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    The people most at risk of HIV in Kenya aren’t using preventive drugs

    Credit: AIXabay / CC0 public domain

    was Gradually decline Percentage of new HIV cases across Kenya 230,000 From the new infection in 1992 to 33,000 in 2020. However, there are certain populations that are at higher risk of becoming infected with HIV than the general population. In these groups, new cases of HIV remain unacceptably high.

    This is especially true for gender and sexual orientation minorities, including men who have sex with men. Transgender female..Transgender woman— Individuals who were assigned a male gender at birth but are now identified as female — Highest risk For worldwide HIV infection.

    Data from sub-Saharan Africa Transgender Females remain limited.But recent discoveries from Kenya, Nigeria When South Africa It provides supporting evidence of an increased risk of HIV transmission in transgender women.

    Increased risk of HIV transmission in transgender women Drive Depending on the combination of factors.Mismatches between their current identities and government-issued documents make transgender women more likely to be unemployed and engaged. Sex work, And face violence from clients and law enforcement agencies.

    In addition, receptive anal sex has been done before It is shown To be an independent predictor of HIV infection. The stigma and criminalization of same-sex relationships makes it difficult for either transgender women or men who have sex with men to seek preventive services in public health facilities.This is even more Compound Their risk HIV infection..

    Since 2017, the Kenyan Ministry of Health has promoted the use of pre-exposure prophylaxis (PrEP) As part of HIV prevention efforts.These prophylaxis are recommended for use by both the general public and the increased population dangerous For HIV infection. Men who have sex with transgender women and men are ideal candidates for the use of PrEP.

    However, Recent data Men from Kenya showed suppressed uptake and adherence to PrEP in men having sex with men. Moreover, Retention in PrEP The care of those who pick it up is reduced with a high loss rate to follow-up.

    In us Recent research, My colleague and I set out to explore the opinions of Health providerLeadership of community-based organizations and current PrEP users. I wanted to know what they think of Kenya’s PrEP program. We participated in the PrEP program and sought to understand the perceived or experienced barriers to continuing. I was also interested in their views on how to improve the delivery of PrEP.

    What we did

    Data were collected on the Kenyan coast between February 2018 and April 2019. Health care providers working in public hospital HIV clinics were invited to participate in two focus group discussions, one at the start of the deployment of PrEP at the facility and one year later. Leaders of community-based organizations who have programs for either men or transgender women who have sex with men were invited to separate focus group discussions. Finally, we invited transgender women and men who have sex with men to a detailed interview. They are currently in PrEP or are the default.

    Discussions and interviews explored PrEP knowledge, perceived or real-world challenges to PrEP intake and maintenance of care, and ways to improve PrEP programming. Data from all three sources was used to get a complete picture of Kenya’s PrEP availability.

    What we found

    Four major themes emerged from the analysis.

    First, healthcare providers admitted that they felt unprepared for the large-scale PrEP deployment in Kenya. They felt they were hit by the goal without sufficient training and consideration of the increased workload. A year later, they seemed less combative, but more passive when it came to PrEP programming. They preferred that potential users appear at the facility and request PrEP, rather than actively driving demand. “Investigations have shown that PrEP works, but the follow-up system is lacking … I feel like I wasn’t ready to implement it,” said one.

    Second, we found that there are differences in motivation for PrEP intake between men who have sex with men and transgender women. Transgender women were aware of their high risk of HIV transmission and seemed to have a strong desire to remain HIV negative. A transgender woman said, “I want to stay HIV negative. I know that being transgender is at risk of HIV, so I heard that PrEP is available here (hospital). When I first asked for it .. “

    For men who have sex with men, the motivation for using PrEP was to promote condom-free sex. One of the men said: “… Before I learned about PrEP, I had two partners. When I started using PrEP, I felt protected (by PrEP), so I added two more (partners). Currently 4 I have a human partner. ”

    Third, healthcare providers did not consider transgender women to be at high risk of HIV transmission. And they didn’t understand the need to pay more attention to transgender women. This is reflected in the views of one health care provider. “… they (transgender women) are at exactly the same level as others exposed to HIV … they are not at very high risk of becoming infected with HIV.”

    Fourth, all respondents seem to agree that public hospitals are not the ideal place to offer PrEP. Leaders of a community-based organization found it better to capture and retain PrEP with additional incentives. “Because it’s so expensive, there are some specific needs like those hormones, treatments, laws … it can be a plus for us.”

    Recommendations

    PrEP is available. However, access will continue to be restricted. Restricted access is due to the combination of the attitudes of health care providers and the emotions between men who have sex with men and transgender women who feel unwelcome in public health facilities. An alternative PrEP dispensing environment is urgently needed. It should be a place where men who have sex with men and transgender women can easily access comprehensive HIV prevention services.

    Health providers need to be trained to meet the needs of these people.Programming guidelines for transgender womendangerous population.

    Working with community-based organizations can help create bespoke solutions that are available to those who need them most.


    HIV in Kenya: High-risk groups are not getting the attention they need


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    Quote: People at the highest risk of HIV in Kenya are not taking preventative medications (November 29, 2021).

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