Country records declined HIV infections in three regions, new survey shows

By GATONYE GATHURA

The number of people infected with HIV in the country has declined dramatically at the Coast, in Nairobi and parts of the Rift Valley but remained worryingly high in Nyanza, according to a national survey released by the government on Tuesday.

The Kenya Aids Indicator Survey (KAIS) 2012, released by Cabinet Secretary for Health James Macharia at the Laico Regency Hotel in Nairobi, shows that for the first time the number of people infected with HIV fell below six per cent of the adult population.

The survey shows that last year, about 1,192,000 adults were infected with HIV, which was 5.6 per cent of people aged 15 to 64 years, representing 200,000 fewer infected people than was the case five-years-ago when the first such study was carried out. Then the prevalence rate was 7.2 per cent.

While 200,000 less infections may not look like an enormous decline, the picture starts to unfold when one looks at prevalence trends in specific regions.

At the Coast, for example, the number of people infected with HIV has gone down by almost half in the last five years while almost similar trends were recorded in Nairobi with a 44 per cent drop and 41 per cent decline in the Rift Valley. North Eastern did not participate in the study because of insecurity.

But it is Nyanza which is a cause of worry to the medical experts being the only region in the country to show a surge, though slight, in the number of people infected with HIV during the study period.

HIV prevalence in Nyanza was found to be almost three times the national average at 15.1 per cent, and much higher than infections in Eastern, which has the lowest prevalence rates at 2.1 per cent.

The survey, mainly funded by the Americans, and led by the National Aids & STI Control Programme, only tells part of the story since it does not explain why the disease has panned out this way, nor does it give a way forward which would be important for HIV programme managers.

For example, it does not explain the dramatic decline at the Coast and Nairobi, areas with the highest number of high risk groups such as prostitutes, commercial homosexuals and drug injectors.

Risky sex

According to the study, a high number of Kenyans, especially men, are still practicing risky sexual behaviour such as sex for pay, reward or gifts.

“About 17 per cent of men reported that they had given money, gifts or favours for sex with five per cent reporting they had done so in the last 12-months,” the study shows.

An earlier study had indicated that one of every three HIV transmissions can be attributed to certain populations that engage in high HIV risk behaviours such as prostitutes, drug injectors and prison populations.

But it is the persistent high rates of HIV infections in Nyanza, an area possibly with the highest number of HIV civil groups, research institutions and interventional programmes that are crying out for an explanation.

Nyanza host some strong institutions such as the Kenya Medical Research Institute, the US Centre for Disease Control and Prevention and the US Army Medical Research Unit-Kenya (USAMRU-K).

One of the major interventions to handle the runaway infections in Nyanza was the introduction of male circumcision, which according to the current survey, has been accepted well.

By last year, the rate of male circumcision nationally covered 91 per cent of the population up from 85 per cent five years ago when the previous survey was released.

“All regions observed increases in the proportion of men circumcised, with the largest increases seen in Nyanza region, from 48 per cent to 66 per cent and in Nairobi region, from 83 per cent to 92 per cent,” said Dr Sharif Shahnaaz, the Director for Public Health in the Ministry of Health, while presenting the Kenya findings of the study on Tuesday.

HIV experts say male circumcision can reduce HIV infections by as much as 60 per cent but this survey does not explain how this intervention is impacting on the high rates of infections in Nyanza or whether it is too early to make any determination.

However, the Health Secretary said that the results released yesterday were preliminary and do not conclusively define the complex HIV epidemic in Kenya.

“A definitive report will be released in December which will offer a broader picture of the HIV status in the country through a comprehensive look at all indicators included in current study,” said Mr Macharia.

In a press statement accompanying the report, experts say the reasons for the HIV decline are not known “at this time but could be due to reductions in new HIV infections, increased deaths among previously infected people or a sampling bias.”

Not explained in the preliminary presentations, are indications that the bulk of HIV infections are moving away from the youth to older persons aged between 45-54 years.

The 2007 study showed HIV prevalence to be highest among the 25-34 year age group but the current study says the most infected today are in the age group between 45-54 years most of who are married.

What the study does not say is whether this older group was infected recently or it is the same people who were infected in their youth who have moved on.