EFFECTIVENESS OF HIV/AIDS PREVENTIONMEASURES TARGETING STREET YOUTH INNAIKUHl, KENYA

A RESEARCH PROPOSAL SUBMITTED IN PARTFULFILLMENT OF THE REQUIREMENTS FORTHE AWARD OF THE DEGREE OF BACHELOR OFSCIENCE IN NURSING, OF THE UNIVERSITY OFNAIROBI

BY

NANCY NYAMBURA KAGWANJAH32/7586/04

JULY 2008

Declaration

I, Nancy Nyambura Kagwanja declare that this is my own original work and further, that

it has not been presented for the award of degree or diploma in any other university

Signed ~-----

Date 9. \.1 O'llo~

11

Certificate of approval

This research proposal has been submitted for examination for the degree of Bachelor of

Science in nursing with my approval as university supervisor.

Date

Dr. James Mwaura, BSc, MSc, PhD

Lecturer and Clinical Psychologist

College of Health Sciences

University of Nairobi

111

Dedication

This research proposal is dedicated to my parents who have been very supportive and

provided the necessary resources for my education.

IV

Acknowledgement

My gratitude and deep appreciation is to all the people who in various ways have assisted

me in accomplishment of this work. In particular, I would like to thank the following

1. Dr. James Mwaura who helped in clarification of issues and painstakingly read all

the drafts of this research proposal.

2. Fellow classmates for their encouragement, support and criticism during the writing

process.

3. Beverly Mademba for her critique of the initial draft.

4. Tarns, Mukami and my parents for their support and encouragement.

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Table of contents

Declaration ii

Certificate of approval iii

Dedication .iv

Acknowledgement v

List offigures x

List of tables x

Acronyms and Abbreviations xi

EXECUTIVE SUMMARY xii

CHAPTER ONE 1

1.1 Introduction 1

1.2 Background 2

1.3 Problem Statement 3

1.4 Study Justification 3

1.5 Hypotheses 4

1.6 Objectives 4

1.6.1 Broad Objective 4

1.6.2 Specific objectives 5

1.7 Research Questions 5

1.8 Expected benefits of the study 5

CHAPTER 2: LITERATURE REVIEW 7

2.1 Introduction 7

2.2 Global HIV Situation 9

2.3 Kenyan HIV situation 10

2.4 Behavioral intervention ModeL 10

2.5 Programs targeting Street youth 12

CHAPTER 3: MATERlALS AND METHODS 18

3.1 Study Design 18

3.2 Study Area 18

3.3 Study Variables 18

3.4 Conceptual model 19

VI

3.5 Sampling method 19

3.6 Study Tools 20

1.7 Data Collection 21

3.8 Data Processing 21

3.9 Presentation of results 22

3.10 Control of biases and errors 22

3.11 Ethical considerations 22

3.12 Study limitations 22

Proposed budget 24

Schedule of Activities .............................•..........•••..•.....................•...••. 25

References 26

Appendices 29

Appendix 1: Questionnaire 29

Appendix 2: Infomed Consent Form 32

Appendix 3: Interview Consent Form .33

Appendix 4: Letter Requestin Authorization for Research 34

Appendix 5: Maps showing study area 35

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Definition of terms

Street youth- Young people livingon the street aged between 10-24 years. For the

purpose of this study it will include even those who have undergone

rehabilitation programs and are either back on the street or out of the

street

Vulnerability- refers to risk of infection with HIV

Risky behavior- Acts/ practices that increase the likelihood of an individual getting

infected. In the context of HIV, these include multiple sexual partners,

unprotected sex, violent sex and sex WIder the influence of drugs and/or

alcohol as well as injecting drug use

BIV prevention

measures- Interventions designed to lower the possibility of infection

with HIV. The ones considered in this study include increasing

awareness through Information, Education and

Communication, IEC, being faithful to one partner, voluntary

counseling and testing, reduction of risk behaviour such as

needle sharing, delivery of newborns in hospital.

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List of figures

Figure 1: Map of Kenya showing location of Nairobi 36Figure 2: Map of Nairobi Province 35Figure 3: Map of Nairobi Central Business District 36

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List of tablesTable 1: HIV prevalence by province 10

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Acronyms and AbbreviationsAIDS- Acquired Immune Deficiency Syndrome

CRTU- Contraceptive and Reproductive Health Technology Research and Utilization

DOW-USA- Doctors of the World, United States of America

FHI- Family Health International

mv-Human Immunodeficiency Virus

IEC- Information, Education and Communication

KEMRI - Kenya Medical Research Institute

KSHS- Kenya Shillings

MOH- Ministry of Health

NACC-National AIDS Control Council

NARC- National Alliance and Rainbow Coalition

NASCOP- National Aids and STD Control Program

NYS- National Youth Service

RH- Reproductive Health

SFRF- Street Families Rehabilitation Fund

SKI- Street Kids International

SPSS- Statistical Package for Social Sciences

STD- Sexually Transmitted Disease

STI- Sexually Transmitted Infection

UNAIDS- United Nations

UNICEF-United Nations Child Emergency Fund

USAID- United States Agency for International Development

VCT-Voluntary Counseling and Testing

. WHO- World Health Organization

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EXECUTIVE SUMMARY

This is a cross-sectional descriptive study that aims at establishing whether Human-

Immunodeficiency Virus (HIV) prevention measures directed at street youth have been

effective in achieving behavior change among the youth living on the streets. There are

many programs that have attempted to rehabilitate street youth and in the course of the

rehabilitation process many have included Information Education and Communication

(IEC) on HIV /AIDS. The information on whether there has been behavior change as a

result of these efforts is not readily available. This could be due to few studies being done

in the area.

Street youth are among the vulnerable groups at risk of HIV infection due to poor

socioeconomic status, violence and a higher predisposition than the general youth to

exploitation. Vulnerable and marginalized communities and groups are often pushed

aside by governments and health services, yet reaching and involving them is the key to a

successful HIV response. The problem of neglect has been very prominent among street

youth with few programs being directed at them, and the few that work with them often

using approaches that may not reach them adequately. The efforts at rehabilitation of

street youth as well as the successes and/or failures more so in relation to HIV /AIDS

have not been documented much. The aim of this study is to fill that gap.

The study area will be Nairobi city, one of the largest urban centers in East Africa chosen

because of its cosmopolitan characteristics which means that the study fmdings can be

generalized to other urban centers. The study will use available published information

and questionnaires to get information from the street youth who have been through some

form of rehabilitation program to fmd out their current perception of individual risk of

.contracting HIV as well as their knowledge, attitudes and practices in relation to HIV

prevention measures. Five BscN students will be used as research assistants to administer

the questionnaires. The study will also use the services of a certified Voluntary

Counseling and Testing (VCT) counselor to test and counsel the participants.

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A study sample of 385 study subjects will be used. The study subjects will be obtained

using snowballing sampling technique. The study tool will be pretested on 20 street

youths randomly selected in Nakuru town. Necessary revision of the study tool will then

be effected to ensure validity and reliability of the tool. The main themes in the tool are

perception of individual risk of HIV infection, HIVIAIDS related knowledge, attitudes

and practices and an evaluation of risky behavior following involvement in a

rehabilitation program. The participants will also undergo HIV testing and counseling.

The data will be entered using the Statistical Package for Social Sciences (SPSS) version

10 and analyzed using both descriptive and inferential statistics including mean standard

deviation and chi square. The results will be presented using bar graphs, frequency

distribution tables, pie charts and tables. The findings of the study will be used to offer

recommendations on how best to address the issue of HIV prevalence among street

youths. The study will be executed in eight months at a projected budget ofKshs 247,085

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