National Kenya Guidelines for HIV interventions in Emergency Settings Draft

National AIDS Control Council

1

Acknowledgement (to be included)

2

Abbreviations AIDS

acquired immunodeficiency syndrome

ART

antiretroviral therapy

ARV

antiretroviral

CD4

cluster of differentiation 4

CERF

Central Emergency Response Fund

HIV

human immunodeficiency virus

IASC

Inter-Agency Standing Committee

IAWG

Inter-Agency Working Group

INEE

Inter-Agency Network for Education Emergencies

KEMSA

Kenya Medical Supplies Agency

NASCOP

National AIDS and STI Control Programme

MISP

minimum initial service package

MARPs

Most-At-Risk Populations. In Kenya, female and male sex workers, Intravenous drug users (IDU), and men who have sex with men (MSM) are Considered primary MARPs.

NEPHAK

Network of People Living With HIV/AIDS in Kenya

OI

Opportunistic Infections

PLHIV

People Living with HIV

PSEA

Prevention of Sexual Exploitation and Abuse

PEP

post exposure prophylaxis

PMTCT

prevention of mother-to-child transmission 3

STI

sexually transmitted infection(s)

VCT

voluntary counseling and testing

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Introduction Global and national HIV epidemic At the end of 2011, 34 million people were living with HIV worldwide, making up 0.8% of adults aged 1549 infected with the virus. Sub-Saharan Africa still remains the most severely affected continent, with 69% (23.5 million) of the global HIV burden placed in the sub-continent. Sub-Saharan Africa accounted for 71% of the adults and children newly infected with HIV in 2011, and 70% of the 1.7 million that died from AIDS-related causes in globally 2011.1 Kenya is experiencing a mixed and geographically heterogeneous HIV epidemic. Its characteristics are those of both a generalised epidemic among the mainstream population and a concentrated epidemic among the most at risk population. The HIV epidemic affects all sectors of the economy. Nationally, most new infections (44 percent) occur in couples who engage in heterosexual activity within a union or regular partnership. Men and women who engage in casual sex contribute 20 percent of the new infections, while sex workers and their clients account for 14 altogether.Men who have sex with men and prison populations contribute 15 percent, and injecting drug users account for 4 percent. Health facility-related infections contribute 3 percent of new cases.2 The HIV epidemic in Kenya shows considerable regional heterogeneity. Nyanza province has an overall prevalence of 14 percent, double the level of the next highest provinces—Nairobi and Western. All other provinces have levels between 3 percent and 5 percent overall, except North Eastern province where the prevalence is about 1 percent. HIV prevalence is by far the highest among women who are widowed (43 percent). Both women and men who are divorced or separated also have relatively high HIV prevalence (17 and 10 percent, respectively). There is strong indication pointing towards male circumcision being an effective tool for HIV prevention: 13 percent of men who are uncircumcised are HIV infected compared with 3 percent of those who are circumcised. Among couples who are married or living together, 6 percent are discordant, with one partner infected and the other uninfected.3

Overview of emergencies and crisis coordination in Kenya Each year, Kenya goes through humanitarian emergencies ranging from natural disasters (floods, drought, landslides) to man-made (ethno-political conflicts), affecting millions of people in the country. In October 2012, 2.1 million Kenyans were food insecure, concentrating in Arid and Semi-Arid Land (ASAL) areas of the country that cover about 88 per cent of the country’s total land mass. On the other hand, floods resulting from long rains affected some 100,980 people between March and early May 1

UNAIDS Global Report 2012 Kenya Demographic and Health Survey 2008/2009 3 Ibid. 2

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2013 mostly in Western Kenya, the coastal strip and in the North Eastern part of the country.4 Intercommunal violence caused the displacement of more than 80,000 people in 2012, resulting in a considerable extent from tensions stemming from the devolution process and the related county border demarcation issues. Additionally, a significant factor in the humanitarian scenario of Kenya is formed by the presence of 673,788 refugees in Dadaab and Kakuma camps. 5 Thus far, a draft Disaster Management bill and policy have not been passed, due to which transition to new county governance structure is not fully operationalized. Therefore it is not feasible to display the new structure with its national, county and sub-county level coordination.

The coordination of

humanitarian response is led by the Government of Kenya and takes place at national and county levels. Key bodies include the National Disaster Operation Centre (NDOC), the National Drought Management Authority and the Kenya Food Security Meeting and its technical group-the Kenya Food security Steering Group(KFSSG). Furthermore, individual emergency sectors hold meetings in Nairobi; inter-sector meetings are also arranged in Nairobi to coordinate the efforts of the sectors. Monthly informational meetings of the OCHA-chaired Kenya Humanitarian Forum also take place in Nairobi. At district level, District Steering Groups under the Kenya Food Security Meeting (DSGs) and District Disaster Management Committees (DDMC) are leading multi-sector response meetings, chaired by District Commissioners. The Government-led sectoral approach is well established in Kenya and supported by global Cluster lead agencies in accordance with the global humanitarian cluster system. Coordination of HIV in emergencies will fit into the new government disaster management structures as they evolve both at national, county and sub-county levels.

