Unreached HIV positive population gives health sector sleepless nights

During a routine HIV sensitization by a local youth group in Awendo, Migori County sometime last year, youth advocates came across a young man in his late 20s who dismissed them and their message.

He taunted the advocacy group that was trying to convince people about knowing their HIV status instead, stating that all he needed was condoms because he was sure he was not infected.

Walter, a boda boda rider, was critical of the group that even his colleagues in the trade were not happy and they all decided to take the test. He tested positive.

Norman Odhiambo, the health activist who was leading the youth group says that the simple act of testing changed everything for the young man.

“Upon testing and learning that he had HIV, he uttered you mean this woman can infect me with HIV and left with his motorbike in a huff. We had to follow him because we did not want to imagine what he would have done,” narrated Odhiambo.

When they followed up, they had him counseled and referred to a facility to start his medication. Walter is one of the best advocates for HIV testing in Awendo, Migori County.

As World Aids Day is celebrated, the Kenya HIV Estimates for 2018 found that women are more likely to test for HIV than men. This even as Kenya starts to feel the pinch of cut in funding for HIV and AIDS programmes by the US President’s Emergency Plan for Aids Relief (PEPFAR) which could see gains made over the years eroded.

Even as new HIV infection rates drop, experts argue that, there is still an unreached group who are yet to test. This has called for new approaches including self-testing for HIV.

The National Aids and STIs Control Programme (NASCOP) notes Kenya has 1.5 million people living with HIV out of which about 500,000 are yet to be initiated on treatment. This is one of the factors that is still pushing new infections even as figures show that new infections are surging in nine counties.

While UNAIDS targets 90-90-90, Kenya seems to be lagging behind. The targets state that by 2020, 90 per cent of all people living with HIV will know their HIV status; 90 per cent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and that 90 per cent of all people receiving antiretroviral therapy will have viral suppression.

Despite concerted efforts, Kenya still has gaps. NASCOP notes that current adults in care stand at only 70 per cent meaning one in three people with HIV is yet to be tested while 23 per cent of those tested are yet to be put on treatment. Also, nearly half of those on treatment are yet to have their viral load suppressed.

This reality has called for new modes of operation to meet the targets which appear a long shot as the targeted period reaches homestretch. Funding cuts towards testing is premised on the reality that testing 15 million people to look for this 340,000 is not efficient use of funds.

In Kisumu, one of the counties where HIV prevalence remains high, a project to have men test is being undertaken. The project which started last month seeks to have men test themselves for HIV. So far 900 men have been reached in Manyatta and Kondele areas. Dinozzof Odhiambo, who coordinates the project says its targets between 18 and 35 years. “Most men do not go to health facilities because of negligence and poor health-seeking habits and this has left them out in testing unlike women who get tested during pregnancy or other visits to health facilities,” says Odhiambo.

Eunice Kinyua, the Kisumu County Aids and STIs Control Officer, concurs and attributes the high prevalence among men to poor health-seeking behaviour. She says that with HIV testing integrated to key service areas, most women are tested as opposed to men who take a bit of time before seeking medical services.

“But we have a strategy called assisted partner notification which we are using to reach out to men through their spouses who seeks services and test positive whereby we get the details of all the sexual partners and contact them telling them that they could be at risk,” says Kinyua.

Health experts argue that to solve this issue, more targeted testing is necessary. Dr Charlotte Pahe, the HIV private sector adviser points out that while figures show that while testing between 2012 and 2016 more than doubled, the number of people who turned positive dropped by almost 84 per cent.  Pahe says this can be attributed to the fact that more people living with HIV have been discovered and the population being looked for has grown small over the years.

“The new strategy being employed which involves connecting a network involves confidentially tracking all the sexual partners of a person who tests positive for HIV as a way towards getting everyone positive put on treatment,” says Pahe.

Nairobi has the lowest testing gap in Kenya while Mandera has the highest number of people who have HIV but are yet to be tested.

Other counties with high testing gaps to be tested people compared to those tested include Wajir, Marsabit, Kwale, Turkana, Lamu, Taita Taveta, Tana River, Samburu, Garissa and Kiambu.