HIV/AIDS in Kenya

Last updated December 15, 2022

Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioral change and increased access to ARV (antiretroviral drugs). Adult HIV prevalence is estimated to have fallen from 10 percent in the late 1990s to about 4.8 percent in 2017.^[1] Women face considerably higher risk of HIV infection than men but have longer life expectancies than men when on ART.^[2] The 7th edition of AIDS in Kenya reports an HIV prevalence rate of eight percent in adult women and four percent in adult men. Populations in Kenya that are especially at risk include injecting drug users and people in prostitution, whose prevalence rates are estimated at 53 percent and 27 percent, respectively. Men who have sex with men (MSM) are also at risk at a prevalence of 18.2%.^[3] Other groups also include discordant couples (where one partner is infected and the other is not) however successful ARV-treatment will prevent transmission. Other groups at risk are prison communities, uniformed forces, and truck drivers.^[4]

History

The following will be a timeline of the major events that have led up to today in the HIV/AIDS epidemic in Kenya from 1984 to 2018.^[5]

1984: First case of HIV found in Kenya^[5]

1985: Sex workers were involved in 26 new recorded cases of HIV^[5]

1985: The condition is still a mystery in Kenya^[5]

1986: There is a mass denial of the disease being a problem^[5]

1987: A study was performed on the unique women from Majengo slum in Nairobi, who were "immune" to AIDS^[5]

1988: HIV prevalence is now at 3,000 cases^[5]

1990: Prevalence rises to 2.5% of the population as the government is still in denial^[5]

1995: By 1995, the death toll rose to about 200,000 people^[5]

1998: Prevalence rate is at 9.8%^[5]

2003: Prevalence rate drops to 6.7%^[5]

2003: Public sector releases low cost ARVs^[5]

2005: Around 65,000 HIV positive individuals in Kenya are on ARVs^[5]

2012: Prevalence has dropped to 5.6%, but Kenya still has the 4th largest HIV epidemic^[5]

Overview of the HIV epidemic

Here is a brief overview of the HIV epidemic in the country as reported by the Ministry of Education in June 2014, as well as the UNAIDS report on Kenya for 2017.^[6]^[1]

53,000 Kenyans were infected with HIV In 2017.
8,000 children, 27,000 women, and 18,000 men were infected with HIV in 2017.
65% of new HIV infections occur in 9 out of 47 counties.^[7]

County	HIV Prevalence (%)
Homa Bay	25.7
Siaya	23.7
Kisumu	19.3
Migori	14.7
Kisii	8
Turkana	7.6
Nairobi	6.8
Busia	6.8
Nyamira	6.4

Every year, 21% of new adult HIV infections occur among young women aged 15–24.
In 2017, 1.5 million Kenyans were living with HIV.
In 2017, 110,000 children were living with HIV.
63% of men and 80% of women know their HIV status.

Social outlook

LGBTQ+

As the LGBTQ+ community has always been part of the fight against HIV/AIDS in all countries, the same has happened in Kenya. Although MSMs and other forms of same-sex contact are not the main risk group or cause of HIV/AIDS in Kenya, they have been a big proponent due to the laws that have been put in place by the country's government. Homosexuality is currently illegal in Kenya, allowing the government to 595 cases of homosexuality from 2010 to 2014. While MSMs and members of the LGBTQ+ community already face discrimination on a regular basis, they are being denied treatment due to their identity and the penal code in many places in Kenya.^[8]

However, in 2016, activist groups have been able to challenge the constitutionality of the laws that are in place, resulting in the government contemplating if they should be repealed. The verdict is currently undecided. Victory has been won in other places that had laws that discriminated against the LGBTQ+ community, so activists have a positive outlook at this point in time.^[8]

Adolescents

With adolescents being a big risk group in Kenya, society has molded the outlook of this group and how they interact with HIV/AIDS. There are many social stigmas involved with people aged 15–19, as they go through harsh environments in schools and in the community. HIV and AIDS in school is viewed as a killer disease that is a sign of sexual immorality. Many adolescents feel afraid to disclose their status, due to the stigma that is behind it. Fear is also found in walking into health centers and asking about HIV/AIDS, due to the conception that health workers will look down on you and your condition.^[9]

Social media has also provided adolescents in Kenya with illegitimate information about the disease, prevention of the disease, and overall outlook. While the main fear is found in public shaming or judging, another problem is that adolescents are not represented in policy very well, compared to that of children and adults. Economic burdens that are placed on adolescents that do not have parents to provide the means for their education and wellbeing is another problem for the group. Sometimes, adolescents are forced into being sex workers to provide for themselves, resulting in an increased risk for HIV infection.^[9]

