Scattering the seeds: Kenyan advocates take knowledge of microbicides to their communities

By Pauline Irungu

When I first met her in August 2009 in a training session in Mombasa, Janet Musimbi struck me as very keen, focused person, eager to learn and inform others. She works for the International Centre for Reproductive Health - Kenya.

In June, Janer participated in GCM's prevention research literacy trainin gin Nairobi, which brought together 15 advocates and community liaison staff from local clinical trial sites, with the aim of equipping them with the knowledge to confidently discuss microbicides with their communities.

As a way of enabling participants to share their learning with others, GCM requested that each one of them develop a personal work plan, committing them to conduct activities with their communities after the workshop.

In June, Janet gave a presentation on microbicides to seven post-test clubs in Mombasa, reaching a total of 40 participants. On July 15, she gave a brief talk on microbicides to 30 peer educators. In her presentations, she described microbicides, the HIV lifecycle, the mechanisms of action of microbicides, and the current state of the field of microbicides research. She also talked about other methods of HIV prevention. GCM’s model of community capacity building is based on strengthening people’s skills and encouraging them to reach into communities and share HIV-prevention research knowledge.

Time has proven my first impression of Janet correct:  she is committed to informing her community and building awareness of new HIV-prevention options.

Ethical Review Studies Underway in Kenya and Zambia:  To clarify how decisions are made to approve HIV-prevention research, GCM is undertaking two studies to analyze the institutional processes and ethical standards for the review of clinical research protocols.  With projects under way in Kenya and Zambia, these studies are being conducted by Benjamin Mason Meier, assistant professor of Global Health Policy at the University of North Carolina at Chapel Hill.  Working closely with GCM Director Yasmin Halima and the Kenya Medical Research Institute, Professor Meier traveled to Nairobi, where he interviewed 16 governmental and nongovernmental officials to assess Kenyan research approval processes.

Given the relative lack of information about these processes in Zambia, Meier has now begun a desk review of the stakeholders there with documented authority over the ethical review of microbicide trials.  Out of these complementary studies, GCM seeks to develop detailed analyses of the landscape for clinical research review—outlining limitations in the laws, regulations, and stakeholders governing research-approval processes.

This information—to be compiled and disseminated in a series of project reports—will guide decisions about GCM commitments to research advocacy and lay a foundation by which policymakers can work with GCM to reform policies for reviewing and approving HIV-prevention research.

Improving Trial Communications and Media Coverage:  GCM’s Deborah Baron, who has been coordinating the MMCI and mentors the GCM fellows, worked with fellow Munyaradzi Chimwara to conduct a media and communications training with researchers and trial staff from the Microbicides Trial Network, International Programme for Microbicides, and other research networks on 28 June in Harare, Zimbabwe.

Aside from a few media savvy veterans, most of the participants had minimal or no experience nor training in working with the media. One medical officer noted, “I don’t like talking to media because they don’t include what I tell them about my study anyway.”

After spending a day learning tips and techniques on how to explain prevention research and his study more clearly, he realized that working with the media is a two-way street, and he now feels more equipped to meet them halfway.

The following day, the facilitators hosted a journalists’ training with local print, radio, and TV journalists.  Following sessions on the HIV life cycle and a talk on the ethics of research with a representative from the Medical Research Council, Baron and Chimwara led a discussion on the common challenges that journalists face. They offered creative ways to keep readers interested in HIV prevention, despite the infrequency of significant news to report.

“This will be the first training we’ve done since the launch of the Communications Handbook at Microbicides 2010. We’re really excited to incorporate the tools and lessons learned from this new resource into a hands-on training with those working on the front lines of HIV-prevention research,” said Baron, who has also served as Chimwara’s mentor in the fellowship program.

Chimwara’s fellowship project addresses how the media reports on and is engaged in HIV-prevention trials in Zimbabwe.  He is identifying needs and opportunities—such as conducting these trainings—to improve the media’s ongoing balanced, accurate, consistent and reliable reporting on HIV-prevention trials in Zimbabwe.

Are you interested in strengthening your skills at communicating about HIV-prevention research?   Visit our download center at www.global-campaign.org/download and email us info@global-campaign.org.

Fellows Update:  GCM fellow Munyaradzi Chimwara conducted workshops for researchers, community advisory board members (CAB), and journalists in Mutare, Zimbabwe, 14-17 June.  On 23 July, he helped lead a training course for the CAB members of the Harare and Chitungwiza VOICE study sites. The CAPRISA 004 study results were disseminated there, followed by a media briefing on the results. Attendees spoke to and were quoted by interested journalists.

Male involvement in HIV prevention trials that enrol women participants

By Patrick Mwai, GCM Fellow, Kenya

In Kenya, the main public transport industry, commonly known as the Matatu Industry, employs thousands of young men as touts, conductors, and drivers--typically called a Matatu crew. On average these young men make about KES 1000 (USD 12) daily wage. With this disposable income, they end up spending their money on illicit alcohol, illicit drugs, and commercial sex. This lifestyle puts them at high risk of HIV infection.

Working in a district where there are clinical trials targeting sex workers, I targeted the local Matatu crew who are clients of sex workers to understand their knowledge and attitudes towards HIV prevention and clinical trials.  I held four focus group discussions (FGDs) in four different locations namely: Changamwe, Likoni, Kisauni, and Mvita in Mombasa District.

From these discussions, I realised that there is still a lot of misinformation about HIV in this community. I recall one FGD session where a participant said that drinking the extract of boiled leaves of a local tree called mkilifi immediately after sex protects him from HIV infection. He repeats the ritual every time he has casual sex.

I also found that sexual violence is rife within some sections of the community. During the FGD session in Changamwe, as we discussed the potential benefit from microbicides, one participant remarked, “I can only hope that it  is found sooner rather than later....I think of the wellbeing of my mother and my sisters...it will help them especially in an area like ours [referring to Bangladesh slums] where a day can’t pass without hearing of a rape case.”

A rather disturbing experience was one narration by a conductor who stated that in his home area of Ganze, one of the poorest constituencies in Kenya, he was once forced to use the polythene paper in which bread is usually wrapped  and used it as a condom. There were no condoms in the local dispensary, and he could not afford to buy one at KES 10 (USD 0.13) at the local shop.

The four FGDs provided insight into sexual practices of men and their efforts to prevent themselves from being infected with HIV as well as their knowledge of clinical trials.The FGDs sought to find out how the Matatu crew  would react if their partners ( sex workers) told them that they were participating in for example a clinical  trial and they had to insert the gel or take a pill before intercourse. Would they encourage the women in their lives to enrol?  Do they have fears about such trials? The discussions documented some of the  knowledge, fears and myths they have heard about clinical trials.

I am working on developing a culturally appropriate and attitude-based training curriculum to educate the community advisory groups and community leaders, media, and organizations working with women, men who have sex with men, and female sex workers and their clients on the conduct of clinical trials in Kenya. In order for them to reach out to their peers with accurate information to correct the myths and misconceptions that have seen clinical trial sites receive little or no support from the community and the target risk population involved in the trial . 

Coming up…

GCM is planning for the upcoming Women’s HIV Prevention Symposium in Kenya slated for 31 August to 1 September in Nairobi. GCM is collaborating with Kenya AIDS NGOs Consortium (KANCO), Liverpool VCT, Action Aid Kenya, and UNAIDS, under the umbrella of the National AIDS Control Council to organize the Symposium.