How Homa Bay is fighting high HIV rate among kids

Governor Cyprian Awiti and EGPAF country director Eliud Mwangi on June 28, 2016
Governor Cyprian Awiti and EGPAF country director Eliud Mwangi on June 28, 2016

Anne Adhiambo, 36, from Othoro village in Kasipul, Homa Bay county, a mother of two, knew about her HIV status after losing three of her children to various complications.

She had not been attending antenatal clinic during pregnancy, and relied on a village midwife even during delivery.

During her fourth pregnancy, she was advised by a relative to visit a nearby health facility, explain her medical history and get a check-up due to her deteriorating health.

She was tested and found to be HIV-positive. She accepted her condition and got enrolled to ARVs, a life-prolonging drug for those living with HIV.

She was then advised to go and inform her husband to accompany her during her next visit, so he could also be tested.

“When I informed my husband, he said men do not attend clinics but only women. He actually refused,” Adhiambo said.

The man died three years later. Adhiambo was left a widow with three children, whom she said are living free from HIV.

“Had my husband heeded the advice, we could be the two of us together, taking care of our children,” she said.

Adhiambo is among a number of residents from Homa Bay who have accepted their condition after testing HIV positive. They have healthy children and are committed to ensuring the prevalence rate reduces further.

LATEST HIV STATISTICS

According to the Kenya Aids Response Progress Report 2018, the HIV prevalence rate in Homa Bay stands at 20.7 per cent, up from 26.7 per cent in 2015, when it used to lead in the country.

It closely follows Siaya county, whose HIV prevalence rate stands at 21.0, against the national prevalence rate, which stands at 4.9 per cent.

Poverty, cultural practices, sexual attitude and behaviour, sex-for-fish culture and lifestyle-related factors have long been blamed as major contributors to the epidemic.

According to the Kenya HIV County Profiles 2018 (KHCP 2018 ), out of the 1,149,024 residents of Homa Bay, about 138,921 people are living with HIV.

The number represents 9.3 per cent of the total ( 1,493,382 ) number of people living with HIV in Kenya, in which women have a higher prevalence rate of 22.1 than men at 19.1 per cent, as compared to the national estimates, where women are at 5.2 and men at 4.5 per cent prevalence.

Some 10,722 children aged between 0-14 are reported to be living with HIV in the 2018 estimates, which represents 10.2 per cent of the total number of 105,213 children living with the virus nationally.

Health executive Richard Muga said this is still worrying, and more focus should be put on preventing mother-to-child transmission to tame the prevalence.

“In 2015, there were only 9,420 cases

recorded in the county. This represents an increase of 13.8 per cent,” he said.

By the end of 2017, about 7,021 pregnant women were in need of PMTC. About 6,304 of them received the services, yielding about 89.9 per cent PMTC coverage.

Between 2015 and 2018, the Mother-to-Child Transmission rate decreased from 16.8 to 8.1 per cent.

Cases of infected youths between 15-24 years of age dropped from 38,812 in 2015 to 19,050 in the 2018 annual estimates, which represent 10.3 per cent contributions to the national estimates.

EGPAF is running a programme dubbed “red carpet” in Homa Bay. They have constructed a friendly health facility and equipped and employed health personnel to offer youth-friendly services, which might have contributed to the positive change.

EGPAF country director Eliud Mwangi said they realised youths, who are the most vulnerable to HIV infections, were left behind in the fight against HIV.

“The project implements adolescent and youth-specific comprehensive linkage to care and early retention programmes, utilising interlinked facility and community-level components,” Mwangi said.

In 2015, 15,323 cases of adolescents living with HIV were realised, as compared to 10,463 cases in the 2018 annual estimates. This is a decrease of 31.7 per cent, equivalent to 9.9 per cent total contributions to the national estimates.

The KHCP 2018 report indicates that 10,624 new cases of new infections were recorded in 2015, as compared to 4,558 cases in the 2018 estimates, which is a reduction of 6,067 ( 57.1 per cent).

Some 3,307 succumbed to HIV-related illnesses in 2015, while 2,326 died in 2018, a difference of 981 ( 29.65 per cent)

VARIANCE REASON

Counties from the Nyanza region currently top the list of those leading in HIV infections, while others such as Mandera have low prevalence rates.

