Standardized mortality ratios between street-connected young people and the general age-equivalent population in an urban setting in Kenya from 2010 to 2015

Kibel, Mia; Pierzchalski, James; Gorfinkel, Lauren; Embleton, Lonnie; Ayuku, David; Hogg, Robert S.; Braitstein, Paula

doi:10.1080/16549716.2020.1802097

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…A body of evidence supports that SCY face multiple and intersecting vulnerabilities and inequities that elevate their risk of acquiring HIV, and that in the context of Kenya, SCY and particularly AGYW connected to the street, have a higher prevalence and incidence of HIV than non-street connected young people [20,22,24,38,39,[56][57][58]. Moreover, a large proportion of SCY's deaths in this context have been attributed to HIV [45,59]. Yet, SCY in SSA are generally overlooked as a separate category of individuals considered a YKP highly vulnerable to acquiring HIV.…”

Section: Discussionmentioning

confidence: 99%

“If they had a place to live, they would be taking medication”: a qualitative study identifying strategies for engaging street‐connected young people in the HIV prevention‐care continuum in Kenya

et al. 2023

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Introduction Street‐connected young people (SCY) experience structural and social barriers to engaging in the HIV prevention‐care continuum. We sought to elicit recommendations for interventions that may improve SCY's engagement along the HIV prevention‐care continuum from healthcare providers, policymakers, community members and SCY in Kenya. Methods This qualitative study was conducted in Uasin Gishu, Trans Nzoia, Bungoma, Nakuru and Kitale counties in Kenya between May 2017 and September 2018 to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY. This secondary analysis focuses on a subset of data interviews that investigated SCY's healthcare needs in relation to HIV prevention and care. We conducted 41 in‐depth interviews and seven focus group discussions with 100 participants, of which 43 were SCY. In total, 48 participants were women and 52 men. Results Our analysis resulted in four major themes corresponding to stages in the HIV prevention‐care continuum for key populations. We identified the need for an array of strategies to engage SCY in HIV prevention and testing services that are patient‐centred and responsive to the diversity of their circumstances. The use of pre‐exposure prophylaxis was a biomedical prevention strategy that SCY and healthcare providers alike stressed the need to raise awareness around and access to for SCY. Several healthcare providers suggested peer‐based approaches for engaging SCY throughout the continuum. However, SCY heavily debated the appropriateness of using peer‐based methods. Structural interventions, such as the provision of food and housing, were suggested as strategies to improve antiretroviral therapy adherence. Conclusions This study identified contextually relevant interventions that should be adapted and piloted for use with SCY. Education and sensitization of SCY and healthcare providers alike were identified as possible strategies, along with affordable housing and anti‐poverty strategies as cash transfers and provision of food. Peer‐based interventions are a clear option but require SCY‐specific adaptation to be implemented effectively.

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Section: Discussionmentioning

confidence: 99%

“If they had a place to live, they would be taking medication”: a qualitative study identifying strategies for engaging street‐connected young people in the HIV prevention‐care continuum in Kenya

et al. 2023

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“…25 Our finding that living in a street setting vs a family-based setting was associated with HIV incidence and death was consistent with other, albeit limited, data from studies conducted in sub-Saharan Africa. [43][44][45] These results highlight the substantial inadequacies of family-based care for many vulnerable young people, given that extreme poverty, family conflict, and child abuse and neglect are the primary reasons children migrate to the street. 28 Although cash transfer programs for households caring for orphaned children have been implemented in Kenya and elsewhere, with generally positive impacts, these programs remain insufficient given the substantial need.…”

Section: Jama Network Open | Global Healthmentioning

confidence: 97%

Association of Care Environment With HIV Incidence and Death Among Orphaned, Separated, and Street-Connected Children and Adolescents in Western Kenya

et al. 2021

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Key Points Question What is the association of care environment with incident HIV and death among orphaned, separated, and street-connected children and adolescents in western Kenya? Findings In this cohort study of 2551 orphaned, separated, and street-connected youths in western Kenya, living in an institutional environment was not associated with either death or incident HIV compared with living in a family-based setting. However, living in a street setting was associated with a higher rate of incident HIV and death compared with living in a family-based setting. Meaning This study’s findings suggest that alternatives for orphaned, separated, and street-connected youths in low-income regions are needed when designing public policies for the care of vulnerable children, including deinstitutionalization, to ensure that the rights and well-being of children and adolescents are upheld.

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“…In Kenya, SCY have poor health outcomes including a high prevalence of HIV and sexually transmitted infections [ 5 – 8 ], unfavourable reproductive health outcomes [ 9 ], growth and development disparities [ 10 , 11 ], respiratory problems [ 12 ], and mental health and substance use issues [ 13 – 16 ]. SCY die prematurely of preventable causes [ 17 , 18 ], suggesting that they are not accessing or receiving adequately responsive healthcare. It is likely that SCY in Kenya endure multiple barriers to care due to their social and economic marginalization and stigmatization [ 8 , 19 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring patient-provider interactions and the health system’s responsiveness to street-connected children and youth in Kenya: a qualitative study

Embleton

Shah

Gayapersad

et al. 2021

BMC Health Serv Res

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Background In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other. Methods This qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness. Results Through three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness. Conclusions This study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY’s experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions.

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Standardized mortality ratios between street-connected young people and the general age-equivalent population in an urban setting in Kenya from 2010 to 2015

Abstract: Braitstein (2020) Standardized mortality ratios between streetconnected young people and the general age-equivalent population in an urban setting in Kenya

Cited by 9 publications

References 8 publications

“If they had a place to live, they would be taking medication”: a qualitative study identifying strategies for engaging street‐connected young people in the HIV prevention‐care continuum in Kenya

“If they had a place to live, they would be taking medication”: a qualitative study identifying strategies for engaging street‐connected young people in the HIV prevention‐care continuum in Kenya

Association of Care Environment With HIV Incidence and Death Among Orphaned, Separated, and Street-Connected Children and Adolescents in Western Kenya

Exploring patient-provider interactions and the health system’s responsiveness to street-connected children and youth in Kenya: a qualitative study

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