As a result, the prevalence rate dropped from 10 per cent in the 1990s to 4.9 per cent in 2008. HIV/Aids workplace policy has been developed to provide support to the affected and to intensify prevention and advocacy activities at all levels.
History of HIV and Aids in Kenya
Between 1983 and 1985, 26 cases of AIDS were reported in Kenya. Sex workers were the first group affected – a study from 1985 reported a HIV prevalence of 59 percent amongst a group of sex workers in Nairobi.
Towards the end of 1986 there were an average of four new AIDS cases being reported to the World Health Organization each month. This totaled to 286 cases by the beginning of 1987, 38 of which had been fatal.
One of the Kenyan government’s first responses was to publish informative articles in the press and to launch a poster campaign urging people to use condoms and avoid indiscriminate sex. A year later in 1987, the Minister of Health announced a year-long health and education programme, funded by a £2 million donation from Western countries.
By 1987 HIV appeared to be spreading rapidly among the population – an estimated 1-2 percent of adults in Nairobi were infected with the virus, and HIV prevalence among pregnant women in the capital had increased from 6.5 percent to a staggering 13 percent between 1989 and 1991.
Estimated National HIV Prevalence in Kenya: Sentinel Surveillance 1990 – 2006
The government was criticized for not responding aggressively to the emerging epidemic, unlike governments in its neighboring countries, such as Uganda. The government was also accused of playing down the threat of AIDS because of the damage it could do to Kenya’s tourism industry.
By 1994 an estimated 100,000 people had already died from AIDS15 and around 1 in 10 adults were infected with HIV.
In a speech at an AIDS awareness symposium in 1999, Kenyan President Daniel Arap Moi declared the AIDS epidemic a national disaster and announced that a National AIDS Control Council would be established imminently. Critics argued that in the speech the President failed to promote the use of condoms as a preventative measure and a way forward for tackling the epidemic. However, at the end of 1999 President Moi broke his silence surrounding condoms and declared in a speech to students at the University of Nairobi:
“The threat of AIDS has reached alarming proportions and must not be treated casually; in today’s world, condoms are a must.”
Estimated National HIV Prevalence in Kenya: Sentinel Surveillance 1990 – 2006
In 2000 plans were drawn up to build a condom factory in Nairobi, with the aim of producing 100 million condoms a year. However, by 2001 the company planning the build moved its project to South Africa, apparently due to excessive government regulations and a lack of responsiveness.
HIV prevalence began to decline from its peak of 13.4 percent in 2000 and continued to decrease steadily to 6.9 percent in 2006.
The decrease in prevalence coincided with the rapid expansion of preventative interventions since 2000, which resulted in a change in sexual behaviour and the increased use of condoms. The decline has also been attributed to the large number of people dying from AIDS in Kenya, which totalled 150,000 in 2003 alone.
Kenya is among the world’s largest HIV and AIDS stricken country. It is estimated that about 1.5 million people are living with HIV, 1.2 million children have been orphaned by it and in the year 2009, 80,000 Kenyan citizens died from AIDS related illnesses.
According to the UNGASS country report of 2010, Kenya’s HIV prevelance peaked during the year 2000 and had been on the decline to 6.3% due to an increase in awareness and education. Still many people are not being reached with HIV prevention and treatment services even with the steady increase in access of services. In 2008/2009, HIV prevelance among women was twice as high than that for men at a figure of 8% and 4.3% respectively.
This unproportionality is even greater among young women aged 15-24 who research show are four times more likely to become infected than men of the same age group. This phenomena has been linked tpo the fact that Kenyan women experience high rates of violent sexual contact, which is thought to contribute to the higher prevalence of HIV.
HIV prevention in Kenya
Following a study in 2009 by National Aids Control Council and UNAIDS, it was identified that the epidemic was changing and that transmission between discordant couples, where one partner is positive and one partner is negative, accounted for the majority of new infections. As a result, prevention for positive people is to be a central element of Kenya’s new approach to prevention which will, among other approaches, include couple-based testing and encourage partner disclosure and condom use.
HIV testing. HIV testing has widely expanded across Kenya since the beginning of the millennium. In 2000 there were only three voluntary counselling and testing (VCT) sites nationwide; by 2007 there were almost 1000. HIV testing and counselling facilities increased to 4,438 in 2010. Alongside voluntary testing, provider initiated counselling and testing (PCT) has expanded and is now available in 73 percent of health facilities. PCT is when individuals are offered a HIV test whenever they go to a health facility, rather than patients having to ask for a test.
Condom use.The Kenyan government has only actively promoted condom use since 2001, when an estimated 12.8 percent of its population were infected with HIV. That year, the government announced its intention to import 300 million condoms. Since then, condom distribution has been radically scaled up; 10 million were distributed in 2004 and 124.5 million in 2008.
Education and awareness. HIV and AIDS education is an essential part of HIV prevention. In Kenya AIDS education is part of the curriculum in both primary and secondary schools, and for a number of years Kenya has delivered educational campaigns to raise nationwide awareness of the issue. As a result, awareness about HIV and AIDS in Kenya is high. In Kenya’s national, population-based survey, nearly all adults aged 15-64 had heard about AIDS, 90 percent knew that a healthy-looking person could be infected with HIV, and most knew how to reduce their chances of becoming infected with the virus. Awareness of the need to use condoms was high with 75 percent of women and 81 percent of men in this age group aware that condoms reduce the risk of HIV infection.
