GFATM) through the Kenya Red Cross Society (KRCS). The National Steering Committee (with a current membership of 12 institutions) has developed a roadmap for the roll-out of the PLHIV stigma index 2.0 based on the templates provided by the PLHIV stigma index secretariat based at the Global Network of PLHIV (GNP+). All the National Steering Committee members attended the consultative meeting in Nairobi.
The Stigma Index is a research process that uses a standardized questionnaire to gather evidence on stigma and discrimination experienced by PLHIV. In this initiative, the process is just as important as the product. The Greater Involvement of People living with HIV and AIDS (GIPA) principle forms the foundation of the research methodology used by the Stigma Index. The Stigma Index addresses HIV-related stigma and discrimination, while also advocating on the key barriers and issues perpetuating stigma.
The PLHIV Stigma Index 2.0 International Partners (UNAIDS, GNP+ and ICW) and the Secretariat based at the GNP+ are providing guidance and standards to guide the roll-out of PLHIV Stigma Index making sure that it remains true to the ethos that it is an initiative ‘by and for people living with HIV’. The SI Standards, the User Guide and other related Stigma Index documents are intended to ensure that the Stigma Index is implemented in accordance with the principles of a human rights-based approach. NEPHAK last undertook a stigma index research in 2011.
Following extensive consultations and piloting, a revised and strengthened Stigma Index 2.0 was launched in 2017. It reflects shifts in the HIV epidemic and the global response, including new questions to better understand how stigma and discrimination affect key populations living with HIV and; a larger section looking at the impact of stigma on access to all health services, not just HIV services. The Stigma Index 2.0 reflects shifts in the HIV epidemic and the global response. The stigma index 2.0 also includes a new questionnaire that is streamlined and easier to use - the data can even be collected using a tablet.
During this first formal meeting on the PLHIV Stigma Index 2.0, the Kenya PLHIV community in their diversity committed to draw on their experience and expertise to support the process. They also asked that the National Steering Committee be expanded to give room for more PLHIV leaders, especially those allied to the faith sector and key affected populations. The consultative meeting participants also called for broad-based consultations and engagements with the PLHIV and KPs leadership to ensure that their opinion informs the roll-out plan. There was a proposal for county consultative meeting and constituency consultative meeting.
To help guide the process, the National Steering Committee has embarked on the search for a researcher to join the team and support with the refining the methodology and approach for the study. The Research Partner will help refine the PLHIV stigma Index 2.0 research protocol and tools which have been provided by the stigma Index Secretariat. Once the Research Partner is recruited from a reputable organization preferably a local University, the team will also seek ethical approval from the relevant authorities. This is also a requirement by the Stigma Index 2.0 Secretariat.
CSOs Now Reach Out to the Ministry of Health for Strengthened Partnership.
MoH Principal Secretary, Susan Mochache
The Kenya civil society organizations, including networks of people living with, at risk of and affected with diseases working in the health sector last week reached out to the Ministry of Health leadership with a call for strengthened partnership. The call for a strengthened partnership was made by the CSOs leadership at a meeting with the Ministry of Health Principal Secretary Ms, Susan Mochache (in the photo above). The meeting, held last week at the request of the CSOs leadership is part of the non-state actors' roadmap developed during an all-inclusive consultative meeting towards the end of 2018.
CSOs leadership forum in 2018 was organized by the HIV-CSOs and premised upon the belief that Kenya’s success in the response to HIV can partly be attributed to the multi-sectoral partnership where the Government plays a leadership role with civil society organizations, including networks of people living with, at risk of and affected with HIV engaging in policy, programming and service delivery initiatives. The forum sought to explore how best to support the Ministry of Health in the acceleration of the fast track plan to deliver on the 90.90.90 HIV Treatment targets by 2020 and end AIDS as a public health threat by 2030 and achieve the universal health coverage goals. The forum emphasized that it is important that CSOs are at the cutting edge of the health policy and programming are up-to-date with the latest strategies and developments so as to effectively engage and positively influence the pace of government efforts are improving the health and well-being of communities.
Realizing that a better coordinated and stronger voice with sustained opportunities is essential for CSOs to work collaboratively with government and noting that CSOs in Kenya have not been able to present their interests with a united voice, the consultative forum ended with a leadership team to help coordinate and meaningfully engage. The leadership is currently guided by a robust roadmap which, among other things provides for the engagement of non-state actors and communities on the national efforts to roll-out universal health coverage.
