By Gift Briton
It is approaching mid-day on Wednesday. The sun beats down harshly as we navigate the narrow alleyways of Kibera, Kenya’s largest informal settlement, on the outskirts of Nairobi. Eyes follow every move we make with curious gazes tracking our progress as we meander the littered streets. After what seems like an eternity of twists and turns, we finally arrive at a local school nestled in the heart of Kibera, where we meet Maya* (not her real name).
A huge smile grows on Maya’s face as we greet her. She is barely 19 but stands as a beacon of inspiration to young people. She came here in the company of a community-based organization to share her knowledge and experience with students to inspire them to take control of their sexual and reproductive health.
We talk about her experience growing up and how she navigated the challenges of adolescence. “I experienced several temptations and influence from bad friends to engage in early sex, some of whom tried to introduce me to drug abuse and advised me to have a boyfriend who could buy me pads,” she remarks.
Many of Maya’s friends succumbed to HIV and early pregnancy. But she resiliently navigated the challenges and remained steadfast in avoiding the all-too-common traps of HIV and unplanned pregnancy.
With a shy demeanor, Maya recalls: “Sometime back when I was in grade eight, I visited a friend, and as we were playing, I noticed a trickle of blood seeping through my skirt. At that time, I was using old, worn-out clothing as a makeshift sanitary towel during my menstrual cycle because getting pads was a challenge.”
There is a high likelihood of adolescents, impoverished girls from this community, either becoming teen mums, positive with HIV, or substance abusers. The Kenya Health Information Systems data indicate that one in four pregnancies recorded in Kenya, Kibera included, is an adolescent. Furthermore, over 30 adolescent pregnancies are recorded every hour in Kenyan health facilities.
The latest Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates show that around 20 young people in Kenya (between 15-24 years) get infected with HIV daily, and less than half of them seek medication.
“In 2023, forty-one percent of the new HIV infections in Kenya were among adolescents aged 15-24. That is quite high because 15-24 is just a difference of eight years, but they form almost half of new HIV infections in the country. A lot of adolescents living with HIV do not know about their status, not enough of those who know about their status are on treatment, and a majority of those who are on treatment have not reached viral suppression,” notes Dr. Hermes Gichane, Head of the Adolescents and Young People Program at the National AIDS and STI Control Program (NASCOP), Kenya.
Nearly half of Kenyan adolescents do not have accurate information on how to prevent and treat HIV, according to the Kenya Demographic Health Survey 2022. “Children get information from their parents and schools. But in Kenya, we do not have comprehensive sexuality education for our adolescents. The government says that sexual education should be done at the appropriate age, but age-appropriate means different things for different people. So, you find that children end up in adolescence without getting full information about their sexuality because even parents shy away from educating their children on matters of sexuality. When these children become adolescents, they run to their peers and the internet to look for information that might be wrong,” explains Dr Gichane.
Having realized the challenges and barriers that constraints adolescents’ access to quality sexual and reproductive health services, Tiko Africa, a global non-profit organization, is supporting vulnerable adolescents and young people (15-24 years) to access sexual and reproductive health services for free, including HIV testing, treatment, and education, access to contraceptives, skills development, and mental health support and counseling.
Tiko uses a mobile-based application that connects adolescents registered on the platform to nearby public or private health facilities that offer sexual and reproductive health services. The digital platform generates real-time data and enables the organization to track the program’s impact.
In Kenya, the internet penetration rate in 2024 will be about 40%. Furthermore, a report by the Kenya Media Council in 2023 revealed that young people between 18 and 24 years old heavily rely on the internet for information.
“Many adolescents face financial obstacles, long distances to health facilities, and other sociocultural factors that prevent them from accessing these facilities. Even when services are available, concerns about privacy and service provider bias often discourage them from seeking help. Such issues highlight the urgent need to support adolescents about their sexual and reproductive health and rights,” United Nations (UN) Kenya Resident Coordinator Stephen Jackson noted during a project launch to end adolescents’ pregnancy and new HIV infections in Kenya.
In 2021, as Maya was on the cusp of starting high school, a community mobilizer enrolled her in the Tiko digital platform. The mobilizer visited households in the community, looking for vulnerable girls to register in the program.
“As a Tiko member, I got free HIV testing and counseling and access to contraceptives. Before I joined the program, I had little knowledge about my sexuality. I used to believe that someone cannot get pregnant when they have sex while standing and that only thin people have HIV. Still, after the counseling and education I got from Tiko, I came to learn that anyone, regardless of whether they are thin or fat, can have the disease,” she adds.
Apart from access to sexual health, adolescents also get to learn valuable life and employability skills from the program. Maya learned how to make sanitary towels, an essential product for menstrual hygiene but often out of reach for many in the slums. She now works with one of the community-based organizations in her community, advocating for adolescents’ sexual and reproductive health rights. They visit schools to inspire students to take control of their sexual health.
