Accessing drop-in services in Kenya: Personal stories

April 15, 2011

Posted by Cecilia Kihara

Alliance Programme Officer: East and Southern Africa

The Ray Drop-in Centre is a KANCO project that has been in operation since 2008 with funding from PEPFAR through the Center for Disease Control and Prevention (CDC). KANCO is the Alliance’s linking organisation in Kenya.

It is operational in two populous sites in the outskirts of the capital city of Nairobi – Ongata Rongai and Mlolongo, and in Thika, a county about 40 minutes from Nairobi County.

On visiting the Ongata Rongai Centre, I spoke to four vibrant young women, all aged 25-28, and all engaging in sex work in the area. They spoke about their interaction with the centre, the value added to their lives and what they would like to see moving forward. Indeed, all of them have seen some change in their lives but have not completely stopped sex work.  You can read their personal stories below, names have been changed for confidentiality.

Veronica, Lucy, Jane, and Mary are friends. The former three have been friends for a long time having gone to primary school together in the Ongata Rongai area. They have been engaged in sex work for varying amounts of time. They found out about the centre when it offered a behaviour change training session for sex workers at its very start in 2008. The knowledge they gained on STIs, including HIV as well as reproductive health, equipped them to make decisions and take action to improve their own health. They are also peer educators and promote safe sex.

The women distribute condoms in bars and dens (which sell Chang’aa and Busaa , forms of fermented beer), where they also give out cards with DIC information, including services provided.  The owners of the dens encourage the peer educators into their dens because their clients ask them a lot of questions and do not leave in a hurry. The women from the centre noted, however, the difficulty in distribution of condoms for lack of proper equipment for demonstration and bags for carrying the condoms.

They have also gone through short trainings on data management, proposal development and entrepreneurship – the latter provided by the Community Capacity Building Initiative (CCBI). While the four young women are very appreciative of the knowledge gained, certificates would be an added advantage that can help them secure employment and they would encourage the management of the centre to consider it.

In addition to the training provided, the centre began to offer HIC/SRH integrated services free of charge. The young women also attend the clinic for STI screening, Family Planning, as well as screening and treatment for malaria and typhoid. Cervical cancer screening is no longer offered at the centre but instead, clients are referred to the Kenyatta National Hospital. This is a challenge for Veronica and her friends because of the expense of local transport in addition to the cost of testing. They also feel that the clinic should have a wider variety of family planning commodities in stock.

Veronica, Trainer of Trainers, 28
“Before the project, I was a sex worker with little knowledge on HIV/STI but I went to training and was informed about them and how to protect myself. I have also attended training as a Trainer of Trainers – which was more in-depth than the usual HIV/STI training and understood commercial sex workers. Since I have a child that needs to go to school and eat, I must continue to do this work but I have reduced the number of clients and I understand the risks. I sometimes sit with the ladies who sell traditional brew because their clients who buy the drink will also take up my service, for however little. However, I am healthier now”.

Lucy, Trainer of Trainers, 25
“I began to use drugs a lot since the age of 10. My mother was a distributor and I helped her to sell. My friend told me about the centre and I started to come for training and discovered that when I go when I’m high, I don’t understand. Therefore, I started using alcohol instead of drugs and gradually stopped because I didn’t want to miss any information provided through the trainings. I started to listen keenly to the trainers and gradually changed my behaviour and reduced the number of clients. When they introduced the clinic, I learned about condoms because I had never used condoms before in my work. The doctor here advised me to stop working so much because I would get multiple STIs. Before the Ray Centre, we used  to perform abortions on ourselves and we couldn’t go to the government clinic because of stigma. At the centre, we speak freely and they address our issues”.

Jane, 25
“When I finished school, I started to go to my friend’s house which was beautifully done with matching furniture. When I asked her how she could afford to keep such a home, she told me it was easy and that I could do the same. She took me to the street. STIs were like a cold for us and we just took medicine for them. I would use traditional herbs to abort but when I was trained on the side effects and understood what was happening to my health, I was shocked and started to reduce clients. When the clinic started to offer services, and with my understanding of HIV, I began practicing safe sex, and came to the clinic to be treated. I can’t stop this work completely because I can’t make ends meet and I have no other form of income generation. I have had many STIs and need to get a pap smear but I can’t afford”.

Mary, 25
“I use to live in Kibera and was a commercial sex worker  there. I was brought here by my friend and we carried on. We heard about the centre and the trainings for commercial sex workers and we came along for the training in behaviour change  and HIV prevention. I have since reduced my client load but not too much because I still need the money”.

About the Ray Drop-in Centre and outreach services

The PEPFAR funded program’s overall aim is to reduce the impact of HIV and AIDS among young people in Kenya through behaviour change, reducing levels of HIV infection, and enhancing access to youth friendly services including VCT services. The Ray drop-in centre uses a peer led approach to reach commercial sex workers.

Psychosocial support for sex workers is two pronged:  groups for those openly living with HIV and those that are negative but also require psychosocial support and access to health services.

People who are tested for HIV and turn out to be positive are referred for treatment and care services at the nearest health provision points. However, the women interviewed noted that the services at the government clinic are not friendly and there are issues with confidentiality. They noted that most people only attend when it is an emergency or when the service providers are strangers who don’t live in the area.

The centre offers integrated services free of charge including: counselling and testing, screening and management of STIs, screening and treatment of TB, family planning services, HIV care and treatment services and psychosocial support. The facility has been identified as one of the TB diagnostic and treatment centres in the Ongata Rongai region and it receives clients from other neighbouring health facilities.

The support groups have their own income generating activities such as beading, soap making and sanitary pad making. The centre also uses edutainment as a strategy to reach young people in the area. They organise recreational activities for young people such as drama skits and football competitions.

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