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Offering HIV testing in the ‘cover of darkness’ seems to appeal to many men particularly in rural settings.
Staff at the Kericho Youth Centre (KYC), an NGO supported by the Walter Reed Project – Kenya (WRP), found an inventive and highly successful way to provide training, HIV testing and counseling services to high-risk youth including commercial sex workers and their clients—by going where they go under the cover of darkness.
Along the major highway that runs through the Kericho District in Kenya’s South Rift Valley, there are many trading centers, or truck stops, for long distance truck drivers and traders making their way across Kenya or heading north to Uganda. With a poor economy, many area youth turn to commercial sex work at these truck stops.
KYC staff developed a plan to reach out to the youth, who are at high-risk of contracting HIV. Staff members visit the truck stops between the hours of 6 p.m. and 2 a.m., or “moonlight” hours. Through one-on-one meetings, they establish contact and build rapport with the commercial sex workers who frequent these truck stops. Through these relationships, KYC staff are then introduced to their sexual networks or clients—truck drivers, traders, and brothel owners. Using training curriculum adapted specifically for area commercial sex workers and target groups, staff train network leaders in HIV prevention and reproductive health. The training program is staggered over many weeks so that target groups can attend without losing income.
In addition to HIV prevention training, KYC provides nighttime voluntary testing and counseling. A clinical officer and nurse are on-site to ensure patients are immediately referred for HIV/STI treatment.
“In a community with a high level of stigma contributing heavily to new HIV infection rates, knowledge of HIV status is an entry point to engage in prevention and reduce the stigma levels,” said Wycliffe Obwiri, Assistant Prevention Program Manager at WRP. “Offering HIV testing in the ‘cover of darkness’ seems to appeal to many men particularly in rural settings.”
This program had provided training to about 1,000 network leaders and more than 20,000 individuals have been reached through peer education. Additionally, approximately 4,000 of the most at risk individuals—commercial sex workers, long distance truck drivers and bar workers—have received voluntary counseling and testing through the moonlight program in the South Rift Valley.
Because of these services, most of the young people who live in and around the trading centers have received counseling and testing and the use of entertainment education has improved community knowledge about HIV. “The community is gradually opening up space for discussion of sex, sexuality and sexual health. With the services now highly accepted in the rural villages, the level of stigma is very gradually but steadily coming down,” said Obiri.
According to Obiri, the program is working because it has been accepted and supported by leadership at all levels. The program started small, but after much success is able to expand with the help of local partners.
This KYC program and a related study were highlighted in a recent WHO report, "Towards universal access: scaling up priority HIV/AIDS interventions in the health sector: progress report 2009." The report examined trends in the availability and use of HIV testing and counseling services.