Sex work

Sex workers have the highest prevalence among the risk groups of HIV/AIDS in Kenya. It has been reported that 29.3% of sex workers have HIV. The main problem within this community is the fear of coming forward about being raped or abused, because it could lead to prosecution for being a prostitute. Therefore, sex workers are less likely to go to anyone for help because of this fear. Being prosecuted and arrested can lead to an interruption in HIV treatment.^[10]

Current status

The Kenyan Ministry of Health published a report in June 2014 called Kenya HIV Prevention Revolution Road Map. The road map aims to dramatically strengthen HIV prevention, with the ultimate goal of reducing new HIV infections to zero by 2030. The following observations and conclusions were outlined:^[6]

Sexual transmission accounts for 93.7% of all new HIV infections (MOT, 2008).
The HIV epidemic in Kenya exhibits extreme geographical and gender disparities. National estimates and modelling indicate that 65% of new adult infections occur in nine of the 47 Counties. There is higher prevalence among women at 7.6% compared to men at 5.6%. There is a treatment gap of over 99,500 women and 64,900 men, in need of ART but not currently receiving treatment. ART coverage is 77% in eligible women compared to 80% in men.
Key populations contribute a disproportionately high number of new HIV infections annually despite their small population size. According to the MOT 2008, although these populations represent less than 2% of the general population, they contribute a third of all new HIV infections. Key populations in Kenya include sex workers, men who have sex with men (MSM) and people who inject drugs. Additionally, there are geographical disparities in the distribution of key populations across the Counties.
A recent development in April 2018 shows Kenya receiving funding from the Children's investment Fund Foundation to buy ARVs for children in the country. The country received 400 million Kenyan shillings after the 38 billion shillings was not enough to cover all the risk groups involved in the epidemic. While the grant for 38 billion shillings was given by the Global Fund to cover a broad spectrum of diseases including tuberculosis and malaria, the new grant has been given specifically for treatment of children with HIV. This is due to the fact that about 120,000 children, ages of fourteen and under, are living with HIV. As of 2012, Kenya has received about 100 billion shillings in funding over the span of 19 grants given by various organizations.^[11]
As of September 2018, adolescents are a high risk group in Kenya to be infected by HIV. Nearly 106,000 adolescents, aging from 15 to 19, are living with HIV. This trend is on the rise due to the stigmatization of HIV/AIDS within adolescent communities and society.^[9]

Cost

Low Cost Antiretroviral Drugs

ART was introduced to Kenya in the late 90s when the treatment was initially being rolled out. However, they did not start receiving low cost drugs until around 2003.^[5] Costs continued to decline, and with enough donor money, more than a million patients receive ART for free through the government. Recently, Kenyans with HIV got access to a high end drug for cheap due to an international deal. The cost per year for this drug treatment is US$75 and is a big improvement as it combines some drugs together to make the treatment plan cheaper and easier for patients living with HIV. This drug has been accessible in high income countries since 2014, but the new deal has placed the drug in middle and low income countries.^[12]

Response

During the initial outbreak of AIDS in the 80s, the Kenyan government stayed away from discussions about how big of a problem there was with HIV/AIDS in the country. By 1993, statements were finally made about the problem and how the situation should have been addressed sooner. Kenya could not afford to lose so many skilled workers to HIV/AIDS when there was currently no treatment for it. The response and plan to reduce the amount of HIV infections has been more extensive going into the new century and currently.^[13]

HTC

HIV testing and counseling (HTC) has been one response to the HIV/AIDS crisis in Kenya. The government has encouraged getting tested and for people to be more open about the diagnosis so it can be addressed appropriately. Self testing kits for low cost have been introduced over recent years, along with community based testing and door-to-door campaigns. In 2008, only 860,000 people were being annually tested for HIV, compared to 9.9 million people that are being tested annually now.^[10]

Condom Availability

Even though condom use wasn't endorsed by the Kenyan government until 2001, the rate of condom usage has gradually increased ever since. Free condoms have been distributed throughout different communities, including the sex workers community. This has decreased unprotected sex, which is critical in lowering new HIV infections.^[10]

Education

Education about HIV/AIDS has been in the school curriculum since 2003, and it has been effective in increasing knowledge within children about the disease. There has been some controversy about the ethics of teaching students about sexual health, due to the fear that it would encourage young people to have sex. However, rates of new HIV infections have said otherwise. Mass media campaigns have also been done to educate people about HIV/AIDS.^[10]

