LIVING ON!

FIGHTING HIV/AIDS IN TURKANA

INTERNATIONAL RESCUE COMMITTEE RESPONDS TO THE
WORLD’S WORST HUMANITARIAN CRISES AND HELPS
PEOPLE SURVIVE, RECOVER AND REBUILD THEIR LIVES.
WE RESTORE SAFETY, DIGNITY AND HOPE TO MILLIONS
WHO ARE UPROOTED AND STRUGGLING TO ENDURE.
THE IRC LEADS THE WAY FROM HARM TO HOME.

The IRC’s Impact in Turkana

2005, the IRC has assisted the local and refugee

Since

populations of the Turkana region in Kenya in their response to

the HIV/AIDS pandemic by basic clinical
providing

services, fighting stigma and raising

awareness. As of August 2010, we have tested more than
110,000 people, provided access to free antiretroviral therapy for
more than 1,500 patients, supported local partners with staff and

equipment worth more than $3 million US , conducted more

than 200 trainings for local target groups, mobilizers and advocates,

supported more than 2,000 awareness outreaches and helped build

institutional and response capacity through trainings ,

financial and expert support. We are effectively

reaching out to more than half of the

population of Turkana.

COVER PHOTO
Couple attending a session at a mobile voluntary
counseling and testing (VCT) station in Nabute
village, Lodwar.
 IRC KENYA / LIVING ON! / COUNTRY DIRECTOR’S MESSAGE 3

MESSAGE
FROM THE
COUNTRY DIRECTOR

Dear Friends, Partners and Supporters,

I am pleased to share our experiences from one of the IRC’s most

successful and longstanding programs in Kenya.

This publication introduces you to our work and our achievements in

responding to HIV/AIDS in Turkana, and outlines the challenges we face in
this fascinating region.

With the support of the U.S. Centers for Disease Control and Prevention, the
IRC has provided a coordinated response to HIV/AIDS in Turkana since
2005. We have a long and successful track record in the region, providing
refugees and Kenyan communities with aid and medical services, including
HIV/AIDS treatment, since 1992.

Much remains to be done, but the IRC has significantly contributed to some
major improvements in the fighting against HIV/AIDS in Turkana.

CONTENTS
4 ACHIEVEMENTS
6 AIDS GLOBALLY, LOCALLY
8 TURKANA ESSENTIALS
16 IRC IN TURKANA
Thanks to our efforts and engagement, the awareness of and the attitude
toward HIV/AIDS have improved, although social stigma
remains an undeniable problem. We were able to expand our focus on
prevention activities that engage and empower local communities.
Furthermore, we assisted in securing accessible, comprehensive and high-
quality HIV/AIDS treatment services through both IRC and partner facilities. Our
approach is based on building local capacity, supporting homegrown structures
and attaining long-lasting impact that goes beyond treating HIV/AIDS.

18 HIV/AIDS PROGRAM A sustainable response to HIV/AIDS in Turkana will require further

government leadership and coordination, continuous commitment from
28 BEST PRACTICES donors and, foremost, regional prioritization. Momentum is needed for the
Turkana region to catch up with the rest of Kenya; improved transport,
49 LESSONS LEARNED health, education and communications infrastructure will not only
contribute to fighting HIV/AIDS but also improve the region’s general
11 map
welfare.
22 timeline
The IRC remains committed to helping the Kenyan government respond to
24 statistics the HIV/AIDS pandemic. We are thankful for the support of our donors, the
Kenyan Ministry of Public Health and Sanitation, the Ministry of Medical
56 endnotes Services and other governmental and local partners, and Kenyan
communities where we work. We wish to express our special gratitude to
57 acronyms and abbreviations our staff, whose dedication and perseverance makes the IRC successful in
achieving our mission to assist those in greatest need.
59 credits

theIRC.org
KELLIE LEESON, IRC KENYA COUNTRY DIRECTOR
4 IRC KENYA / LIVING ON! / ACHIEVEMENTS

Since 2005, the IRC has persistently and systematically worked with local and
refugee communities and with partner organizations to combat HIV/AIDS in
Turkana, and it has significantly contributed to the following

ACHIEVEMENTS
ENSURED AVAILABILITY AND
QUALITY OF HIV/AIDS
SERVICES IN TURKANA
The IRC has been instrumental in raising the awareness of HIV/
AIDS in Turkana. It has helped create a demand for basic services
by taking a lead in HIV-monitoring and providing voluntary
counseling and testing services (VCT). Moreover, by operating
medical facilities, establishing comprehensive care clinics and
supporting the region’s main healthcare providers, the IRC has
assured access to higher quality HIV/AIDS treatment in Turkana.

ENGAGED AND EMPOWERED

COMMUNITIES
Local and refugee communities are the focus of the
IRC’s response to HIV/AIDS in Turkana. Shifting from
delivering services and information, the IRC now assists
communities in targeting at-risk populations and
ABOVE Voluntary counseling and testing session in Lodwar
District Hospital VCT center.
individuals. Raising awareness, building community-
tailored response capacity and assuming ownership and
responsibility is central to the success of this strategy.

RIGHT Community
outreach session in a
village near
Lokichoggio.
 IRC KENYA / LIVING ON! / ACHIEVEMENTS 5

RIGHT Awareness mobilization in

a village near Lokichoggio.

IMPROVING
AWARENESS
AND
FIGHTING
STIGMA

The attitude towards HIV/AIDS in Turkana has notably improved and the IRC has played a crucial role in facilitating
this change. HIV/AIDS stigma has decreased among local and refugee communities, which have access to basic
information on its prevention and treatment. Although much remains to be done, this achievement is essential in
engaging the community to take the lead in fighting HIV/AIDS and in generating hope for the future.

Through its support for local partners and authorities, the IRC has contributed significantly to building local capacity,
improving basic healthcare services and creating better support structures in the region. By operating hospitals and
clinics, supporting partners’ facilities with staff and equipment, and providing management training, planning and
assessment assistance to local and provincial structures, our impact has gone beyond the HIV/AIDS response.

IMPROVED
LOCAL
CAPACITY,
HEALTH AND
SUPPORT
STRUCTURES

RIGHT IRC-sponsored laboratory

in Kakuma Mission Hospital.
6 IRC KENYA / LIVING ON! / HIV/AIDS GLOBALLY, LOCALLY
HIV/AIDS
GLOBALLY, LOCALLY
Nearly three decades after the first cases of AIDS were recorded,
the disease remains a grave threat to health and development. It
affects individuals, families, communities and societies worldwide.
This modern plague has taken 34 million lives by 2010, making it
one of the most destructive diseases in recorded history.
According to the latest global statistics, the number of people
living with HIV reached an estimated 33.4 million in 2008— a 20%
increase from 2000. In 2008 alone, an estimated 2.7 million new
HIV infections occurred and 2 million people died as a result of
AIDS-related illnesses.1
The continuing rise of the population living with HIV clearly
demonstrates that humankind is struggling in our efforts to stop
the spread of the AIDS pandemic. But the growing numbers also
reflect the beneficial impact of antiretroviral therapies (ARTs). The
accessibility of antiretroviral drugs (ARVs) increased drastically in
recent years, particularly in low– and middle–income countries.
In times of increased global mobility, HIV/AIDS spares no
continent, nation or society, but patterns of the AIDS pandemic
differ considerably from region to region, afflicting some more
severely than others.
While the pandemic is spreading most rapidly in Eastern Europe
and Central Asia, where the number of people living with HIV
increased 67% between 2001 and 2008, sub-Saharan Africa
bears the biggest AIDS burden in absolute numbers.
The region currently accounts for two-thirds of HIV-infected
individuals globally. High poverty levels, slow response and the
underdeveloped health systems, along with cultural and behavioral
habits, are commonly cited as causes for such high regional HIV/
AIDS prevalence rates. An estimated 1.9 million new HIV
infections occurred in sub-Saharan Africa in 2008, bringing the
total number of people living with HIV in the region to
approximately 22.4 million.2
The rate of new HIV infections in sub-Saharan Africa has been
declined by 25% in comparison to the pandemic’s peak in 1995,
but the total number of people in the region living with HIV
continues to climb. In 2008, the adult HIV prevalence in the region
(ages 15 to 49) was 5.2%, resulting in an estimated 1.4 million
AIDS-related deaths— a number representing an 18% decline in
annual HIV-related mortality since 2004.3
Heterosexual intercourse remains the primary mode of HIV
transmission in the region, followed by extensive ongoing
transmission to newborns and breast-fed infants. The modes of
transmission are more numerous than previously thought, however.
According to recent research from East, West and Southern
Africa, infection occurs among men who have sex with men and
inject drugs.4
RIGHT The Kenyatta International Conference Centre, a symbol of modern
Kenya and national unity. AIDS was declared a national disaster in 2001, with
prevalence rates peaking at 13% the same year and dropping to 7% in 2009.
KENYA
Kenya did not avoid the early HIV/AIDS pandemic, although it was,
at least partially, able to contain the disease’s drastic spread from
1990 onward. The country’s HIV prevalence peaked at 13% in
2000, when AIDS was declared a national disaster, and was
dramatically reduced to 6-7% in the following years, partially due to
an increase in education and awareness, but also high death rates.5
It continues to present a significant burden for Kenyan society
despite institutional and policy responses from the government.
Determining the HIV/AIDS prevalence rate in Kenya is challenging,
with various estimates around 7%. Indicators for 20086 show a
relatively stable HIV prevalence rate of 6.3% for adult Kenyans
between 15 and 49, which is comparable to rates reported in
2003.7 But alternative studies have indicated an increased HIV
prevalence of 7.4% in 2007, reversing the previously reported
decline.8 The most commonly cited factor for this increase is the
decline in HIV-related mortality, stemming from more rapid
treatment and the availability of ARVs. AIDS-related deaths in
Kenya have also fallen by 29% since 2002. However, an increase
in risky sexual behavior may be playing a key role in the apparent
reversal of epidemiological trends.9
HIV prevalence in Kenya is higher among women (8%) than men
(4.3%) at both national and provincial levels,10 percentages in line
with regional trends in sub-Saharan Africa. Women’s greater
vulnerability to HIV stems not only from greater physiological
susceptibility to heterosexual transmission, but also to severe
social, legal and economic disadvantages.11
Girls and young women are particularly at risk of becoming
infected in Kenya. Those aged 15 to 19 are three times more likely
to be infected than their male counterparts, while those between
20 and 24 years are 5.5 times more likely to be living with HIV
than their male counterparts.12
Epidemics in sub-Saharan Africa have matured and models
suggest that the proportion of new infections among people in
stable, so-called ”low-risk” partnerships is often high. In Kenya in
2006, heterosexual sex within a union or regular partnership
 IRC KENYA / LIVING ON! / HIV/AIDS GLOBALLY, LOCALLY
RIGHT Nairobi, Kenya’s
capital, accounts for
approximately 10% of all
HIV infections in the
country.
accounted for an estimated 44% of incident HIV infections
compared to 20% of new infections caused by casual heterosexual
sex.13
HIV prevalence in Kenya is higher in urban areas than in rural areas
(7% vs. 6%), although the pattern differs by sex. Urban women
have a considerably higher risk of HIV infection than rural women
(10% vs. 7%), while rural men have a slightly higher level of HIV
infection than their urban counterparts (5% vs. 4%).14 However,
since approximately three-quarters of Kenyans live in rural areas,
the majority of HIV positive people can be found there—
TURKANA
HIV/AIDS has always been viewed as a pandemic of Kenya’s urban
population17 and therefore not acknowledged as an issue in
scarcely populated Turkana. Available statistics have indicated,
however, that the region has not been spared the spread of HIV/
AIDS, consistently scoring above the national HIV prevalence rate.
Accurately assessing HIV/AIDS impact in Turkana is a challenge
due to the remoteness and vastness of the region, high mobility of
the local population and security concerns. HIV awareness in
Turkana has increased, with levels up to 98%, due to sustained
national and regional HIV/AIDS information campaigns. However,
the region has reported some of the highest HIV prevalence rates
in the country in the last decade. In 2001 and 2002, HIV sentinel
surveillance on antenatal mothers and patients with sexually
transmitted infections showed HIV prevalence rate of 13% and
18%, respectively.18
According to a 2007 study carried out among the rural Turkana
population, HIV prevalence was 4.1% in rural areas and 8% in
urban centers.19 In the same year, data from the District AIDS and
Sexually Transmitted Infections Coordinator (DASCO) in Turkana
Central indicated a prevalence rate of 6.7%, increasing to 14% in
some urban centers. Data from the 2009 Turkana Central District
Ministry of Public Health and Sanitation puts the HIV prevalence
7
approximately one million individuals aged 15 to 64 compared to
400,000 in urban areas.15
There are significant differences in HIV prevalence rates within
Kenya, which indicates regional heterogeneity of the country’s AIDS
pandemic. Although numbers cited by different studies vary, the
western parts of Kenya tend to have higher HIV prevalence rates
than those in the east.16 Three provinces (containing half of Kenya’s
population) have 65% of the country’s HIV infections: Nyanza
province accounts for over one-third, Rift Valley province (where
Turkana is located) one-fifth, and Nairobi province one-tenth.
TURN THE PAGE TO LEARN ABOUT TURKANA
rate at 7%, close to the prevalence rates the IRC found during
testing in the region.20
Access to ARVs in Turkana is greatly hampered by the isolation and
mobility of the nomadic community. According to the National STI
and AIDS Control Program (NASCOP) 2007 report, an estimated
2,883 people in Turkana were in need of ARVs in 2006, but this
number could be higher because of increased access to HIV testing
and counseling services in Turkana in recent years. Access to ARVs
has increased from an estimated 300 people on treatment at the
end of 2006 to about 1,500 in 2010.21
One of the leading causes of death among people living with HIV/
AIDS is tuberculosis (TB). Its presence is an important eligibility
criterion for the initiation of ARV treatment. TB prevalence rates are
high in Turkana among both pastoral and urban communities, and
the co-infection rates are sometimes shockingly high. A 2002 study
showed that 80% of TB patients in Lodwar District Hospital were
HIV positive.22
TURN TO PAGE 19 TO LEARN ABOUT THE
IRC HIV/AIDS PROGRAM
8
IRC KENYA / LIVING ON! / TURKANA ESSENTIALS
TURKANA
ESSENTIALS
Turkana is one of the hottest, most arid and remote Kenyan
regions, located in the Rift Valley Province in northwest Kenya. This
scenic region of plains, broken by lava hills,23 is bordered by Uganda
to the west, Sudan and Ethiopia (including the disputed Ilemi
Triangle) to the north, Lake Turkana (with the Marsabit District on
the lake’s opposite side) to the east, and the West Pokot, Baringo
and Samburu districts to the south. It encompasses an area of
nearly 77,000 square kilometers (30,000 square miles), similar in
size to Scotland or South Carolina.
The region is an administrative part of the Rift Valley Province, also
known as the breadbasket of Kenya, but such labels are misleading
as the area hardly permits crop farming. The local economy, which
relies on livestock, is regularly hit by droughts and famine. These
rough conditions make Turkana one of the poorest regions of
Kenya, with 74% of its population living in absolute poverty.24 The
area is scarcely populated, with an estimated 539,263 people as of
2010,25 accounting for approximately 1.3% of Kenya’s total
population. The region’s population is genderbalanced26 but
SETTLEMENTS AND INFRASTRUCTURE
The Turkana people traditionally did not occupy
permanent settlements, despite their introduction
during the colonial period. Following the droughts that
hit the region in the 1980s, approximately one-half of
Turkana’s population settled in or close to famine-relief
camps. About the same number remain in or around
settlements such as Lodwar or Lokichoggio, or in
villages located along the region’s rivers and streams.
Larger settlements suffer from limited investment and
often lack basic infrastructure such as roads and
transport services, sanitation, water, energy supplies
and public lighting.
LEFT Traditional Turkana village, near Lodwar.
 9
LEFT Entering Kalokol, a fishing village on the
shores of Lake Turkana.

