Toward an AIDS-Free Generation: Kenya Makes Progress, More to Do

Toward an AIDS-Free Generation: Kenya Makes Progress, More to Do

 {Photo credit: MSH}Kenyan youth holds AIDS education pamphlet.Photo credit: MSH

The Kenya National AIDS and STI Control program (NASCOP) under the Ministry of Health (MOH) disseminated preliminary results of the Kenya AIDS Indicator Survey (KAIS) 2012 on September 10, 2013. The dissemination conference was attended by all major stakeholders in the HIV and AIDS response in Kenya, including Management Sciences for Health (MSH).

The second such report, the KAIS 2012 (PDF) provides national data in comparison with the first survey in 2007.  Overall, huge improvements have been made, despite the remaining challenges and the gender, age group and geographical disparities that have persisted.  Adult HIV prevalence dropped from 7.2 percent in 2007 to 5.6 percent in 2012. The total number of people living with HIV is now estimated at 1.2 million, down from 1.4 million in 2007. Among children 18 months to 15 years, the prevalence was estimated at less than one percent (0.9 percent), which translates into about 104,000 children living with HIV in 2012. 

Other major achievements have included more awareness of HIV in the general population and among people living with HIV. The percentage of people who know their HIV status rose from 34 to 72 percent; and people living with HIV who know their status increased from 16 to 47 percent. About 88 percent of HIV-positive pregnant women know their status. 

Of men and women who know their HIV status and are eligible for treatment, about 90 percent are on treatment. (Overall, only 60 percent of people living with HIV who were eligible for treatment were actually on treatment.)

The demographics of the epidemic are changing. The peak has shifted from a 25-34 year age group to a 45-54 year age group. This is a significant shift that has happened in just 5 years.  There has also been an increase in the uptake of prevention of mother-to-child transmission (PMTCT) and other services such as voluntary counseling and testing, care and treatment, and voluntary male medical circumcision. 

While these changes and improvements are significant, HIV is still a huge threat in the country and Kenya remains among the most HIV-burdened countries in the world. 

No more business as usual 

The AIDS survey has implications for future HIV programming. Close to 40 billion Kenya Shillings is spent on fighting the epidemic annually and these investments are beginning to pay off.  But, the HIV epidemic in Kenya has reached a point when incremental improvements will become harder. It is critical that the achievements outlined in the KAIS are not reversed, as has been the case in some of the early achiever countries in the Africa region. Therefore new ways of delivering interventions that have proven to be successful in the Kenyan environment must be devised in order to reach the harder to reach populations and change the harder to change attitudes and practices. 

The future should not be business as usual. Targeted and larger-scale interventions should become even more focused to bring about further change. Addressing HIV as part of Kenya’s wider health context could attract the late adopters in the population. 

Programmers will need to apply a business-like model using market forces in HIV programming aimed at creating and sustaining inherent demand for prevention, care and treatment of disease conditions among the entire Kenyan population. The household rather than the community is likely to be the more successful frontline. A case in point is HIV testing and counseling, which should become more available outside formal institutional settings.  

Early treatment initiation such as Option B+ for PMTCT will need to be adopted country wide, and Kenya may need to open to other forms of early treatment for non PMTCT. With early treatment initiation, it is plausible that Kenya could one day achieve the desirable AIDS-Free Generation as could be deduced from the shifting HIV prevalence peak. 

Push progress further

Devolution of health service management in Kenya poses new opportunities as well as challenges for the country to make new leaps in the fight against the epidemic.  Devolution offers opportunities for more precise targeting of resource allocation and closer monitoring of their use; however, the lack of experience and inadequate capacity at the newly devolved subnational levels to apply data and evidence in planning, coordination, and oversight could pose an immediate challenge that must be addressed. HIV programmers must therefore integrate capacity building of institutions in their next set of interventions.  

In conclusion, the potential for Kenya to make yet another leap towards an AIDS-Free Generation is huge. The ability and willingness of programmers and funders to design new delivery systems for successful interventions—while at the same time integrating institutional capacity development in service delivery especially at subnational levels—could likely push this potential to actual achievement.

Dr. Daraus Bukenya is the MSH Kenya country representative and Chief of Party of FANIKISHA Institutional Strengthening Project.