PMTCT

Preventing mother to child transmission (PMTCT) has also been a big step in preventing the spread of HIV/AIDS. The country's dedication to eliminating this type of transmission has led to a drop of children born with HIV from 12,000 children in 2010 to 6,600 in 2015. Male partners have also been encouraged to take part in this type of treatment, by getting tested along with the soon-to-be mother.^[10]

VMMC, Harm Reduction, and PrEP

Voluntary medical male circumcision (VMMC) was implemented as an option in 2008 in Kenya as a prevention method. By 2016, 92% of men in Kenya are circumcised.^[10]

Harm reduction is the distribution of clean needles and syringes along with counseling and medically assisted treatment with methadone, implemented by the government in 2012. The amount of Intravenous drug users that are using clean needles now is up to 90% compared to the 51% in 2012.^[10]

Pre-exposure prophylaxis has been an ongoing trend in Kenya, as HIV negative people have been receiving ART to prevent against any future infection of HIV. It is being offered for people who are in high risk groups that have an ongoing risk of HIV infection.^[10]

Related Research Articles

HIV/AIDS originated in Africa in the early 20th century and is a major public health concern and cause of death in many African countries. AIDS rates vary significantly between countries, though the majority of cases are concentrated in Southern Africa. Although the continent is home to about 15.2 percent of the world's population, more than two-thirds of the total infected worldwide – some 35 million people – were Africans, of whom 15 million have already died. Sub-Saharan Africa alone accounted for an estimated 69 percent of all people living with HIV and 70 percent of all AIDS deaths in 2011. In the countries of sub-Saharan Africa most affected, AIDS has raised death rates and lowered life expectancy among adults between the ages of 20 and 49 by about twenty years. Furthermore, the life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic with life-expectancy in some countries reaching as low as thirty-nine years.

The global epidemic of HIV/AIDS began in 1981, and is an ongoing worldwide public health issue. According to the World Health Organization (WHO), as of 2021, HIV/AIDS has killed approximately 40.1 million people, and approximately 38.4 million people are infected with HIV globally. Of these 38.4 million people, 75% are receiving antiretroviral treatment. There were about 770,000 deaths from HIV/AIDS in 2018, and 680,000 deaths in 2020. The 2015 Global Burden of Disease Study estimated that the global incidence of HIV infection peaked in 1997 at 3.3 million per year. Global incidence fell rapidly from 1997 to 2005, to about 2.6 million per year. Incidence of HIV has continued to fall, decreasing by 23% from 2010 to 2020, with progress dominated by decreases in Eastern Africa and Southern Africa. As of 2020, there are approximately 1.5 million new infections of HIV per year globally.

The Caribbean is the second-most affected region in the world in terms of HIV prevalence rates. Based on 2009 data, about 1.0 percent of the adult population is living with the disease, which is higher than any other region except Sub-Saharan Africa. Several factors influence this epidemic, including poverty, gender, sex tourism, and stigma. HIV incidence in the Caribbean declined 49% between 2001 and 2012. Different countries have employed a variety of responses to the disease, with a range of challenges and successes.

Since the first HIV/AIDS case in the Lao People's Democratic Republic (PDR) was identified in 1990, the number of infections has continued to grow. In 2005, UNAIDS estimated that 3,700 people in Lao PDR were living with HIV.

Although Senegal is a relatively underdeveloped country, HIV prevalence in the general population is low at around 0.08 per 1000 people, under 1% of the population. This relatively low prevalence rate is aided by the fact that few people are infected every year– in 2016, 1100 new cases were reported vs 48,000 new cases in Brazil. Senegal's death due to HIV rate, particularly when compared it to its HIV prevalence rate, is relatively high with 1600 deaths in 2016. Almost two times as many women were infected with HIV as men in 2016, and while almost three times as many women were receiving antiretroviral therapy (ARV) as men, only 52% of HIV positive people in Senegal received ARV treatment in 2016.

HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).

With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.

The first HIV/AIDS cases in Nepal were reported in 1988. The HIV epidemic is largely attributed to sexual transmissions and account for more than 85% of the total new HIV infections. Coinciding with the outbreak of civil unrest, there was a drastic increase in the new cases in 1996. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and Male Labor Migrants (MLMs) as well as their spouses. Socio-Cultural taboos and stigmas that pose an issue for open discussion concerning sex education and sex habits to practice has manifest crucial role in spread of HIV/AIDS in Nepal. With this, factors such as poverty, illiteracy, political instability combined with gender inequality make the tasks challenging.

