Decades later, Kenya has seen significant progress and hurdles in HIV fight

Ugandan HIV activists Barbara Kemigisa shows Antiretroviral (ARV) packagings and tablets in an art design encouraging people infected with HIV to use the ARVs and fight against stigmatisation during the Nairobi Summit on ICPD25 at KICC on November 12, 2019. [File, Standard] As Kenya joins the globe in celebrating World Aids Day today, the road ahead remains fraught with challenges despite significant gains. The disease has killed more than 40 million people globally since it was first recorded in 1981. Here in Kenya, the disease left many widows, widowers and orphans with some still living with the virus. Despite a gradual reduction in new HIV infections in the country, more men and boys continue to succumb to AIDS-related complications. The deaths are reported at a time when the country has intensified efforts to eliminate the disease as a public health threat by 2030. The latest report by the National Syndemic Diseases Control Council (NSDCC) reveals that at least 1, 378, 457 Kenyans are living with HIV with men accounting for 35 per cent (487,710), against 890,747 women living with the virus. In 2023, Kenya recorded 20,480 AIDS-related deaths, marking a slight increase from 18, 473 recorded in 2022. Among these, 8,490 were men while 9,382 were women. "Although more women and girls live with HIV than men, the proportion of men dying from AIDS-related causes remains alarming," says Caroline Kinoti, NSDCC Deputy Director for Health Promotion and Capacity Development. Reproductive health Unlike women who often interact with healthcare systems during pregnancy or other reproductive health needs, men are less likely to seek routine care or HIV testing services. "Men generally avoid seeking healthcare unless they are seriously ill. Even when infected with HIV, they may live with the virus for a long time without being diagnosed or starting treatment, increasing the risk of transmitting the virus if their viral load is high," says Kinoti. Dr Japheth Kioko of NSDCC monitoring and evaluation division highlighted several gaps in HIV care for men, including low testing rates, delayed initiation of antiretroviral therapy (ART), and poor treatment adherence. "Kenya has exceeded its treatment target, with 97 per cent of people living with HIV on ART and 94 per cent achieving viral suppression," he says. "However, men are lagging behind. For instance, 91 per cent of men are on ART compared to 100 per cent of women," he adds. Out of the 1,378,457 Kenyans living with HIV, 1,336,681 are on treatment, leaving a gap of over 41,000 people. Kioko says those not on treatment are more likely to transmit the virus to others. "It is our responsibility to bring everyone living with HIV into treatment. While overall progress is impressive, challenges remain, especially among men, boys, and young people aged 20 to 24." Virally suppressed "We want to stop HIV-related mortality. We want people to die of other causes, but not necessarily due to HIV. When we keep people on ART, and we ensure they are virally suppressed, then we can ensure that they do not transmit HIV. It is the business of the government to ensure that we reduce, and scale down all deaths, which are related to HIV," he continues. The report indicates that 4,072 new infections in 2023 were among men aged 15 and above, compared to 8,937 of women in the same age group. Additionally, 3,743 children aged 0 to 14 were newly infected. In the last 10 years, new HIV infections in Kenya declined by 83 per cent across all populations from 101. In 2013, infections jumped from 448 to 16,752, translating to at least 46 infections every day. The reduction of new HIV transmission in children between 2013 and 2023 is 71 per cent, whereas in adults' the reduction stands at 85 per cent. "In adults, the reduction is faster as compared to children," says Kioko, adding that transmission in children is mostly due to vertical (mother-to-child) transmission. According to the report, the country has made remarkable progress in terms of access to care, with 97 per cent of those diagnosed with HIV receiving treatment; and 94 per cent of those on treatment achieving viral suppression. "While this (reduction in new infections) is commendable, we are still not where we need to be. Our target was a 75 per cent reduction in new infections by 2025," says Kinoti. HIV prevalence in Kenya stands at 3.3 per cent, with significant geographic disparities. The NSDCC report identifies a stark regional variation in HIV prevalence, with the highest burdens concentrated in counties within the Nyanza, Western, and Rift Valley regions. Kisumu County has the highest prevalence