Preventing mother-to-child transmission (PMTCT). Since 2000 PMTCT efforts in Kenya have rapidly expanded. There are now more than 3,397 health facilities offering PMTCT services. In 2010 an estimated 83 percent of pregnant women were tested for HIV and 43 percent of pregnant women living with HIV received the most effective antiretroviral regimen for preventing the transmission of HIV to their babies. Whilst only half of HIV-exposed infants received ARVs for PMTCT in 2009, testing of HIV-exposed infants improved in 2010 with 64 percent tested by 2 months of age.
Harm reduction and needle exchange services. HIV transmission through injecting drug use is a growing problem, particularly in the capital and in coastal areas. HIV prevalence among injecting drug users (IDUs) reached 21 percent in 2010 and in Nairobi around 1 in 3 IDUs are infected with HIV. Even where IDUs in Kenya know how HIV can be transmitted, needle sharing and unprotected sex is commonplace. Up to 4 percent of all new infections are as a result of injecting drug use. Although Kenyan drug laws and government policy have hindered the prevention of new infections among IDUs, there has been a recent change of view in the Kenyan government. This follows a similar turnaround by the American initiative PEPFAR (the largest foreign funder of HIV and AIDS programmes in Kenya), which now supports a variety of harm reduction approaches to HIV prevention among IDUs.
HIV/AIDS treatment in Kenya
In 2003 only 5 percent of people needing ART were receiving antiretroviral therapy. In 2006 Kenya’s President announced that antiretroviral drugs would be provided for free in public hospitals and health centres. In 2007 treatment coverage was low at 42 percent with only 172,000 on treatment. Nevertheless, by 2009 the number of people receiving antiretroviral therapy had significantly increased to 336,980. However, due to a 2010 change in WHO treatment guidelines, which recommend starting treatment earlier, the proportion of people eligible to receive antiretroviral treatment remained at only 48 percent. Under the previous guidelines, treatment coverage would have been 65 percent. By 2010, access to treatment had increased further with 432,621 receiving treatment, around 61 percent of those in need.
Due to the expansion of treatment, the number of people that have died from AIDS has declined since its peak in 2003. In 2011 a Kenyan pharmaceutical company was given the green light by the WHO to start producing antiretroviral drugs. This could result in significant savings for the government’s treatment programme, as ARVs currently have to be imported from India.
Around half of those infected with tuberculosis (TB) are co-infected with HIV in Kenya, although this varies widely according to region. Antiretroviral treatment for co-infected individuals has been found to improve patient survival if it is administered as soon as possible after TB treatment. Therefore, WHO recommend antiretroviral therapy for all HIV and TB co-infected patients, whatever the stage of HIV progression. However, facilities where dual treatment is available are limited and many of those who require ARVs alongside TB treatment are not receiving it.
Despite an increase in access to HIV treatment for children, the overall coverage for children remains extremely low. Of those receiving treatment, most are adults with 74 percent of adults in need of treatment receiving it. In contrast only 21 percent of children living with HIV in need of treatment are receiving it. A child’s access to treatment can sometimes be inhibited by reasons other than the reach of treatment services. According to Human Rights Watch reasons for this include: neglect on part of the children’s caregivers; a lack of accurate information about medical care for children; and the stigma and guilt associated with HIV and AIDS.
Source: Women Fighting AIDS in Kenya
HIV stigma and discrimination in Kenya
Even though awareness of HIV and AIDS in Kenya is high, many people living with the virus still face stigma and discrimination. Studies have shown that although people are aware of the basic facts about HIV and AIDS, many are not informed of the more in-depth knowledge that addresses issues of stigma.
One report revealed that only a third of healthcare facilities that have policies to protect people living with HIV against discrimination were actually implementing such policies. People are still afraid to disclose their status and will often avoid health centres that provide HIV services, from fear of being seen by neighbours or community members.
HIV funding in Kenya
In 2008/09 total funding for HIV/AIDS in Kenya amounted to $687 million. Funding comes from a range of donors, the most significant of which is the U.S. government. In FY 2009 funding from the U.S. President’s Emergency Plan for AIDS relief (PEPFAR) amounted to $541.5 million. The Global Fund is the second largest contributor to HIV/AIDS funding in Kenya, having distributed $87,417,519 in total.
Corruption is a major deterrent to donors and a lack of transparency of the distribution of funds may result in donors withholding funding. In 2009 Kenya was ranked in the bottom third of countries worldwide for corruption (146 out of 180). These problems have directly affected the influx of funding, as in 2003, 2008 and 2009 the Global Fund delayed and refused applications for funding to Kenya. It has been suggested a lack of clarity and accounting problems were the cause of Kenya’s most recent grant refusal in 2010. Other sources have attributed the refusal to rivalries between the ministries of Medical Services and Public Health who are dually responsible for the management of donor funds. The effects of the Global Fund’s rejection of recent applications will inevitably be felt by future programmes.
The flat-lining of PEPFAR funds also raises financial concerns for the future as funds will be fixed whilst costs continue to increase with inflation. With funding shortfalls already calculated to be around $1.7 billion by 2013 for HIV prevention, treatment and care, the need for sustainable funding for HIV and AIDS in Kenya has become increasingly apparent.
The Kenyan government have pledged to address their HIV funding crisis by focusing on past and present shortfalls in financial management, tracking and transparency. In addition, Michel Sidibe, executive director of UNAIDS, has identified Kenya’s need to achieve financial sustainability for its AIDS programmes through domestic funding. The government of Kenya has pledged $34 million annually for five years to go towards HIV and AIDS programmes. However, external sources continue to account for 85 percent of all HIV funding.