HIV/AIDS infection in the Philippines might be low but growing fast. The Philippines has one of the lowest rates of infection, yet has one of the fastest growing number of cases worldwide. The Philippines is one of seven countries with growth in number of cases of over 25%, from 2001 to 2009.

Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2016, Thailand had the highest prevalence of HIV in Southeast Asia at 1.1 percent, the 40th highest prevalence of 109 nations.

HIV/AIDS in Bolivia has a less than 1 percent prevalence of Bolivia's adult population estimated to be HIV-positive and therefore the country has one of the lowest HIV prevalence rates in the Latin America and Caribbean region.

Cases of HIV/AIDS in Peru are considered to have reached the level of a concentrated epidemic. According to a population-based survey conducted in Peru’s 24 largest cities in 2002, adult HIV prevalence was estimated to be less than 1 percent. The survey demonstrated that cases are unevenly distributed in the country, affecting mostly young people between the ages of 25 and 34. As of July 2010, the cumulative reported number of persons infected with HIV was 41,638, and there were 26,566 cases of AIDS, according to the Ministry of Health (MOH), and the male/female ratio for AIDS diagnoses in 2009 was 3.02 to 1. The Joint United Nations Program on HIV/AIDS (UNAIDS) estimates 76,000 Peruvians are HIV-positive, meaning that many people at risk do not know their status. There were 3,300 deaths due to AIDS in Peru in 2007, down from 5,600 deaths in 2005.

The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total, with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013.

HIV/AIDS in El Salvador has a less than 1 percent prevalence of the adult population reported to be HIV-positive, El Salvador and therefore there is a low-HIV-prevalence country, but the virus remains a significant threat in high-risk communities, such as commercial sex workers (CSWs) and men who have sex with men (MSM).

According to the Global Fund, Honduras is the Central American country most adversely affected by the HIV/AIDS epidemic. As of 1998, Honduras had the highest prevalence of HIV out of all seven Central American countries according to a study published by the office of the Honduran Secretary of Public Health. As of that same year, Hondurans made up only 17% of the Central American population, yet Honduras contained 50% of the initial AIDS cases in Central America and 60% of all Central American cases in 2001. In more recent years, new HIV infections have decreased by 29% since 2010 while AIDS-related deaths have increased by 11% since then. HIV/AIDS heavily affects the young, active, working population in Honduras, and HIV/AIDS deaths account for 10% of the overall national mortality rate. As of 2008, AIDS was the leading cause of death among Honduran women of childbearing age and the second-leading cause of hospitalization among both men and women. Sexually transmitted infections are common, and condom use in risky sexual encounters is sporadic and variable. HIV remains a mainly heterosexual epidemic in Honduras, as 90% of emerging infections are attributed to heterosexual transmission. It is estimated that the prevalence of HIV among Honduran adults is 1.5%.

HIV/AIDS in Jamaica has a 1.5 percent prevalence of the adult population estimated to be HIV-positive and no significant change over the last five years and therefore Jamaica appears to have stabilized its HIV/AIDS epidemic.

In 2016, the prevalence rate of HIV/AIDS in adults aged 15–49 was 0.3%, relatively low for a developing country. This low prevalence has been maintained, as in 2006, the HIV prevalence in Mexico was estimated at around 0.3% as well. The infected population is remains mainly concentrated among high risk populations, men who have sex with other men, intravenous drug users, and commercial sex workers. This low national prevalence is not reflected in the high-risk populations. The prison population in Mexico, faces a fairly similar low rate of around 0.7%. Among the population of prisoners, around 2% are known to be infected with HIV. Sex workers, male and female, face an HIV prevalence of around 7%. Identifying gay men and men who have sex with other men have a prevalence of 17.4%. The highest risk-factor group is identifying transgender people; about 17.4% of this population is known to be infected with HIV. Around 90% of new infections occur by sex-related methods of transmission.. Of these known infected populations, around 60% of living infected people are known to be on anti-retroviral therapy (ART).

Discrimination against people with HIV/AIDS or serophobia is the prejudice, fear, rejection, and stigmatization of people with HIV/AIDS. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.