at 11.7 per cent, followed by Homa Bay, Migori, Siaya, and Busia. Wajir County, on the other hand, has the lowest prevalence at 0.1 per cent. Other counties bearing the highest prevalence, include Nairobi, Kisii, Kakamega, Busia, Nyamira, and Trans Nzoia. On the other hand, counties in the arid and semi-arid regions of Kenya, such as Mandera, Wajir, Garissa, Turkana, and Marsabit, have significantly lower HIV prevalence rates, often below one per cent. Boys and men Young people aged 15 to 24 account for a significant proportion of new infections, with boys and men aged 15 to 45 particularly affected. One of the most significant findings from the 2024 report is the gender disparity in the impact of HIV in Kenya. Women constitute 58 per cent of all people living with HIV and, hence, are disproportionately affected by the epidemic. Women are also more likely to experience HIV-related deaths, with 65 per cent of all HIV-related deaths in Kenya occurring among women, compared to 35 per cent among men. ALSO READ: Shifting epidemic: How fight against HIVAids has evolved over the years This disparity is attributed to a number of socio-economic factors, including gender inequality, high rates of gender-based violence, limited access to sexual and reproductive health services, and socio-cultural barriers to seeking treatment and prevention. Young women, in particular, are at a higher risk, with HIV prevalence rates among females aged 15-24 years being substantially higher than in their male counterparts. Factors such as limited education, early marriages, and power imbalances in relationships contribute to their increased vulnerability to HIV infection. To address these disparities, the NSDCC, in collaboration with the Ministry of Health and other partners, has organised a marathon to mark World AIDS Day today, December 1, 2024. Themed "It Is a Race Against Time: Promoting Health and Wellbeing of Men and Boys," the event will take place at Nyayo Stadium. It aims to engage men and boys in championing HIV prevention, testing, treatment, and viral suppression. "Men and boys are disproportionately affected by HIV-related deaths. By empowering them to take charge of their health, we can close the gaps in testing, treatment, and prevention," Kinoti said. Health threat The council aims to meet the global 2030 target of eliminating AIDS as a public health threat. "As a country, we must join hands to stop new infections and ensure that all people living with HIV adhere to treatment. Ending AIDS-related deaths is achievable, but only if everyone plays their part," Kinoti concluded. The economic burden of HIV on Kenya is immense, both in terms of healthcare costs and lost productivity. The NSDCC report estimates that the annual healthcare costs for HIV-related care amount to approximately Sh87 billion. Furthermore, the economic impact of HIV-related absenteeism and reduced productivity is estimated to be around 3.1 per cent of the country's Gross Domestic Product (GDP). The government spends about Sh45 billion annually on antiretroviral (ARV) treatments, which remain essential for the survival of millions of Kenyans living with HIV. The high costs associated with treatment are vexed by economic inequalities, which make it more difficult for marginalised populations to access healthcare services. Although the government has made strides in providing universal access to testing and treatment, issues such as treatment interruptions and the high cost of new preventive drugs like PrEP (pre-exposure prophylaxis) continue to pose significant barriers. Efforts to prevent HIV transmission from mother to child during pregnancy and childbirth have posted positive results, with transmission rates declining steadily over the past decade. Safe sex Community-based prevention programmes, including condom distribution, HIV testing campaigns, and education on safe sexual practices, have helped reduce new infections, particularly among high-risk populations. However, with the looming scale-down in donor funding for HIV prevention and management programmes, and a meltdown in the public health sector, fears of more infections and possible deaths from the disease are too real to ignore. In the recent budgetary allocations, the Ministry of Health has been scaling down on allocations. This, coupled with the incautious and grouchy transition from the old National Health Insurance Fund to the new health scheme (Social Health Authority) that has seen disruptions in the delivery of health services, are some of the issues that could impact the fight against HIV.

Decades later, Kenya has seen significant progress and hurdles in HIV fight

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