When violence broke out following the announcement of Kenya’s poll results in 2007, Henry Mwiterere and his family fled to safety shortly before their house, in the Rift Valley town of Burnt Forest, was burned to the ground.
Mwiterere, who has lived with HIV for over a decade, escaped with his life-prolonging antiretroviral drugs (ARVs), but many people were not so lucky. They were forced to abandon their ARVs in the frenzy, missing several days' doses and risking drug-resistance in the process.
This time around, Mwiterere - who is a support worker with the Academic Model Providing Access to Healthcare (AMPATH), an organization that treats more than 140,000 HIV-positive people in western Kenya - says patients are much more aware. With the 2013 general election just around the corner, many are coming to collect their drugs early to ensure that, should the worst happen, they will be prepared.
"We now give patients drugs every three months, and we've seen patients coming early to collect them. Although we've seen movement - people from Kisumu, for instance, are leaving Nakuru to go home where they feel safer - people are getting their drugs and taking them with them."
Health service providers are doing their best to make sure their patients are not left stranded. Médecins Sans Frontières (MSF), which is caring for 10,500 HIV-positive people in Nyanza Province's Homa Bay and 2,400 in the Nairobi slum of Mathare, as well as hundreds of tuberculosis (TB) patients at both sites, will be operating with a full staff and with extra staff on stand-by throughout the election period. The organization has also made preparations to provide additional first aid and trauma care should it be required.
"In anticipation of possible election-related violence, we started to modify our patient appointments. Since September 2012, we've been adjusting their schedules to ensure that we have minimum consultations in the two weeks around the election and patients have the required medications during this period," Hajir Elyas, deputy medical coordinator for MSF, told IRIN.
"We have ordered extra supplies and medications that are provided by MSF to cover for a couple of months, but we have also liaised with the Ministry of Health, which supplies our ARVs, to create a buffer stock of medication during this period," she added.
In early 2008, MSF was able to organize mobile teams to supply health centres with additional medication; these will also be available this year, as will a 24-hour hotline for patients who find themselves without medication or the means to reach a health centre.
Joseph Sitienei, from the National AIDS and Sexually Transmitted Infections Control Programme (NASCOP), told IRIN that the government had provided additional stocks of HIV and TB medication to its health facilities ahead of the polls.
"Emergencies seriously disrupt people's treatment process, and with diseases like TB or HIV, where adherence is critical, the consequences of such disruptions are even more severe. We realize that," he told IRIN. "We have greatly decentralized [stocks of] both TB and HIV medicine so that they can be easily accessible during this period. The government has issued a circular to all health facilities to ensure that they all have medicines that can last for one more month over the three months of stocks they normally receive."
He said health centres had also advised patients to carry their patient cards - issued by their primary health facility and containing their history and treatment regimens - at all times so that they would be able to access their medication from the closest government-run health facility in the event of an emergency.
Another major problem following the last election was the high level of sexual violence. Women, men and children experienced rape and sexual assault, with many contracting sexually transmitted infections and suffering post-traumatic stress. Few of these cases were prosecuted; on 21 February, eight survivors of sexual violence committed during that period took the government to court over its failure to protect them or investigate the crimes committed against them.
"Political violence highly increases women and even men's... risk of sexual violence and of sexual transmitted infections such as HIV," said Saida Ali, the executive director of the Coalition on Violence Against Women (COVAW).
She said the Peace Initiative Kenya, a coalition of civil society groups, were distributing dignity kits - containing reusable sanitary towels, cotton wool, a kanga (sarong), reusable baby nappies, underwear, petroleum jelly and soap - to hospitals in Nairobi to support women who may suffer sexual violence. They have also donated post-exposure prophylaxis (PEP) - a course of ARVs given to people recently exposed to HIV to reduce their likelihood of contracting the virus - to a hospital in the capital and to one in the Rift Valley.
She stressed, however, that the onus was on the government to ensure that survivors of sexual violence were able to access emergency medical treatment.
"Things that women need in an event that they report rape, like PEP, must be available at facilities," she said. "For marginalized areas like North Eastern [Province], the government should ensure that emergency centres exist, because in such places available health facilities are far apart and not easily accessible to many and particularly in emergencies."