Organizations involved
University of Toronto; Moi University; AMPATH
Summary
The overall objective of this project was to adapt and pilot a combined gender, livelihoods, and HIV prevention with street children and youth (SCY) in Eldoret, Kenya using a multi-stage, mixed methods study design (May 2017 to January 2018). In the first stage, the Stepping Stones and Creating Futures interventions and a matched-savings programme were adapted using a modified ADAPT-ITT model. During adaptation, community-based research methods, informed by a rights-based approach, were used with four Peer Facilitators and 24 street children and youth aged 16 to 24 years. Numerous adaptations were made to the programme content and delivery. This adaptation process resulted in a comprehensive intervention entitled ‘Stepping Stones ya Mshefa na Kujijenga Kimaisha’.
In the second stage, the adapted intervention was piloted with 80 street children and youth using a pre- and post-intervention convergent mixed methods design. The primary outcomes of interest were HIV knowledge and gender equitable attitudes. Secondary outcomes included condom-use self-efficacy, sexual practices, economic resources, and livelihoods. Participants had significant increases in HIV knowledge and gender equitable attitudes from pre- to post-intervention. Attendance level at the intervention was significantly associated with HIV knowledge and gender equitable attitudes change scores. Intervention participants reported encouraging changes in condom use knowledge, condom use self-efficacy, health-seeking practices, daily earnings, housing, livelihood activities, and street-involvement.
Social norms of interest
Gender equity; contraceptive use
Behaviors of interest
Sexual risk taking; economic and livelihood practices; gender equitable behaviours
Project components
The adapted Stepping Stones ya Mshefa na Kujijenga Kimaisha intervention included 24 sessions that occurred over 14 weeks and included a matched-savings component.
Social norms measurement
The primary outcome of interest was gender equitable attitudes. Gender equitable attitudes were assessed using the 24-item Gender Equitable Men (GEM) scale, a validated instrument used in Kenya. Additionally, focus group discussions followed an interview guide that asked participants what they learned about how men and women live and relate to each other, and how the programme changed or did not change their gender equitable attitudes.
Key findings to date
Participants showed a significant change in gender equitable attitudes from pre- to post-intervention from 43 (IQR 38–48) to 47 (IQR 42–51) (p < .001). Quantitatively and qualitatively, participants reported increases in daily earnings, changes in street involvement, housing and livelihood activities. Participants also experienced changes in HIV knowledge, and encouraged changes in condom use knowledge, condom use self-efficacy, and health-seeking practices.
Attribution statement
Embleton, L., Di Ruggiero, E., Logie, C.H., Ayuku, D., and Braitstein, P. (2020) Improving livelihoods and gender equitable attitudes of street-connected young people in Eldoret, Kenya: Results from a pilot evidence-based intervention. Health Society Care Community.
Embleton, L., Di Ruggiero, E., Logie, C.H., Ayuku, D., and Braitstein, P. (2020) Piloting an evidence-based intervention for HIV prevention among street youth in Eldoret, Kenya. International Journal of Public Health.
Embleton, L., Di Ruggiero, E., Odep Okal, E., Chan, A., Logie, C., Ayuku, D., and Braitstein, P. (2019) Adapting an evidence-based gender, livelihoods, and HIV prevention intervention with street-connected young people in Eldoret, Kenya. Global Public Health.
For additional information, including the Stepping Stones ya Mshefa na Kujijenga Kimaisha manuals, please contact Dr. Lonnie Embleton.
For further information on the Stepping Stones curriculum, see:
Jewkes, R., Nduna, M., Jama, N. (2010) Stepping Stones 3rd Edition South Africa: A Training Manual for Sexual and Reproductive Health Communication and Relationship Skills. Third Edit. South Africa: Medical Research Council.
For further information on the Creating Futures curriculum, see:
Misselhorn, A., Jama Shai, N., Mushinga, M., Washington, L., Mbathe, M. (2013) Creating Futures: Supporting Young People in Building Their Livelihoods. South Africa: Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Project Empower and South African Medical Research Council.