References

1 2 "UNAIDS: Kenya fact sheet". 2017.
↑ Hodgkinson, Luqman Mushila; Abwalaba, Roselyne Asiko; Arudo, John; Barry, Michele (2020). "Ten-year survival with analysis of gender difference, risk factors, and causes of death during 13 years of public antiretroviral therapy in rural Kenya". Medicine. 99 (21): e1–e8. doi: 10.1097/MD.0000000000020328 . PMC 7249944 . PMID 32481319.
↑ "UNAIDS Data Book 2017" (PDF).
↑ "Kenya ranked fourth worldwide in HIV Infections". August 20, 2014.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 timeline. "HIV: past, present and future". www.tiki-toki.com. Retrieved 2018-10-30.
1 2 "Kenya_HIV_Prevention_Revolution_Road_Map" (PDF).
↑ "Counties With Highest HIV Infections - Report - Kenyans.co.ke". Kenyans.co.ke. Retrieved 2018-11-09.
1 2 "THE REPEAL OF THE ANTI HOMOSEXUALITY LAWS IN KENYA". Kuchu Times. 2018-09-28. Retrieved 2018-10-30.
1 2 3 Africa, Science. "HIV: Kenyan Adolescents Hardest Hit | Science Africa". scienceafrica.co.ke. Retrieved 2018-10-30.
1 2 3 4 5 6 7 8 "HIV and AIDS in Kenya". AVERT. 2015-07-21. Retrieved 2018-10-30.
↑ "Kenya gets Sh400m to buy ARVs for children". The Star, Kenya. Retrieved 2018-10-30.
↑ Jamah, Ally. "Kenyans to access new, highly-effective HIV drugs at lower prices". The Standard. Retrieved 2018-10-30.
↑ Lorch, Donatella. "After Years of Ignoring AIDS Epidemic, Kenya Has Begun Facing Up to It" . Retrieved 2018-10-30.

External links

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[:1-1] 1 2 "UNAIDS: Kenya fact sheet". 2017.

[:14-2] Hodgkinson, Luqman Mushila; Abwalaba, Roselyne Asiko; Arudo, John; Barry, Michele (2020). "Ten-year survival with analysis of gender difference, risk factors, and causes of death during 13 years of public antiretroviral therapy in rural Kenya". Medicine. 99 (21): e1–e8. doi: 10.1097/MD.0000000000020328 . PMC 7249944 . PMID 32481319.

[3] "UNAIDS Data Book 2017" (PDF).

[4] "Kenya ranked fourth worldwide in HIV Infections". August 20, 2014.

[:3-5] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 timeline. "HIV: past, present and future". www.tiki-toki.com. Retrieved 2018-10-30.

[:0-6] 1 2 "Kenya_HIV_Prevention_Revolution_Road_Map" (PDF).

[7] "Counties With Highest HIV Infections - Report - Kenyans.co.ke". Kenyans.co.ke. Retrieved 2018-11-09.

[:4-8] 1 2 "THE REPEAL OF THE ANTI HOMOSEXUALITY LAWS IN KENYA". Kuchu Times. 2018-09-28. Retrieved 2018-10-30.

[:2-9] 1 2 3 Africa, Science. "HIV: Kenyan Adolescents Hardest Hit | Science Africa". scienceafrica.co.ke. Retrieved 2018-10-30.

[:42-10] 1 2 3 4 5 6 7 8 "HIV and AIDS in Kenya". AVERT. 2015-07-21. Retrieved 2018-10-30.

[11] "Kenya gets Sh400m to buy ARVs for children". The Star, Kenya. Retrieved 2018-10-30.

[12] Jamah, Ally. "Kenyans to access new, highly-effective HIV drugs at lower prices". The Standard. Retrieved 2018-10-30.

[13] Lorch, Donatella. "After Years of Ignoring AIDS Epidemic, Kenya Has Begun Facing Up to It" . Retrieved 2018-10-30.

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v t e HIV/AIDS in Africa
Sovereign states	Algeria Angola Benin Botswana Burkina Faso Burundi Cameroon Cape Verde Central African Republic Chad Comoros Democratic Republic of the Congo Republic of the Congo Djibouti Egypt Equatorial Guinea Eritrea Eswatini Ethiopia Gabon The Gambia Ghana Guinea Guinea-Bissau Ivory Coast Kenya Lesotho Liberia Libya Madagascar Malawi Mali Mauritania Mauritius Morocco Mozambique Namibia Niger Nigeria Rwanda São Tomé and Príncipe Senegal Seychelles Sierra Leone Somalia South Africa South Sudan Sudan Tanzania Togo Tunisia Uganda Zambia Zimbabwe
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