HIV risk and vulnerability in crisis situations In 2006, some 1.8 million people living with HIV were affected by humanitarian crises, making up 5.4% of the global number of PLHIV.6 A number of complex factors are involved in determining the interplay between HIV and humanitarian crises. Emergencies often impact livelihoods adversely, increasing the occurrence of sex work and sexual exploitation of particularly women and children. HIV vulnerability of women and children can also be heightened by sexual violence and rape being used as a means of warfare. Displacement of groups of people may cause disruption of community cohesion and separation of family members, as well as socio-culturally influenced norms regulating sexual behavior. Emergency situations often disrupt vital HIV prevention, treatment and care services, challenging the affected populations’ access to information and distribution of condoms, ARV treatment, PMTCT services and treatment of opportunistic infections. The health of people living with HIV is at risk due to the possible 4

OCHA Floods Update May 9, 2013 Kenya Emergency Humanitarian Response Plan 2013 6 Lowicki-Zucca et al. Estimates of HIV Burden in Emergencies. 2008: 84; i42-i48. 5

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shortage of adequate nutrition, as well as due to inadequate palliative and home-based care programmes.

Background and rationale for National Guidelines for HIV Interventions in Emergency Settings A number of processes have been undertaken in recent years in Kenya to assess and improve the status of HIV mainstreaming in crisis settings. As a starting point, a multi-agency “After Action” review of HIV inclusion in the humanitarian action responding to 2007/8 post-election violence in Kenya was conducted in May 2008. According to the report, notable shortcomings were observed with coordination and leadership, including lack of clarity on the role of various partners, as well as overall preparedness, stemming from issues such as inadequate capacity of humanitarian and HIV actors to plan and carry out HIV/AIDS interventions in emergency settings. Additionally, an assessment of HIV response during the 2011 drought, and an analysis study of gaps in the emergency policy environment, strategies and preparedness plans were conducted, with results pointing to a lack of systematic integration of HIV into existing government and humanitarian actors’ emergency preparedness and response mechanisms. HIV was declared a national disaster in 2009, however the framework of HIV response is not structured within the response to other frequent emergencies such as floods, drought or conflict, and hence there is a need to mainstream it as a crosscutting issue within disaster management. Utilizing the guidance in the InterAgency Standing Committee (IASC) Guidelines for Addressing HIV in Humanitarian Settings (2010), capacity of actors has since been built both at national and decentralized levels to respond to HIV specific requirements in humanitarian settings more adequately; shortcomings in local level adaptation of the global guidance were however noted, resulting in the production of national HIV in emergencies guidelines.

Objectives and guiding principles, and intended users of the guidelines These guidelines have been produced in line with the IASC Guidelines for Addressing HIV in Humanitarian Settings, adapted to the Kenyan context. The overarching objective of these guidelines is to set standards for the integration of HIV prevention, care, treatment, and support services in humanitarian assistance activities. The guidelines spell out various aspects of advocacy, coordination, and capacity building, and community empowerment, continuation of services, management, monitoring and evaluation to reach this objective. Following guiding principles are at the base of these guidelines: • • • •

Confidentiality, non-discrimination and de-stigmatisation; recognition of human rights and the needs of special groups within humanitarian settings. Meaningful involvement of people living with HIV/AIDS Multisectorial partnerships Cultural sensitivity and Do no harm principle (consideration for possible negative impacts of providing specific services for special populations) 7

• • • •

Accountability, sustainability Coordinated and timely response Adherence to the standards of humanitarian service provision (Sphere) Flexibility – designing and implementing programmes that are adaptable to the situation at hand

Intended users , both government and non-governmental, vary from policy makers, national and grassroots level implementing agencies; County, sub-county and community actors; and service providers at health facility and other institution levels, and include HIV as well as humanitarian actors across all sectors involved in emergency programming.

Coordination and governance of HIV interventions in emergencies in Kenya In line with the UN General Assembly Special Session (UNGASS) resolution of 2005 to scale up HIV prevention, treatment, care and support services to all those in need of them in order to reach the Universal Access targets, The Kenya National AIDS Strategic Plan 2010-2013 (KNASP III) highlights the need for enhanced HIV related service provision for populations of humanitarian concern, by recognizing them as a vulnerable group in the Kenyan context. A multi-sectoral National Steering Committee on HIV in Emergencies (NSC) was set up in 2011 under the auspice of the National AIDS Control Council coordinating the national HIV response; resulting from numerous consultations with stakeholders, the role of the NSC is focused on advocacy and policy level influence to strengthen HIV programming within humanitarian processes at that level. To bring together HIV and emergency programming effectively, strong linkages with relevant, existing humanitarian structures, notably the Kenya Food Security Steering Group, Crisis Response Centre, and the National Disaster Operations centre will be pertinent. It is necessary that the linkage between HIV and humanitarian actors reaches decentralized structures also, allowing for adequate service provision at beneficiary level across the country. Linkages with Kenya Red Cross as subsidiary government agency and a first line responder to emergencies at all levels are elemental. At national level, the UN Joint Team on AIDS, with IOM and UNHCR leading the Joint Team, participation in the agenda, is represented in the National Steering Committee on HIV in Emergencies. UN Joint Team provides a linkage with the UN coordinated disaster management mechanism, the Inter-Sectoral Working Group (ISWG)7 led by UN-OCHA, Within the ISWG, the Joint Team on AIDS advocates for the inclusion of HIV concerns in sectoral activities and supports them technically to mainstream HIV in their programmes.

