HIV rates down but stigma and gender disparity linger

Kenya has made great gains in the war on HIV the past decade, with nearly 30,000 fewer infections a year.

However, girls and women still bear the brunt, and those living with the virus still struggle for social acceptance.

The country recorded 41,416 new HIV infections in 2019, with 6,806 of the new infections being among children.

The latest report by the Health ministry, however, shows this was a decline from 75,000 in 2010 among adults and a decline from 18,000 in 2010 among children.

This, health experts say, amounts to a 44 per cent reduction of cases, which is indicative of substantial progress, but short of the reduction by 75 per cent envisioned by 2020.

From the report, at least two million Kenyans have succumbed to the disease since the first case was officially reported in the country in 1984.

However, the deaths declined rapidly from 51,000 in 2010 to 20,997 in 2019, representing a 59 per cent reduction, with the reduction being more significant among children, reducing from 16,000 in 2010 to 4,300 in 2019.

Aids-related deaths among women also declined from 22,000 to 7,300, while the deaths among men only declined moderately from 13,000 in 2010 to 9,400 in 2013.

According to the report, by the end of 2019, at least 1.5 million Kenyans were found to be living with HIV, while 20,997 Aids-related deaths had occurred.

COUNTY INFECTION RATES

The report shows 13 counties had more than 1,000 new HIV infections, accounting for 72 per cent of all new infections in the country, with Homa Bay, Kisumu, Siaya and Migori counties having HIV prevalence at hyper epidemic levels.

“Key HIV epidemic and programme coverage indicators show gaps in Mombasa, Kisumu, Siaya, Nairobi, Kisii, Homa Bay, Migori, Busia, Kakamega, Nakuru, Kiambu and Uasin Gishu counties that require intensified focus to stem new HIV infections,” the report states.

Experts have warned that Marsabit county has an emerging HIV epidemic that needs to be mitigated.

The report further warns that the HIV epidemic in the country continues to be disproportionately higher among females than males, with the burden of HIV remaining highest among people aged 15-49 years.

The report shows that nine counties with more than 2,000 new infections account for 44 per cent of all new infections in the country.

Health CS Mutahi Kagwe said Kenya will continue to invest in a multi-sectoral HIV response and strengthen coordination and governance structures, led by the National Aids Control Council.

“Despite notable progress, HIV and Aids continues to impact on mortality rates, burden households and strain national health systems in Kenya,” he said.

Homa Bay county has the highest HIV prevalence at 20.2 per cent, followed by Kisumu with 18.6 per cent, Siaya with 17.8 per cent and Migori with 12.8 per cent.

Other counties of concern include Busia, which recorded a prevalence of 7.2 per cent, Mombasa with 6.9 per cent, Uasin Gishu with six per cent, Kisii with 5.4 per cent, Nairobi with 5.4 per cent and Vihiga with 5.1 per cent.

Marsabit, Tana River, Garissa, Mandera and Wajir recorded prevalence rates of below one per cent.

“Further granular analysis of new infections at the subcounty level will be done for better targeting and decision-making on intensity of interventions. Cities and urban areas within the counties have higher HIV incidence and populations with heightened risk and vulnerabilities,” it says.

From the report, adolescent girls and young women aged 15-24 years contribute to a third (30 per cent) of the 41,728 new HIV infections in the country.

In terms of annual new HIV Infections among children aged 0-to-14 years across counties as at 2019, Nairobi recorded the highest number with 873, followed by Kisumu with 602, Homa Bay with 569, Siaya with 436, Migori with 362 and Nakuru with 351.

Uasin Gishu, Mombasa, Kakamega and Busia recorded 287, 259, 225 and 189 infections respectively, while Marsabit, Lamu and Tana River recorded the lowest cases with nine, eight and six cases respectively.

This has been attributed to factors such as intergenerational sex, teenage pregnancies, sexual and other forms of gender-based violence, discontinuation of school especially during transition from primary to secondary school, and prevailing gender norms.