ethnically diverse, due in part to its recent transitional and refugee-

hosting status following the establishment of Kakuma Refugee Camp in
1992.

The majority of the region’s population is composed of the local

Turkana, a Nilotic nomadic tribe that has, over the centuries, adapted to
the arid environment by herding livestock and moving frequently. The
Turkana are, in fact, one of the most mobile populations in the world.

The Turkana depend on camels, cattle, sheep, and goats for

subsistence; they use donkeys to transport household goods during
migrations. They also engage in small-scale agriculture and basket
weaving, products which can be traded along with livestock for grain
and other necessities. Men are mainly responsible for herding, while
women are in charge of watering and milking the livestock, feeding the
family, household tasks and errands.

Evidence suggests that in recent years, these pastoral communities

have experienced rapid and unprecedented changes in their livelihood,
exacerbated by recurrent droughts, the most recent of which occurred
in mid-2010.27 Livestock numbers have remained stagnant over the last
few decades and natural resources remain scarce. While their numbers
are increasing, the Turkana have seen many of their tribe move to towns
like Lodwar, Kakuma and Lokichoggio, settlements that have become
areas of concentration for IRC services.

In addition to persistent security concerns, the region’s population is

afflicted by malnutrition and health issues. MALNUTRITION remains a
serious problem in Kenya, where every fifth child under five is
underweight and 31% of the total population is undernourished,28 even
more so in arid and semi-arid areas like Turkana. Seasonal droughts,
high poverty levels and limited infrastructure add to food insecurity in
the region; 2009 numbers have shown alarming levels of global acute
malnutrition (GAM) above 20% and severe acute malnutrition (SAM) at
3.5%.29 During the 2009 drought, 74% of Turkana’s population relied
on food aid.30

BELOW Kakuma Refugee Camp (Kakuma I) and the typical Turkana landscape.

GEOGRAPHY AND CLIMATE

Much of Turkana is a broad low-lying plain, interspersed with lava hills. The plains are arid and lie at an elevation of 300-800 meters
(980-2620 feet); the mountains receive more precipitation and rise up to 2,200 meters. The climate is hot and dry, with precipitation
from April to June and occasionally during November. The mean annual rainfall in Lodwar (506 m / 1660 ft), the region’s main
settlement, is 16.5 cm (6.5 in), with a high of 49.8 cm (19.6 in) and a low of 1.9 cm (0.74 in).
10 IRC KENYA / LIVING ON! / TURKANA ESSENTIALS
RIGHT An IRC vehicle is part of a
convoy, with security escort,
traveling from Lokichoggio to
Kakuma.
.
SECURITY
The security situation in Turkana is often cited as one of
the main causes hindering its development, but is also a
consequence of its geographic location and economic
situation. The reliance of traditional populations on
livestock economy and the scarcity of resources have
historically caused conflicts among the Turkana, and also
with a number of local communities in Kenya that border
the region and even some beyond these borders. Relative
instability in the regions northwest of Kenya has hampered
security in Turkana considerably over the past several
decades, a period marked by civil wars in neighboring
Southern Sudan, a major transport route to Sudan. The
region was affected by firearms trafficking and used as a
springboard for humanitarian operations in Southern
Sudan. The signing of the Southern Sudan 2005 peace
accords has opened up the transport corridor to a flurry of
activity and prompted many nonindigenous peoples to
settle in the region. However, limited road infrastructure
and persistent poverty in the region foster banditry and
looting and render travel difficult and dangerous, often
requiring a security escort.
GO TO PAGE 12 FOR IRC PROJECT SITES
GO TO PAGE 18 FOR HIV/AIDS PROGRAM
HEALTH CONCERNS in Turkana are numerous and aggravated by its
remoteness, make the healthcare infrastructure additionally inaccessible
and unaffordable for most of the population. The situation is worsened
by high malnutrition rates, Turkana’s location in a malarial endemic zone,
limited sanitation facilities and high prevalence rates of HIV/AIDS and
TB.
Limited investment and marginalization, the high mobility of the local
population, its transitional location and the vastness of the region make it
hard to obtain accurate demographic information, to provide much-
needed public services and to implement effective and accurate
development policies.
Turkana was previously administered as the largest district in Kenya. The
region is now split into six districts: Loima, Central, South, North, West
and East Turkana, which are further broken down into 17 administrative
divisions.
The region, which currently has three representatives in the Kenyan
parliament, remains largely off the national political map with limited
political participation at the local level. For 2007 elections, the region
registered 138,223 voters (109,567 for the 2010 constitution
referendum), accounting for less than a quarter of its total population.31
BELOW Cattle graze near FLORA AND FAUNA
Kakuma.
The vegetation of the area is
characterized by annual grasses
and shrubs in the plains and
perennial grasses and large trees
in the highlands. The lowlands
are crosscut with temporary
streams and rivers. The larger of
the river courses, the Kerio and
the Turkwell, support dense
gallery forests; acacia trees grow
along the banks of smaller
streams and river beds. Although
the region is arid, Turkana
benefits from numerous springs
and underground water sources.
Early travelers reported an
abundance of wild animals in
Turkana, but today most wildlife
is restricted to the forested areas,
and to the unoccupied areas that
serve as a buffer between the
Turkana and the tribal groups on
their borders.32
 IRC TURKANA PROJECT SITES (2010)
Sudan
Ethiopia

Eastern
Rift valley
Uganda Somalia
KIBISH
Western N. Eastern
Lokwanya Central
Nyanza
!
( Nairobi
SUDAN ( Kaiemothia
!
Coast

Tanzania
Lokoilo
!
(
LAPUR
!
( ETHIOPIA
Namuruputh
Lomoru
LOKICHOGGIO !
(
Lokitaung

L. Turkana
Lokichoggio KAALING
p!
( !
(
Lodongoro
!
(
LOKITAUNG

( Moru
!

KAKUMA ( Murangering
!

!
( Kakuma
OROPOI MARSABIT
Kalokol !
(

KALOKOL
CENTRAL
UGANDA pLodwar
LOIMA TURKWEL

!
(Moruesis Kosipirr
!
( ( Lorukumu
! KERIO
IRC TURKANA PROJECT SITES
p Airfields
" Hospitals Lolimo
!
( Kakulit
!
( LOKICHAR
Kolitak
!
( Major Towns !
(
Naoiyapua
Lokichar
IRC Project Sites !
(
!
( !
( Loperat
Major Rivers Natapotimoru
!
( Kaloniwai
Major Roads KATILU
Nakwamoru
LOKORI
International Boundary !
(
!
( Kaputirr
Lakes
!
( Lokori
Division Boundaries KAINUK

Map Doc Name:

KE_IRC HIV/AIDS Map
Creation Date: 05 August 2010 ( Napeitoro
!
Projection/Datum: WGS 1984
Web Resources: http://ochaonline.un.org/kenya
Nominal Scale at A4 paper size: 1:2,000,000
WEST
LOMELO SAMBURU
0 5 10 20 30 Kms
!
( Lomelo
Map data source(s):
Administrative boundaries data is from Data Exchange Platform for the
Horn of Africa 2006
Roads data is from Communication Commission of Kenya 2006
Towns data is from World Food Program 2006
(Kapedo
!
Rivers data is from Data Exchange Platform for the Horn of Africa 2006

Disclaimers:
TRANSNZOIA MARAKWET BARINGO
The designations employed and the presentation of material on this
map do not imply any opinion on the part of the Secretariat of the
United Nations.
12 IRC KENYA / LIVING ON! / TURKANA ESSENTIALS

IRC PROJECT SITES:

LODWAR
Located in Turkana Central District, Central Division, population
40,000. Administrative and commercial center of northwestern Kenya.

The town of Lodwar is located on the banks of the Turkwell River, 50 kilometers from Lake Turkana’s western shore. It is considered the
capital of the region, housing local and governmental facilities, including Turkana’s biggest health facility and the main referral hospital,
Lodwar District Hospital (LDH).

The settlement was established in the 1930s by traders and soon became the seat of the Turkana district commissioner’s office, with a
small medical clinic and a government prison. During the colonial period, Lodwar functioned as a transit point for British officials moving
Kenyan political prisoners to the north. The town had developed a reputation as an isolated outpost removed from in the rest of Kenya, but
in recent years, Lodwar has expanded and gained commercial and economic prominence.

Lodwar is the seat of several of IRC’s Turkana operations, including the HIV/AIDS program.

LEFT IRC-supported VCT center in Lodwar District Hospital.

ABOVE Entry to Lodwar from Kakuma (North).
BOTTOM Lodwar seen from the closest hill.
BOTTOM LEFT Villages surrounding Lodwar. Such villages, located in the outskirts of
Turkana’s major towns, have grown in size and numbers during the recent decades.
TOP OF THE PAGE The main street of Lodwar.
 IRC KENYA / LIVING ON! / TURKANA ESSENTIALS 13

IRC PROJECT SITES:

KAKUMA
Located in Turkana West District, Kakuma Division. Population
138,000, including roughly 67,000 refugees in Kakuma Refugee
Camp. The largest settlement in northwestern Kenya.

Kakuma made it onto the map in the early 1990s after the establishment of Kakuma Refugee Camp, now the second largest refugee
camp in Kenya. Following the influx of refugees from neighboring Sudan and the transfer of refugee populations from numerous Kenyan
camps that began to close in 1992, Kakuma has turned into a multinational community. The camp currently provides a home to refugees
from over 20 ethnic groups and 12 African countries— Burundi, Central African Republic, Democratic Republic of Congo, Eritrea, Ethiopia,
Republic of Congo, Rwanda, Somalia, Sudan, Tanzania and Uganda. Somalis form the majority of the camp’s population (58%), followed by
Sudanese (28%), Ethiopians (9%) and Congolese (3%).

IRC is the exclusive provider of medical services in Kakuma Refugee Camp, where it operates a hospital and several clinics. It also
supports Kakuma’s Mission Hospital, which is the main referral hospital for Turkana North and West districts.

LEFT VCT center in Kakuma Refugee Camp (Kakuma I).

