HIV care and support services greatly expanded to reach the most vulnerable

Each Monday evening at 7:30 p.m., 442,000 people in Kenya’s Western Province switch on their radios to absorb Jua Afya Yako—a Swahili radio show that teaches listeners how they and their families can lead healthier lives.

We introduced Jua Afya Yako—or “Know Your Health”— in 2008 as part of a larger project in Kenya commonly referred to as “APHIA II Western”—or AIDS, Population, and Health Integrated Assistance II, Western Province.

“Through the program I have taken all my children and grandchildren to be tested for HIV,” said Protus Simiyu, a regular listener. “They are my life. They mean everything to me, and what better way to protect their life than [to] let them know their status?”

Focus on pregnant women

Western Kenya is one of the most densely populated areas in the country, with a high HIV prevalence rate. These two factors lead to large numbers of people in need of care and support. However, many Western Kenyans, fearing stigmatization by their communities, never get tested for HIV—or if they do test positive, they never get treatment.

“Through the program I have taken all my children and grandchildren to be tested for HIV.”

The overwhelming need for HIV services in this sensitive environment led us to create “one-stop-shops” where people could discreetly get tested and treated while receiving other general health services. We focused on reaching pregnant women, in particular, as women in Western Kenya are not often empowered to seek services for themselves or their children. Only one-quarter of pregnant women deliver at a health facility, and the transmission of HIV through pregnancy is common.

Surpassing our goals

We have worked with international and local partners since 2006 to increase the uptake of prevention services for tuberculosis, family planning, reproductive health, maternal and child health, and malaria—with a focus on HIV/AIDS—in Kenya’s Western Province.

When the project began, 115,000 people in Western Province were living with HIV and 260,000 orphans and vulnerable children had been left stranded by parents who were sick or had died from HIV/AIDS. Over the life of the project, we and our partners reached these individuals and others, surpassing many of the project's goals. For example, we reached:

• About 51,000 people with antiretroviral therapy.
• Nearly 703,000 people with information about HIV/AIDS.  
• More than 13,000 HIV-positive pregnant women with antiretroviral prophylaxis, which helps to prevent the transmission of HIV to their children.
• Almost 400,000 pregnant mothers with HIV/AIDS counseling and testing services.

Creative communications

Radio is just one communication pathway—and testing and treatment is just one slice—of how the project reached the local population with lifesaving health information and services.

Families themselves became caregivers of their infected and affected relatives through the project, which trained community members in home-based care, psychosocial and legal support, transition planning, and loss and bereavement. Discussion groups, worksite programs, in- and out-of-school youth activities, and magnet theater performances provided a supportive environment for those suffering from HIV and AIDS, at the same time reducing stigma associated with the disease.

By changing the health-seeking behaviors of the local population, the project created an increased demand for health services. To meet this demand, PATH and our partners improved and expanded health services through staff trainings and support and updated facility infrastructure, equipment, and suppliers. We also worked in close partnership with the Kenya Ministry of Health to ensure the ability of the health system to manage the influx of new patient data, and the capability of community health workers and community members themselves to refer those in need of services.

Expanding our reach

Although APHIA II Western has ended, many infected and affected people remain in need of care and support.

We are continuing to partner with The Elizabeth Glaser Pediatric AIDS Foundation, Jhpiego, and World Vision to lead a new USAID-funded initiative—APHIAplus Zone 1—until 2016. We are using the in-depth knowledge of Western Kenya gained during APHIA II Western work to scale up existing interventions, with a focus on integrating health services, strengthening health systems, fostering community involvement, and building the capacity of health workers and the Government of Kenya to offer high-quality health services to Western Province as well as neighboring Nyanza Province.

Photographer: PATH/Wendy Stone.