By Joseph Maina
We met with Dorothy Onyango, the CEO of Women Fighting AIDS in Kenya (WOFAK) at her offices on Ngong Road. Dorothy was preparing for the IAS AIDS 2018 conference that was held in Amsterdam. Women Fighting AIDS in Kenya is an NGO founded by a group of women living positively with HIV in August 1993.
The organisation began as a support group of women living positively with HIV/AIDS and later grew to one that fully supports, and implements programs that target women, youth and children who are particularly vulnerable to the infection in Homa Bay, Kisumu and Nairobi. WOFAK is one of 17 organisations that form the SRHR Alliance consortium. Under the Amplify Change program implemented by the alliance, WOFAK works on three of the priority areas:
Why should HIV & AIDS be included in the National Health Insurance Fund (NHIF), especially now with the discussion on universal health coverage (UHC)?
HIV /AIDS needs to be included in UHC because if you look at the health care system currently, almost 40 per cent of bed occupancy (in-patient) is for HIV-related reasons and that is why HIV needs to be covered. This, I think, we will have more people’s medical needs taken care of. With treatment and proper care, HIV and AIDS patients are able to continue being productive in the society. The issue of hospitalisation is minimized and costs reduced.
It will also provide an opportunity for our healthcare system to address opportunistic infections, which in some cases remain unaddressed. People assume that taking ARVs is as good as getting well, but there are opportunistic infections that a person living with HIV needs to take care of. Most hospitals especially the Comprehensive Care Clinics (CCCs) do not provide the opportunistic infection treatment thus leaving the client to look for ways of taking care of their selves. The clinics will only give you ARVs and you go back home.
With the current healthcare system in the country, is UHC too ambitious a goal? What has devolution done for the healthcare system in the county?
With the devolution of healthcare, there is still a problem of coordination between the National and County governments. For instance, KEMSA (Kenya Medical Supplies Authority), a state corporation under the Ministry of Health, are responsible for providing drugs and non-pharmaceuticals to all government facilities in the country. However, the county governments have other priorities and health is not their top priority.
Supplies of health commodities and drugs run out and it takes months to get the supply yet people need medication to remain productive. Negative attitudes and unpleasant language among healthcare providers are among the greatest barriers people living with HIV (PLWH) face when accessing care.
To mitigate these challenges, organizations such as the SRHR Alliance strive to provide training, capacity building and capacity strengthening to health care workers onyouth-friendly approachespecially for young people living with HIV. Apart from stigma and discrimination, monitoring the progress of ARV consumption by those infected with HIV medication is an area that needs immediate attention.
What are your thoughts on self-testing and especially the availability of the kits with regard to equity?
Self-testing is a good idea if the public and population were aware that one can do the test when they want to. Proper Dorothy Onyango, the CEO of Women Fighting AIDS in Kenya information and knowledge on HIV/AIDS is key for the concept to yield good results. Awareness-creation is necessary for everyone to sufficiently appreciate the use of self-testing kits. It will also reduce stigma and discrimination amongst our communities.
While Kenya has made a lot of progress to address the HIV/ AIDS epidemic, what shortcomings still exist for ensuring treatment and access to care for our key populations?
Cultural inhibitions remain a key shortcoming in ensuring treatment and access to care for key populations, which include men sleeping with men (MSM), sex workers, adolescent engaging in transactional sex and injection drug users, especially in the Homa Bay and the Lake Basin Regions. We need policies that support health issues of key populations, because if the leaders themselves do not understand these issues, they will keep on stigmatising and criminalising the key populations.
What impact will KENPHIA (Kenya Populationbased HIV Impact Assessment) have towards improving access to care?
KENPHIA is a nationwide HIV survey by National AIDS and STI Control Program (NASCOP) to assess HIV prevention, care and treatment in Kenya. KENPHIA will help the government, its partners and the public to know: how many people are currently infected with HIV; how many people have new infections, and how many people with HIV are on effective treatment.
What is your assessment of Kenya’s progress towards achieving the 90-90-90 targets?
Launched in 2014, by UNAIDS and partners; the aim was to diagnose 90 per cent of all HIV-positive persons, provide antiretroviral therapy (ART) for 90 per cent of those diagnosed, and achieve viral suppression for 90 per cent of those treated by 2020. Achieving the 90-90-90 targets is a remarkable thing, despite the country’s reliance on donor funding to the tune of 70 per cent.
As a founding member of WOFAK, and having worked in the civil society space in Kenya for more than a decade, what is the role of CSOs and communities in the support of UHC?
Civil Service Organizations (CSO) are an essential partner in the realization of UHC. CSOs are advocates for increased funding to ensure that more people are covered in the national schemes. CSOs connect the policy makers with the communities and foster ownership of healthcare especially at the community level. They fill the gaps in social health care and government can leverage on these organizations for capacity building and trainings and also improve access to healthcare through improvement of infrastructure especially in the arid areas of the country.
What does the SRHR Alliance see as the responsibility of duty bearers in promoting right to quality health and services for youth/ LGBTQ/ Orphan Orphans and Vulnerable Children (OVCs) living with HIV?
Duty bearers have a responsibility to protect, respect and fulfil the rights of the rights-holder. The SRHR Alliance advocates for the rights of all persons and as entrenched in the Kenya Constitution 2010. All citizens have the right to the highest attainable standards of health.
The SRHR Alliance works very closely with both the Ministry of Health and Education to formulate policies with stakeholders including government so as to come up with appropriate policies in promoting right to quality health and services for especially for the youth living positively with HIV. The SRHR alliance currently has 5 implementation programs in 5 counties among them WOFAK implementing at the Makadara Health Center in Nairobi.
The Alliance believes that policies can significantly affect young peoples’ SRH outcomes by influencing their access to information and services. In supporting the development of policies and guidelines in the country, the alliance believes that young people are able to become informed rights-bearers which encourage them to advocate for their appropriate programs.