BOTTOM CENTER Children in Kakuma Refugee Camp.
BOTTOM RIGHT Entry to Kakuma, refugee camp in background.
RIGHT Kakuma Refugee Camp.
ABOVE CENTER IRC-supported Kakuma Mission Hospital.
ABOVE LEFT The main street of Kakuma town.
TOP OF THE PAGE Kakuma Refugee Camp (Kakuma IV).
14 IRC KENYA / LIVING ON! / TURKANA ESSENTIALS

IRC PROJECT SITES:

LOKICHOGGIO
Located in Turkana West District, Lokichoggio Division. Population 36,187. Former humanitarian
hub for Southern Sudan.

The town of Lokichoggio, often referred to a Loki, is located about 30 kilometers from the border with Sudan. Daily temperatures
frequently reach 40°C/100°F, and it is hot and dry year-round.

Loki was established in 1992 as the base for the U.N.’s Operation Lifeline Sudan, a response to the humanitarian emergency in Southern
Sudan in the wake of the prolonged civil war and famine. Loki became a transit center for refugees and and satellite location for
international organizations and NGOs operating in Southern Sudan. At the height of operations, the IRC partnered with African Inland
Church to offer comprehensive HIV prevention as well as support to aid workers. The partners opened the first stand-alone VCT center in
town, expanding its services over the next few years.

Due to its transitional location Loki became a vibrant commercial and multiethnic center— a temporary home for about 1,000 humanitarian
workers who lived alongside the local urban and rural Turkana populations plus the Kikuyu, Luhya and Somalis. . The recent relocation of
humanitarian operations to Juba in Sudan has downscaled and marginalized the importance of Lokichoggio, although the town remains the
main entry point for Southern Sudan.

The IRC has operational presence in Lokichoggio, working through and supporting the Africa Inland Church Medical Center, the main
medical facility in the area.

TOP OF THE PAGE The main street of Lokichoggio.

LEFT IRC-supported VCT center, located at AIC Health

Centre, Lokichoggio.

BOTTOM Abandoned aircraft at Lokichoggio airstrip that

used to serve as the base for Operation Lifeline Sudan.
 IRC KENYA / LIVING ON! / TURKANA ESSENTIALS 15

IRC PROJECT SITES:

KALOKOL
Located close to the shores of Lake Turkana, in Turkana Central District, Kalokol Division.
Population 29,000.

Due to the proximity of Lake Turkana, fishing is one of the main livelihoods in Kalokol, which even has a fish-processing facility. The area is
windy, dusty, hot and dry— harsh even for local livestock such as goats and camels, allowing only limited pastoral activities and business
development. The landscape is characterized by lowlands that stretch along the lake’s western shores.

Africa Inland Church’s Kalokol Medical Center, which has been supported by the IRC since 2005, is the only medical facility in the area
and on the western shores of Lake Turkana.

GO TO PAGE 49 TO MEET IRC PARTNERS IN KALOKOL AND LOKICHOGGIO

TOP OF THE PAGE Fishing is the main livelihood in

Kalokol.
ABOVE LEFT, RIGHT AIC Health Center Kalokol and
the IRC-supported VCT center.
BOTTOM LEFT View of Kalokol from the town water
tower.
BOTTOM RIGHT Kalokol main street.
16 IRC KENYA / LIVING ON! / IRC IN TURKANA

IRC IN TURKANA
IRC Kenya operation is intimately linked to the Turkana region
where the IRC has been working since 1992.

HISTORY
The IRC began working in the region by providing health-related
outreach activities in Kakuma Refugee Camp, initiating a primary
healthcare program and establishing a network of clinics. In 1995
the IRC’s services were expanded at the request of the community
to include a small self-reliance program comprised of adult
education and community-based rehabilitation. In 1997, the IRC
took over the camp’s health services and became the sole
implementing health-sector partner under the operational umbrella
of the U.N. High Commissioner for Refugees (UNHCR). It then
assumed responsibility for the camp hospital, bringing all
preventative and curative health-sector activities under its
management. Since 2001, the IRC’s activities have gradually
expanded in scope and area, including Kenyan communities. The
HIV/AIDS prevention and care program led the expansion of IRC’s
activities across the greater Turkana region to Kakuma town in
September 2001, Lokichoggio in 2004, Kalokol in 2005 and
Lodwar in 2007. This was followed by the introduction of
region-wide child health and nutrition programs, a water and
sanitation program and a cross-border peace-building program
operated with the IRC Uganda since 2009. The IRC also promptly
responds to emergencies like the devastating 2006/2007 drought
and 2009 cholera outbreaks.
APPROACH
In the greater Turkana region, the IRC provides essential services
through the implementation of its programs, which target two
groups of beneficiaries: thousands of refugees who have fled
conflicts in other African countries such as Somalia, Sudan,
Ethiopia, Uganda and DRC, and Kenyan communities in need
of humanitarian or development assistance.
In order to assure maximum impact and effectiveness of its Turkana
programs, the IRC bases its approach on thorough and
continuous assessments of needs in the region; situating
more programs in the same geography; integrated
mainstreaming of new services through existing ones to
reinforce results; and supporting and partnering with actors
already present on the ground to avoid replication and build
local capacity.

The IRC has been supported by the following donors in the

implementation of its Turkana programs: BPRM, CDC, DFID, EU,
Otto Family Foundation, RIJ, SV, UNHCR, UNICEF, USAID, WFP
and WHO.
PROGRAMS
MATERNAL, NEONATAL AND CHILD HEALTH PROGRAM
(KENYAN COMMUNITIES)
Since early 2009, the IRC has been running maternal, neonatal and child health
programs for host communities, implemented through its partners, Diocese of Lodwar
and African Inland Church Health Center in Lokichoggio. At facility level, IRC supports
antenatal and postnatal care, maternity services, emergency obstetric care,
immunization outreaches and malnutrition stabilization centers. At community level,
the IRC offers support for the treatment of childhood illnesses and training of
community health promoters, screens for malnutrition, promotes safe motherhood and
conducts behavioral-change outreaches on hygiene and disease prevention.

CROSS BORDER PEACE BUILDING (KENYAN COMMUNITIES)

Together with IRC Uganda and partners, IRC Kenya aims to strengthen the
cross-border capacity of civil society networks and organizations in the Karamoja,
Turkana and Pokot regions to prevent and resolve conflicts between communities
along the Kenya-Uganda border. The IRC assists civil society in building capacity to
successfully lobby local representatives and authorities to prevent and mediate
conflicts.

OPPOSITE PAGE AT RIGHT Somali refugee

girl received by IRC clinicians at KRC Clinic 5.

LEFT Local woman vaccinated against tetanus in Kakuma Refugee Camp Clinic 4.
Although intended primarily for the refugee population, many locals use IRC-run
medical facilities in the camp.
 IRC KENYA / LIVING ON! / IRC IN TURKANA 17

RIGHT Management of acute malnutrition at Kakuma Mission Hospital by

the nutrition team.

NUTRITION (KRC, KENYAN COMMUNITIES)

In Kakuma Refugee Camp, the IRC runs a range of preventive
and curative activities including growth monitoring, infant and
young-child feeding, health and nutrition education, community-
based management of acute malnutrition, and hospital inpatient
feeding services. In the local communities, the IRC operates a full
community therapeutic program through partners’ health
facilities—AIC health centers and Kakuma Mission Hospital—
including supplementary feeding, outpatient therapeutic feeding
and stabilization centers. Outreach centers have been set up at
community level to ensure high coverage and accessibility to
services. Main activities include food distribution, health and
nutrition education, vitamin A supplementation, de-worming,
and infant and young-child feeding practices.

RETURN AND EDUCATION PROGRAM (KRC)

Through this program, the IRC offered a curriculum in literacy
and numeracy in English and Kiswahili, as well as courses in
peace and reconciliation, gender and community development.
The IRC also supported other programs through business skills
and facilitators’ training courses, and prepared people who were
scheduled for resettlement in the United States. The IRC handed
over the program at the end of 2008.

CLINICAL SERVICES AND SUPPORT (KRC)

The IRC runs a 90-bed primary care hospital with a minor oper-
ating theater, outpatient department, male and female inpatient
wards, a pediatric ward, an isolation ward, a tuberculosis ward,
laboratory, pharmacy and a therapeutic feeding center. In
addition, the IRC supports four outpatient clinics providing
curative services, preventative health care, pre- and postnatal
care, immunizations and family planning. The IRC also offers
physiotherapy and rehabilitation for persons with disabilities.

COMMUNITY HEALTH PROGRAM (KRC)

The IRC focuses on preventive health care and education in the
camp with a team of community health workers, traditional birth
attendants, vaccinators, and reproductive and mental health
workers. The program includes therapeutic feeding and
supplementary feeding centers and a 24-hour emergency
feeding center located in the pediatric ward of the hospital.
Under the program, defaulter tracing and referral is undertaken,
as well as hygiene education and birth supervision.

ABOVE Access to drinking water remains a major issue in Turkana.

ABOVE CENTER Latrines at Kakuma Refugee Camp.

ENVIRONMENTAL HEALTH (KRC)

The community-based sanitation program in the camp
covers solid, liquid and human waste control, vector
control, food quality and animal slaughter inspection, and
burial of the dead.

WATER PROGRAM
(KENYAN COMMUNITIES)
From 2007 to 2008, after Turkana was heavily affected by
droughts, the IRC implemented a comprehensive water
program, providing towns like Kalokol or Nadapal with
gravity flow systems or similar infrastructure projects that
provided thousands with access to drinking water.
 IRC KENYA / LIVING ON! / HIV/AIDS PROGRAM

IRC TURKANA
HIV/AIDS PROGRAM

19 BASICS
20 PROGRAM OBJECTIVES
22 TIMELINE
23 IRC BCC STRATEGY: KAKUMA CAMP PILOT
24 STATISTICS
28 BEST PRACTICES
49 LESSONS LEARNED
 IRC KENYA / LIVING ON! / HIV/AIDS PROGRAM 19

BASICS
HISTORY The ORIGINS of the IRC’s HIV/AIDS program in Turkana date
back to the 1990s, when IRC Kenya became the main provider of
health services in Kakuma Refugee Camp under the operational
umbrella of UNHCR. With HIV prevalence rates in Kenya rising and
hitting remote areas like Turkana particularly hard, it became clear
that there was a need to help the Kenyan government address the
issue in a comprehensive manner. Relying on the support of
individual donors and ultimately the U.S. Centers for Disease
Control and Prevention (CDC), IRC Kenya started an HIV/AIDS
prevention and care program in the Turkana region, beginning in
Kakuma town (2001) and spreading to Lokichoggio (2004),
Kalokol (2005) and Lodwar (2007).

In implementing its HIV/AIDS program, the IRC must tackle the

ACCESS usual challenges associated with operating in Turkana. The region
TO CLINICAL is vast and most areas remote, with limited or no healthcare
facilities. Assuring ACCESS to HIV/AIDS-related CLINICAL
SERVICES SERVICES and information is vital for the successful
implementation of the program. IRC facilities are spread throughout
the region, covering hot-spots and major urban centers as well as
surrounding rural areas.
Whenever possible, the IRC helps build local capacity and supports
partners and local structures. In Lodwar, Lokichoggio, Kalokol and
Kakuma town, the IRC supports the clinical dimension of the HIV/
AIDS program with equipment and counseling, financing and
training for its implementing partners: Diocese of Lodwar, Africa
Inland Church and the Ministry of Health. In Kakuma Refugee
Camp, the refugee population relies solely on IRC-provided
healthcare and HIV/AIDS prevention and treatment.

BEHAVIORAL The behavioral change communication (BCC) component of the

program, the forefront of prevention, is managed and facilitated by
CHANGE the IRC. Poverty, lack of education and the prevalence of certain
cultural practices increase the risk of HIV/AIDS contraction and
COMMUNICATION transmission and underscore the BCC’s importance, but also make
implementation a challenge. BCC activities target clusters of
problems with direct or indirect link to HIV/AIDS which, when
addressed, also spur development in local communities. These
activities are attached to existing initiatives, networks and
community structures as often as possible, generating individual
inclusion and empowerment.

Turkana has high malnutrition rates and is affected by droughts and

PROGRAM insecurity, harsh living conditions the IRC tries to ameliorate through
MAINSTREAMING numerous other programs. In order to increase the scope of the
HIV/AIDS program outreach and the effective use of resources,
these programs are often used as a platform for
MAINSTREAMING HIV/AIDS ACTIVITIES and providing a
LEFT Voluntary counseling and testing (VCT) holistic approach to issues such as nutrition, child, maternal and
session at Kakuma Mission Hospital. community health, and water and sanitation.
 IRC KENYA / LIVING ON! / HIV/AIDS PROGRAM

IRC HIV/AIDS PROGRAM

OBJECTIVES

ASSURING IMPROVED ACCESS

TO QUALITY HIV/AIDS
PREVENTION, TREATMENT AND
CARE SERVICES IN TURKANA,
REQUIRES THE IRC TO...

Offering comprehensive services is crucial for successful care and treatment in underserved areas.