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Emergency sectors (mirroring the global emergency cluster system) in Kenya consist of health, protection (incl. child protection sub-group), education, food aid, nutrition, water, sanitation and hygiene, agriculture and lifestock, shelter and ab and non-food items, multi-sector assistance to refugees, and early recovery

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At decentralized levels, the County AIDS Control Council and NASCOP representation at county and community level emergency coordination structures – County Disaster Management Committees and Community Relief committees as well as Community Leaders’ engagement Forums. Local PLHIV groups should be incorporated in grassroots level community relief committees and community leaders’ engagement forums. Both at national and decentralized levels however, the structures are evolving due to the ongoing devolution process, and NACC/NASCOP representation will adapt to create linkages to the humanitarian structures taking shape. Necessary linkages between national humanitarian and HIV actors are illustrated below:

NATIONAL LEVEL

Nat. Steering Committee on HIV in Emergencies

National DM body e.g.: NDMA NDOC KFSSG/KFSM KFSM/KFSG

NSC Task Forces

COUNTY LEVEL

COMMUNI TY LEVEL

CACC/DASC Os/PASCOs /PASCOs PLHIV networks/ NEPHAK

County Disaster Management Committees; County Steering Groups

Community Relief Committees/Communi ty Elders’ Engagement Forums

Emergency phase approach for mainstreaming HIV activities in emergency sectors programming These guidelines provide emergency sector specific guidance on HIV interventions based on four phases of emergency management: Phase I: preparedness; Phase II: Emergency response at the onset of the emergency prior to rapid assessments; Phase II: Emergency response after the establishment of the emergency situation through sectoral needs assessments and Phase IV: Recovery and reconstruction activities. 9

Preparedness refers to capacities and knowledge developed to anticipate and respond effectively to the impact of likely, imminent or current hazard events or conditions. It precedes efforts to mitigate the effects of the emergency (disaster risk reduction). Preparedness includes plans or preparations to save lives and to assist the emergency response (evacuation plans, stocking of commodities etc). Within preparedness, contingency planning is a management tool used to analyse the impact of potential crises to ensure proper arrangements in advance to respond to needs of affected populations in an appropriate way. Sectoral preparedness for HIV will tap into early warning systems in Kenya, which include for instance:  Integrated Food Security Phase Classification (IPC) system;  the Famine Early Warning system (FEWS Net);Flood early warning system (rainfall forecast data from Kenya meteorological department)

Response includes the provision of assistance or intervention during or immediately after a disaster to meet the life preservation and basic subsistence needs of those people affected. Immediately after an emergency, the magnitude of the crisis is not accurately known and most importance is placed on immediate actions to save lives; once sectoral assessments (HIV inclusion in assessment has been dealt with in a separate chapter) have established the magnitude of the crisis, a more targeted response is possible. Recovery and reconstruction consists of activities to restore systems, structures and livelihoods destroyed or damaged by the emergency. It includes an element of disaster risk reduction to avoid the reoccurrence of emergencies. It is to be noted that since these phases are often overlapping, due to which some activities from two different phases can be running simultaneously. The activities are expected to be carried out in line with other relevant national and international guidance, including international standard operating procedures and standards of quality, particularly the. SPHERE standards. The partnerships required to conduct the activities vary according to the nature of the interventions as well as location (national/county/community level). At national level, key actors include the Disaster Management Authority, National Drought Management Authority, and relevant governmental disaster management authority, and relevant line ministries, NGOs and CSOs, private sector, specific humanitarian sector, bilateral agencies and the UN. At county level, key partners include, County authorities, NGO/CSO partners in disaster management, and HIV service provision and PLHIV network, from Constituency AIDS Control Committees, KEMSA, as well as decentralized level NASCOP actors. At community level, necessary partnerships include HIV service providers from NGOs/COS, NASCOP, PLHIV networks, Community Relief Committees and Community Elders’ Engagement Forums.

HIV ACTIVITY SHEET 1: HEALTH SECTOR

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Phase I: Preparedness At preparedness phase, HIV specific activities aim to ensure that the continuation of HIV prevention, treatment and care services in the event of an emergency are planned for.

