Marking 28th World Aids Day: The Road So Far

Today, on the first day of the month of December 2016, Kenya is joining the rest of the world to mark the 28th World’s AIDS Day, with the international theme of “Hands up for HIV for HIV Prevention”.

The theme is after looking at ways that will help improve prevention strategies and identifying key areas among specific groups of people who are vulnerable to transmission especially adolescent girls and young women.

There have been great milestones that have been achieved in reducing the number of new HIV infections and Aids-related deaths across the world, and especially in Kenya. Despite the fact that there are still new infections, the country is doing its best to ensure that it has achieved zero new infections, zero discrimination and zero HIV and Aids-related deaths.w

In a statement released ahead of World Aids Day 2016, Michel Sidibé, executive director of UNAIDS, said the world has committed to end the ongoing epidemic by 2030 and countries are increasingly working to stop transmission between mother and baby.

In November, UNAIDS released a report showing 18.2 million people are now on antiretroviral therapy. However, it found women aged between 15 and 24 were at great risk. For this reason, they called for a “life-cycle” approach, so prevention targets every stage of a person’s life.

The report showed more and more countries were getting on the Fast-Track – an initiative launched in 2014 that sets out plans to bring the Aids epidemic to an end by 2030. The latest report found that in the six months to June 2016, an additional million people had gained access to anti-retroviral treatment.

“We are winning against the Aids epidemic, but we are not seeing progress everywhere,” Sidibé said. “The number of new HIV infections is not declining among adults, with young women particularly at risk of becoming infected with HIV.”

“We know that for girls in sub-Saharan Africa, the transition to adulthood is a particularly dangerous time. Young women are facing a triple threat: a high risk of HIV infection, low rates of HIV testing and poor adherence to HIV treatment.”

He said co-infections such as TB, cervical cancer and hepatitis C mean the target of having fewer than 500,000 Aids-related deaths by 2020 “out of reach”. Indeed, women living with HIV are up to five times more likely to develop cervical cancer, while TB caused around a third of Aids-related deaths last year.

The first case of HIV in Kenya was detected in 1984, and by the mid-1990s it was one of the major causes of mortality in the country putting huge demands on the healthcare system as well as the economy. HIV prevalence peaked at 10.5 percent in 1996, and had fallen to 6 percent by 2013 mainly due to the rapid scaling up of antiretroviral treatment (ART).

Kenya has an average HIV prevalence rate of 6 percent and with about 1.6 million people living with HIV infection, it is one of the six HIV ‘high burden’ countries in Africa. The western part of the country through Homabay, Siaya and Kisumu are the most affected with HIV with rates of 25.7 percent, 23.7 percent and 19.3 percent respectively. The counties with the least infection rates are Wajir, Tana River and Marsabit with rates of 0.2 percent, 1 percent and 1.2 percent.

According to the UNAIDS Gap Report 2016, 1.5 million people were living with HIV in Kenya in the year 2015. The report further disclosed that there was 5.9 percent HIV prevalence among Kenyan adults. Women in Kenya, with a HIV prevalence rate of 7.6 percent are more vulnerable to HIV infection compared to men, with a HIV prevalence rate of 5.6 percent.

Even as the prevalence of the virus continues to decline among the general adult population, hyper-epidemics persist in parts of the country and among certain groups such as sex workers, men who have sex with men and people who inject drugs. Nearly one in three persons newly infected with HIV is a teenager or youth, aged between 15-24 years. Teenage girls and young women are contributing an increasingly large share of new infections.

In recent years, HIV testing and counselling (HTC) has been a major feature of the HIV response in Kenya. The country has adopted a number of strategies including provider initiated testing and counselling (PCT), outreach testing and counselling, home-based testing and counselling (HBT) as well as the integration of HTC in antenatal care, sexually transmitted infections (STI) and sexual and reproductive health services. As a result, there has been dramatic progress in terms of the number of people getting tested for HIV.

Kenya is widely regarded as one of sub-Saharan Africa’s HIV prevention success stories. Annual new HIV infections are less than a third of what they were at the peak of the country’s epidemic in 1993, and as a country, we have reasons to celebrate the great miles hat we have been able to come in terms of HIV prevention and eradication.

