The goal of the nocturnal clinics is to reach two groups of people particularly vulnerable to infection -- truck drivers and commercial sex workers -- at a place where both live and work.
The trucks arrive nightly, massive and wheezing, their cargo bays loaded down with food, clothes, electronics and petrol, collected from the port of Mombasa and bound for the continent’s landlocked interior.
Each evening, hundreds of them pull off the road at Maai Mahiu, a trading post 53km northwest of Nairobi in the Great Rift Valley, their drivers lured by a growing collection of hotels, bars and restaurants splayed out along the busy highway.
And by something else too.
“I make my living from these truck drivers,” says Esther Gacheru*, a sex worker who, like many in the town’s hospitality industry, moved here with the promise of growing business opportunities in the transit boom town. And she hasn’t been disappointed.
But now another group has recognised the strategic value of this location as well — a health organisation called North Star Alliance, which, since 2010, has operated a nocturnal HIV “wellness centre” in a repurposed blue shipping container in the truck parking lot.
A health charity called North Star Alliance has operated a nocturnal HIV “wellness centre” in a repurposed blue shipping container in the truck parking lot since 2010. (Benard Kimani)
The clinic is one of eight established since 2009 along the spine of Kenya’s northern corridor, the main trade route between the country and its neighbours and a major source of HIV transmission in the region.
The goal of the mobile clinics is simple, says Snowrinna Ndida, an outreach co-ordinator of the North Star Alliance Wellness Centre in Maai Mahiu. It is to reach two groups of people particularly vulnerable to infection — truck drivers and sex workers — at a place where both live and work.
To do that, the clinics also try to keep the same hours as their clients, which has another benefit too. They can come for free HIV counselling, testing and treatment under the cover of darkness.
“We prefer visiting these clinics at night so that we minimise chances of being seen by people who are well-known to us,” says Adam Kiplagat*, 35, a long-distance truck driver. He believes he contracted HIV in 2009 while on the road in Uganda. Kiplagat says trucking keeps men away from home for long stretches of time — in his case a month or more at a go — and having partners besides their spouses are common.
For decades, sex workers and long-haul truck drivers have been cast by many as villains of the HIV epidemic, maligned for their role in rapidly spreading the virus through their many partners and across widespread areas. But now organisations such as North Star are flipping that script.
If these groups — often referred to in public health speak as “key populations” — are at high risk for contracting and spreading HIV, they reason, that also means they are likely to be at the core of any successful effort to keep it contained.
Sex workers and long-haul truck drivers have, for decades, been cast as villains of the HIV epidemic. (Benard, Kimani)
That’s why, although North Star offers HIV treatment, it focuses most of its efforts on prevention, says Stephen Gichina, a clinician and site co-ordinator at the North Star clinic in Maai Mahiu.
“We normally have a large batch of condoms at our disposal,” he says. “At the moment we have in our stores over 250 000 condoms, which we expect to be out of stock in less than two months’ time.”
The clinic has a roving band of eight peer educators recruited from the local sex worker community. Among them is Gacheru, who is also HIV-positive.
“When I realised [10 years ago], I thought it was the end of me but after undergoing several counselling sessions I realised I can live longer,” she says, holding a packet of condoms.
Now she tries to offer the same assurances to her colleagues, making nightly visits to 63 sex workers scattered around 24 cruising spots, where she distributes free condoms and lubricant, counsels people and answers questions about safer sex, and refers new sex workers to the clinic for check-ups.
To date, North Star says it has been able to reach 524 sex workers in Maai Mahiu with the help of these peer educators. Their efforts appear to be paying off.
According to the 2016 Kenya Aids Progress Report, Nakuru County — where Maai Mahiu is located — saw its rate of new HIV infections plunge from 4 127 in 2013 to 801 in 2015, one of the largest percentage drops in the country during that period.
“Sex workers are now more aware of how HIV is transmitted and are even quick to report cases of condoms bursting,” says Ndida.
Still, the county continues to rank in the top third for HIV prevalence nationwide, and the stigma surrounding HIV infection remains high, according to the “stigma index” of the progress report.
Although the North Star clinics have been particularly successful in reaching out to sex workers, they still need to make more significant efforts to include truck drivers in their outreach, says Nicholas Mbugua, the secretary general for the Kenya Long-distance Truck Drivers’ and Allied Workers’ Union. After all, more than half the people who visit the clinic for testing and treatment don’t live in Nakuru county, according to North Star. And most of those just passing through are likely to be drivers.
“The clinic’s closing time is unpredictable — you will [sometimes] find them closing around 8pm while most of our drivers [arrive] past that time,” says Mbugua.
North Star has recently begun to target drivers through a programme it dubs Star Driver. It provides free medical checkups, defensive driving lessons, the renewal of driver’s licences, reflector jackets and monetary rewards to drivers who make regular visits to its clinics.
“We have seen a significant number of drivers visit our centre since the programme was initiated two years ago,” says Gichina.
The clinic as a whole continues to do a brisk business — it is nearly as busy most nights as the clogged Nairobi-Naivasha highway that runs past it.
A truck driver on his way to Uganda says he has come to collect condoms from the clinic. “You know, we’re only human. It’s easy to fall into temptations if you’re away from home for so long.”
Early the next morning, when the suns starts to rise over the Great Rift Valley, the 35-year-old driver gets ready for the next part of his long-distance journey. He gets into his truck and says: “These condoms will help me to protect myself against HIV.”
* Not their real names