Kenya has the joint fourth-largest HIV epidemic in the world (alongside Mozambique and Uganda), in terms of the number of people living with HIV, which was 1.6 million people in 2013. Roughly 58,000 people died from AIDS-related illnesses in the same year although this dropped by 32% between 2009 and 2013.1 There are now 1.1 million children orphaned by AIDS.2
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% in 1996, and had fallen to 6% by 2013 mainly due to the rapid scaling up of antiretroviral treatment (ART).3
Key affected populations in Kenya
However, in recent years, a number of studies have identified concentrated epidemics among certain groups who are particularly vulnerable to HIV transmission.
Men who have sex with men (MSM) and HIV in Kenya
HIV prevalence among men who have sex with men (MSM) in Kenya is almost three times that among the general population. Latest statistics reveal that in 2010, HIV prevalence among MSM was an estimated 18.2%.4
Condom use among MSM is fairly low but has been rising. In 2013, an estimated 69% of MSM reported using a condom the last time they had anal sex, up from 55% in 2011.5
Sexual relations between people of the same sex are illegal in Kenya and can carry a prison sentence of up to 21 years.6
"Homosexuality is "largely considered to be taboo and repugnant to [the] cultural values and morality" of Kenya." 7
This stance leads to high levels of stigma and discrimination towards MSM as well as other members of the lesbian, gay, bisexual and transgender community (LGBT), deterring many people from seeking the HIV services they need. Many have been harassed by state officials and held in 'remand houses' without being informed of the charges against them.8
People who inject drugs (PWID) and HIV in Kenya
One study found that 3.8% of new HIV infections occur among PWID. In the capital Nairobi, this rises to 5.8%.11 Condom use and safe injecting practices are very low among this group (29.8% and 51.6% respectively) and are the cause of high rates of HIV transmission.12
Sex workers and HIV in Kenya
Female sex workers (FSW) have the highest reported HIV prevalence of any group in Kenya. In 2011, an estimated 29.3% of FSW were living with HIV.13 By comparison, data from the Sex Workers Outreach Program (SWOP 2011) showed an HIV prevalence of 30% among FSW and 40% among male sex workers.14
The 2009 Modes of Transmission Study (MOT) reported that 14% of new HIV infections occurred among FSW and their clients. However, FSW are reportedly better at protecting themselves from HIV transmission compared to groups such as MSM and PWID. 86% of FSW have reported using a condom with their most recent client.15
Women and HIV in Kenya
Although HIV prevalence among the general population has fallen in Kenya, women continue to be disproportionately affected by the epidemic. In 2012, 6.9% of women were living with HIV compared with 4.2% of men.16 Young women (aged 15-24) are almost three times as likely to be living with HIV than men of the same age (3% and 1.1% respectively). However, HIV prevalence among young women has almost halved since 2003, showing that progress is being made.17
Like in many parts of sub-Saharan Africa, women and girls in Kenya face discrimination in terms of access to education, employment and healthcare. As a result, men often dominate sexual relationships with women not always able to practice safer sex even when they know the risks.
Young women in Kenya are over three times more likely to be exposed to sexual violence than young men.18 They are often forced into early marriage and unable to negotiate safe sex.19 Young women also have a lower level of HIV knowledge than young men in Kenya. The 2014 Demographic Health Survey found that only 54% of young women could correctly identify ways of preventing sexual transmission of HIV and reject misconceptions about HIV transmission compared to 64% of young men.20
HIV testing and counselling (HTC) in Kenya
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.21
As a result, there has been dramatic progress in terms of the number of people getting tested for HIV. In 2000, there were just three voluntary counselling and testing (VCT) sites in Kenya; by 2010 there were over 4,000. In 2008, 860,000 people were being tested annually for HIV, by 2013; this had increased to 6.4 million.22
Though annual testing rates have nearly doubled since 2008/2009, there remains a significant disparity between men and women. In 2014, 53% of women had tested for HIV in the past 12 months and received their results, alongside 45% of men.23 To address this, there has been a concerted effort to increase testing rates among Kenyan men with community-based testing programmes proving successful in particular.24
Like HTC coverage among the general population, testing rates among pregnant women have risen substantially. From 2009 to 2013, the percentage of pregnant women tested for HIV increased from 68% to 92%.25
HIV prevention programmes in Kenya
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 1993.26 In 2013, there were an estimated 100,000 new HIV infections in Kenya.27
The National AIDS Control Council (NACC) is the body responsible for coordinating the response to the HIV epidemic in Kenya. The Kenya AIDS Strategic Framework 2014/15-2018/19 sets out four objectives over its five year duration:
- reduce new HIV infections by 75%
- reduce AIDS-related mortality by 25%
- reduce HIV-related stigma and discrimination by 50%
- increase domestic financing of the HIV response to 50%.28