Meanwhile the CSOs under the leadership of the HENNET and with support of the International Federation of the Red Cross and UNAIDS last week held consultations to deliberate on the up-coming high-level meeting on the UHC. Among other things, the CSOs will be reaching out to the Ministry of Health and allies to find out who shall be joining the meeting in September and what the country priorities are. The CSOs also want their representative to join the delegation attending the high-level meeting on UHC in September.
New Report Wants ‘Communities at the Centre’ if the World wants to End AIDS as public health disaster; but where is the Money?
The new UNAIDS’ Global AIDS Update report was released last week themed Communities at the Centre, highlighting how communities have been and are central to ending AIDS. According to this report, Communities at the center, the pace of progress in reducing new HIV infections, increasing access to treatment and ending AIDS-related deaths is slowing down. UNAIDS Deputy Executive Director, Gunilla Carlsson stated: “We urgently need increased political leadership to end AIDS,” adding that; “This starts with investing adequately and smartly and by looking at what’s making some countries so successful. Ending AIDS is possible if we focus on people, not diseases, create road maps for the people and locations being left behind, and take a human rights-based approach to reach people most affected by HIV.”
The report is part of a series of releases by the UNAIDS calling upon the governments and the global community to do more to end AIDS as a public health disaster. At the halfway point to the 2020 deadline and in July 2018, UNAIDS released its report, Miles to go—closing gaps, breaking barriers, righting injustices. It warned that the pace of progress is not matching the global ambition and called for immediate action to put the world on course to reach the critical 2020 targets. In the report, UNAIDS also urged that countries would need to adopt innovative strategies and strengthen partnership with vibrant, engaged and well-informed communities that can claim their right to health.
As the reports confirm, the challenge is with AIDS financing. The report shows that the gap between resource needs and resource availability is widening. And when resources dwindle, it is the allocations to communities and community-based interventions that are cut. In Kenya, the HIV response is increasingly becoming a purely biomedical affair with both leading financiers, including the USG – PEPFAR and the GFATM allocating a significant part of their resources to commodities and supplies needed to provide treatment and care. The donor community is also shifting their focus and availing their resources to international agencies and governments leaving community networks with no allocation to meaningfully engage in the response. This is contradictory to the UNAIDS assertion that communities and PLHIV are at and/or should be at the centre if AIDS is to be ended as a public health epidemic. Hence our question: Where are resources to keep communities at the centre?
Although large disparities still exist between young women and young men, with young women 60% more likely to become infected with HIV than young men of the same age, there has been a success in reducing new HIV infections among young women. Globally, new HIV infections among young women (aged 15–24 years) were reduced by 25% between 2010 and 2018, compared to a 10% reduction among older women (aged 25 years and older). But it remains unacceptable that every week 6200 adolescent girls and young women become infected with HIV. Sexual and reproductive health and rights programmes for young women need to be expanded and scaled up in order to reach more high-incidence locations and maximize impact.
The other notable challenge is stigma and discrimination. The report acknowledges that gains have been made against HIV-related stigma and discrimination in many countries but discriminatory attitudes towards people living with HIV remain extremely high. There is an urgency to tackle the underlying structural drivers of inequalities and barriers to HIV prevention and treatment, especially with regard to harmful social norms and laws, stigma and discrimination and gender-based violence. Criminal laws, aggressive law enforcement, harassment, and violence continue to push key populations to the margins of society and deny them access to basic health and social services. Discriminatory attitudes towards people living with HIV remain extremely high in far too many countries. Across 26 countries, more than half of the respondents expressed discriminatory attitudes towards people living with HIV.
As we observe above, the report highlights how communities are central to ending AIDS. Across all sectors of the AIDS response, community empowerment and ownership has resulted in a greater uptake of HIV prevention and treatment services, a reduction in stigma and discrimination and the protection of human rights. However, insufficient funding for community-led responses and negative policy environments impede these successes reaching full scale and generating maximum impact. This is the case with Kenya.
UNAIDS continues to urge countries to live up to the commitment made in the 2016 United Nations Political Declaration on Ending AIDS for community-led service delivery to be expanded to cover at least 30% of all service delivery by 2030. Adequate investments must be made in building the capacity of civil society organizations to deliver non-discriminatory, human rights-based, people-centred HIV prevention and treatment services in the communities most affected by HIV. The Kenya CSOs leadership has proposed to undertake an assessment to gauge where the country stands with regard to the 2016 United Nations Political Declaration on Ending AIDS for community-led service delivery to be expanded to cover at least 30% of all service delivery by 2030.
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