At all (national, county, community, health facility) levels, following activities are to be carried out:  Identify actors and establish a coordination mechanism for HIV service delivery  Stock pile HIV commodities, including. ARVs, Post-Exposure Prophylaxis, ARV for PMTCT , OI drugs, condoms, test kits and other lab agents; Stock pile STI drugs based on national protocol on syndromic management  Provide PLHIV information on treatment adherence and on counseling; establish confidential registers and medication cards  Conduct regular feedback meetings  Establish communication mechanism/strategy from national to county level linking clients to health facilities where they can access medication; utilize hotline numbers  Establish safe adequate blood banks  Train medical staff on the clinical management of rape; strengthen coordination for the

prevention and management of SGBV in emergency settings    

Work with in-country national and UN agencies WHO/UNFPA /KEMSA to procure STI/PEP/Maternity kits Train actors on Contingency planning and national guidelines for HIV in emergencies Establish a multi-sectoral gender-based violence coordination mechanism, including identification of focal points and setting up telephone hotlines. Develop an HIV prevention, care and treatment awareness package for young men and women and adolescent boys and girls

At national and county levels, following activities will be expected to be conducted:      

Develop protocol for HIV prevention, and treatment for slow onset emergencies like drought Conduct HIV profiling at household level, including prevalence, need of ART, nutritional support etc. Establish a database on human resources, including. needs for HR assessed; mobilize extra resources and build their capacity on a minimum training package on HIV in emergencies Train DDR committees on HIV interventions in preparedness Train actors on standard precautions, blood safety and waste management (IASC guidelines) Strengthen the capacity of emergency responders, such as police officers, on SGBV.

Following activities are designed for county, facility and community levels: 11

 

Buffer medical sites with relevant commodities and Buffer clients with ART and CTX to clients for 3 months, TB drugs , PMTCT, Infant NVP, Contraceptives for 1 month,

 

Follow protocol for slow onset/drought emergencies for nomadic patients on ART Conduct HIV awareness in the community, to include where to access HIV services such are PEP and what to do

Phase II: Activities at the onset of the emergency prior to rapid assessments; In early phase of emergency health sector should provide services that adhere to international standards (SPHERE, MISP) to reduce HIV transmission and to care and support to reach universal access to HIV treatment, prevention, and care and support goals. While at this stage, it may not be possible to establish the number of affected PLHIV and the focus of interventions is in the provision of key lifesaving interventions, in terms of HIV specific activities this would include ensuring safe blood transfusions to the injured and the provision of post-exposure prophylaxis. Prior to the onset of the emergency, ARV patients should have been provided with adequate supply of medication as a preparedness measure.

At all levels, the health sector is expected to: 

 

Facilitate access to ARVs (including eMTCT treatment), condoms, Post Exposure Prophylaxis, cotrimoxazole prophylaxis for OI, FP,syndromic treatment of patients with STI symptoms at the first encounter and presumptive STI treatment for rape survivors; Conduct regular feedback meetings on HIV service provision Facilitate security for staff, patients and commodities/liaise with security services to ensure security for staff, patients and commodities

Following facility and community level activities are designed to prevent HIV transmission in healthcare settings

  

Facilitate adherence to standard precautions and access to safe blood in health-care settings Segregate and store all waste from patients, collect it daily and dispose of infectious waste in a safe manner Ensure safe blood supply and rational use of blood

Post-Exposure Prophylaxis (PEP) and post-rape services:  

Include PEP in clinical management of rape survivors Inform community on available services 12

 

Provide PEP for occupational exposure Provide presumptive treatment for STI in treatment for rape

Phase III: Activities after the establishment of the emergency situation through sectoral needs assessments

At county, community and facility levels, following activities are to be implemented:

         

Identify people in need of continuation of ART, PMTCT,TB and provide ART to those previously on treatment Ensure access to HIV testing services Provide key populations (MARPs) access to HIV prevention interventions, incl. clean injecting equipment for injecting drug users Roll out HIV prevention activities for youths and adolescents, targeting young women and men Follow up on adherence issues, track defaulters and document defaulter rates Monitor possible violations (access to services/human rights/protection?)during the interventions Support home-based care programmes Expand multi-sectoral gender-based violence coordination mechanism /working at national, county and local level Roll out comprehensive public health package for STI control based on national protocol Immunize HIV exposed/infected infants based on national protocols

Phase VI: Recovery and reconstruction activities to ensure HIV services are integrated in efforts to rebuild systems and structures damaged by the emergency At all levels, the health cluster is expected to:  Provide refresher courses on standard guidelines and precautions  Establish and restore blood bank services  Establish and roll out a public health package for STI control and quality STI programmes At county, community and facility levels:     

Establish linkages and referrals between facilities Facilitate continuation of home based care programmes Reconstruct treatment records Expand condom promotion campaigns, using adapted messages and multiple information channels Ensure access to routine immunizations 13

    

Ensure access to nutritional care and support Ensure continuation of care services for people living with HIV/AIDS including home-based care. Establish voluntary counseling and testing services. Initiate and scale up ART programmes. Expand interventions targeting key populations at higher risk e.g. sex workers, men who have sex with men, transgender people, and injecting drug users.

