Nzioka Samuel, 23, wandered around the corridors of Makueni's public hospital, searching for the HIV Testing Services (HTS) room. He was anxious but eager to know his status. When he found his way, contrary to his expectations, the HTS provider did not receive him warmly. After a brief discussion to understand what Nzioka wanted, she took him through the basics of what the test result might show and how to interpret it.
After undergoing the HIV test, Nzioka breathed a sigh of relief when the results came back negative. However, his experience at the facility was marred by the cold and unfriendly demeanour of the healthcare worker. This negative encounter left a lasting impression, and Nzioka vowed never to return.
Unfortunately, his experience is not an isolated incident, as many young people in Kenya face similar barriers when seeking sexual and reproductive health (SRH) services, including unfriendly and judgmental healthcare providers.
Although nearly 35 million Kenyans, about eight out of ten persons are below the age of 35, access to SRH services and adequate information about their HIV status remains a challenge. While the government has set up policies and frameworks such as the National Guidelines for Provision Of Adolescent And Youth Friendly Services In Kenya, its implementation has been slow.
This provided a unique opportunity for Machakos County in 2022 to set up the Machakos Youth Drop-In Centre (DIC) in partnership with the Red Cross and Deaf Empowerment Kenya (DEK). Nzioka is one of the young people who has benefitted. He said he has visited the HTS provider in Machakos' DIC twice and has referred many of his friends. "The staff at this place are young and very friendly. They are also open to discussing issues with you. Unlike in the [public] health centre, where the HTS providers are not welcoming," he said.
Nzioka added that, unlike the other HTS providers who did not provide post-test counselling because of the DIC, he is now aware of Pre-exposure (PrEP) and Post-exposure Prophylaxis (PEP) and how and when to use them.
Kenya's HIV burden and USAID funding cuts
Over half of Kenyans aged 15-24 remain uninformed about HIV prevention, despite this demographic accounting for the majority of the 17,000 new HIV infections reported in 2023.
Due to this burden, over the past two decades, the U.S. government, through the President's Emergency Plan for AIDS Relief (PEPFAR), has dedicated a staggering $8 billion towards providing life-saving HIV/AIDS treatment to nearly 1.3 million Kenyans.
Although Machakos' DIC doesn't directly receive these funds, the ripple effects of this change could impact their operations. The World Health Organization (WHO) has warned that the current United States administration's decision to freeze foreign aid is severely impacting the supply of HIV treatments, substantially disrupting the global response to the epidemic.
The organisation also noted that Kenya and seven other countries, including Haiti, Lesotho, South Sudan, Burkina Faso, Mali, Nigeria and Ukraine, could exhaust their supply of HIV treatments in the coming months.
Remaining relevant in uncertain times
Unlike the national government's approach of placing sexual and reproductive health services in a health facility only, the DIC is a stand-alone facility where youths can easily access these services and the information they need.
Beyond the challenges posed by HIV, limited access to sexual and reproductive health services hinders young people's ability to make informed decisions about their bodies, relationships, and futures. Accessible and comprehensive services are essential for empowering youth to prevent unintended pregnancies and STIs, develop healthy and respectful relationships, and achieve overall well-being and autonomy.
According to Alex Mavuti, the DIC's Site Coordinator, the centre -- which targets 15 to 24-year-olds -- was established to deal with the triple threat of HIV, teen pregnancies and gender-based violence (GBV).
As such, the facility, through support from the Global Fund, not only offers HIV testing and preventive measures for HIV but also offers free cervical cancer screening as well as screening for other sexually transmitted infections (STIs) and counselling for Sexual and Gender Violence (SGBV) survivors. However, for family planning products and post-abortion care, they refer clients to Machakos Level 5 hospital.
Mavuti notes that "the centre presents a no-stigma and discrimination environment; any young person can walk in, ask questions, receive guidance and counselling, or receive reproductive health-related services. The service provision is enabled by the existence of clinical equipment and professionals at the centre."
A unique pulling factor
According to the centre's records, the number of young people accessing HTS services has been on the rise, going from 88 in 2022 to 514 by October 2024. To achieve this, the centre created a distinctive attraction by having themed events, inviting them and making the centre's services available.
They also hold outreach programmes in colleges and universities where they raise awareness about their facility while providing services to the students.
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The centre is also equipped with recreational materials such as pool tables, chess boards, scrabble boards, playing cards, darts, volleyball and football courts, including a wireless internet connection which attracts the youths. "In the process of accessing these amenities, we mobilise them to also access our services," Mavuti said.
Onesmus Musyoka, a HTS provider at the centre, noted that the number of young people accessing HTS services and information has been increasing. "Most young people do not have enough information on HIV, including students at the university. They do not know about prevention and HIV testing. This centre has helped many of them," he said.
Fear of the unknown
On the patients' side, Onesmus observed that although young people want to find out about HIV prevention, including the proper use of condoms, they fear being tested. There is still a lingering stigma in using PrEPs and PEPs, making uptake low. According to him, young people, especially girls, are less informed about HIV prevention methods.
When asked about the future of the DIC in the face of funding cuts, the centre's representative declined to comment but emphasised that funding is vital for supporting prevention strategies, providing life-saving treatments like antiretroviral therapy (ARV), and advancing medical research in Africa and other low -- and middle-income countries.