Other factors are poor access to comprehensive sexuality education, limited access to HIV, STI, SRHR services and low socio-economic status.

TREATMENT GAPS

The data shows that 34,337 (32 per cent) of children living with HIV were not on ART treatment by the end of 2019.

Among those on treatment, only 51 per cent were virally suppressed, leaving a large cohort of children prone to HIV related co-morbidities and ill health.

Similarly, by the end of 2019, a total of 1,160,479 (1,087,511 adults and 72,968 children) were on antiretroviral therapy, representing an estimated treatment coverage of 80 per cent among adults (68 per cent among children).

The positive health outcomes attributed to ART still remain elusive for close to half a million Kenyans, who are not aware of HIV status.

In relation to stigma and discrimination, the country is making slow progress.

For instance, the percentage of reporting accepting attitudes towards PLHIV reduced from 33 per cent in 2010 to 26 per cent in 2014. Similarly, the same indicator showed a decrease from 48 per cent to 44 per cent among men who reported accepting attitudes.

Nelson Otwoma, director of the National Empowerment Network of People Living with HIV in Kenya, said the commitment to leave no one behind requires that we eliminate HIV-related stigma, human rights discrimination and legal barriers that impede access to health services.

“The barriers only serve to fuel new HIV infections and lead to worse health outcomes for people living with HIV. An effective HIV response must be anchored on the foundation of health justice,” he said.

The report calls for the need to address the problem among specific groups, such as the key populations who continue to face stigma and discrimination even in healthcare settings.

STATUS AWARENESS

In 2019, 90 per cent of all Kenyans living with HIV knew of their HIV status, which means the 2020 target of achieving 90 per cent across the cascade was achieved, the report has shown.

“Kenya has made progress over the last decade in her response to HIV, evidence of which is the reduction of new HIV infections, increased access to life-saving antiretroviral therapy, and reduction of Aids-related deaths,” NACC chairperson Angeline Siparo said.

In addition, 74 per cent of people living with HIV were on treatment against a target of 81 per cent and 68 per cent had a suppressed viral load against a target of 73 per cent.

According to the report, progress varies by age and sex, as 74 per cent of adult women had a suppressed viral load, achieving the 2020 targets was however only 61 per cent of adult men and 51 per cent of children had a suppressed viral load.

“The lower levels of viral suppression among men contribute to higher mortality rates among men and impact negatively on increased number of new HIV infections among their sexual partners. The low level of viral suppression among men and children points to continued service gaps and barriers that need to be urgently addressed.”

The report has flagged HIV transmission among children due to early sexual debut and defilement cases to be worrying adding that in 2019, proramme data showed that 20,362 children aged 10-14 were pregnant.

From the data, 28 per cent (399,028) of all pregnancies registered were among adolescents aged between 10 and 19 years.

A third of the teenage pregnancies occurred in nine counties, namely, Nairobi (26,545), Kakamega (17,555), Nakuru (16,502), Meru (15826), Narok (14,962), Bungoma (14,512), Kiambu (13,562) Homabay (13,644) and Kwale (11,251).

The report calls on the need to target locations with high teenage pregnancies as a proxy indicator of heightened risk to HIV infections among girls.

National Aids and STI Control Programme head Dr Catherine Ngugi said Nascop plans to scale up biomedical interventions focused on narrowing the gaps in diagnosis, HIV prevention, the commitment towards eliminating mother-to-child transmission of HIV and syphilis, and universal ART for improved health outcomes for people living with HIV across all sub-populations in the next five years.

“Innovative differentiated models for test and treat will be scaled up with intensified focus on priority populations, including key populations, adolescent and young people, pregnant and breastfeeding mothers, among others,” she said.

“Effective HIV prevention interventions, such as Voluntary Male Medical Circumcision, Pre-Exposure Prophylaxis and condoms distribution will be implemented to scale. Integration of management of HIV across other disease management platforms will be promoted for efficiency gains and to improve the effectiveness of interventions.”