For Phases I, II and Recovery, reconstruction phase at national and county levels: Track the progress on response (monitoring and evaluation)

HIV ACTIVITY SHEET 2: PROTECTION

Phase I: At preparedness phase, HIV specific activities aim to ensure that the continuation of HIV prevention, treatment and care services in the event of an emergency are planned for

At all (national, county and community,) levels, following activities are to be carried out:      

Create linkages with access to HIV-related service provides for people living with HIV and key populations at higher risk of exposure to HIV. Give special consideration to the elderly and people with disabilities. Prepare for continuation of legal referral systems for GBV and HIV related human rights human rights violations Ensure that systems are in place to document HIV-related human rights violations, including in situations where children are separated, and/or orphans Advocate for inclusion of HIV issues in national emergency preparedness and response policies and including internally displaced persons policies, strategies and guidelines Establish hotlines, database of GBV service providers Train providers: Police, HCWs, magistrates , volunteers, community members

At national and county levels, following activities will be expected to be conducted:   

Review existing laws and policies concerning people living with HIV and key populations at higher risk of exposure to HIV Develop a coordinated response for gender-based violence prevention and response Develop programmes addressing gender-based violence

Following activities are designed for community levels:

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 

Plan for safe sites taking into account special vulnerabilities of women and girls Create awareness on prevention of GBV and inform on access to available services

(Package on specific vulnerabilities of youth in respect to protection to be included) Phase II: Activities at the onset of the emergency prior to rapid assessments; In early phase of emergency, the sector should provide services that adhere to international standards (SPHERE, MISP) to reduce HIV transmission and facilitate access to care and support to reach universal access to HIV treatment, prevention, and care and support goals.

Following activities should be carried out at facility and community levels:   

Ensure HIV service provision that respects human rights Establish protection for women and girls Register, monitor and support vulnerable children

PhaseI II: Activities after the establishment of the emergency situation through sectoral needs assessments

At county, community and facility levels, following activities are to be implemented:  

Trace families of unaccompanied and separated children and carry out efforts to reunite them Provide them with the same essential information and services as all children.

Phase IV: Recovery and reconstruction activities to ensure HIV services are integrated in efforts to rebuild systems and structures damaged by the emergency

National level recovery activities should include:

   

Mainstream a human-rights-based approach into all HIV programmes Track the progress on responses (monitoring and evaluation) Conduct full assessment of the human rights situation. Mainstream a human-rights-based approach into all HIV programmes. 15

 

Build capacity for working with orphans and other vulnerable children, in accordance to the Service Standards for Quality Improvement for OVCs through the relevant ministry Ensure that HIV is integrated into a multisectoral gender-based violence response. Ensure gender-based violence programmes take into account key populations at higher risk of exposure to HIV.

Actors at county and community levels should carry out following activities:    

Build local capacity to address human right’s needs. Respond to protection threats by taking appropriate community guided actions and set up tracing systems. Re-establish or set up appropriate child protection mechanisms. Establish and support care arrangements.

For all phases and levels: Track the progress on response (monitoring and evaluation)

HIV ACTIVITY SHEET 3: FOOD SECURITY, AND LIVELIHOODS SUPPORT

Phase I: Preparedness. At preparedness phase, HIV specific activities aim to ensure that the provision of food aid is adequate and properly targeted at PLHIV in the event of an emergency

At all (national, county community and food distribution site) levels, following activities are to be carried out:  



Map relevant actors. Train staff and partners on (a) integration of HIV interventions in food programmes and (b) integration of food security, skills in support of people living with HIV and orphans and other vulnerable children. Integrate HIV proxy indicators (household headed by children or elderly, presence of a chronically ill person in a household) into food security and vulnerability analyses.

At national and county levels, following activities will be expected to be conducted:



Develop IEC materials 16

   

Develop estimates of HIV-affected households that would potentially need food assistance Determine criteria for food assistance to affected individuals and communities. Procure supplies and determine criteria – existing criteria for PLHIV to be reviewed; preposition supplies. Involve PLHIV/HIV community providers in Food relief committees

Following activities are designed for community and food distribution site levels:    

Preposition supplies Identify vulnerable PLHIV, OVC, child headed households for special considerations as regards to their access to food and nutritional needs. Establish contacts with existing PLHIV networks and community health workers Include HIV affected households in Kenya food security assessments on household food security status;

Link with early warning systems such as Integrated Phase Classification (IPC) system, the Famine Early Warning system (FEWS),

Phase II: Activities at the onset of the emergency prior to rapid assessments; In early phase of emergency, the sector should provide services that ensure adequate food aid service provision to PLHIV. .

At all levels, the food security sector/cluster is expected to: Ensure PLHIV are targeted with adequate food assistance through collaboration with PLHIV networks and CHWs

Following community and food distribution site level activities are designed ensure adequate food support for PLHIV: 

Target and distribute food assistance to HIV-affected communities and households, ensuring that food distribution (include. packaging) is sensitive to local issues of stigma, yet targets vulnerable populations.