1 INCREASE ACCESS TO A COMPREHENSIVE HIV/AIDS CARE

PACKAGE AT ALL PROGRAM SITES
The IRC operates a Comprehensive Care Clinic (CCC) at the Kakuma Refugee Camp hospital and in Lokichoggio, supports and
strengthens CCC in Kakuma Mission Hospital, provides a basic HIV care package in Kalokol and has introduced a basic care
package for adult/pediatric ART at several other locations. The IRC provides Cotrimoxazole Preventive Therapy (CPT) to all
eligible patients; strengthens links to care clinics and other services such as home-based care (HBC), voluntary counseling and
testing (VCT), and prevention of mother-to-child transmission (PMTCT); and introduces nutritional support services to ART
patients. The IRC facilitates training on HIV/AIDS care service provision for its staff and partners, and offers support in the
provision of medical equipment.

The knowledge of HIV/AIDS in the region is limited and the sources of information scarce.

2 INCREASE ACCESS TO HIV PREVENTION EDUCATION

SERVICES AT PROGRAM SITES
The IRC supports group-specific HIV/AIDS behavior change campaigns (BCC) that make use of media including film, drama,
dance, song, community meetings, targeted education and promotional materials. This requires development and adaptation of
culturally appropriate messages, refresher training and resource materials to help outreach staff and peer educators achieve their
goals. Additionally, various awareness activities on HIV prevention are conducted in bars and video halls, and condoms
distributed.
GO TO PAGES 28 TO 40 TO LEARN MORE ABOUT PREVENTION INTERVENTIONS

Knowing an individual’s status is a starting point for addressing HIV/AIDS issues and providing treatment.

3 MAINTAIN AND EXPAND ASSESS TO HIGH-QUALITY HIV

COUNSELING AND TESTING (CT)
The IRC provides high quality CT services at the six project sites, support for the creation of post-test clubs in all six sites,
strengthening the institutional capacity to provide quality CT services in the six locations, and bolstering institutional capacity to
implement routine quality assurance CT systems in the six locations.
 IRC KENYA / LIVING ON! / HIV/AIDS PROGRAM 21

LEFT Awareness outreach in Kakuma Refugee Camp

delivered through a dance skit.

Sexually transmitted infections (STIs) increase the chances of HIV contraction and HIV/AIDS patients are more
susceptible to TB infections.

4 INCREASE EXISTING TB/HIV CO-INFECTION AND STI

CONTROL SERVICES
The IRC provides STIs and refers clients to HIV counseling and testing, monitors partner treatment rates, offers refresher training
on STI syndrome management, provides systematic diagnostic counseling and testing of HIV for TB patients as well as treatment
to TB/HIV-positive patients, and strengthens institutional capacity to manage TB/HIV infections.

Blood safety is a basic requirement for the prevention, control and treatment of HIV/AIDS.

5 CONTINUE TO EXPAND THE EXISTING BLOOD AND

INJECTION SAFETY PROGRAM AT SERVICE DELIVERY POINTS
The IRC conducts training on universal precautions at all project sites, ensures that all blood for transfusion is screened for HIV,
Hepatitis B and syphilis, and supplies health facilities with equipment to ensure blood safety.

Mother-to-child transmission remains a major concern in Turkana.

6 INCREASE ACCESS TO QUALITY PREVENTION OF MOTHER-

TO-CHILD TRANSMISSION (PMTCT) SERVICES AT ALL SITES
This is done by ensuring PMTCT services to pregnant women are integrated into the antenatal care package; by improving
referrals of HIV-positive pregnant women for hospital delivery; by increasing institutional capacity to provide PMTCT services; by
introducing early infant diagnosis; and by monitoring sero-status and growth of children born to HIV-positive mothers.

GO TO PAGES 46-48 FOR PMTCT BEST PRACTICE

Turkana is vast and its population extremely mobile, presenting a challenge for HIV/AIDS data collection.

7 IMPROVE THE AVAILABILITY AND QUALITY OF HIV DATA IN

TURKANA
The IRC undertakes continuing data collection and monthly reporting of client– and provider–initiated counseling and testing
(CT), STI client CT, tuberculosis client CT, and prevention of mother-to-child transmission. The IRC also conducts training on HIV/
AIDS data management, disseminates information through reports and/or meetings with stakeholders and helps build the
capacity of the Turkana Health Records Department on data management.

GO TO PAGE 43 FOR HIV/AIDS DATA MANAGEMENT

Home-based care is vital to assuring HIV/AIDS treatment for patients unable to access medical facilities.

8 EXPAND THE COVERAGE OF THE EXISTING HOME-BASED

CARE PROGRAM
The IRC provides home-based care services to HIV/AIDS patients and strengthens the capacity of its partner organizations to
provide home-based care services.
 22
IRC TURKANA HIV/AIDS PROGRAM TIMELINE
JAN 2001 2007 2008 2009 2009
P Kakuma town KRC program program program
R Prevention and care BCC training and Induction and roll out of “Prevention with Active participation in
program launched. BCC pilot strategy. response to disasters
O Families Matter program. Positives” at Clinical
and Community levels. and disease outbreaks.
G Early Infant Diagnosis
R training and program. Integrated database Advocacy for special
A development. food rations for
2006 HIV comprehensive care PLWHA and TB
M KRC clinics data reconstruction. Nutrition and patients at national and
2002
2004 Reproductive Community programs provincial levels.
KRC
D Lokichoggio Health program mainstreaming.
VCT at MPC1 and
Stand-alone VCT changed to HIV
E MPC4.
program, safe 2008
and BCC.
V Lodwar
motherhood
CD4 Machine installed
E transferred to
(LDH). 2009 2010
Clinical Services
L 2004 program. Loki Kakuma
O Kalokol CSW involvement in CD4 machine
Integrated VCT and HIV prevention. installed
P BCC. 2008 (KMH).
M Lodwar CD4 machine installed,
E HIV/AIDS awareness AIC HC.
through radio.
N
T

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
D
2006 2010
O Networking with MoH Active membership in Technical
N HIV/AIDS structures at Working Group at national level
district, provincial and
O national levels.
2007 (NASCOP).
Lodwar
R MoU with LDH to Direct support to Provincial Health
S 2006 implement HIV/ 2008 Management Teams.
Lokichoggio AIDS program. Lokiriama,
& MoU with AIC – stand St.Monica, 2010
alone VCT and HIV/TB. St.Catherine, Expansion
2007 Lokori strategies through
P 2006
KRC
POA project and
MoU with NCCK MoU with DOL.
A Kalokol
to implement life
APHIA plus
R MoU with AIC to run HIV/ project.
skills for youth.
AIDS program.
T 2008
2001 Organizational 2009
N KRC
2005
Participating in
KRC 2006 capacity
E UNHCR-funded Repro- CDC funding, integrated Kakuma 2007 assessment MoH Annual
R ductive health program HIV/AIDS program. MoU with KMH to run HIV/ KRC (OCA) exercise Operations
AIDS program. GLIA funding. among partners. Planning.
S
 IRC KENYA / LIVING ON! / HIV/AIDS PROGRAM 23

KAKUMA CAMP PILOT

DEVELOPING GLOBAL IRC BEHAVIOR CHANGE

COMMUNICATION (BCC) STRATEGY
Kakuma Refugee Camp served as a pilot site for the development of IRC’s global behavior change
communication (BCC) strategy in 2007. BCC interventions are crucial but challenging components of
programming, as they need to take into consideration the specificities of the environment and audience to
result in meaningful and lasting social change.

IRC’s Kakuma operation was chosen as the pilot site IRC BCC FRAMEWORK
because its health program and team are among the
strongest in the IRC, providing for a positive
environment to launch the 12-step approach to BCC.
Additionally, the complex mix of ethnic groups, cultures
and languages in a setting like Kakuma Refugee Camp
requires a carefully planned and targeted
communication strategy, particularly in relation to
behavior change for culturally sensitive issues related to
reproductive health, sexuality and HIV/AIDS.

The IRC recognized the importance of a detailed,

structured process in the design of an effective
communications intervention and developed a 12–step
approach to creating a BCC project. A thorough
understanding of the audience and analysis of the
context were the foundation of this approach.
Community involvement and participation were crucial
for the success of a BCC strategy that included:

(A) identifying risky behaviors;

(B) selecting the target group;
(C) identifying communication activities and methods; and
(D) facilitating commitment to and support for the BCC process.

IRC’s BCC strategy was rolled-out in Kakuma Refugee Camp and across other IRC country programs in 2007.

RIGHT BCC and awareness

outreach in Kakuma
Refugee Camp.
24 IRC KENYA / LIVING ON! / HIV/AIDS PROGRAM

HIV/AIDS PROGRAM
IN NUMBERS
VCT SERVICES
The data demonstrates a gradual and consistent
increase in the number of clients who have
accessed voluntary counseling and testing
services supported by the IRC, and a shift from static
to mobile or home-based services. Acknowledging
that access to medical services is one of the main
problems in Turkana, the IRC adopted a multipronged
strategy of proactively reaching out to the population
and bringing HIV/AIDS treatment services closer to
the people, either where they congregate, do
business or live. In addition, mobile VCT services also
targeted pastoralist populations in remote and rural
areas with few or no medical facilities. Some locations
were several days’ walk from the nearest hospital,
clinic or dispensary. The overwhelming majority of
clients accessing VCT stations use both, testing and
counseling services.

The total number of people reached by testing and

counseling services, which combines VCT and all
types of provider-initiated counseling and testing, is expected to reach 50,000 for year 2010 and has been increasing steadily every
year. This clearly demonstrates that if these services are accessible, people’s health-seeking behavior will change.

PMTCT-RELATED TESTING
Prevention of mother-to-child transmission (PMTCT) is crucial to IRC’s HIV/AIDS intervention in Turkana. Identification of women in
need of PMTCT treatment presents one of the major challenges in remote areas with limited healthcare facilities. Providing testing
with antenatal care offers an ideal opportunity for identifying HIV-positive women. The number of women tested for HIV in IRC-
supported facilities while attending antenatal care has risen since 2005.

GO TO PAGE 44 FOR PMTCT BEST PRACTICE

 IRC KENYA / LIVING ON! / HIV/AIDS PROGRAM 25

ANTIRETROVIRAL THERAPY
The number of people initiating and
adhering to the antiretroviral
therapy in Turkana has traditionally
been low for reasons of limited ac-
cess to healthcare facilities and
high ART costs. The IRC has
provided ART available free of
charge since the early stages of
HIV/AIDS program’s
implementation and increased the
ARV coverage along with the
expansion of its activities. ARV ad-
herence remains a major
challenge for various reasons,
including the high mobility of local
communities, their remote location
and limited health knowledge. The
data shows a gradual increase in
the number of individuals who have
newly initiated ARV treatment.

The IRC data from 2007 to 2009 on ARV defaulters reveals that approximately 600 individuals discontinued their ARV treatment.
About 15% were transferred to locations outside of IRC’s coverage and the rest ether defaulted or the IRC lost track of them. About
20% of the individuals died during the survey.
GO TO PAGE 43 FOR HIV/AIDS DATA MANAGEMENT BEST PRACTICES

HIV/AIDS AWARENESS
During the early stages of the HIV/AIDS Turkana intervention, the IRC expanded the scope of its HIV/AIDS awareness activities and
channels. New and innovative ways to spread the message about HIV/AIDS, from radio to formal education, were introduced, a
strategy intended to address one of the biggest challenges in the region— reaching out to and raising awareness among populations in
the most remote and rural areas of Turkana. Since 2010, the awareness outreach is more targeted and focuses increasingly on
specific groups at-risk.

GO TO PAGES 28-48 FOR AWARENESS BEST PRACTICES

26 IRC KENYA / LIVING ON! / HIV/AIDS PROGRAM

BUILDING LOCAL CAPACITY

Building local capacity through training and
education is one of the cornerstones of IRC’s
approach in the region. The variety of HIV/
AIDS-related training sponsored or supported
has increased significantly, as well as the
range of beneficiaries who now include
medical staff, community health and
development workers, teachers, public
officials, parents, youth, at-risk groups and
others. The increased frequency of these ca-
pacity building activities has also led to more
comprehensive coverage, meeting the needs
of the region more closely. Generally, building
capacity through training of medical and com-
munity staff has beneficial effects beyond the
HIV/AIDS program.

PROGRAM FUNDING (CDC/PEPFAR)

IRC’s HIV/AIDS program has seen an increase in funding since its start in 2005, which confirms the persistent need for HIV/AIDS-
related services in Turkana. During this time, the IRC has expanded the number of locations where VCT, care and treatment services
are accessible, it scaled up its PMTCT activities and emphasized the prevention focus of its outreach. Accordingly, the funding for
prevention activities has increased two-fold in absolute terms but decreased relative to other components. This indicates a more
targeted approach to prevention; for example, funding for care, treatment and support, for which includes access to ARVs, has
increased six-fold. Changes in relative numbers of program fund allocation demonstrate that the IRC reprioritizes in accordance with
best interests and needs of the beneficiaries of its programs on the ground. Furthermore, the IRC has had to adapt to limited funding,
a challenge that could negatively impact on the achievements of the HIV/AIDS program.

