When antiretroviral drugs were provided for free to persons living with HIV, patients greeted the news with a sigh of relief. Several of them had lost all hope of being able to lead a normal life. However, this medication only proves to be effective if taken faithfully, and with proper nutrition.
In 2003, the government rolled out free antiretroviral drugs to those whose CD4 count was above 200. In 2010, the CD4 count had changed to 350 and in 2015, it was availed to those who had a CD4 count of 500 and above.
The World Health Organisation later on changed the guidelines on HIV treatment in 2016, requiring that anyone who tests positive for HIV be put on treatment immediately.
So many gains have been recorded globally on the number of people who are on treatment. Currently, there are close to 18.2 million people on lifelong treatment. As countries grapple with reducing new HIV infections and HIV-related deaths by 2030, Kenya is trying to comprehend why infection rates and deaths, especially among adolescents and young people, are on the rise, despite the infection rates going down from 100,000 in 2013 to 77,647 in 2016.
The Kenya Aids Response Progress report 2016, released by the National Aids Control Council (NACC), revealed that half of these new infections are from those between the ages of 15 and 24 years.
The data shows this age group contributed 51 per cent (39,868) of new HIV infections.
Kenya currently has 1.5 million people who are living with HIV, whereby more than 800,000 people are on lifelong treatment.
The data also shows that the country recorded 35,821 deaths last year, 14 per cent (5,004) of which were from children below the age of 14, 30 per cent ( 10,681 ) from adolescents and young people, and 59 per cent (20,136) from adults.
Back in 2013, adolescents and young people contributed 21 per cent (29,352) of new HIV infections. That year, 44 per cent of new HIV infections were among married couples and those in stable relationships.
Health stakeholders fighting the spread of the virus are worried about the trend of the somewhat ‘stubborn’ infection, as it is now affecting the leaders of tomorrow: adolescents and young people.
NACC head of research Vernon Mochache says two scenarios are contributing to new infection rates among this group.
He says some of the young people living in urban areas are engaging in cross-generational sex, where they are in relationships with people who are twice or thrice their age. He adds that the second scenario applies to those living in rural areas, who are married off early as the second or third wife.
“Back in our days, when you were spotted with sponsors, who we used to call sugar mummies and sugar daddies back then, it was an embarrassment. It wasn’t something that was celebrated. Nowadays, if you have a sponsor, it looks like a good thing. Some are even happy about it, basically because of the gifts they receive,” Mochache says.
The ‘sponsor’ trend is where older men support girls and young women to live lavish lifestyles in exchange for sex. In some countries, they are called blessers because they offer gifts to this young population.
Despite the country trying to come to terms with the rate of new HIV infections, this group contributes to the nationwide infection rates. The country is also trying to understand why they are defaulting on treatment, which in the long run leads to death.
According to the Network of Persons Living with HIV in Kenya (Nephak), 16 adolescents and young people died between the first week of December last year and early February this year. The 16 were between the ages of 15 to 21. Five were 21 years old, four were 22 years, three were 23 and one was 18 years. In total, 51 adolescents and young people living with HIV died last year.
Those in this age group are usually in high school or have joined university or a college to further their education.
DEFAULTING ON TREATMENT
Nephak chairman Nelson Otuoma told the Star the country should be worried about the loss of these 16 people, who died due to Aids-related illnesses.
“People must know that 16 is not just a number," he said. "The 16 were human beings and could have been a brother, sister, son or daughter to someone out there. We must find out why adolescents are not adhering to treatment.”
Mochache cites the stigma they face from the society. “Despite the awareness created by the government and NGOs fighting HIV, the society still stigmatises and discriminates against people living with HIV," he says. "This has an effect on those who are on treatment; and because they do not want to be ‘treated differently’ by their peers, they opt not to take their medication.”
Another factor is drug adherence. A number of youths opt to take a drug holiday (not taking drugs for a short span of time) because of the effect the drugs have on their body.
“All drugs have an effect on the body. However, a number of people who stop taking their medicines at some point are those whose parents or guardians had not told them about their status. These children end up knowing about their status when they are in their teens, and some of them also get the wrong information from their peers, who tell them that HIV kills,” Otuoma says.
Children who are born HIV-positive and are on lifelong treatment are rarely told the truth about their medicine.
Some of the common names used by parents and guardians about ARVS are TB, pneumonia and malaria drugs. Others were told that the drugs were to keep them from getting sick. Some were even told that the drugs are meant to help them get by with the weather.
“When you keep telling young people false things about their status and the medication, they will lose their trust in you and default on their medication. So once they know the truth and realise that they are still okay, even after missing out in a day or two, they stop adhering to treatment," Otuoma added.
In a previous interview with the Star, Otuoma said the best time to disclose HIV status to a child is when he or she is between five and nine years.
“If you delay until when they are going to high school, it will not help. At this stage, they know so many bad things about HIV and they will stop taking medication,” Otuoma said. "If they take such a move, they develop opportunistic infections and later die."
Before a person defaults on treatment, he or she must be battling something that he does not want to share. He or she will then start isolating themselves and later on stop taking medication. When asked, he or she will just reply that they are taking their medicine.
Young people also need sex education.
“We should not be resistant to talking to young people about HIV-prevention,” Mochache says. "Comprehensive Sexuality Education educates young people on sexual matters. However, people need to know that when you make something available as a preventive tool, it does not mean you are telling people to do the wrong thing."
He added that adolescents and young people need to test for HIV so they can know their status.
Young people often fear going for a HIV test because they do not want to go to a facility and find someone who is older than them. However, if we want to keep making progress in the fight against HIV, we must ensure that young people test for HIV, as well being taught ways of preventing themselves from getting infected, in line with UNAids' 90-90-90 target (that by 2020, 90 per cent of people living with HIV know their HIV status, 90 per cent of those diagnosed with HIV receive sustained antiretroviral therapy, and 90 per cent of those on lifelong treatment have attained viral suppression).
“If we do not do anything about our current epidemic among adolescents and young people, then we will roll back the gains we have made in the fight against HIV-Aids,” Mochache says.
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