Phase III: Activities after the establishment of the emergency situation through sectoral needs assessments 17

At county and community food distribution site levels, following activities are to be implemented:

   

Target and distribute food assistance to HIV-affected communities and households Integrate HIV(IEC material distribution, condom distribution) into existing food assistance programmes and food security activities Introduce specific measures to protect/adapt the livelihoods of HIV-affected households and support homestead food production Assess and protect women and girls vulnerability to SEA (sexual exploitation and abuse) through food distribution, monitor incidences of sex for food/protection incidences

Monitoring assessments to include the following information:   

Percentage of pregnant mothers receiving nutrition support accessing PMTCT /HIV services in the spirit of eMTCT and KMA Percentage of HIV positive under- five children receiving nutrition support accessing HIV services What proportion of those receiving food/nutrition support for PLHIV

Phase IV: Recovery and reconstruction activities to ensure HIV services are integrated in efforts to rebuild systems and structures damaged by the emergency

National level recovery activities should include:

  

Adapt agricultural methods and build capacity Adapt food distribution rations for hyperendemic settings Document lessons learned

Actors at County and, Community and food distribution site should carry out following activities   

Expand nutrition and care programmes for vulnerable people living with HIV Integrate nutritional support with other services Strengthen the capacity of people living with HIV and those on ART to provide for their nutritional needs 18

  

Involve PLHIV in food for asset programmes; follow stipulated standards while engaging PLHIV. Work with parents and HIV community providers to ensure children infected and affected by HIV/AIDS attend school, and benefit from school feeding programmes in crisis settings. Government food distribution channels to provide food rations to vulnerable PLHIV through PLHIV networks, Community health workers and other HIV service providers

For Phases I, II and Recovery, reconstruction phase at national and county levels: Track the progress on response (monitoring and evaluation) Monitoring assessments to capture following indicators: Percentage of vulnerable PLHIV and affected households provided with nutrition and livelihood skills programmes

HIV ACTIVITY SHEET 4: NUTRITION Phase I: Preparedness. At preparedness phase, HIV specific activities aim to ensure that the provision of food aid is adequate and properly targeted at PLHIV in the event of an emergency  

Map relevant actors. Train staff and partners on (a) integration of HIV interventions in nutrition programmes and (b) integration of nutritional skills in support of people living with HIV and orphans and other vulnerable children.

Include HIV affected households in Kenya food security assessment on household nutritional status;

Phase II: Activities at the onset of the emergency prior to rapid assessments; In early phase of emergency, the sector should provide services that ensure adequate nutritional provision to PLHIV.

 

Ensure adequate nutrition and care for vulnerable people living with HIV Respond to the specific needs of pregnant and lactating women living with HIV and their children





Include vulnerable PLHIV , in supplementary feeding interventions for under 5, pregnant women and the elderly Ensure adequate nutrition and care for vulnerable people living with HIV



Protection feeding targeting malnourished children should also include PLHIV 19

Phase III: Activities after the establishment of the emergency situation through sectoral needs assessments Integrate HIV (IEC material distribution, condom distribution) into existing, nutrition projects and activities

Phase IV: Recovery and reconstruction activities to ensure HIV services are integrated in efforts to rebuild systems and structures damaged by the emergency HIV ACTIVITY SHEET 5: LIVELIHOODS SUPPORT

Phase I: Preparedness. At preparedness phase, HIV specific activities aim to ensure that livelihoods support measures include PLHIV in the event of an emergency



Map relevant actors.

Train staff and partners on (a) integration of HIV interventions in livelihoods programmes and (b) integration of livelihoods skills in support of people living with HIV and orphans and other vulnerable children.Phase II: Activities at the onset of the emergency prior to rapid assessments; In early phase of emergency, the sector should that ensure adequate nutritional provision to PLHIV. 

Introduce specific measures to protect/adapt the livelihoods of HIV-affected households and support homestead food production

Phase III: Activities after the establishment of the emergency situation through sectoral needs assessments



Integrate HIV(IEC material distribution, condom distribution) into existing livelihood support programmes

Phase IV: Recovery and reconstruction activitiesto ensure HIV services are integrated in efforts to rebuild systems and structures damaged by the emergency 

Adapt agricultural methods and build capacity

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

Provide appropriate relief inputs and training to vulnerable and affected households to restore and rebuild livelihoods

HIV ACTIVITY SHEET 6: EDUCATION Phase I: Preparedness. At preparedness phase, HIV specific activities aim to ensure that the continuation of HIV prevention, treatment and care services in the event of an emergency are planned for

At all (national, county, community, teaching institution) levels, following activities are to be carried out:     



Ensure HIV is included in all formal and alternative education curriculums. Train teachers and auxiliary staff as well as learners on HIV, sexual violence and exploitation PSEA, life skills, dealing with children with special needs, and counseling skills. Ensure sufficient stocks of key HIV and life skills educational materials and curricula including sanitary towels Ensure access to ARVs, PEP, condoms for affected and infected teachers through collaboration with relevant service providers. Establish systems to monitor supervise and respond to violence and abuse and HIV-related stigma and discrimination Facilitate access to education for children affected and infected by HIV

Phase II: Activities at the onset of the emergency prior to rapid assessments; In early phase of emergency, the sector should provide services that adhere to international standards (SPHERE, MISP) to reduce HIV transmission and facilitate access to care and support to reach universal access to HIV treatment, prevention, care and support goals.

