Single, divorced and underweight persons, especially young men, are at higher risk of dying from HIV, a study has shown.
These surprise findings recorded in Kiambu, Muranga, Nyeri, Nyandarua and Laikipia counties are thought to mirror what is happening across the country.
Marriage, according to the study which followed 23,890 adult patients on ARVs over a three-year period in the five countries, was seen to reduce the risk of death among infected men.
The researchers from the US Centres for Disease Control and Prevention - Nairobi, and Centre for Health Solutions, a local NGO, suggest marriage may have a stabilising effect on HIV patients.
“This could be due to single and divorced persons’ nondisclosure to sexual partners of their HIV status,” say the researchers. This group they say is also likely to be in unstable relationships with weak social support systems.
Married women and cervical cancer
An earlier study at the Kenyatta National Hospital (KNH) had showed married women were less likely to die from cervical cancer compared to their unmarried counterparts.
This, the study led by Farida Kirema Makena suggested, was due to spousal support and stability that may come with being in a marriage.
Men in a marriage, the new study suggests are likely to adhere to treatment and at low risk of dropping out of care.
“This could probably be due to a spouse being a potential treatment supporter,” suggest the authors.
And the difference is quite big. “Divorced and separated individuals were 4.3 times more likely to die of HIV and Aids than married individuals.”
Single and never married persons were also 13 times as likely to die of the disease compared to their married counterparts.
Also closely related, the study found that underweight people, especially men, were at higher risk of early death.
Low BMI was found to be associated with increased deaths in our study. Patients with low body mass index, known as BMI, of less than 18.5 kg/m2 were at higher risk of death. This may roughly translate to about less than 55kg for women and less than 62kg for men.
The underweight or malnourishment, the study says maybe caused by the disease itself but could be aggravated by a lack of adequate food or poor eating habits.
Studies have shown ending a marriage may lead to deterioration in men’s diets that could have negative health effects, while women’s diets don’t change significantly
The new study involved 23,890 patients on ARVs supported through the US President’s Emergency Plan for AIDS Relief (Pepfar), the biggest HIV donor in Kenya.
The patients were followed in 104 health facilities - 36 in Nyeri, 33 in Muranga, 26 in Kiambu, seven in Nyandarua, and two in Laikipia.
During the three-year study period, 3,222 patients had died and a staggering 8,950 dropped out of treatment or were lost to care.
Again young men aged 20-35, single or divorced were the most likely to drop out of treatment. Other factors leading to deaths of course were older persons aged over 51, those presenting with late-stage disease and being on an ABC-based treatment. Patients on the ABC-containing ARVs, the study found were twice as likely to die of HIV complications compared to those on other types of drugs.
The ABC regimen contains the medication abacavir whose use has been linked to heart attacks and other cardiovascular problems.
However, Kenya is increasingly replacing abacavir containing ARVs with tenofovir as the first-line drug claimed to be less toxic.
Tenofovir also the main component in the daily HIV prevention pill called PrEP has been linked to a decline in bone density and impaired kidney function among users.
A study published last month in the East African Medical Journal found 19 per cent of HIV patients at Kenyatta National Hospital on tenofovir-containing medicines to have damaged kidneys.
“Given the positive impact marriage has been shown to have on infected men; to singles, I would prescribe they get married,” says Jenifer Wangeci, an HIV peer educator in Kikuyu, Kiambu County.
Though the best prescription, Wangeci concedes this may not be a practical solution. However, the researchers led by Dr Paul Wekesa want the country to adopt male friendlier HIV treatment programmes.
For example, to reduce the number of men dropping out of treatment, the team suggests adoption of male sensitive visiting hours and fewer trips to the hospital.
“Implementation of HIV treatment programmes should therefore be tailored based on gender, age profiles, nutritional and marital status of patients.”
The high treatment dropout rates are a major concern to Pepfar. In its 2020 Kenya plan, which kicked in last month, the donor says patient retention must be a top priority.
“Retaining individuals on lifelong ARVs and bringing back to care those who are lost to follow-up will be a key intervention for Pepfar in 2020.”
In its 2020 operating document, the donor says special attention will be given to young individuals who are at a higher risk of being lost to care.
“All clients testing positive will be physically escorted to the clinician’s desk and handed over to initiate treatment.”
Pepfar says it is already in discussions with the Ministry of Health to develop a policy allowing up to six months dispensing of ARVs to reduce hospital visits.
On underweight persons, the donor says the new plan will increase support for all nutrition and therapeutic feeding for severe and acute malnutrition cases.