Maya is among the over 290,000 young people in Kenya who have benefitted from the digital platform. Tiko operates in 15 counties in Kenya: Mombasa, Kisumu, Nairobi, Kisii, Migori, Homa-Bay, Kisumu, Kakamega, Bungoma, Nyamira, Siaya, Kilifi, Vihiga, Machakos, and Kajiado. It has partnered with a network of 48 community-based organizations, 1500 community mobilizers, and over 450 public and private facilities in Kenya.
“Many adolescents do not believe that having unprotected sex without knowing the status of the other person has repercussions. We must continue to educate young people to ensure that information is not scarce. As parents, we need to normalize the conversation about sexual health with our children to allow them to have the correct information about their sexuality,” noted Dr. Ruth Masha, CEO of Kenya’s National Syndemic Diseases Control Council (NSDCC), during a recent scientific conference in Nairobi.
“Tiko platform provides young people who primarily may not be able to pay for service access in the private sector a choice on where to access the services. We work with adolescents who are likely not to have enough information about sexual reproductive health and are at risk of teen pregnancy or HIV infection,” said Serah Malaba- Chief Impact Officer at Tiko Africa.
A young person (15-24 years) can benefit from the program by registering on the digital platform. A community mobilizer who visits households clad in vibrant Tiko-branded T-shirts to enroll deserving adolescents registers them on the platform (whether they have a phone or not).
One can also be enrolled in the program (if they possess a smartphone) by a fellow young person a mobilizer had previously enrolled. The mobilizers are employees of local community-based organizations affiliated with Tiko Africa and are facilitated by the organization to move around. One mobilizer is assigned to around 100 households.
Once a person is enrolled on the platform, they get a unique code in the form of a short message service (SMS) if they have a phone or are given a card with a unique code, which they can use to access a service of their choice from the Tiko-affiliated health facilities. The mobilizer will then show the newly registered person where health facilities affiliated with Tiko are found.
With each service accessed, the adolescent and community mobilizer earns points, each of which can be redeemed at select retail shops. This reward enables adolescents from disadvantaged backgrounds to purchase essential products like sanitary pads. One point is equal to one Kenyan shilling. It is one way of encouraging more enrolment and use of the services rendered.
Tiko Africa has service-level agreements with specific retail shops in communities where users can redeem points to buy goods of equivalent value to the points earned. Every actor in the program gets compensated for their efforts and service offered.
“The Tiko platform also prompts reminder messages for users to attend appointments. The reminders support adolescents in coming back on time for service uptake. Because the platform affords us real-time data that tells us where these services are happening, we can adapt and make decisions quickly. The platforms help make real-time decisions, understand the user’s behavior, and support them to continue using the services,” notes Malaba.
According to Malaba, one of the program implementation challenges is competition from other non-governmental organizations. She adds, ” It is important to appreciate that no single organization can address a young person’s needs. This calls for all of us to collaborate to ensure that the service we are setting up is adolescent-friendly. We need to stop competing and begin to collaborate to ensure that we offer holistic service delivery and a continuum of care for adolescents and young people.”
Faizer Achieng got pregnant at nineteen years old. The now 21-year-old lady lived with her aunt in Nairobi then. In the process, she was abandoned and felt judged by friends and relatives for being pregnant at that age. “Some of the people who were close to me abandoned me, with some advising me to undertake abortion,” says Achieng.
As days turned into nights, her relationship with her aunt became strenuous, igniting frequent arguments and disagreements. Achieng became depressed and even contemplated suicide. However, one chilly morning, a community mobilizer reached out to her with support.
The mobilizer enrolled her in the Tiko digital program, where she was offered counseling and guidance. She was relocated from her aunt’s house to a place of safety where she could nurture the life growing within her. “After delivering, I was given free family planning services. Every time I get a service from Tiko clinics, I earn points. I have been using the points to buy Pampers for my child and other basic needs,” she noted.
“Adolescents face several barriers to accessing accurate information about their sexuality. Most of them lack the go-to person when they face sexual health challenges. They feel that the community will judge them for being sexually active. This prompts them to make decisions alone, which sometimes may ruin their lives,” narrates Ida Akoth, a Tiko Community mobilizer in Kibera.
Akoth is a graduate psychologist and mother of a four-year-old boy. She was recruited as a community mobilizer in 2020. The 25-year-old mother was born in Kibera and grew up in the face of overwhelming odds, finding herself caught in the tangled web of unplanned pregnancy. She got pregnant on campus and was forced to defer her studies for several years to take care of her newborn son. Akoth draws her motivation to go to the field daily to enroll more adolescents into the Tiko program so they would not have to experience the same hardships she underwent.
“More adolescents are becoming aware of the importance of taking their sexual health seriously and are willing to talk about it freely. Parents are also reaching out to us to enroll their children in the program because they can see that it has helped other young people live better and achieve their dreams,” Akoth adds.
However, Akoth notes that a mobilizer’s work can sometimes be tiresome and challenging, especially in dealing with adolescents below 18 years old due to the issues of parental consent. “When you meet an adolescent below the age of 18 who is willing to join the program, but their parents do not consent because there are a lot of myths and misconceptions around services such as the use of contraceptives. Some parents tend to believe that some contraceptives cause infertility wrongly.”
This story was first published in Science Africa