At community and facility levels, following activities should be undertaken: 

Facilitate as high a retention rate of pupils as possible, including children and youth with special vulnerabilities (PLHIV, child headed households/OVCs) Ensure access to essential HIV services to learners and staff

Phase III: Activities after the establishment of the emergency situation through sectoral needs assessments

At national level, following activities are to be undertaken: 21

     

Provide all children and young people with free access to formal and non-formal education Provide needs- and outcome-based participatory life-skills based HIV education Provide enabling and protective learning environments for all children and young people Ensure continuation of essential HIV services to learners and staff Ensure a minimum package for comprehensive HIV and sexuality education Endeavor to use educational structures / schools and the human resources(teachers)

Following activities are designed for community and facility levels: Ensure that young people, including those affected by HIV, participate in planning, implementation and evaluation of education programmes.

Phase IV: Recovery and reconstruction activities to ensure HIV services are integrated in efforts to rebuild systems and structures damaged by the emergency At all levels, the education sector/cluster is expected to: 

Refer affected children and young people to specialist services

Refer affected teachers to specialized services including psychosocial support groups for those infected (National level recovery activities should include:

Actors at County/Community/teaching institution levels should carry out following activities:

For all phases at national and county levels: Track the progress on response (monitoring and evaluation) HIV ACTIVITY SHEET 7: SHELTER Phase I: Preparedness. At preparedness phase, HIV specific activities aim to ensure that the continuation of HIV prevention, treatment and care services in the event of an emergency are planned for

At all (national, county, community and at the site of intervention) levels, following activities are to be carried out:  

Ensure the safety of potential sites by designing shelter that decreases vulnerability to HIV and that accommodate the needs of people living with HIV Train staff in the understanding of HIV vulnerability as well as the needs of people living with HIV with regard to the design of sites, camps, and urban housing and shelter environments. 22

At national and county levels, following activities will be expected to be conducted:  

Provide overall guidance on minimum standards on HIV mainstreamed shelter site identification, planning, shelter management and coordination. Regularly review the minimum standards from time to time based on new information or unique disaster situations.

Following activities are designed for the site of intervention and community levels: Develop profile of the affected population with special attention to identifying the number and location of those likely to require more protection such as orphans, separated and unaccompanied minors, female and child-headed households, people with specific vulnerability factors (marginalized, disabled, chronically ill).

Phase II: Activities at the onset of the emergency prior to rapid assessments; In early phase of emergency health sector should provide services that adhere to international standards (SPHERE, MISP) to reduce HIV transmission and facilitate access to care and support to reach universal access to HIV treatment, prevention, care and support goals.

Phase II: Activities after the establishment of the emergency situation through sectoral needs assessments. The shelter cluster is expected to carry out following county and community level activities:   

 

Ensure that HIV is integrated in all assessments (situational and needs) with regard to shelter through a participatory approach involving the vulnerable individuals affected by the disaster. Select sites that are safe and secure by conducting a participatory assessment involving the most at risk people. They should be consulted about security and privacy, sources and means of collecting fuel for cooking and heating and access to housing supplies. Ensure that distance to health facility as well as other communal services (market, community centres, etc) is at reasonable and safe distance. Provide men and women toilet blocks while where possible provided and allocate family toilets.

Integrate HIV prevention messages into shelter programmes

Phase IV: Recovery and reconstruction activities to ensure HIV services are integrated in efforts to rebuild systems and structures damaged by the emergency At all levels, the shelter cluster should: Allocate shelter, land and housing in a non-discriminatory manner

For Phases I, II and Recovery, reconstruction phase at national and county levels: Coordinate and supervise community level shelter sites identification, planning, shelter management and coordination.

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HIV ACTIVITY SHEET 8: CAMP COORDINATION AND CAMP MANAGEMENT

Phase I: At preparedness phase, HIV specific activities aim to ensure that the continuation of HIV prevention, treatment and care services in the event of an emergency are planned for

At community/camp levels, following activities are to be carried out:



Ensure familiarity with existing available HIV programmes and services and how to access these

Phase II: Activities at the onset of the emergency prior to rapid assessments; In early phase of emergency, the sector should provide services that adhere to international standards (SPHERE, MISP) to reduce HIV transmission and facilitate access to care and support to reach universal access to HIV treatment, prevention, care and support goals.

And:

Phase III: Activities after the establishment of the emergency situation through sectoral needs assessments

Following activities are designed for community/camp levels: 

Establish HIV-sensitive camp governance mechanisms and services; mainstream HIV into camp coordination and camp management

Phase IV: Recovery and reconstruction activities to ensure HIV services are integrated in efforts to rebuild systems and structures damaged by the emergency

National level recovery activities should include:

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Actors at County/Community/Camp levels should carry out following activities: 

Assess the situations of the affected camp population and plan appropriate programmes

 Expand camp governance mechanisms that protect people against HIV infection and promote the rights of people living with HIV

For all phases/levels: Track the progress on response (monitoring and evaluation)

HIV ACTIVITY SHEET 9: WATER AND SANITATION

Phase I: Preparedness At preparedness phase, HIV specific activities aim to ensure that the continuation of HIV prevention, treatment and care services in the event of an emergency are planned for.

