BY PATRICK NGENOH.
Kenya has the joint fourth-largest HIV epidemic in the world alongside other countries with 1.9 million people living with HIV in 2018. In this year, 36,000 people died from AIDS-related illnesses, while this is still high it has declined steadily from 64,000 in 2010.
According to Dr Geoffery Langat the first case of HIV in Kenya was detected in 1984. By the mid-1990s, HIV was one of the major causes of illness in the country, putting huge demands on the healthcare system as well as the economy. In 1998, 10.8% of Kenyans were living with HIV, although prevalence has almost halved since then, standing at 6.2% by 2015. This progress is mainly due to the rapid scaling up of HIV treatment and care. In 2016, 64% of people living with HIV were on treatment, 51% of whom were virally suppressed.
Kenya’s HIV epidemic is driven by sexual transmission and is generalised, meaning it affects all sections of the population including children ,
young people , adults, women and men.
"As of 2015, 660,000 children were recorded as being orphaned by AIDS. However, a disproportionate number of new infections happen among people from key populations . In 2014, it was estimated that 30% of new annual HIV infections in Kenya are among these groups," He says.
"Geographic location is also a factor, with 67% of all new infections occurring in nine out of the country’s 47 counties – mainly on the west coast of Kenya. . In particular, new HIV infections in major cities Nairobi and Mombasa increased by more than 50% (from a collective total of 4,707 in 2013 to 7,145 in 2015). As a result, HIV prevalence ranges from from 0.1% in Wajir to 25.4%in Homa Bay," Langat adds.
Sex workers have the highest reported HIV prevalence of any group in Kenya. The most recent data from 2011 estimates 29.7% of female sex workers are living with HIV. Similarly, a 2015 study of female sex workers in Nairobi found that around one-third were living with HIV.
“They said that I was careless and irresponsible that’s why I got infected. They had refused to attend to me and I was in so much pain. The doctor refused to take me to theatre saying that he can never touch a person with HIV he also said that he is very sure that the child I am carrying is also positive,"
Mr Langat further said, Female sex worker from Kenya in 2015 study led by GNP+ found Kenyan sex workers face heightened risk of violence with little or no protection from law enforcement officers. For example, whilst all respondents who had experienced rape had accessed post-rape medical care, none had reported the incidents to the police for fear of being prosecuted for engaging in sex work. For those sex workers living with HIV, frequent arrests and detention result in an interruption of HIV treatment.
Mr Langat said despite this, female sex workers are reportedly better at protecting themselves from HIV transmission compared to other groups who are vulnerable to HIV such as men who have sex with men. This may be due to the fact that 86% of sex workers are estimated to be able to access HIV services, higher than among other key population groups.
"Condom use is high, estimated at just under 92%, with 330 condoms distributed to each sex worker enrolled in HIV prevention programmes in 2016. Antiretroviral treatment coverage is also high at 79.7% among those aware of their status," He mentioned.
Mr Langat mentioned out a statement shy away by many said Men who have sex with men (MSM) and HIV in Kenya,
HIV prevalence among men who have sex with men (sometimes referred to as MSM) in Kenya is almost three times that among the general population. The most recent data from 2010 estimates HIV prevalence among men who have sex with men at 19.3%.
"Condom use among men who have sex with men has been rising. In 2016, 80% of men who have sex with men reported using a condom the last time they had anal sex , up from 55% in 2011.Homosexuality is illegal in Kenya and can carry a prison sentence of up to 14 years. This, coupled with entrenched social attitudes, leads to high levels of stigma and discrimination towards men who have sex with men as well as people who are lesbian, gay, bisexual and transgender (LGBT), deterring many people from seeking the HIV services they need. As a result, programming and policy to address the HIV epidemic among Kenyan men who have sex with men has lagged behind,"He said as he fears to say much about it.
He said In 2013, a group of Kenyan civil society organisations presented a report to the Committee Against Torture stating that people who are LGBT in Kenya face constant harassment, violence and death threats by police officials, who also blackmail them with threats of arrest if they refuse to pay bribes.
"Although such harassment still exists, there have been an increasing number of court rulings in the favour of LGBT communities, for example in 2015 the high court ruled that the ‘National Gay and Lesbian Human Rights Commission (NGLHRC)’ could formally register their organization with the Non-Governmental Organizations coordination board," He said.
Originally, their request to join had been rejected as their organisation was seen as ‘unacceptable’ and at odds with the illegal status of homosexuality in Kenya.
People who inject drugs and HIV in Kenya.
In 2011, an estimated 18.3% of people who inject drugs (sometimes referred to as PWID) in Kenya were living with HIV.
The majority of people who inject drugs are concentrated in specific geographical areas such as Nairobi and Mombasa.