As demonstrated throughout this document, the implementation of the IRC’s HIV/AIDS program in Turkana has had significant effects
on the behavioral patterns related to HIV/AIDS in the region. It is essential to secure further funding to support program activities and
local partners beyond the 2005-2010 program phase.
 27

Many lessons and best practices have been drawn from the IRC’s experience
working with local communities and numerous local, national and international
partners in Turkana for more than two decades, along with five years of
coordinated response to HIV/AIDS. The IRC strives to reflect upon its
experiences and apply them to its programs and activities. The IRC also shares
them with partners and donors on a regular basis to contribute to the continuous
improvement of development and humanitarian programs in Turkana.

BEST PRACTICES
28 COMMUNITY THEATER
32 TARGET-GROUP ADVOCATES
34 HIV/AIDS AWARENESS ON RADIO WAVES
37 PREVENTION WITH POSITIVES
40 FAMILIES MATTER!
43 HIV/AIDS DATA MANAGEMENT
44 VCT AND INTEGRATED OUTREACH SERVICES
46 PMTCT, EARLY CHILD DIAGNOSIS AND HOSPITAL DELIVERIES

LESSONS LEARNED
49 THE IRREPLACEABLE POWER OF PARTNERSHIP
51 NEED FOR ALTERNATIVE WAYS TO UNDERSTAND THE CONTEXT, REACH OUT TO
THE POPULATION AND DELIVER THE HIV/AIDS MESSAGE
52 THE BENEFITS OF LINKING AND MAINSTREAMING HIV/AIDS THROUGH OTHER
PROGRAMS
52 NEED FOR A STRONGER PUSH FROM THE GOVERNMENT ON THE HIV/AIDS FRONT
53 INSEPARABLE THREATS: HIV AND TB
54 MORE STRUCTURAL INVESTEMENT IN TURKANA
 IRC KENYA / LIVING ON! / BEST PRACTICE

BEST PRACTICE

COMMUNITY THEATER
 IRC KENYA / LIVING ON! / BEST PRACTICE 29

Raising HIV/AIDS Awareness and Engaging

Communities in Turkana Through Youth Advocacy Groups
Raising general awareness about HIV/AIDS is at the core of the
IRC’s strategy to prevent the disease’s spread and manage its
negative social impacts, especially stigma. For the awareness
activities to be as effective as possible, it is crucial that they be
engaging, attractive and entertaining, which community theater
groups supported by IRC in Turkana strive to achieve.

Since many youth in Turkana are out of school but unemployed, the
IRC seeks to engage them actively in HIV/AIDS awareness
campaigns to reach out to their peers. Community theater groups
are usually composed of local youth who have undergone voluntary
HIV/AIDS counseling and testing and were then recruited to help
with community outreach.

The IRC supports seven groups that conduct outreaches six to

eight times a month in the form of skits, dances, role-playing and
short performances. These activities can be an integral part of a
larger outreach event or a singular activity at community meetings
or celebrations.

The performances focus on delivering messages on HIV/AIDS or

general health: They promote health services and facilities, inform
on basic principles of hygiene, sanitation and care, challenge myths,
stereotypes and attitudes, and try to break down barriers about sex
and sexuality. The latter is especially important, given the taking

THIS PAGE Lodwar-based St. Augustine Youth Centre group performing

a skit in Nabute village, Lodwar. Storyline: Young man returns to his village
from Nairobi, has unprotected sex with his ex-girlfriend and contracts an
STI. He visits a hospital, talks to a counselor and is advised by health
workers and friends to use protection and know his HIV-status in the
future.

OPPOSITE PAGE Dance skit performed by a Community Theater Group

in Kakuma Refugee Camp.
30 IRC KENYA / LIVING ON! / BEST PRACTICE

into general reluctance among the population to address such

issues in public settings. Performances are part of a larger HIV/
AIDS mobilization activity and take place in busy public places,
such as markets or water wells, at different times of the day.

Performances often attract the attention of the whole village or

town. The audience is encouraged to participate and ask
questions, but also to undergo voluntary HIV/AIDS counseling and
testing at mobile counseling and testing stations located close to
outreach venues.

Community theater groups in Turkana present an innovative

method of conveying HIV/AIDS-related messages and have
proved successful in raising awareness among locals who often
refer to these events as the source of their knowledge about HIV/
AIDS.

Future plans to improve Community theater outreach include

adaptations of the program for specific targeted groups, including
through puppetry performances for children, touring performances
and support for the establishment of similar groups in the region.

THIS PAGE Lokichoggio theater group

performing skits on HIV/AIDS and stigma
in Lokichoggio and surrounding villages.
 IRC KENYA / LIVING ON! / BEST PRACTICE 31

BANJUKA (Kalokol)
The theater group from Kalokol has been active since 2007. Lucy, Susan,
Florence (below, first row from the left), Rose, Said, Jacqueline (second
row) and their colleagues practice twice weekly and perform in the
villages of Kalokol division at least six times a month. They say the best
way to attract attention through theater is to make people laugh, even
when topics are serious. They are proud of their work and believe they
have influenced their audience—condoms, sexuality and STIs are topics
that do not cause negative reaction
anymore. Although they must travel
to remote locations and have
problems informing communities
about upcoming performances, the
group remains ambitious and wants
to perform outside of the Turkana
region.

PHOTOS ABOVE Banjuka group performing a skit in Kalokol. Storyline:

After being tested and found HIV-postive, a girl (and her mother) is chased
from their home by her father. They turn to a doctor for help. He talks to
the father and provides him with basic information about HIV/AIDS,
antiretroviral therapy and confronts disease-related myths. As a
consequence, the father accepts his daughter and wife back into the
home.

LEFT Theater group from Kakuma Refugee Camp performing during an

HIV/AIDS community outreach.
LEFT BELOW Dance skit in Kakuma Refugee Camp.
BELOW Lodwar theater group performing during Families Matter!
graduation ceremony in Lodwar.
 IRC KENYA / LIVING ON! / BEST PRACTICE
BEST PRACTICE
TARGET-GROUP
ADVOCATES
The IRC has worked extensively with most-at-risk populations in
Turkana, including commercial sex workers, truck drivers en route
to and from South Sudan, and the fishing communities of Lake
Turkana. Initially these groups were considered only as target
groups for behavior change communication and HIV/AIDS-related
messages. If properly educated, trained and supported, they can
become an effective advocacy group for continued
behavior change communication on HIV/AIDS and general health
among their peers and in the local community.
Young women and girls are particularly vulnerable to HIV, more so
when frequently changing sexual partners or as a result of
commercial sex activities. The IRC has designed outreach
activities in Lokichoggio and Lodwar specifically for these groups.
Initially the objective was to make them aware of the risks linked
to such behavior and to encourage them to reach out to their
peers, sexual partners and, in some cases, customers. After
training 20 young women in Lokichoggio and attaining the initial
objective of disseminating information through them to their peers,
eight girls from the group were mobilized for further
outreach.
Their engagement is particularly valuable since they have
privileged access to the local communities. They were also
already trained on HIV/AIDS or issues of general health and know
who to turn to for additional information. The women work in pairs,
reaching out to different villages and settlements twice a week. An
initial outreach at a specific location is repeated,
focusing on the same topic or addressing a new issue,
depending on the needs.
This approach has proven extremely efficient in addressing basic
hygiene and health-related misconceptions persistent among the
locals or in fighting HIV/AIDS and the related stigma. People are
more ready to listen and trust the members of their own
community, even more so when talking about personal matters
such as health or sexuality.
Even though the primary aim of such community outreach is
curtailing the spread HIV/AIDS, such activities provide basic
information on hygiene and nutrition, diseases such as diarrhea
and pneumonia, and issues such as home delivery, referrals,
antenatal and child care. Community members are encouraged to
visit health facilities sooner rather than later, although financial
considerations remain an important deterrent to seeking medical
assistance. It often happens that locals do not go to the clinic for
fear that they will need to pay for treatment, even if it is provided
free, as in the case of HIV/AIDS antiretroviral or tuberculosis
treatment.
Frequent access to all communities, particularly the remote ones,
 IRC KENYA / LIVING ON! / BEST PRACTICE 33

Actively Engaging Most-at-Risk

Populations in Response to HIV/AIDS

LEFT Fabulous, a group of young women and

girls that provide awareness outreach, talking to
villagers in Lokichoggio.

remains a challenge. Fabulous, as one group of young women from

Lokichoggio have named themselves, are few in number and have
privileged access to some villages and parts of Lokichoggio only, a
common situation with similar outreach groups in other towns and
villages. They emphasize that outreaches must occur on a more
regular basis that in order for behavioral patterns and habits to
change. This will require additional recruitment and training, but
also a change in locals’ perception of their work, which is often
stigmatized or misperceived because of the topic it
addresses.

FACT BOX: GIRLS AND

WOMEN AT RISK
Although HIV spares no one, the
likelihood of contracting the virus is BELOW Concepta, left, and Sura, members of Lodwar women’s target group, share their thoughts
higher for some groups, particularly about outreach challenges among their peers, especially those practicing commercial sex work.
women. In sub-Saharan Africa, this
stems not only from their greater
physiological susceptibility to
heterosexual transmission, but also
from the severe social, legal and
economic disadvantages they confront.
The risk of becoming infected is
especially disproportionate for girls
and young women. In Kenya, young
women between the ages of 15 and
19 are three times more likely to be
infected with HIV than their male
counterparts, while those between 20
and 24 are 5.5 times more likely to be
living with HIV than men their age.
Furthermore, due to economic hardship
and limited livelihood activities, many
women are forced to resort to
commercial sex work for their own and
their families’ survival. This is
particularly the case in Turkana,
significantly increasing the risks of HIV
contraction. In Kenya, the data on
modes of transmission suggest that sex
workers and their clients account for
an estimated 14.1% of incident HIV
infections.33
 IRC KENYA / LIVING ON! / BEST PRACTICE
BEST PRACTICE

HIV/AIDS AWARENESS
ON AIR
 IRC KENYA / LIVING ON! / BEST PRACTICE 35

Fighting Stigma and Raising Awareness

with Help from Turkana’s Radio Waves

Radio is a popular medium in Kenya as demonstrated by the

growing number of local-language radio stations.34 These
stations play an important role in stimulating public discussion and
provide a regular source of information for majority of
Kenyans.35

In remote areas such as Turkana, where access to TV, print and

internet is, at best, limited, radio is disproportionately important as
a source of information. Several pockets still lack radio
coverage, as was the case with Kakuma until recently.

The IRC adopted radio in Turkana in 2008 as a platform to

disseminate awareness of HIV/AIDS, partnering with stations in
Lodwar and Lokichoggio soon after they began broadcasting.

Radio outreach is based on weekly half-hour to one-hour shows,

usually focused on one particular topic. Program hosts,
community health workers, HIV/AIDS counselors and IRC
program staff disseminate basic information or hold debates,
sometimes introducing drama and skits by local groups and, when
time permits, taking questions and comments from
listeners. The programs are broadcast in Kiswahili and Turkana
languages and are promoted at HIV/AIDS-related events,
awareness activities and VCT centers.

Without exception the response of the listeners has been

overwhelmingly positive, demonstrating the demand for program
time focusing on health and HIV/AIDS issues. The shows
regularly run overtime, indicating a need for more frequent or
longer broadcasting. The initial audience response also
confirmed that knowledge of HIV/AIDS remains riddled with
misconceptions and myths.

RIGHT By 2010, the IRC was airing HIV/AIDS-related programming on

four Turkana-based radio stations: Radio Hossana (Lodwar), Biblia
Husema (Lokichoggio), Radio Sayare (Lodwar) and Radio Akicha
(Lodwar).

LEFT Eddy James Andebe, branch manager and on-air host at

Lokichoggio's only radio station, Biblia Husema.
36 IRC KENYA / LIVING ON! / BEST PRACTICE

BELOW An on-air host at Radio Akicha. Listeners desire for information is

demonstrated by their frequent call-in questions at the end of the weekly
HIV/AIDS program.

RIGHT Eregae, a presenter at Radio Sayare on 93.9 FM. Most of the

programming on Sayare FM is prerecorded, although there is always a
possibility for listeners to interact and ask questions at the end of the show.

Radio has proved to be one of the most valuable tools for

behavioral change communication, reaching both literate and
illiterate audiences, villages and remote areas. Broadcasting on
four local radio stations, the IRC has, up to mid-2010, reached
approximately 35% of potential listeners in Turkana and provided
17 hours of HIV/AIDS-related airtime per month. The IRC is the
first NGO in the region to use mass media for HIV/AIDS
awareness campaigns.

LEFT The IRC radio awareness outreach debuted in 2008 on Radio

Hossana when it became evident that there is a vacuum in publicly
available channels for communicating the message about HIV/AIDS and
health in general. After launching the program, the IRC and Radio Hossana
collaborated on alternative methods of HIV/AIDS awareness activities,
including concerts for youth and mobile outreaches.
 IRC KENYA / LIVING ON! / BEST PRACTICE 37

BEST PRACTICE

PREVENTION WITH
POSITIVES
Raising Awareness Through Empowered HIV-affected
Community Advocates

Prevention with Positives (PwP) is an innovative way of spreading
awareness of HIV/AIDS in the community and is based on the
active involvement, reintegration and empowerment of those
affected by the disease. People living with HIV/AIDS can and
should play a significant role in the design and implementation of
HIV/AIDS prevention and care programs. Because of their
personal experience, they are unique advocates for reducing
stigma associated with HIV/AIDS, promoting accurate self-risk
perception and correct and consistent condom use.
The first and crucial step of the approach is the engagement of
HIV/AIDS-affected individuals. IRC does this through
psychosocial support groups at its comprehensive care centers in
the region, which provide support and counseling for individuals
recently tested positive. Group facilitators help identify individuals
who are recruited for prevention activities. They undergo a two-day
training workshop on behavioral change communication
focused on HIV/AIDS issues, positive living, disclosure of HIV/
AIDS status, opportunistic infections, stigma and discrimination and
presentation skills.