At all (national, county, community, area of intervention) levels, following activities are to be carried out: 

Train partners in HIV-related considerations for water, sanitation and hygiene programming.

At national level, the water and sanitation sector is expected to:

 

Create IEC materials addressed to women, men, girls and boys. Ensure an adequate supply of water treatment kit for vulnerable populations

Following activities are designed for county, facility and community levels:

25



Integrate HIV in water, sanitation and hygiene programmes

Phase II: Activities at the onset of the emergency prior to rapid assessments; In early phase of emergency, the sector should provide services that adhere to international standards (SPHERE, MISP) to reduce HIV transmission and facilitate access to care and support to reach universal access to HIV treatment, prevention, and care and support goals.

Following activities are designed forage of intervention and community levels:  

Ensure that people living with HIV and their carers have access to an appropriate and sufficient quantity and quality of water, sanitation and hygiene services Distribute water treatment kits at facility level to PLHIV

Phase III: Activities after the establishment of the emergency situation through sectoral needs assessments

At county, community and area of intervention levels, following activities are to be implemented:  

Ensure that water, sanitation and hygiene programmes minimize the risks of violence and stigma/discrimination against vulnerable groups, including people living with HIV Integrate HIV prevention messages into water, sanitation and hygiene programmes to help dispel misconceptions about HIV

Phase IV: Recovery and reconstruction activities to ensure HIV services are integrated in efforts to rebuild systems and structures damaged by the emergency

At all levels, the water and sanitation sector is expected to: 

Expand/provide HIV/AIDS education programmes. 26



Ensure access to appropriate water, sanitation and hygiene services in high-prevalence settings.

For all phases at national and county levels: Track the progress on response (monitoring and evaluation

Resource mobilization In addition to the globally established Central Emergency Response Fund (CERF) and the appeals processes (Flash and Consolidated Appeals, or CAPs), the humanitarian funding mechanism in Kenya includes a country specific Emergency Response Fund (ERF), managed by the Humanitarian/Resident Coordinator. These funding mechanisms generally have specific criteria on funding opportunities for vulnerable populations. Further funding opportunities include: •

Reprogramming regular HIV funds from national sources, bilateral donors and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

•

Allocating existing HIV programming funds to the humanitarian response; costing of HIV in emergencies within the National AIDS Strategic Plan.

•

Advocating for HIV specific funds within the national humanitarian planning and response funding process

•

Including HIV as a mainstreaming component within humanitarian funding proposals.

•

Exploring the possibilities of raising funds for HIV specific interventions from sectoral emergency funds.

•

Private sector support

•

Inclusion in county budgets

Information management, monitoring and evaluation

HIV inclusion in needs assessments HIV specific indicators should be included in humanitarian needs assessment tools. In Kenya, cyclic sectoral needs assessments are conducted after long rains and short rains seasons; Kenya Initial Rapid Assessment (KIRA) tool is in use for rapid onset emergencies, providing qualitative data, with 27

triangulation of secondary data. Sectoral HIV specific indicators for needs assessments have been included in Annex X.

Monitoring and Evaluation HIV specific indicators are to be included in humanitarian information management as well as monitoring and evaluation in order to track the success of HIV inclusion in planning and response. Taking into account the current human resource restrictions data capture mechanisms in the country, capacity building of data capturers should be conducted at adequate intervals, and data cleaning and quality checks should be performed regularly at grassroots level. A national database merging humanitarian information (using the WESCOORD model of centralized information gathering) should be advocated for, with adequate inclusion of HIV specific information.

(Peers to review M & E indicators from IASC guidelines).Data collection and reporting mechanisms for multisectoral response to fit within the NACC’s Monitoring and Evaluation framework.

Appendixes: Annex 1: Annex Information flow-chart for HIV in Emergencies actors Annex 2: Annex Stand-alone HIV needs assessment tool; KIRA and sector specific guidance for HIV mainstreaming in needs assessments Annex 3: Annex Monitoring and evaluation framework Annex 4: HIV protocol for protracted emergencies Annex 5: Information package on specific vulnerabilities of young people (and people with disabilities) Further resources Annex 2: Examples of sector specific guidance for HIV mainstreaming in needs assessments 1. Health sector:    

HIV service disruption No. of clients enrolled at facilities with service disruption No existing facilities providing all services: ART/PMTCT/PEP/VCT/ safe blood transfusion/services to MARPS/defaulter tracing Community outreach service disruption 28

 

providing all services: ART/PMTCT/PEP/VCT/ safe blood transfusion/services to MARPS/defaulter tracing Community outreach service disruption

2. Nutrition Sector:  

Number of PHIV among affected Percentage PLHIV receiving food/nutrition assistance

29