Imagine you’re a young person who left or was forced out of your family home due to factors such as abject poverty, violence and abuse, or family conflict. With limited education, a lack of an extended family to turn to, and minimal resources, you find yourself turning to the streets for survival.
This is often the case of young people who find themselves in street situations in Kenya. Once on the streets, young people’s vulnerability to acquiring HIV is elevated due to a lack of safe and adequate housing, violence, and limited opportunities for employment and income generation resulting in many young people, particularly adolescent girls and young women, relying on selling or exchanging sex for money, food, shelter, or other material resources. At the same time, street-connected young people’s ability to access and use health services is extremely restricted owing to their stigmatized identity, lack of health insurance, and other barriers to accessing care.
Evidence demonstrates that the burden of HIV among street-connected young people in Kenya is high. At the same time, these young people face several hurdles to accessing HIV testing and knowing their HIV status and being connected to and remaining engaged in HIV care.
Peer navigators are young people with lived experience on the streets, who are well known by the street community. Peer navigators, as the name suggests, help young people in street situations navigate and gain entry to the health system, by removing many of the barriers that prevent this stigmatized group from accessing care. The peer navigators work to engage street-connected young people in HIV testing and counseling, while providing HIV prevention information and other HIV-related support.
Evans is one of the founders of the adolescent peer mentor program at the MTRH-Rafiki Centre for Excellence in Adolescent Health at AMPATH.
Evans, a young man with experience living and working on the streets, is one of the founders of the adolescent peer mentor program at the MTRH-Rafiki Centre for Excellence in Adolescent Health at AMPATH. He did a three-year term as one of the first peer mentors (peer mentors are based at the clinic versus peer navigators who tend to work out in the community).
Now he is a staunch advocate for children, youth, and families in street situations in Eldoret. He is also an aspiring politician and a volunteer program manager at Inuka Pamoja, which is a community-based organization that provides financial and other support to children and adolescents to help them remain in school. He sat down with Lonnie Embleton PhD, MPH, an Adolescent Health Advisor and Assistant Professor, Department of Global Health and Health Systems Design, to discuss his passion for getting street-connected young people into care, the psychological hardship and support needed for peers who deal with difficult circumstances, and his hopes for adolescents and young people in Kenya.
What does the day in the life of a peer mentor or navigator look like?
Peer mentors act as a bridge between the clients who are coming to MTRH or AMPATH and their clinicians, and give them a voice; they act as a support system for young people with whom they have shared experiences.
There was once a young man who had a problem with taking medication; this had created viral resistance and he was on third-line antiretroviral therapy. He was chased away by family due to stigma, so I came in to help. I discussed his situation with stakeholders, a counseling team, and went to visit the home. The family members didn’t want to be with him, but the boy is now healthy, well, and in school. As a peer mentor, I was able to help link him to the right people; because I had a good rapport with him, I was able to create a trusted environment, and link him to the best professionals who can help him.
How has being a peer mentor changed your life?
Being a peer mentor impacted my life in a very big way. It was my first job, and with the salary I was given I could pay my bills. I gained a lot of experience in how to handle youth and received AMPATH training. The peer mentorship program helped me a lot, and I’m still using the lessons I learned now in life.
Can you tell us more about what you do now?
Currently, I am a volunteer program manager at Inuka Pamoja, and an active aspiring politician. I’m trying to get a breakthrough in life. I joined politics because for people to listen to you in Kenya, you have to be in politics. Then, you meet a lot of people who are connected, and have a bigger voice on how better to help young people in street situations. I wanted to introduce a bill to parliament to help children and youth in the slums and on the streets in Eldoret. I ask myself, how can we help the less fortunate people in the community? Most are coming from Eldoret informal settlements—Langas, Kamukunji, Mali Nne, and Huruma.
What is one thing that you wish people knew about the role of youth peer mentors?
I really need people to understand that peer mentors are doing very tough work, and people should know that they go through psychological problems, dealing with clients with serious issues. They need and must be offered psychological support. Dealing with street children every day, I don’t go home okay. It can drain you—peer mentors need support and care to deal with what they see. Peer mentors are not paid enough, and are doing very important work.
What are some of the challenges young people face you work with?
Children, youth, and street families need care. For example, the two peer navigators that work at the Rafiki clinic and in the community hold medications for adolescents that live on the street to come and take every day. But often adolescents do not want to be seen at the Rafiki clinic because of stigma, so they do not take their meds. Many of the children and youth in street situations who are on medications have changed their drug regimen, often because of poor adherence and viral resistance. This is a huge issue in these communities. The location they go to take their HIV medicine is an issue because of stigma, and most of the street-connected young people on medication lack access to basic needs, which affects treatment adherence as well. For me, I didn’t take my drugs because I didn’t have food or somewhere to stay when I lived on the street. Then, the drugs interfered with my body. Something that is really important is mass testing in the streets–many people are still infecting others because they don’t know their status.
What motivated you as a peer mentor? What was your favorite thing about working as a peer mentor?
My initial motivation was poverty. I went to the Rafiki clinic to look for a job and earn a living. Looking back to the life I had when I was taking medication and living on the street, I had a very hard time with it. I got a lot of support, and I wanted to pass that support onto someone else. People with HIV can live when they take their medications. My life and experiences encouraged me and inspired me. My favorite part about working as a peer mentor was that I could learn something new every day! I was always learning new things, I got to interact with so many different people.
How would you describe yourself?
I’m a go-getter, and I love pushing things to move. I’m an honest and straightforward guy, and sometimes I get angry when things are not right.
What do you want the world to know about young people and young people in Kenya?
I want the world to know that adolescents are a part of the population that people forget about, a lot. Something more needs to be done about adolescent care in Kenya, because we are not doing much for them, and it’s a critical age.
If you had three wishes, what would they be?
My current wish is about children, youth, and families in street situations who are on medication: I hope the HIV prevalence among them can reduce. I wish that people in street situations who are on HIV medication and who cannot afford a meal, can be given a meal a day and given their medication. I wish for them to have the opportunity to enroll in training and financial literacy classes.
Lonnie Embleton, PhD, MPH, is an Adolescent Health Advisor and Assistant Professor, Department of Global Health and Health System Design.
Ava Boal is an Associate Researcher.