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Opening the door to young "key populations"

By MSF

April 29^th, 2024

In November 2023, the photographer Nora Nussbaumer spent a week embedded in MSF's project providing medical assistance to adolescents and youth, including key and vulnerable populations in and around the city of Mombasa, in Kenya’s coast.

Here is the story of this project through the images she collected.

Opening the door to young "key populations"

When a team from Médecins Sans Frontières (MSF) working in the Kenyan city of Mombasa discovered that there were significant gaps in healthcare for adolescents and young people, they decided to do something about it.

The assessment they conducted in May 2021 revealed that many of the adolescents and youth, aged 10 to 24 years old, had specific medical needs and were struggling to get basic healthcare.

Several young people MSF teams met had experienced teenage pregnancies, unsafe abortions and sexual and gender-based violence, yet they had not received appropriate counseling or treatment.

“People with unique health needs often face challenges accessing appropriate health services.”

Inner courtyard of the "Wana wa mola" children's home. A home for street-dwelling male children and adolescents. ©Nora Nussbaumer/MSF

Providing health care services and counselling to “Key populations”

UNAIDS first defined key populations as groups of people at increased risk of HIV irrespective of the local context; however, in Kenya, other factors do play a role, including socioeconomic factors.

“Key pops”, as they are usually called, include sex workers, people who use drugs, transgender and gender non-binary people, men who have sex with men.

In this context, they are not only at increased risk of HIV, but also violence. The Mombasa project therefore reaches other special vulnerable groups such as children living in the street and persons with disabilities.

These groups often experience a greater prevalence of health risks and mental health issues, while often enduring marginalization and systemic discrimination from their own community.

Together with the Mombasa County Department of Health and several community-based organizations, MSF launched its project in 2021. It included the opening of Adolescent and Youth (AYP) Friendly Services and regular outreach activities to breach the barriers to health.

The aim was to launch a peer-led project that would make it easier for young people, including young key populations, who found themselves marginalized or excluded from healthcare, to get the advice and healthcare they need.

Barnabas, peer educator

“They are just humans. When you show them that you care, show respect, and are interested in speaking to them, they open up.”

Barnabas Mwaivu is one of the MSF supported peer educators who welcome and engage patients at the Ganjoni Youth Friendly ©Nora Nussbaumer/MSF

Khadija, peer educator

“I mostly interact with young mothers who live on the streets. The youth-friendly centre makes them feel comfortable, especially because the services are confidential.”

Khadija Khamisi, a peer educator at Ganjoni Youth Friendly Centre, checks a flipchart used in her peer education sessions at the centre and outreach activities ©MSF/Lucy Makori

Peers and young populations as partners

“It is one thing to offer specific healthcare services, but quite another to convince people living in fear of being stigmatized to go there.” Agripina Toni, MSF Health Promotion Manager in Mombasa.

This is why, in partnership with local associations, MSF has set up community "safe spaces", where community peers lead the health promotion activities and link the patients from the community to the public health services.

Safe Spaces for care and exchanges without bias or judgement

Temporary and permanent safe spaces, such as a local church, a football club, a theater hall, a hotel backyard, the inner courtyard of a children’s home or the backroom of a bar are places identified by the peers to meet the target groups. These are considered to be safe places. Adolescent and youth populations are not worried to come and benefit from specific and confidential sessions and follow-up.

Understanding the population to improve healthcare programming

In June 2023, MSF and the Mombasa Department of Health launched a study aimed at better understanding the health and well being of young people aged 10 to 24. The collected information aims at improving available services and designing better and more adapted health programs to their needs.

Mombasa County Gender Based Violence and Adolescents Health Program Coordinator, Celina Kithinji, offering her comments at the study launch ©MSF/Lucy Makori

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