NYIKAL, LANG'AT & OTINDO: Kenya at crossroads - Call for courage in HIV response

As the curtains fell on the 13th International Aids Society (IAS) Conference on HIV Science on July 17 in Kigali, one message echoed with urgency across Africa—and especially in Kenya: the global HIV response is at a turning point. IAS 2025 was not just a conference; it was a wake-up call. A convergence of scientific breakthroughs and a funding crisis served as both a reflection and a challenge to governments, donors and communities.

Kenya has been lauded for significant progress in the HIV response over the years—rising ART coverage, declining new infections and pioneering community-led approaches. But the warning from Kigali was clear: these gains are at risk. The ripple effects of global funding cuts, especially the sudden slashing of the United States' HIV aid in early 2025, are already being felt in many sub-Saharan countries, including Kenya.

Already, civil society organisations in Kenya report funding delays affecting outreach services such as testing and linkage to care—especially among key populations. As we celebrate advancements like Lenacapavir, the long-acting injectable PrEP now endorsed by WHO, /it is imperative to acknowledge that such innovations will remain out of reach for many unless they are accompanied by sustained financial investment and unwavering political commitment.

IAS 2025 brought renewed calls for African countries to take greater ownership of their responses. As global partners recalibrate their roles, the mantle of responsibility is increasingly shifting to domestic leadership. The conference showcased commendable examples of bold political commitment from countries such as Rwanda and South Africa while also drawing attention to the worrying trend of declining prioritisation in other contexts.

Kenya, long seen as a regional leader in health innovation, must reaffirm its role. The HIV response was catalysed by political will—and it is political will that must now sustain it. The strong presence of Kenyan parliamentarians at IAS 2025 underscores a vital opportunity: to protect HIV funding, oversee effective implementation and enact legislation that advances equity and inclusion for all communities.

“This is a cusp moment for African leadership,” said Patrick Munene. “The world may be signalling that we’re on our own—but in truth, we have always had the capacity to lead ourselves. Now we must.”

At IAS 2025, it became increasingly clear that fragmented, siloed programmes are no longer viable for governments seeking sustainable, efficient health systems. Integration—or service convergence—is likely the pathway many governments, including Kenya, will adopt as part of broader health system reforms.

However, integration must not come at the cost of patient trust, safety or dignity. For people living with HIV, especially key populations facing intersecting layers of stigma and criminalisation, service delivery models must remain people-focused and patient-centred. This means preserving tailored, affirming care while enhancing coordination across services such as tuberculosis, mental health and sexual and reproductive health.

Kenya’s early moves under Universal Health Coverage and county health initiatives are promising, but the next phase must be intentional. As emphasised in Kigali: Integration is not simply about merging systems; it is about reimagining care that meets people where they are. As Rosemary Mburu of WACI Health rightly urged, “Design for the people. Respond to their realities. When you plan around patients, not systems, you get results.”

While the recent bipartisan effort in the United States to safeguard Pepfar from severe funding cuts is a positive development, the ripple effects of earlier disruptions are already evident. Declines in HIV testing, reduced ART initiations and loss of access to life-saving services for thousands across the Global South underscore the fragility of current gains.

For Kenya, long a beneficiary of robust support from PEPFAR and the Global Fund, this is a pivotal moment. The country must continue to advocate sustained donor engagement while concurrently stepping up domestic investment in the HIV response. In doing so, Kenya must also demonstrate commitment through enhanced transparency, improved efficiency and measurable results. Fiscal constraints, while real, must not become a rationale for policy stagnation or delayed action.

Innovation took centre stage at IAS 2025, with Lenacapavir—now FDA-approved and endorsed by the World Health Organization—hailed as a major advancement in HIV prevention. Yet, the promise of scientific breakthroughs can only be fulfilled through systems that ensure equitable access. For Kenya, this means accelerating regulatory approvals, investing in workforce training and adopting forward-looking procurement strategies to make long-acting prevention options widely available.

Emerging innovations, such as MK-8527, a once-monthly oral PrEP, and AI-powered diagnostic tools, demonstrate how science is rapidly reshaping the response landscape. However, the true impact of these technologies depends on their integration into real-world settings. Applauding innovation is not enough; building the systems to support their delivery is where transformation occurs.

The scaling down of Pepfar-supported parallel delivery systems in Kenya has left a significant void, not only in services, but in the people who delivered them. Community health workers, peer educators and grassroots service providers, many of whom are themselves living with HIV, have lost their jobs, even as their roles remain critical. These parallel systems filled gaps that the government could not easily or efficiently address, particularly in reaching key populations and marginalised communities.

The challenge now is not just about restoring services, it is about redefining roles, responsibilities and relationships. As Kenya recalibrates its HIV response within the Universal Health Coverage framework, the central question is: how can the state meaningfully partner with communities, not just as beneficiaries, but as co-implementers and co-designers of care?

This moment calls for a new social contract—a rethinking of how community-led delivery systems are supported, legitimised and sustained within public frameworks.

“Kenya has the tools, talent, and tenacity to lead Africa’s next chapter in the HIV response. But it must act now—with courage, clarity and commitment”, emphasised Prof Kenneth Ngure, a renowned scientist and president-elect of the IAS.

Ending AIDS by 2030 is still within reach, but only if we: Align resources to the true scale of need; deliver services with efficiency and accountability; invest in communities as partners; and lead with fearless, equity-driven governance

This is not just about science. It is about justice, dignity and our shared humanity. IAS 2025 gave us the evidence. Now, Kenya must craft the response.

We stand at a crossroads. The question is not whether we know what to do. The question is whether we will do it—together, boldly and without delay.

Dr James Nyikal is the chairperson of the National Assembly Department Committee for Health and Member of Parliament for Seme constituency.

Angella Lang'at, MBS, serves as a director at the National Syndemic Diseases Council. She is passionate about driving sustainable solutions for health and equity. 

Violet Otindo is an award-winning science and health journalist and editor. She has covered health, gender and social justice stories for over a decade and is a passionate advocate for evidence-based reporting, solution-based journalism and equitable health policies in Africa and beyond.