NAIROBI, 9 July 2009 (IRIN) - As Kenya prepares its third National AIDS Strategic Plan, several high-risk groups are calling on the government to give them more say in the fight against HIV and AIDS.

Commercial sex workers, injecting drug users (IDUs) and men who have sex with men (MSM) were mentioned as vulnerable groups in previous strategic plans, but government-funded HIV programmes have largely ignored them.

A UNAIDS analysis [http://www.unaidsrstesa.org/files/MoT_0.pdf ] of HIV transmission modes and prevention responses found that even though heterosexual sex caused 80 percent of new infections, IDUs, clients of sex workers and MSM were "significant contributors" to new infections. UNAIDS recommended that these "most at-risk populations" (MARPs) should have a higher profile in the country's strategy.

Dr Nicholas Muraguri, director of the National AIDS and STIs [sexually transmitted infections] Control Programme (NASCOP), told a national stakeholders meeting for MARPs in the capital, Nairobi, on 7 July, that it was high time the government realized these groups were a major source of new HIV infections and started formulating programmes for them.

"We must stop living in denial as a country, and start to foster programmes that would integrate these groups adequately," he said. "We cannot afford to leave out some groups ... they also have rights."

Jared Mulwa*, 30, says the government and society have forced him into leading a double life: he is married and has a one-year-old daughter, but also has same-sex relationships; he did not marry his wife because he wanted to, but to fit into society.

"It is torturous being an MSM in Kenya because there is nobody to turn to - to society you are an outcast, and before the law you are a criminal who should be behind bars," he said.

"How do we get involved in HIV programmes ... when we are in every sense of the word grouped with criminals? We are endangering both our lives and those of others due to silence and stigmatization."

Dr Muraguri promised that the third National AIDS Strategic Plan would include a target of universal access to HIV and AIDS services for most at-risk populations by 2013.

"We need to start doing things differently by discussing changes to policies and laws that criminalize and discriminate against MARPs, and developing mechanisms for identifying these groups and their networks to make it easier to reach them," he said.

John Mark*, an injecting drug user, appealed for a programme to ensure that drug users did not have to share needles, which can rapidly spread HIV. "When you are addicted to hard drugs, like me, so long as you can get the drug into your system, the means matters very little," he said. "Why can't they just build a centre where we can go and get needles, and in the process counsel those of us who are ready to change?"

Dr Joshua Kimani, clinical director of the Kenya AIDS Project, a joint programme between the University of Nairobi and the University of Manitoba, in Canada, called for a greater involvement of MARPs in designing programmes, and a minimum package of HIV/AIDS services for them. "We never consult sex workers because we assume we know what they need, but we never ask them," he said.

A study by the Kenya AIDS Project revealed that only 30 percent of male sex workers and 31 percent of female sex workers knew how to use a condom correctly, while 33.5 percent of female sex workers and 49.2 percent of male sex workers were infected with HIV.

The Kenya AIDS Project has set up voluntary HIV counselling and testing sites in Nairobi solely for commercial sex workers and their clients. So far, 65 clients and over 5,000 female sex workers have made use of the services.

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