We’ve made significant progress in prevention
Question: What significant progress has the country made in curbing spread of HIV?
Answer: Based on the previous Kenya Aids Strategic Framework 2014-2020, the national prevalence has reduced from 6.04 per cent in 2013 to 4.24 per cent in 2021.
Further, incidence levels have reduced from 3.9 per 1,000 persons to 0.93 per 1,000 by 2021 and Aids-related mortalities reduced from 58,446 in 2014 to 19,486 in 2021.
Against what targets?
The country targeted to achieve up to 90 per cent of People Living with HIV/Aids (PLHIV) who know their HIV status, the country achieved a 96 per cent by 2020. Eighty-six per cent of PLHIV on ART was achieved in 2020 up from against a target of 90 per cent by 2020.
The country also targeted to achieve a 95 per cent on the retention levels on ART at 12 months, but has only 90 per cent, with an 81 per cent level of suppressed viral load against a target of 90 per cent. There is still no data on late HIV diagnosis, and this is area the national and county governments need to invest in.
On the mother-to-child transition, the county has achieved 9.7 per cent up from 11.7 per cent in 2018. However, this is below the global target of less than five per cent transmission.
The HIV testing in pregnant women increased from 76 per cent in 2018 to 84.3 per cent in 2020, though below the targeted 90 per cent.
Division, disparity and disregard for human rights are listed as an obstacle. How have we adressed this?
At the national level, Kenya’s commitment to combat violence against women and girls, eradicate child marriage and teen pregnancy is evident from the domestication of various regional and international conventions, treaties and human rights standards and programmes of action that seek to prevent or eradicate gender inequality and discrimination which are the major causes of gender-based violence.
The political will to fight gender-based violence is evident from the raft of national laws and policies on that place an obligation on public authorities to implement measures to address violence against women and girls.
These laws and policies are spread across different sectors which include but are not limited to education, the criminal justice system, the judiciary and health.
In 2011- Kenya established the first HIV tribunal to facilitate access to justice for PLHIV and guard against institutionalised discrimination based on HIV status.
The human rights approach that had been achieved to facilitate access to services for PLHIV, key populations and other priority groups in all sectors have been enhanced with the number of cases at the HIV tribunal current at 35 by 2020 from 0 cases in 2013.
Further, scaling up of the sensitisation on violence and human rights, reporting of violence has also increased and so has the response and support to those who report.
Overall, as at 2020, 89 per cent, 93 per cent and 94 per cent of cases of violence reported against Female Sex Workers (FSW), men having sex with men (MSM) and People Who Inject Drugs (PWID)were responded to.
There has been almost double increase in contacts for FSW from 90,653 in 2013 to 161, 346 in 2020; six-fold increase in last eight years (9,626 in 2013 to 65,070 by 2020) in the MSM Programme and an increase contacts from 5,309 in 2013 to 23,048 in 2020 for the PWID Programme.
Under the Medically Assisted Therapy (MAT)- the Opioid Substitution Therapy for PWID-, there are seven MAT sites providing methadone to PWID, including clinics within prisons.
As at 2020, 7,219 clients have in initiated on programme, representing 28 per cent of estimated population. For transgender people, the programme begun implementation and reporting in 2020. During the year, out of the estimated 4,307 transgender people, 601 (14 per cent) were contacted.
Some obstacles faced include stigma and discrimination from society, violence from police and community on key populations especially sex workers, constant and intermittent incarceration of key populations, which affects MAT and HIV prevention, as well as overdose in PWIDs after incarceration.
The legal environment in the counties and national level to facilitate access to health services by the key and vulnerable populations is also another structural gap.
In what respect has Covid made the lives of PLHIV more challenging?
Covid-19 affected both lives and livelihoods: social economic and structural factors, including poverty, unemployment, loss of income, crowded housing conditions and lack of clean running water increased vulnerability of PLHIV and their ability to prevent exposure to Covid-19. Distribution of food and nutrition supplements to PLHIV and other vulnerable households cushioned them from this effect.
Some of the key services the pandemic interrupted include HIV testing. Analysis shows that during the peak of the four Covid-19 waves, there was a decline in the number HIV test undertaken.
There was disruption in programmes to prevent mother-to-child transmission, which could increase HIV infections among children. Disruption in HIV treatment could result in increased AIDS related deaths.
How have you responded to the challenge?
Kenya has made progressive steps towards managing the two viruses (HIV and Covid -19) through continuity of services (HIV Testing, Viral Load Monitoring, Treatment) at health facilities; scheduled and staggered appointments at facilities to avoid crowding; dispensation of multi-month drugs for Kenyans living with HIV covering three to six months through the differentiated service delivery models.
This reduced frequent visits to health facilities; distribution of community centred tools such as HIV self-testing kits that allow people to know their status in the privacy of their home and cash transfer to vulnerable households to mitigate the effects of Covid-19. Among beneficiaries were people with chronic illness including HIV.
Others include mainstreaming, integration and scale up youth friendly SRH and HIV services, and coordinate transition to adult services; use of community workers to deliver essential prevention and treatment services and provided peer support to individual households and clients
Kenya HIV estimates 2018 report indicated a general HIV financing decline. When did the rain start beating us?
The government target to achieved domestic financing was 50 per cent by 2020. This was advised by the country transitioning from Lower Income to Lower Middle Income Country, which could result to decline in donor support, and thus the country should transition to domestic financing more to its strategic commodities.
Transition is a process, and the country is prepared to achieve the same. Currently, the government is preparing a transition roadmap to domestic financing.
However, it has increased its domestic financing for the HIV programmes to 32.34 per cent of the total HIV expenditures up from 26 per cent in 2016.
The possible consequence is lack of essential and strategic commodities for HIV programmes, which are currently estimated at Sh25 billion.
There could also be an effect on prevention programmes that may be key in reducing new infections.
This calls for multi-sectoral support and interventions to the domestic financing for HIV, especially from the private sector.