Community-based organisation leads the way on successful PrEP rollout for young Kenyan women
Safe spaces, peer mentors and education for male partners and parents result in more young women in Kisumu County, Kenya taking the HIV prevention pill
Research into the strategies used by Pamoja, a community-based organisation, suggests its use of safe spaces, peer mentors and education for parents and partners have led to a successful roll-out of PrEP among adolescent girls and young women.
Pamoja is a main implementer of the DREAMS Initiative in the Seme Sub-County of Kisumu. The Kenyan Government has prioritised this area for PrEP rollout because of the high number of adolescent girls and young women at risk of HIV there.
Researchers ran focus group discussions with 40 young women (ages 16-24) receiving PrEP and peer mentors. They also carried out five interviews with Pamoja staff, five with healthcare providers and five with community leaders.
Since 2017, Pamoja has supported 938 young women to start taking PrEP. Young women’s reasons for taking PrEP included being in polygamous marriages, wife inheritance, having multiple sexual partners and taking part in transactional sex.
Pamoja promotes PrEP use among DREAMS participants through discussion groups run by trained peer mentors in girls-only ‘safe spaces’.
Young women who choose to take PrEP go to a local government clinic to start it and for initial follow-up. They can then get refills and follow-up monitoring at the safe space.
The young women interviewed said the safe space encouraged them to take PrEP. This is because they felt it was a private and friendly space, where they could express themselves without fear of discrimination, shame or stigmatisation. They also said the knowledge about PrEP they got in the safe spaces increased their motivation to keep taking it.
Young women said getting PrEP refills in the safe spaces was useful as it meant they did not have to travel to clinics to get their medication.
Peer mentors played an important part in young women taking and staying on PrEP. This was due to their role in the safe spaces and the adherence support they provided. They monitored young women’s PrEP appointments, traced anyone who stopped taking PrEP, and linked them back to the service if they wanted to return.
Young women said the views of others often determined their decision to take PrEP. This is why education sessions for young women’s parents and their male partners were also seen as important, as they helped improve their understanding about PrEP use.
The sessions helped young women tell their partners and family they were taking PrEP. This in turn helped them continue to take PrEP.
Pamoja also organised meetings with local leaders and community members about the benefits of PrEP for young women.
But stigma was still something that stopped young women taking PrEP. People linked PrEP to promiscuity, sex work and living with HIV. PrEP pills were often mistaken for antiretroviral treatment (ART) because the pills and packaging look similar.
Other things that stopped young women taking PrEP were side effects, such as dizziness and vomiting, or worries about having them. Some young women moved due to schooling or marriage. This meant they were more likely to stop taking PrEP as they lost touch with Pamoja.
A lack of resources and qualified PrEP healthcare workers were also barriers to access. Staffing and resource issues also happened during the early stages of ART rollout. Things like task sharing helped address the issue. A similar approach is needed to support effective PrEP scale-up in Kenya, including more resources from the Kenyan Ministry of Health.
The findings suggest that Pamoja’s ability to establish trust with young women who have been marginalised helped these young women engage in services. The use of community-based organisations like Pamoja, and addressing the barriers identified in this study, will be necessary if PrEP is to reach more adolescent girls and young women in similar settings.