MEET AN ADVOCATE: JOSEPH EPETET

Joseph is HIV-positive and has been a PwP advocate for six months,
helping to spread information about HIV/AIDS in local communities.

He comes from a village near Lokichoggio that was hard hit by AIDS—
many people were sick or dying, including his wife and four children.
When he finally sought medical assistance, he was extremely weak,
weighing only 30 kilos (66 pounds), but his health has gradually
improved since he began antiretroviral therapy. He is proud to say that
he currently weighs 60 kilos (132 pounds). As part of IRC assistance to
those testing positive, Joseph became involved in the activities of the
psychosocial support group and was recruited to assist with HIV/AIDS
outreach.

He is now extremely happy and proud of his work, although he admits

that the challenges are numerous. People are deterred from visiting
medical facilities because they simply can’t afford to reach them or
because they fear they will be charged for services provided. When it
comes to HIV/AIDS, many are afraid to get tested, because they fear the
results or because they are afraid that this information could be leaked
to the community.

“The attitude of the community towards me and my colleagues is

sometimes still negative and based on a misunderstanding of HIV/
AIDS,” he says. “Women come and get tested with their kids, but many
positives [persons living with HIV], especially men, don’t.”

He revealed that it is often very hard to make people understand that

life as an HIV-positive person is possible, but that it requires a healthy
lifestyle, responsible behavior and strict, life-long antiretroviral
therapy. Much of his work is therefore about identifying and counseling
those who have disappeared or defaulted from their ARV therapy.
38 IRC KENYA / LIVING ON! / BEST PRACTICE
can go on if one lives healthily and adheres to ARV therapy.
Once trained, PwP advocates are a powerful voice in HIV/AIDS
prevention activities. They are a real-time example, confirming that
HIV/AIDS can affect anyone, brothers, sisters and neighbor, with
names and faces. PwP advocates relate their problems but also
share positive aspects of their stories— how they continue with
normal life, contributing to community health and fighting stigma
and.
PWP advocates reach out in many ways. They help spread HIV/
AIDS awareness and encourage testing at local events such as
barazas, or public meetings organized by community chiefs, and in
schools and at football matches and other public events.
They conduct individual outreaches, targeting their own
communities and speaking to men and women of all ages to
promote behaviors that prevent new infections.
They also play an integral role in the clinical dimension of the HIV/
AIDS program in Turkana by providing initial counsel to clients who
have just tested positive at VCT clinics. It is extremely
important to provide psychological support and counseling for HIV-
affected clients as early as possible. PwP advocates assist them to
overcome the initial shock and accept their HIV-positive status;
MEET AN ADVOCATE: JOSEPH EMEJEN
Joseph is an HIV/AIDS and ex-tuberculosis patient who was
not aware of the seriousness of his health problems for a
long time. At the time he was admitted to the hospital, he
could not even walk. After testing HIV-positive, he had a
hard time accepting his status, his response complicated by
the fact that he tested positive for tuberculosis as well. His
family members and friends abandoned him and, although
his health gradually improved, he stayed at home believing
his life was over.
After joining IRC-sponsored psychosocial support groups,
Joseph experienced a change of attitude. “It was an
eye-opener”, he says, “encouraging me to contribute to the
benefit of my community with my own experience, to assist
people who need help the same way I did and to spread
the message about HIV/AIDS.”
When approaching people in community outreaches,
Joseph says that one needs to be informal, relaxed and
willing to listen. People have many questions and some still
challenge him when he speaks of HIV/AIDS, condoms or
living with HIV.
“Stigma in the communities is still very high, people are
uncomfortable talking about those things or even say that
HIV is not their problem—they ask why I didn’t rather bring
some food.” He tends to begin his talk addressing issues of
general hygiene, such as washing hands and cleaning
nails, avoidance of sharing sharp objects and the
importance of visiting hospitals when necessary.
Joseph reiterates that the biggest hurdle he faces during his
outreaches is persuading people to seek help. “People don’t
do that either because they are afraid the information of
their illness will leak or because they don’t have the
money. If they are HIV-positive, facing reality is another big
problem.” People are usually surprised when he shares that
he is HIV-positive, but this is the best way to show that life
FACT BOX:
HIV/AIDS STIGMA IN KENYA
HIV/AIDS-related stigma remains a problem in Kenya. Many
Kenyans see HIV as a punishment for immoral behavior, which
tends to encourage stigma against people infected with the
virus.
The 2010 study “Extent and Impact of Stigma and
Discrimination on Women and Children Infected and Affected
by HIV and AIDS,” conducted by ActionAid International and
Women Fighting AIDS in Kenya, found that 74% of respondents
in 430 households in three districts in western Kenya felt
people with HIV deserved their positive status as a punishment
for morally unacceptable conduct, while 70% believed people
with HIV were promiscuous.36
The 2007 study in northern Kenya confirmed that stigma
toward people living with HIV is prevalent in the region. There
was widespread belief that HIV is a “foreign disease” affecting
urban populations only, and few people knew the basics about
the disease. People living with HIV were discriminated against
and excluded from community support systems crucial for their
survival, especially during periods of drought. They feared
disclosing their status as this would lead to loss of social
capital.
 IRC KENYA / LIVING ON! / BEST PRACTICE 39

they share their experiences, explain the availability of

antiretroviral therapies, advise on prevention of further infections
and the importance of a healthy life.

IRC started the PwP program in 2010 and has so far engaged and
trained 19 advocates who have reached out to approximately
5,800 individuals in Turkana project sites. Each advocate takes
part in approximately eight outreaches per month and is on duty in
the local comprehensive care center to provide post-test support.

Although they occasionally encounter obstacles during their

outreaches, mainly driven by the persistent social stigma linked to
HIV/AIDS, their own empowerment has proven priceless. IRC aims
to train more PwP advocates, providing each of its clinical project
sites with their permanent presence and their integration in all
HIV/AIDS outreach and mobilization activities.

GO TO PAGE 25 FOR AWARENESS STATISTICS

MEET THE ADVOCATES: JANE EKALE AND SIMON LOKOLONYOI

Simon and Jane are HIV-positive PwP advocates from Kalokol. They say that there is always more work than time, but they enjoy what
they do and take pride in their efforts.

Their work can be hard, and they had to get used to answering many questions, especially after revealing their positive status. People
often do not believe them and their story of living positive, forcing them to show their ARV medication or their training certificates.
Still, they emphasize that it is important “to build trust even before you start talking about unconventional topics like HIV/AIDS, or
health in general.”

The hardest thing to explain about HIV/AIDS treatment and positive living, according to Simon and Kane, is the individual’s lifelong
fight against the
disease and the
necessity to em-
brace a healthy
lifestyle. Much of
their time is dele-
gated to finding
those who
stopped their
ARV treatment
and HIV-positive,
they say.

But it is also im-

portant to talk
about altering
lifestyles regard-
less of one’s
status. This in-
cludes practicing
safe sex and gen-
eral hygiene, and
seeking medical
assistance when
needed.
 IRC KENYA / LIVING ON! / BEST PRACTICE

BEST PRACTICE

JAMII INAFAA!
FAMILIES MATTER!
 IRC KENYA / LIVING ON! / BEST PRACTICE 41

Those Who Learn, Teach:

Using and Strengthening the Home Link

Families Matter! interventions aim to encourage effective

communication on topics such as sexual risk reduction by
TESTIMONY OF AN ELDERLY MALE
providing guidance to caregivers on the importance of talking with GRADUATE OF FAMILIES MATTER!
children and young adolescents (9 to 12 years old) about “According to the Turkana tradition, these
sexuality, as well as how best to approach such sensitive subjects. things are not discussed openly. Children
usually get embarrassed and surprised
The Families Matter! approach is an evidence-based intervention
when their parents try to talk to them
that draws upon the Parents Matter! program devised by the U.S.
Centers for Disease Control and Prevention. Families Matter! about sexuality or diseases like HIV.
directly responds to gaps identified by the IRC during earlier stages Initially, I wasn’t open; I was not able to
of the HIV/AIDS program in Turkana, particularly addressing speak to my children about these things.
concerns that caretakers were left out when conducting sexuality Since I’ve started coming here, I’m able to
and sexual risk reduction education.
talk to them.”
The approach was adjusted to provide support to parents and other
primary caregivers so that they could convey their values and
expectations about sexual behavior to their children and
dependants. Additionally, they were given basic training on crucial
messages related to HIV, STIs and pregnancy prevention. The
intervention now empowers parents in their role as responsible and
knowledgeable caregivers and raises their own awareness of HIV/
AIDS.

BELOW “You are the best teacher for your child!”, Families Matter
program slogan.

LEFT Cover of the instruction manual for participants of the Families

Matter! program. In the background, a program graduate is reviewing
lessons learned during the five-week training course.
42 IRC KENYA / LIVING ON! / BEST PRACTICE

IRC’s target outreach for Families Matter! is 25% of families with TOP RIGHT Program participant
TOP LEFT A program
children between 9 and 12 in all IRC Turkana sites. To date, the graduate in Lodwar is in Kalokol reviews the lesson with
IRC has trained 39 facilitators who take groups of parents and/or congratulated by an IRC his class.
guardians, called “waves,” through five weekly sessions on sexual staff member.
topics and sexual risk reduction. Participants graduate after the
completion of their “wave,” and further participants and groups are
recruited for new sessions. Fifteen waves have been
completed by mid-2010, reaching roughly 517 parents and 813
adolescents. The next challenge will be expanding the program to
other locations in the region and planning follow-up sessions with
the waves of graduates.

RIGHT Families Mat-

ter! helps parents and
guardians talk with
children about sensitive
issues, including
sexuality, which are not
commonly discussed
openly in traditional
Turkana household.

ABOVE The Families Matter! program occasionally reaches out directly to

children, as in a 2010 Kalokol “wave”. Here, young graduates who
participated in the training course with their parents proudly pose at the
graduation ceremony.

LEFT 2010 graduate waves from Lodwar (above) and Kalokol (below).
 IRC KENYA / LIVING ON! / BEST PRACTICE 43

BEST PRACTICE

HIV/AIDS
DATA MANAGEMENT
Providing Reliable and Accurate
Data on HIV/AIDS Care and Treatment

Vast and remote regions like Turkana, especially when inhabited
by pastoralists, are particularly difficult to survey for accurate and
reliable HIV/AIDS-related data.
Apart from understanding regional prevalence rates and patterns,
researchers must cope with particular date-management
challenge of the ARV therapies (ART) themselves.. Individuals
often begin a therapy only to default because after finding it
difficult to access to healthcare facilities and services, or because
they lacked knowledge or understanding about medication intake.
These problems only compound the task of collecting and
maintaining accurate information and data to monitor and run HIV/
AIDS response programs.
Possessing an accurate and reliable HIV/AIDS data system,
available at all program sites, is particularly valuable when
monitoring and tracking patients’ movements in the region, a
common phenomenon in the Turkana region where nomadic
lifestyles are common. Accurate information also allows for easier
tracing of ARV defaulters.
On the other hand, the need remains for trained data
management staff to oversee data reconstruction, particularly
reconstruction involving multiple databases. In order to be able to
extract useful information for programming response, data must be
collected systematically over long periods across the entire region,
a task that requires consistent staffing, methodology and funding.

Based on a recommendation from the Kenyan National AIDS/STD

Control Program (NASCOP), the IRC has been systematically
collecting accurate data in Turkana to assure quality of care, to
monitoring patients undertaking ARV therapies and to provide
reliable HIV/AIDS-related data for the region. Every patient has a
personal file, a compilation of reports and information, which also
allows for a conduct of cohort analysis if required. Every effort is
GO TO PAGE 25 FOR ARV STATISTICS
made to assure strict confidentiality.

RIGHT Shadrack, a data clerk at the IRC-supported

VCT center at Kakuma Mission Hospital, manages
data at the VCT center and also participates at
mobile VCT locations and villages around Kakuma
like Uropui, Letea, Kalobeyei, and Lokorei.
 IRC KENYA / LIVING ON! / BEST PRACTICE

BEST PRACTICE

COUNSELING AND
TESTING FOR EVERYONE!
Knowing an individual’s status is the foundation and starting point services is assured for more than half of the population of
for any HIV/AIDS treatment or awareness activity. A successful Turkana, access for all of these services in remote rural areas
HIV/AIDS program must allow community members to access remains challenging due to lack of roads, vehicles, personnel and
testing and counseling instantly and affordably. The IRC is directly financial resources.
implementing or supporting several types of counseling and
testing geared to the location and needs of the environment.