"Condom use amongst people who inject drugs is increasing, rising from 24.7% in 2011 to 70.3% in 2015. The introduction of harm reduction services since 2012 is also helping to address unsafe injecting practices, and in 2016, UNAIDS found nearly 90% of people who inject drugs had used a clean syringe last time they injected, compared to 51.6% in 2012," He said.
Young people in Bomet county is More than (6%) of all new HIV infections in Bomet in 2015 occurred among adolescents and young people (aged 15-24 years), a rapid rise from 8% in 2013. Many of these infections will have occurred among young key populations.
Young women are almost twice as likely to acquire HIV as their male counterparts, and accounted for 13% of the total number of new infections (9,312) in 2015. In comparison, young men accounted for 6% of all new HIV infections (5,464).
"A number of factors contribute to the increasing rate of HIV infection among young people including incorrect perception of HIV risk; and having unprotected sexual intercourse under influence of alcohol or drugs," he adds.
Forced sex and sexual violence also increase young people’s vulnerability to HIV. This particularly affects young Bomet women who are three times more likely to be exposed to sexual violence than young Bomet men. It is estimated that 33% of girls in Kenya have been raped by the time they reach the age of 18, with 22% of girls aged 15-19 describing their first experience of sexual intercourse as forced.
In 2016, women accounted for 9000 of the 23,456 people living with HIV in Bomet county.
Langat said as in many parts of the country women face discrimination in terms of access to education, employment and healthcare. As a result, men often dominate sexual relationships, with women not always able to practice safer sex even when they know the risks.
"For example, in 2014, 5% of adult women (aged 15-49) who were or had been married had experienced spousal violence and 4% had experienced sexual violviolence in targets set for the next strategic period aim to reduce new infections in women by 10% and eliminate unmet family planning needs among this group. They also aim to reduce gender-based violence by 10%," He said.
According In April 2018, the nongovernmental organization Women Fighting AIDS in Kenya ,held a two-day workshop on advancing the sexual and reproductive health and rights of women living with HIV. The workshop provided more than 30 women with the chance to meet representatives of government, civil society and the United Nations to have their say on how to provide sexual and reproductive.
“What stood out for me was the message that as women living with HIV we need to accept ourselves and love ourselves first and as a result we will be able to fight for our rights.” said Joyce kirui who is a doctor dealing patients living with HIV AIDS in Bomet county.
According to Langat More than (3%) of the 23,456 million people living with HIV in Bomet are unaware of their HIV status. HIV testing and counselling (HTC) has become a major feature of Kenya’s HIV response. This is in part a response to the large number of HIV sero-discordant couples, in 2012 it was estimated that there were 5,000 sero-discordant couples in Bomet (when one partner is HIV negative and one is positive). These couples significantly contribute to new infections, especially when individuals are unaware of their status.
"The country has adopted a number of innovative approaches to HIV testing in recent years, including targeted community-based HIV testing, door-to-door testing campaigns, and the introduction of self-testing kits. These efforts have led to a dramatic rise in the number of people testing for HIV. In 2008, 4,000 people were being tested annually for HIV. By 2015, this had increased to 7,320," Langat mentioned.
Langat said there remains a significant disparity between men and women. In 2014, 5% of women had tested for HIV in the past 12 months and received their results, compared to 4% of men. To address this, there has been a concerted effort to increase testing rates among Kenyan men, with community-based testing programmes proving particularly successful. One such approach is to give home-based testing kits to pregnant women to pass on to their male partners. One study found this achieved 91% testing coverage in male partners within three months, compared to 51% among men who were invited to take a test at a clinic.
"Like HTC coverage among the general population, testing rates among pregnant women have risen substantially. Between 2009 and 2013, the number of pregnant women tested for HIV increased from 68% to 92%.
In May 2017, the Kenya government introduced self-testing kits, as part of their ‘Be Self Sure’ campaign. The kits are now available to buy from pharmacies across the country for around US$8 each. Recent studies have shown a high-demand for self-testing among people in Kenya but for some the price of tests will be a barrier," Mr langat adds.
HIV prevention programmes in Bomet
is widely regarded as one of sub-Saharan Africa’s HIV prevention success stories Mr Langat said, annual new HIV infections are less than a third of what they were at the peak of the country's epidemic in 1993. In 2016, there were an estimated 62,000 new HIV infections in Kenya, following a trend of falling figures year on year since 2013 when 100,000 new infections occurred. Impressive gains have been made in particular areas, with 16 counties reducing their number of new HIV infection by more than 50%.