The National AIDS Control Council (NACC). a body responsible for coordinating the response to the HIV epidemic in the country has put in place the AIDS Strategic Framework 2014/15-2018/19, which sets out four objectives over its five-year duration:

• reduce new HIV infections by 75 percent
• reduce AIDS-related mortality by 25 percent
• reduce HIV-related stigma and discrimination by 50 percent
• increase domestic financing of the HIV response to 50 percent.

In recent years, Kenya has made huge strides in tackling its HIV epidemic and has been pioneering in the provision of HIV prevention. However, current efforts are not reaching all of those who need these services. As a result, concentrated epidemics are emerging among vulnerable groups. Prevention initiatives need to target these groups as part of wider efforts to stem the HIV epidemic in Kenya.

There are still an unacceptable number of people who do not know their HIV status. The scale up of HIV testing is vital in order for people to learn their HIV status and be referred onto the appropriate treatment, care and support.

However, in order to get more people in Kenya to test for HIV, as well as an increase in the provision of HIV services, a number of social, cultural and legal barriers need to be overcome which prevent many people, particular those belonging to key affected groups from accessing them.

The Kenyan government needs to work to develop sustainable methods of funding to sustain and scale up existing prevention efforts and to reduce the country’s reliance on external funding from international donors.

Below are a number of facts about HIV with data from National Aids Control Council (NACC), National Aids and STI Control Programme (NASCOP) and the World Health Organisation (WHO).

Just who is affected?

1. An estimated 1.6 million people, or roughly four per cent of the population, are living with HIV in Kenya.
2. Every year an average of 89,000 adults and about 11,000 children in Kenya are infected with HIV.
3. About 11,000 Aids-related deaths, a quarter of total deaths occur among children.

Are Kenyans being tested and treated?

1. From the Kenya Aids Indicator Survey 2012, more than half of Kenyans living with HIV did not know their HIV status; 16 per cent had never tested (or received test results if tested) and 37 percent believed they were negative based on self-reporting.
2. Over 680,000 persons living with HIV, including 60,000 children aged 0-14 received antiretroviral treatment.
3. More than 70 percent of HIV-positive pregnant women received antiretroviral prophylaxis to prevent transmission to their new born

Who is most at risk from HIV?

1. At more than 10 percent, HIV prevalence is highest among women and men aged 25 to 44.
2. AIDS is the leading cause of death and illness among adolescents and young people in Kenya: 9,720 adolescents and young people died of AIDS in Kenya in 2014.
3. About 16 percent of people living with HIV are teenagers and youth.
4. Nearly one in three persons newly infected with HIV is a teenager or youth, aged between 15-24 years.
5. Young women are particularly at risk with those aged 15 – 24 years contributing to 21 per cent of all new infections in Kenya.

How are people being infected?

1. Condom use among people with multiple sexual partners is less than 40 percent.
2. One in six men who have sex with men and people who inject drugs are HIV positive.
3. About 30 percent of the more than 130000 sex workers in Kenya are living with HIV. This is equivalent to more than 38,000 people.
4. Due to a fast-track programme targeting sex workers, incidence of sexually transmitted infections dropped from 27 per cent among those screened in 2013 to just three per cent in 2015.

Where in Kenya is HIV most prevalent?

1. About 65 per cent of new HIV infections in Kenya occurred in nine counties: Bomet, Homo Bay, Kisii, Kisumu, Migori, Nakuru, Nyamira, Siaya and Turkana.
2. Homa Bay has an HIV prevalence of about 26 per cent, it is followed by the counties of Siaya with 24 per cent. In other words, in the two worst hit counties, one in four residents is living with HIV. 
3. The county of Wajir has an HIV prevalence of 0.20, the lowest in the country, followed by Tana River with 1.00 per cent.

What global efforts are in place to control HIV?

1. In 2015, Cuba was the first country declared to have eliminated mother-to-child transmission of HIV.
2. The world has committed to end the spread of Aids by 2030 as part of the Sustainable Development Goals.