Most testing in Turkana is conducted on a voluntary basis in

mobile or static VCTs, encouraged by various outreach activities. GO TO PAGE 24 FOR VCT STATISTICS
Additionally, IRC conducts provider-initiated testing and
counseling as well as diagnostic counseling and testing (DCT)
through its and partners’ medical facilities.

Because most of Turkana’s population resides outside of urban

centers or in remote areas, a proactive approach in providing
counseling and testing services through mobile CT-units is
important. Mobile counseling and testing accounts for the majority
of tested individuals in the region and is often supported by
awareness outreach activities to attract and persuade individuals to
get tested.

From 2005 to 2010, the IRC organized or supported more than

1,800 mobile testing outreaches, which currently run at an
average frequency of 60 per month. Although access to VCT
 IRC KENYA / LIVING ON! / BEST PRACTICE 45

Providing a Comprehensive
Package of Counseling, Testing
and Integrated Outreach Services
RIGHT Local Turkana men approach IRC’s mobile
VCT site in Lodwar to inquire about counseling and
testing.

LEFT A Sudanese refugee attending a voluntary

counseling and testing session held as a side event
of an awareness outreach in Kakuma Refugee Camp.

ABOVE Mobile VCT site in Naqualele village near Lodwar.

RIGHT Mobile VCT site in Nabute village near Lodwar.

LEFT OPPOSITE PAGE IRC-supported static VCT center at Kakuma

Mission Hospital. All HIV/AIDS-related services in Turkana are available free
of charge.
 IRC KENYA / LIVING ON! / BEST PRACTICE
BEST PRACTICE

PMTCT,
EARLY CHILD DIAGNOSIS
AND HOSPITAL DELIVERIES
The chances of an HIV-positive pregnant mother transmitting the
virus to her baby is as high as 30%, but can be significantly
reduced with prevention of mother-to-child transmission (PMTCT)
interventions. Mother-to-child transmissions account for most
infections of children under the age of 15, 90% of which occurred
in Africa in 2008.37

Following national and international guidelines, the IRC has been

offering a comprehensive approach to PMTCT at all of its
programs sites in Turkana. The approach includes prevention of
HIV infection, family planning to prevent unplanned pregnancies,
antiretroviral therapies, prophylaxis treatment, antenatal care, safe
delivery, feeding options, and follow-up with mothers and babies
who are tested for HIV six weeks after delivery.

One of the biggest challenges of preventing mother-to-child

transmission is identifying HIV-positive pregnant women. The IRC
targets women of childbearing age through mass awareness,
special target groups and maternal child health (MCH) clinics with
reproductive health messages. The involvement of female
community health workers is crucial in this process, as are women
participating in the Prevention with Positives (PwP) program.

Once identified, HIV-positive women are encouraged to join

 IRC KENYA / LIVING ON! / BEST PRACTICE 47

Fighting HV/AIDS from the Outset

LEFT A Somali Bantu refugee and future mother at Kakuma Refugee Camp, Clinic 5, taking part in
the VCT session as part of the antenatal care program.

support groups for persons living with HIV/AIDS. Community

health workers at maternal and child health clinics conduct
special counseling sessions for them, discussing topics like HIV/
AIDS stigma, positive living or HIV treatment. These sessions are of
crucial importance, giving hope to HIV-positive women and
providing them with essential information on preventing virus
transmission.

Kenyan national PMTCT guidelines recommend formula feed for

mothers who cannot exclusively breastfeed and who meet the
AFASS criteria, recommending that the replacement feeding
should not be used unless it is acceptable, feasible, affordable,
sustainable and safe (AFASS). The substitute milk, expensive and
often unavailable, is not provided free of charge.

RIGHT Aisha, a Somali Bantu HIV-positive refugee mother,

takes part in the IRC-run prevention of mother-to-child
transmission (PMTCT) program in Kakuma Refugee Camp.
Her greatest concern is preventing the transmission of HIV
to her newborn son, Muhina.

LEFT Young mothers from local communities in front

of the IRC-sponsored Comprehensive Care Clinic at
the Lokichoggio AIC Health Center. Such clinics help
to identify women who are in need of PMTCT
intervention.
48 IRC KENYA / LIVING ON! / BEST PRACTICE

LEFT Young or future mothers in front of the VCT

center at Lodwar District Hospital. One of the biggest
challenges with PMTCT is to identify HIV-positive
women who require intervention.

HOSPITAL DELIVERIES
Delivery presents a particularly risky event
during which an HIV-positive mother is more
likely to transmit HIV to her newborn.
Providing professional pre-, intra- and
post-delivery care to HIV-infected women is
an effective way of minimizing the risks of
Acknowledging that an average Turkana woman would not be able to afford such transmission, a goal easier achieved if
substitute milk, the IRC provides formula milk free to women who pass the AFASS delivery is performed in a medical facility in
criteria. IRC-supported community health workers also try to ensure that the presence of medical staff. This is
HIV-positive pregnant women and mothers complete prophylaxis, deliver in health particularly challenging in Turkana where, due
facilities and have their babies tested at six weeks. to the remoteness of the area, lack of medical
facilities and cultural habits, the rate of
Many challenges are associated with successful prevention of mother-to-child
hospital deliveries is below 8%.
transmission interventions. It is particularly hard to identify and retain women who
need PMTCT services due to the distance of health facilities from their homes and
In order to reduce maternal mortality rates,
low involvement and support of their partners. To bridge these gaps, the IRC is
and scale up safe deliveries supervised by
focusing on integrated outreach services supported by targeted and mass
professional staff as a PMTCT intervention,
awareness campaigns.
the IRC has been actively advocating for
hospital deliveries among pregnant women in
Turkana, particularly those future mothers that
will require a PMTCT intervention.

Advocacy led to a significant increase in

hospital deliveries at IRC-supported sites
between July 2009 and June 2010 among
PMTCT mothers. Half of them now give birth
in clinical settings, compared to extremely
low hospital delivery rates among the general
population in Turkana.

LEFT Mohamed, a Somali refugee recruited to help

conduct IRC/UNHCR’s behavioral surveillance survey in
Kakuma Refugee Camp, interviews a young Somali refugee
mother. Such surveys not only provide IRC with data to
asses the situation on the ground, but also serve as one of
the tools to identify young women who might be in need of
PMTCT interventions.

GO TO PAGE 24 FOR PMTCT STATISTICS

 IRC KENYA / LIVING ON! / LESSONS LEARNED 49

LESSONS LEARNED

THE IRREPLACEABLE
POWER OF PARTNERSHIP
Working together with partners, a cornerstone of the IRC’s approach in the region, has proved instrumental for the
achievements and implementation of the IRC’s HIV/AIDS program. Based on experience, this strategy has been most effective
in building local capacity and achieving a sustainable regional HIV/AIDS response. When targeting local communities, the IRC
partners with local faith-based organizations—the major providers of healthcare services in the region as well as with local
nongovernmental organizations and community-based initiatives. Offering support in human resources has proved to be
valuable and effective, as well as assistance with equipment and medical supplies, and management and technical expertise. In
Kakuma Refugee Camp, the IRC finds strong partners in local and international governmental and nongovernmental
organizations such as UNHCR, IOM, World Food Programme (WFP), National Council of Churches of Kenya (NCCK), Lutheran
World Federation (LDW), Jesuit Refugee Service (JRS) and FilmAid.

AFRICA INLAND CHURCH’s health facilities were started by missionaries in the 1970s and handed over to the local community in
the early 1990s. Government support has been extremely scarce or nonexistent, with the maintenance and provision of services
almost exclusively funded by user contributions (in a region with high unemployment rate and extremely low incomes) until the CDC’s
and IRC’s involvement in 2005.

AIC Lokichoggio Health Center serves mainly local urban

and transit populations but also encompasses communities
from neighboring Southern Sudan. At the height of Operation
Lifeline Sudan, which conducted major operations from
Lokichoggio, the IRC partnered with AIC to offer a
comprehensive HIV prevention and support package to the
then high number of aid workers in Lokichoggio.
Achievements included the first stand-alone VCT center in
Lokichoggio, HIV treatment services at the health center and
strengthened mobile outreach services for the pastoral
community. Samuel Ikeny, the program administrator, and
Bethwel Lochor, AIC’s rural health area supervisor, mentioned
many challenges, including insecurity, inaccessibility, high staff
turnover and frequent lack of basic supplies, but they also
praised the IRC for its support with “staffing, expertise and
with general local health system strengthening.”

AIC Kalokol Health Center is the sole static health post in the
Kalokol Division on the eastern shores of Lake Turkana. Prior to
2006, IRC HIV/AIDS intervention activities did not exist in the
Kalokol area, hard hit by tuberculosis. Samuel Losuru, the center’s
administrator, says that challenges are numerous but that partnership
with the IRC has been “exceptional and critical for delivering a
comprehensive HIV/AIDS treatment package, as well as vital for
providing other health services in the area.”
50 IRC KENYA / LIVING ON! / LESSONS LEARNED

LODWAR DISTRICT HOSPITAL (LDH), a government facility with a large clientele and outreach, is the main referral hospital of
Turkana. The IRC partnered with LDH in 2007 to strengthen its systems capacity and improve the general clinical care for HIV/AIDS.
This is an important part of an initiative to assist the Government of Kenya in response to HIV/AIDS, a crucial determinant of a
successful response.

Gilchrist Lokoel, district medial officer of health, notes that Turkana is, slowly but
steadily, catching up with the rest of Kenya in response to HIV/AIDS. The role of
the IRC has been vital: “The IRC does not seek to establish parallel structures on
the ground but builds on what is already existing or being implemented.”

THE CATHOLIC DIOCESE OF LODWAR (DOL) provides an extensive range of primary healthcare services and is supported
by the IRC to increase HIV/AIDS outreach, particularly in rural areas. DOL is working through the Kakuma Mission Hospital (KMH), the
main referral center for northern Turkana, including patients from the IRC-run Kakuma Refugee Camp Hospital.

At the Kakuma Mission Hospital, the IRC assists with equipment, financial support, expertise
and staffing. Through this partnership, which started in 2006, the IRC has supported an average
of 17 employees every year. Sister Elizabeth Mwaniki, KMH administrator, mentions countless
problems: cost-sharing, staff retention, high electricity costs and cuts, irregular supplies, lack of
transport, floods of referrals and ineffective follow-up with patients. “Without the IRC support,”
she says, “the hospital could not offer HIV/AIDS or other services at current levels!”

In reaching out to youth, DOL is supporting youth facilities such as the

Bishop Mahon Youth Centre, in Lodwar where the St. Augustine Youth
Friendly Services VCT station is located. This strategy has proven
successful as many youth gather there in their free time.
 IRC KENYA / LIVING ON! / LESSONS LEARNED 51

LESSONS LEARNED
NEED FOR ALTERNATIVE WAYS TO
UNDERSTAND THE CONTEXT,
REACH OUT TO THE POPULATION
AND
DELIVER THE HIV/AIDS MESSAGE
HIV/AIDS is a social problem with
region-specific permutations. Turkana is no
exception. It is a vast and heterogeneous
region with many remote areas, high
illiteracy rates and various cultural practices
that influence modes of HIV/AIDS
transmission, treatment and perception.

The IRC has been gradually shifting from

prevention intervention towards a
comprehensive prevention, care and support
program, increasingly relying on
evidence-based prevention strategies and
“out of the box” thinking. HIV/AIDS
messages and response need to be locally
tailored, relevant and acceptable to the
community. Future programs should
consider filling gaps through community support initiatives like care for
orphans and vulnerable children (OVCs) and linkages to income-generating
activities.

ABOVE Talking about HIV/AIDS and STIs during an awareness outreach in Kalokol.
RIGHT IRC staff member talking about HIV prevention during life skills training for
teachers in Lokichoggio.
BELOW Primary school teachers attending life skills training in Lokichoggio. The IRC
sponsors such trainings and provides instructors who conduct modules on HIV/AIDS
awareness, prevention and treatment.
52 IRC KENYA / LIVING ON! / LESSONS LEARNED

LESSONS LEARNED
THE BENEFITS OF
LINKING AND MAINSTREAMING
HIV/AIDS THROUGH
OTHER PROGRAMS
The IRC’s HIV/AIDS program in Turkana has made tremendous efforts to ensure and increase access to HIV/AIDS prevention,
care and treatment services in the region. However, the region remains heavily afflicted by factors that demand other
emergency interventions, particularly in healthcare and nutrition, and is often affected by cattle rustling and other incursions
from neighboring communities. The achievements and success realized in one area can easily be eroded by complex
emergencies. The implementation of the HIV/AIDS program in Turkana has shown that due to other pressing needs the
importance of HIV/AIDS-related problems is too often scaled back by the local population.

An integrated and holistic approach to healthcare programming is needed in areas like Turkana. Such an approach includes the
integration of health systems and primary health, nutrition, HIV/AIDS and community health interventions, as well as water,
sanitation and livelihood programs. The IRC has recognized the benefits of this approach compared to other competing health
and social issues in Turkana and emphasizes specific interventions to mainstream health systems in order to increase access.
The IRC also improved health outcomes by working in collaboration with the community using a mix of health promotion
interventions. This not only leads to better long-term impact and results on the ground, but also provides for more
cost-effective spending of donor funds.

