This 8-page paper, published by Pathfinder International, presents evidence supporting the theory that although the population of North Eastern province, who are mostly ethnic Somalis, has long been culturally and geographically isolated from the rest of Kenya, the sexual behaviours of key populations in Garissa are comparable to other areas of Kenya, putting them and their sexual partners at risk of contracting HIV. The assessment found that risky behaviours such as concurrent relationships, commercial sex, transactional sex, intergenerational sex, and drug and alcohol use were reportedly practiced.

According to the report, little information has existed specific to the North Eastern province (NEP) to inform HIV prevention activities. Although anecdotal evidence suggested that sexual behaviour in Garissa was similar to the rest of Kenya, little empirical evidence existed to that effect. Because of this gap, Pathfinder's AIDS, Population and Health Integrated Assistance programme for the North Eastern province (APHIA II NEP) conducted an assessment of sexual networks in the area with the objective of evaluating the level of risk behaviour among key groups and identifying gaps in HIV knowledge, behaviour and practices. The assessment is to be used to inform the programme's strategies and messages.

The research found that knowledge regarding transmission was mixed, with many people naming both correct and incorrect modes of transmission, including sharing utensils, kissing, mosquito bites, or punishment from God. There were also disparities between respondents' perceptions of their own risk versus others' risks, and between their knowledge of prevention methods and their use of them.

In Garissa, 56% of men and 42% of women reported abstinence as a prevention strategy. About a third of the men and a quarter of the women reported consistent use of condoms as a way to prevent HIV transmission. Eleven percent of women say requiring a partner to take a test is a strategy. Over 50% of women knew that having only one partner is effective but only 39% of men reported fidelity as a prevention strategy.

The study also looked at sources of information and communication preferences, and found that more respondents learned about HIV through religious leaders or family members, that their preferred source of information was radio or television, and that the preferred agents for delivering messages about HIV were nurses and religious or other leaders. However, authors say the lack of a clear pattern suggests that careful tailoring of different messages for different groups may be necessary.

According to the report, stigma is higher in Garissa than in Eastleigh, though it is still present in Eastleigh. For example, when asked if it is reasonable to refuse to buy goods from someone who may be HIV positive, about a third of respondents in both places thinks it is reasonable. Much of the stigma reflects a lack of knowledge and the continuing fear of infection through casual contact. These attitudes are relatively easy to change through education. But half the respondents in both Garissa and Eastleigh think that HIV-infected individuals should be ashamed of themselves, and almost 75% believe that AIDS is a punishment from God.

The report concludes that from these findings, APHIA II NEP can develop a carefully designed, evidence-based prevention strategy. This will include:

• designing a programme for key populations at higher risk, emphasising "risky behaviours" rather than "risky groups";
• leveraging the endorsement and influence of religious leaders, as they have potential to be strong allies;
• projecting familiar social settings and "our face" in all communication materials, as there is currently a lack of materials picturing Muslims; and
• intensifying school-based programmes, as many myths can be dispelled at that level.

Email from Mary Burket of Pathfinder International on March 25 2009.