"This reduction has been driven by the National AIDS Control Council (NACC), the body responsible for co-ordinating the HIV response in Kenya. In 2013, NACC launched the Prevention Revolution Roadmap to End New HIV Infections by 2030. Linked to this, the Kenya AIDS Strategic Framework (KASF) 2014/15-2018/19 outlines how the first phase of the roadmap will be implemented. KASF aims to reduce new infections by 75% through a combination of biomedical, behavioural and structural interventions," He adds.
Condom availability and use in Bomet county, the Kenyan government has only actively promoted the use of condoms since 2001, but distribution has substantially increased year on year. In 2013, around 37 million free condoms were distributed.
"Condom use appears to be increasing. The 2014 Kenya Demographic and Health Survey (KDHS) reported just 40% of women and 43% of men who had two or more partners in the last 12 months used a condom the last time they had sex. However, data published by UNAIDS in 2017 indicates 73% of men and 55% of women used a condom the last time they engaged in sex with a non-marital, non-cohabiting partner," langat said.
HIV education and awareness is an important component of HIV prevention in BOMET county. HIV education has been part of the school curriculum in Kenya since 2003. The most recent HIV education policy, published in 2013, includes education about HIV prevention, care and support for school pupils and education personnel like teachers.
"Knowledge of HIV prevention among young people is increasing. In the 2008 KHDS, 4% of young women and 5% of young men demonstrated adequate knowledge of HIV prevention, compared to 3% of young women and 2% of young men in 2014," he adds.
Teaching young people about HIV and sexual health remains controversial. KDHS 2014 found 4% of adults were against educating young people about condoms. Many cited fear of encouraging young people to have sex as a reason.
Antiretroviral treatment (ART) in Bomet county, In 2015, Kenya adopted the World Health Organization’s recommendations to immediately offer treatment to people diagnosed with HIV.
As a result, in 2016, around 5,000 adults and 6,000 children were accessing antiretroviral treatment (ART). This equates to 64% of adults who are in need of treatment receiving it, and 65% of children.
"Men living with HIV are significantly less likely to be on treatment than women. The most recent statistics showed that only 58% of men accessed treatment, compared to 68% of women. ART coverage is markedly lower among key populations, ranging from 6% among men who have sex with men to 34% among female sex workers," he said.
He further said In 2015, 81% of people initiated on treatment were still in care after 12 months, an improvement on the 2013 retention rate, which stood at 70%.
Of those people on treatment in 2015, 64% were virally suppressed, which equates to 51% of all people in Kenya living with HIV. This is when treatment has suppressed the level of HIV in someone’s body to the extent that their health is in good condition and HIV will not be transmitted to others.
"Initiating and staying on treatment is particularly problematic for adolescents and young people. In 2014, only 34,800 out of 141,000 adolescents (aged 10-19) with a known HIV positive status were on ART, of whom 22,600 were virally suppressed. AIDS remains the leading cause of death among adolescents and young people in the country with 9,720 adolescents and young people dying from AIDS-related illnesses in 2014," He said.
According to Langat Poor adherence to treatment can also lead to increased drug resistance. Drug resistance monitoring tests are not routinely performed in Bomet county, so assessing levels of drug resistance in the country is difficult. In a recent study sample transmitted drug resistance of at least one type was recorded in 9.2% of cases. This is where patients have been infected with a form of HIV already resistant to some medications, which can make treatment options more limited before they have even started ART.
"Barriers to the HIV response in Kenya
Kenya has demonstrated commitment in providing an enabling legal, social and policy environment at the national and county level to reduce barriers to health services for people living HIV. The country established the first HIV tribunal in the world to increase access to justice related to HIV issues," he adds.
HIV stigma and discrimination in Bomet is still high, Although awareness of HIV and AIDS is comparatively high in Kenya, and there have been countrywide anti-stigma campaigns, many people living with HIV continue to face high levels of stigma and discrimination Langat said, this deters many people living with HIV - particularly vulnerable groups - from seeking vital HIV services.
"Attitudes towards people living with HIV are measured by the Kenya Demographic and Health Survey. The 2014 results - the most recent available – found 34% of men and 26%of women expressed wholly accepting attitudes towards people living with HIV, levels that were slightly lower than in the 2008 survey when 40% of men expressed wholly accepting attitudes and 30% of women did," he adds.
It is very unfortunately people most at risk of HIV still face stigma, discrimination and violence. This adds to their vulnerability. Research from 2014, shows that 44% of female sex workers, 24% of men who have sex with men and 57% of people who inject drugs were beaten up in urban centre where they are there.
“ Some of them are calling us lesbians, simply for attending to MSM, but I am not a lesbian, so I don’t care. ”
Female counsellor, age 57 years legal and structural barriers, Homosexuality is currently criminalised in Kenya. Between 2010-2014, the Kenyan government prosecuted 595 cases of homosexuality," a victim said.
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