Non-adherence to antiretroviral treatment among migrating fishermen in western Kenya's islands: a rapid qualitative study.

Fishing communities in many Sub-Saharan African countries are a high-risk population group disproportionately affected by the HIV epidemic. The association of migration with HIV and AIDS in sub-Saharan Africa is well documented. Frequent mobility, high consumption of alcohol, multiple sexual partners, transactional and commercial sex, poor health infrastructure and limited access to health services are reported among the main factors shaping the HIV epidemic in fishing communities. Moreover, studies have been conducted in sub-Saharan Africa on adherence to antiretroviral treatment (ART) among fishers; however, non-adherence to ART remains poorly understood among migrating fishermen in the western Kenya islands. This qualitative study investigated factors contributing to non-adherence among fishermen in the western Kenya islands. This study utilised 51 in-depth interviews and six focus group discussions to highlight factors contributing to non-adherence to ART by mobile fishermen. Data were analysed using a contextualised thematic analysis. Results show that migration, alcohol consumption and ART sharing contributed to non-adherence. Adherence to ART is a powerful predictor of survival for individuals living with HIV and AIDS. The Kenyan government can use lessons from this study to target fishermen to achieve the UNAIDS 2025 recommendations on people-centred and context-specific service responses to AIDS as this would move Kenya closer to the 90% reduction in annual infections by 2030. This article contributes to a deeper understanding of how and why fishermen from the islands in western Kenya struggle to adhere to treatment even though they can access ARTs through the public health care system. Longitudinal studies should be conducted to explore how the factors associated with non-adherence correlate with other key health outcomes such as drug resistance.

Wimbo: implications for risk of HIV infection among circumcised fishermen in Western Kenya.

Medical male circumcision has been shown to reduce the risk of heterosexual transmission of HIV infection in men by up to 60% in three randomised controlled trials. However, not much anthropological literature exists to provide a holistic understanding of sexual behaviour among migrating fishermen who have been circumcised. This qualitative study used cultural ecology theory and anthropological methods to develop a more holistic understanding of Luo fishermen's sexual behaviour after circumcision when they migrate (wimbo) to islands in western Kenya. Results from focus-group discussions show that during wimbo there is a deviation from community norms governing sexual expression, influenced by the belief that circumcision provides protection against HIV infection. Through the exchange of sex for fish, circumcised men access new sexual partners in the destination beaches and engage in risky sexual behaviours without any HIV prevention measures. The processes and practices associated with wimbo may therefore help explain why rates of HIV infection are increasing among fisherfolk despite new interventions to combat HIV. These results have relevant implications for HIV-related intervention and policy in sub-Saharan Africa.

Can "the expanded free maternity services" enable Kenya to achieve universal health coverage by 2030: qualitative study on experiences of mothers and healthcare providers.

Introduction: Universal health coverage is a global agenda within the sustainable development goals. While nations are attempting to pursue this agenda, the pathways to its realization vary across countries in relation to service, quality, financial accessibility, and equity. Kenya is no exception and has embarked on an initiative, including universal coverage of maternal health services to mitigate maternal morbidity and mortality rates. The implementation of expanded free maternity services, known as the Linda Mama (Taking Care of the Mother) targets pregnant women, newborns, and infants by providing cost-free maternal healthcare services. However, the efficacy of the Linda Mama (LM) initiative remains uncertain. This article therefore explores whether LM could enable Kenya to achieve UHC. Methods: This descriptive qualitative study employs in-depth interviews, focus group discussions, informal conversations, and participant observation conducted in Kilifi County, Kenya, with mothers and healthcare providers. Results and discussion: The findings suggest that Linda Mama has resulted in increased rates of skilled care births, improved maternal healthcare outcomes, and the introduction of comprehensive maternal and child health training for healthcare professionals, thereby enhancing quality of care. Nonetheless, challenges persist, including discrepancies and shortages in human resources, supplies, and infrastructure and the politicization of healthcare both locally and globally. Despite these challenges, the expanding reach of Linda Mama offers promise for better maternal health. Finally, continuous sensitization efforts are essential to foster trust in Linda Mama and facilitate progress toward universal health coverage in Kenya.

Access to Maternal Health Services During the COVID-19 Pandemic: Experiences of Indigent Mothers and Health Care Providers in Kilifi County, Kenya.

COVID-19 has spread rapidly in Kenya and has not spared pregnant women. Evidence from Kenya shows that during the COVID-19 pandemic, health systems have been either stressed to their maximum capacity or are becoming overwhelmed. However, the population is advised not to attend hospital unless strictly necessary, and this advice seems to apply to all, including expectant mothers. There is a dearth of information on how poor expectant mothers with low bargaining power cope during COVID-19 in Kenya, which this study addresses for those in Kilifi County. This rapid qualitative study draws data from an extensive literature review and from interviews with 12 purposively selected mothers who were either expectant or had newborn babies during the pandemic in Kilifi County. Five matrons-in-charge of maternal health services and four traditional birth attendants were also interviewed via mobile phone. Data were analyzed thematically and are presented in a textual description. It emerged that expectant mothers feared attending hospitals for perinatal care due to the possibility of contracting COVID-19. Therefore, there was an increase in home deliveries with the assistance of traditional birth attendants (TBAs)/traditional midwives, who were also overwhelmed with women who sought their services. Since most causes of maternal morbidity and mortality can be prevented by prompt, suitable treatment by qualified health practitioners, the health officials interviewed recommended training and integration of TBAs in emergency healthcare responses to help during crises in MHS because they are trusted by their local communities. Notably, such integration of traditional midwives should be supported and should also include additional training and monetary incentives.