Ken Oluoch, a finance officer at the National Aids Control Council, said the variance in HIV prevalence is down to varying lifestyles in the counties.

He said each county has its own unique lifestyle that contributes to HIV infections.

“Stakeholders should identify these factors and decide on the best ways to tackle them to reduce the prevalence rate,” he said.

“At the NACC, we cannot give solutions to each and every county, since they have different unique challenges. It is up to the people on the ground to offer unique solutions to their unique challenges, while others focus on other health issues, while forgetting the pandemic,” he said.

He said Nyanza counties should now start focusing on boda boda operators, who make a larger population, and fishmongers, to create awareness by equipping them with the correct information concerning HIV and Aids.

Female sex workers (FSWs), men who have sex with men (MSMs) and people who inject drugs (PWIDs) have the highest risk of contracting and transmitting HIV, yet they also have the least access to prevention, care and treatment services due to stigma and discrimination.

According to the KHCS 2018 report, 1,463 FSWs, 38 MSMs and 105 PWIDs were tested in Homa Bay in 2018.

It is estimated that there exists 133,675 FSWs, 19,000 MSMs and 18,327 PWIDs in the country.

Oluoch said commercial sex business among women contributes to the rise of HIV infections. It depends on their client’s demands.

“In most brothels, the girl’s charges depend on whether it is with or without protection, which is far much expensive,” he said.

The officer suggested that sex education be introduced in schools and be taught to appropriate age groups, so children can grow having information on sexuality to reduce the percentage.

He called for 100 per cent condom programming in bars, brothels, learning institutions and even public offices, but it must first begin with people normalising condoms as a source of protection.

ART UPTAKE

Among the 128,199 adults in need of ART in Homa Bay, 78.5 per cent of them received the services in 2017, while of the 10,722 children in need of the services, 90 per cent of them were on ART services.

“Homa Bay is doing well in ART uptake against the national uptake, since in 2018 estimates, 78.5 per cent of those living with the virus are enrolled in the system, against national estimates that stand at 75.0 per cent,”Muga said.

He said factors essential to improving the health outcome and wellness of people living with HIV include timely HIV diagnosis, optimal linkage and retention in care of persons diagnosed with HIV, increased coverage of ART and viral suppression.

According to KDHS 2014, six per cent of women and 16 per cent of men in Homa Bay have never been tested for HIV.

By the end of 2017, 1,315,849 HIV tests were done in Homa Bay, where about 1,012,097 were from repeat testers (DHIS-2 )

County Medical Services director Dr Kevin Osuri said consistent proper use of condoms can reduce the risk of HIV and other sexually transmitted infections by more than 90 per cent.

In Homa Bay, about 48 per cent of men who had reported two or more sexual partners used a condom during their last sexual intercourse (KDHS 2014 ) by the end of 2017.

Some 7,185,600 condoms were distributed in Homa Bay, yielding to an average of 27 condoms per man ( 15-64 ) per year (LMIS-Kemsa 2017 )

Osuri added that medical male circumcision, which reduces the risk of female-to-male HIV transmission by about 60 per cent, also contributed to the decreased prevalence rate in the county.

Among men who participated in the 2014 KDHS, 56 per cent in Homa Bay reported to have undergone circumcision, whereas in 2017, 44,644 men were circumcised through the voluntary male circumcision programme (VMCC).

FACT SHEET

1,149,024: Population in Homa Bay

138,921: People living with HIV 20.0%: HIV prevalence rate

1,907: Adults above 15 years who succumbed to Aids-related illnesses ( 2018 estimates)

7,185,600: Condoms distributed by the end of 2017

4,558: Annual new HIV infections

Problems faced

Increased teenage pregnancies and early marriages

Stigma among adolescents and young people

Inadequate uptake of voluntary circumcision services by males above 25 years

Low male involvement in HIV care Late antenatal clinic attendance among pregnant mothers

Low health facility deliveries

Solutions

Programmes that target men, to increase their uptake in HIV testing

The Dreams project to empower teenage girls to ensure they are retained in schools

Advocacy to mobilise and improve social accountability

Programme on maternal, newborn, child and adolescent health