LESSONS LEARNED

STRONGER GOVERNMENT PUSH

ON THE
HIV/AIDS FRONT
Fighting HIV/AIDS in Turkana will remain a challenge until a comprehensive Turkana-specific approach can be devised to reach
out to both urban and rural regions. As much as community actors and nongovernmental organizations can assist in this
outreach, it will be sustain only with strong, tailored regional interventions, and with the involvement of local authorities and
coordinated leadership at all levels.

An integral part of such a push by authorities will require more local capacity building. A concrete recent and immediate step
toward improved local capacity was the revamping of the national HIV/AIDS training guidelines and curriculum, taking into
better consideration the specific needs, background and potential of trained staff.
 IRC KENYA / LIVING ON! / LESSONS LEARNED 53

ABOVE Young Turkana girl gets her tuberculosis medication at the AIC
Health Center in Lokichoggio.

LESSONS LEARNED

INSEPARABLE THREATS:
HIV AND TB
Tuberculosis remains a public health and social issue with a significantly
negative impact in Turkana. Due to the intrinsic connection between TB and
HIV/AIDS, the gains being realized in the fight against HIV/AIDS could be
eroded or slowed if there is no commensurate investment in TB prevention
and control. As much as the IRC has supported the Ministry of Public
Health and Sanitation on TB/HIV collaborative activities, a great deal
remains to be done.

RIGHT Tuberculosis
ward at the IRC-run
Kakuma Refugee
Camp Hospital.
54 IRC KENYA / LIVING ON! / LESSONS LEARNED

LESSONS LEARNED

MORE STRUCTURAL INVESTEMENT

IN TURKANA

Turkana is a region with vast cultural and economic potential, the realization of which depends on sufficient resources and
investment, proper leadership, and local involvement in and ownership of development initiatives. Decades of sub-optimal
regional development combined
with a challenging environment will
require a strong push and
momentum for Turkana to catch up
with the rest of Kenya in obtaining
sufficient transport, health,
education system and communica-
tions infrastructure.

Focusing on specific improvements

will accelerate the general
development of the region. In
remote underdeveloped areas like
Turkana, the fight against HIV/AIDS
should be treated as a health
problem in an emergency, and not
as an emergency of its own.

RIGHT Entry into Lodwar from Kitale.

Turkana roads are few and ill-maintained.

OPPOSITE PAGE IRC medical

supplies delivered to Turkana through
Lokichoggio airport .
IRC KENYA / LIVING ON! / LESSONS LEARNED
56

ENDNOTES
1 UNAIDS. 2009 AIDS Epidemic Update. Geneva: UNAIDS, 2009; at 7.
2 Ibid, 21.
3 Ibid.
4 Ibid, 29.
5 NACC. United Nations General Assembly Special Session on HIV and AIDS, Kenya Country Report. Nairobi: NACC,
2010.
6 KNBS. Kenya Demographic and Health Survey 2008-09. Nairobi: KNBS/NACC/NASCOP/MOPHS, 2010; at 210.
7 2003 Kenya Demographic Health Survey estimated prevalence rate among adults (15-49) at 6.7%. CBS. Kenya
Demographic and Health Survey 2003. Nairobi: CBS/MOH/KMRI/NCPD/ORC/CDC, 2004.
8 NASCOP. KAIS/Kenya AIDS Indicator Survey 2007. Nairobi: NASCOP/KMRI/NACC/KNBS/CDC/USAID/UNAIDS/, 2009.
9 UNAIDS. 2009 AIDS Epidemic Update. Geneva: UNAIDS, 2009; at 29.
10 KNBS. Kenya Demographic and Health Survey 2008-09. Nairobi: KNBS/NACC/NASCOP/MOPHS, 2010; at 215.
11 UNAIDS. 2009 AIDS Epidemic Update. Geneva: UNAIDS, 2009; at 22.
12 Ibid, 31. KAIS 2007 shows similar trends.
13 Gelmon et al. Kenya: HIV Prevention Response and Modes of Transmission Analysis. Nairobi: 2009, NACC.
14 KNBS. Kenya Demographic and Health Survey 2007. Nairobi: KNBS; at 216-7.
15 NASCOP. KAIS/Kenya AIDS Indicator Survey 2007. Nairobi: NASCOP/KMRI/NACC/KNBS/CDC/USAID/UNAIDS/, 2009.
16 Nyanza province has an overall prevalence of 14%, double the level of the next highest provinces—Nairobi and
Western, at 7% each. All other provinces have levels between 3% and 5%, except North Eastern province where the
prevalence is about 1%. KNBS. Kenya Demographic and Health Survey 2007. Nairobi: KNBS; at 217.
17 Practical Action. Breaking the Siege - Mainstreaming HIV/AIDS in Peace Building. Practical Action PEACE Bulletin,
December 2003, http://www.itdg.org.
18 MOH/NASCOP. KAPB Survey, Central Division – Turkana. Nairobi: NASCOP, 2003.
19 NASCOP/NACC. National HIV Prevalence Report June 2007. NASCOP/NACC, 2007.
20 MPHS/MMS. 2009 Health report, Turkana Central and Loima Districts. MPHS/MMS, 2009; at 6.
21 NASCOP/NACC. National HIV Prevalence Report June 2007. NASCOP/NACC, 2007.
22 Owiti, J.A. Tuberculosis and HIV/AIDS are Like Co-Wives: The Conception of HIV/AIDS and Tuberculosis Among Urban
Turkana population at Lodwar Township, Kenya. International Conference on AIDS, July 7-12 2002, abstract no.
WePeD6409.
23 McCabe, J.T. Encyclopedia of World Cultures. 1996.
24 GOK. Turkana District Development Plan 2002-2008. Nairobi: GOK, 2002.
25 Kenya National Bureau of Statistics website—http://www.knbs.or.ke.
26 According to the 1999 Kenya national census 50.2% females and 49.8% males, respectively. Ibid.
27 OCHA. Kenya Humanitarian Update, Vol. 61, 23 June-21 July 2010.
28 Von Grebmer et al. 2009 Global Hunger Index. Bonn/Washington: WHH/IFPRI/ConcernWorldwide, 2009.
29 IASC. Kenya Drought Alert, July 2009; and Malnutrition Crisis in Northwest, IRIN, July 16 2009,
at http://www.irinnews.org/Report.apsx?ReportId=83003.
30 Ibid.
31 Kenya Interim Independent Election Commission, Regional Voter Registration Statistics As At Close Of Registration,
2010, at http://www.iiec.or.ke/sites/default/files/statistics-1_0.pdf .
32 McCabe, J.T. Encyclopedia of World Cultures. 1996.
33 UNAIDS. 2009 AIDS Epidemic Update. Geneva: UNIADS, 2009; at 22.
34 Freedom House. Freedom of the Press 2009: Kenya. New York: Freedom House, 2009; also at
http://www.freedomhouse.org/template.cfm?page=251&year=2009
35 Hannah Bowen. Information at the Grassroots: Analyzing the Media Use and Communication Habits of Kenyans to
Support Effective Development. InterMedia/Africa Research, 2010.
36 PlusNews. Kenya: HIV Carries Moral Stigma, at http://www.plusnews.org/Report.aspx?ReportId=89316. Okal, J. and
Bergmann, T. HIV in Emergencies Case study: Northern Kenya. London: ODI, 2007; at 4-7.
37 UNAIDS. 2009 AIDS Epidemic Update. Geneva: UNAIDS, 2009.
 57

ACRONYMS AND ABREVIATIONS

AFASS Acceptable, feasible, affordable, sustainable JRS Jesuit Refugee Service
and safe breastfeeding. KMH Kakuma Mission Hospital
AIC Africa Inland Church KMRI Kenya Medical Research Institute
AIDS Acquired Immune Deficiency Syndrome KNBS Kenya National Bureau of Statistics
ANC Antenatal Care KRC Kakuma Refugee Camp
ART Antiretroviral Therapy LDH Lodwar District Hospital
ARV Antiretroviral Drug LWF Lutheran World Federation
BCC Behavior Change Communication MOH Ministry of Health of Kenya
BPRM U.S. Bureau of Population, Refugees, and MOPHS Ministry of Public Health and Sanitation
Migration
NACC National AIDS Control Council
CBS Central Bureau of Statistics
NASCOP National AIDS and STI Control Program
CCC Comprehensive Care Clinic
NCCK National Council of Churches of Kenya
CDC Centers for Disease Control and Prevention
NCPD National Council of Population and
CPT Cotrimoxazole Prophylaxis Therapy Development
CHW Community Health Worker PEPFAR President’s Emergency Plan for AIDS Relief
CT Counseling and Testing PITC Provider Initiated Testing and Counseling
DASCO District AIDS and Sexually Transmitted PMTCT Prevention of Mother-to-Child
Infections Coordinator
Transmission
DCT Diagnostic Counseling and Testing
PWHA People with HIV/AIDS
DFID UK Department for International
PwP Prevention with Positives
Development
RIJ Refugees International Japan
DOL Catholic Diocese of Lodwar
STI Sexually Transmitted Infection
EID Early Infant Diagnosis of HIV
SV Stichting Vluchteling
FMP Families Matter Program
TB Tuberculosis
HBC Home-Based Care
UNHCR U.N. High Commissioner for Refugees
HCW Health Care Workers
UNICEF U.N. Children's Fund
HIS Health Information Systems
USAID U.S. Agency for International Development
HIV Human Immunodeficiency Virus
VCT Voluntary HIV Counseling and Testing
HTC HIV Testing and Counseling
WFP World Food Programme
IOM International Organization for Migration
WHO World Health Organization
ABOUT IRC
The International Rescue Committee (IRC) responds to the world’s worst crises
and helps people to survive and rebuild their lives. Founded in 1933 at the
request of Albert Einstein, we offer lifesaving care and life-changing assistance to
refugees forced to flee from war or disaster. At work today in over 40 countries
and 22 US cities, the IRC restores safety, dignity and hope to millions who are
uprooted and struggling to endure. The IRC leads the way from harm to home.

IRC KENYA Strategic Objectives 2010-2015

• Urban Programming: To foster a stable environment for vulnerable urban
populations (poor and refugees) by boosting household viability, strengthening
the voice of the urban poor and refugees, as well as increasing government
accountability.
• Governance: To increase IRC’s programmatic impact and sustainability
through institutional capacity strengthening, accountable use of resources and
greater political and conflict analysis.
• Disaster Risk Reduction: To optimize IRC’s impact through targeted
programming that minimizes vulnerability and increases capacity to proactively
mitigate and reactively address disaster impacts for sustainable development.
• Refugees: To maintain IRC’s high quality refugee program and amplify its
impact through appropriate research and advocacy to influence global and
national refugee policies and practices.

theIRC.org
INTERNATIONAL RESCUE COMMITTEE KENYA
P.O. Box 62727-00200
Nairobi, Kenya
+254 20 272 0064
ircnbi@kenya.theirc.org

INTERNATIONAL RESCUE COMMITTEE

122 East 42nd Street
New York, NY
10168-1289, USA

PUBLICATION CREDITS
WRITING, EDITING, PHOTOGRAPHY and PRODUCTION DESIGN: Matija Kovac

BACK COVER PHOTO
“Moonlight” voluntary counseling
testing (VCT) session in Lodwar.
COMMENTS, CONTRIBUTIONS and REVIEWS: Peter Mutanda, Kizito Mukhwana, Lizzy
and Masila, Prafulla Mishra, Felister Nekesa, Geoffrey Luttah, Kellie Leeson, Sophia Mwangi,
Katherine Sarkis, Gretchen Larsen, Melissa Winkler, Steven Manning, Symon Wambugu,
Kenneth Sisimwo, Jemimah Khamadi, Raphael Lokol, Paul Wasike and other IRC staff
members
COPYEDITING: Rex Roberts
MAPPING SUPPORT: UN OCHA Kenya, Information Management Unit
LAYOUT and PRINTING: Ecomedia
DESIGN based on prototype by Radley Yeldar, London.

CONSENT HAS BEEN SOUGHT AND SECURED FROM ALL INDIVIDUALS WHO
APPEAR IN THE PHOTOS FEATURED IN THIS PUBLICATION.
This publication was made possible
by financial support from the U.S.
Centers for Disease Control and
SEPTEMBER 2010 Prevention.
 IRC TURKANA HIV/AIDS PROGRAM
Since 2005, the IRC has assisted the local and refugee populations of Turkana, Kenya, in their response
to the HIV/AIDS pandemic by providing basic clinical services, fighting stigma and raising awareness.
As of August 2010 we have tested more than 110,000 people, provided access to free antiretroviral
therapy to more than 1,500 patients, supported local partners with staff and equipment worth more than
$3 million US, conducted more than 200 trainings for local target groups, mobilizers and advocates,
supported more than 2,000 awareness outreaches and assisted in building institutional and response
capacity through training, financial support and expertise. We are effectively reaching out to more than
half of the population of the Turkana region.