Linking Sexual and Reproductive Health and HIV/AIDS, Gateways to Integration: A Case Study from Kenya

This 24-page case study is part of a series published by the World Health Organization (WHO), United Nations Population Fund (UNFPA), Joint United Nations Programme on HIV/AIDS (UNAIDS), and International Planned Parenthood Federation (IPPF) to raise awareness of the pressing need for more widespread linkages between sexual and reproductive health and HIV/AIDS. According to the publication, the process of linking sexual and reproductive health and HIV/AIDS needs to work in both directions, which means that traditional sexual and reproductive health services should integrate more general services for sexual and reproductive health.

This case study focuses on the Kenyan organisation Family Health Options Kenya (FHOK), which is a member association of International Planned Parenthood Federation and is the second largest supplier of contraceptives in the country after the government. According to the report, FHOK runs nine clinics across the country that serve around 120,000 clients per year. Over the years, these clinics have transformed their programmes from basic family planning services to provide more comprehensive family health services with an emphasis on reproductive health care. More recently, with the Kenyan President's declaration that AIDS is a "national disaster", the organisation looked at where traditional sexual and reproductive health services and HIV/AIDS services overlapped. They made a decision to pinpoint what HIV/AIDS services their clinics could provide. According to the report, eight FHOK clinics provide voluntary counselling and testing (VCT); all clinics offer prevention of mother-to-child transmission (PMTCT) programmes; and five clinics provide antiretroviral therapy.

The case study details FHOK's activities and approaches to providing VCT, community outreach, antiretroviral therapy, and follow-up care and support. According to the study, as VCT services at the organisation's clinic became more widely known, demand for sexual and reproductive health services increased. It also brought men to the clinics.

FHOK also began introducing VCT at its youth centres.  Four experienced young people, seeing that increased information created increased demand, started a mobile counselling and testing service. The youth centres provide clinical services on site or referrals to FHOK clinics. These activities are part of a general programme geared toward developing life skills. Peer educator training is also part of this programme, and peer educators are responsible for outreach activities at schools and on the streets.

In terms of community outreach, the case study looks at the importance of involving men in reproductive health and HIV programmes, including developing information materials designed for men, advocating for family planning and other sexual and reproductive health services in places where men gather, and making sure that clinic opening times are convenient for men. In addition, the organisation has created outreach teams to access communities who are unable to reach health facilities. These volunteer teams distribute condoms, raise awareness of family planning, and provide education for people about other sexual and reproductive health issues.

According to this case study, the organisation provides follow-up services for those who test HIV-positive and who must begin antiretroviral treatment. Community volunteers play an important role by providing psychosocial support, counselling on nutritional , and encouraging adherence to treatment. The clinics rely on their partners within communities to help identify and recruit people in need of antiretroviral therapy.

The case study includes a number of lessons learned from the experiences and challenges FHOK has faced. For example, to create an enabling environment for linked services, donors need to review the terms and conditions of their funding and allow greater flexibility on how money is spent. Also, FHOK has demonstrated that providing antiretroviral therapy within sexual and reproductive health settings is plausible, possible, and practical. Providing services for HIV/AIDS at sexual and reproductive health clinics attracts new clients and creates opportunities for promoting sexual and reproductive health to a wider population.

The case study recommends that in order to achieve their core aims and to maximise the public health impact, sexual and reproductive health and HIV programmes should take specific steps to meet the needs and concerns of men as well as women in providing services. In addition, the best way to promote sexual and reproductive health among young people and raise awareness of HIV is to make information and services available as part of a wider programme that addresses their social needs and helps empower them to make healthy choices. Finally, by providing space for community groups to meet or a base for their activities, clinics can strengthen the links with their client population to their mutual benefit.