Condom distribution and use
However, many people still find condoms difficult to acquire. For example, one report from rural northern Kenya showed how men could only afford to use condoms once, and due to a shortage in supply, would often wash condoms and hang them out to dry for reuse, or use plastic bags and cloth rags instead:
"Many rural areas in the country are inaccessible due to the poor road network and this makes distribution of condoms difficult and challenging…because government condoms are mostly made available at health facilities and there are not many in rural areas, this creates another challenge in distribution." - Peter Cherutich, NASCOP31
Even where condoms are widely available, this does not guarantee their use. The 2014 Kenya Demographic and Health Survey revealed that only 40% of women and 43% of men who had two or more partners in the last 12 months, reported using a condom the last time they had sex.32
Preventing mother-to-child transmission (PMTCT)
Kenya is committed to eliminating the mother-to-child transmission (MTCT) of HIV by 2015. Key strategies to achieve this include efforts to increase knowledge of PMTCT, greater male involvement, universal attendance of pregnant women at antenatal clinics, universal uptake of HIV testing among pregnant women, as well as the provision of antiretroviral drugs for those who test positive.33
From 2008 to 2013, 58,000 women annually were offered PMTCT services, out of an estimated 79,000 (76% coverage). Between 2010 and 2013, PMTCT coverage actually fell from 86% to 70%. However, this was due mainly to an increase in demand for PMTCT services.34
In 2009, the Kenyan government emphasised the importance of male involvement in PMTCT, and in 2010 started a campaign to encourage partner testing, exclusive breastfeeding and the delivery of ART to children.35 36 From 2010 to 2013, the percentage of women and their infants given ARVs during breastfeeding to prevent HIV transmission increased from 65% to 71%. By comparison, male involvement in PMTCT remains very low in Kenya (4.5%).37
Voluntary medical male circumcision (VMMC)
In 2008, Kenya implemented the voluntary medical male circumcision (VMMC) for HIV prevention programme. The programme aimed to circumcise 860,000 males aged 15-49 by 2013 to achieve universal coverage (80%).
The number of VMMCs performed annually has increased dramatically, although by the end of 2013 only 670,000 VMMCs were performed, about 77% of the original target, with roughly 50% of Kenyan men aged 15-19 circumcised. Regions with the highest HIV prevalence among uncircumcised adult males - Nairobi (20.2%), Nyanza (17.3%), Rift Valley (7%) and Western (6.8%) were selected as priority regions for the implementation of VMMC.38 80% of all operations were conducted in the Nyanza region.39
In 2012, a new initiative was introduced to boost the number of men being circumcised annually. It involved handing out vouchers to men who had the procedure, which could be exchanged for money upon attending a follow-up appointment. They were also encouraged to bring a friend who was interested in becoming circumcised.40
In 2011, as part of efforts by the National AIDS Control Council (NACC) to provide free HIV prevention and treatment for PWID, previously disallowed harm reduction methods including needle and syringe programmes (NSPs), and services such as psychosocial support were made available. Opioid substitution therapy (OST) remains unavailable in Kenya, but work to establish its use is in progress.41
In June 2012, the Kenyan government announced plans to distribute free needles and syringes to over 50,000 PWID. By the end of the programme, the government aims to have distributed over 8 million needles and syringes nationwide. However, only 10 NSPs are currently operational, and only 15% of people who inject drugs are thought to be accessing the service.42
One report found high HIV prevalence levels among people who inject drugs (PWID) in a number of prisons, with many having no access to NSP or OST services.43
HIV education and awareness
HIV education and awareness is an important component of HIV prevention in Kenya. The Education Sector Policy on HIV and AIDS 2013 aims to develop programmes to enhance HIV prevention, care and support for school pupils as well as education personnel (e.g. teachers). It emphasises that strategies must be gender sensitive because women and girls are disproportionately affected by the epidemic.44
HIV and AIDS education has been part of the school curriculum in Kenya since 2003. However, the 2014 Demographic and Health Survey found that only 54% of young women and 64% of young men aged 15-24 had comprehensive knowledge about HIV prevention.45
The provision of HIV and AIDS education does not necessarily equate to lower HIV prevalence. For example, the Kenya AIDS Indicator Survey 2012 reported almost no difference in HIV prevalence between those who had completed primary education (6%) and those who had completed secondary education (5.8%). In fact, the lowest HIV prevalence was among people without any schooling (3.6%). Moreover, HIV prevalence was higher among women than men across all education levels.46
In contrast, one study among participants from both secondary schools and universities found that while both had very high levels of knowledge, knowledge was significantly higher among university students. This shows that education delivered in the correct way can be an effective means to empower people to protect themselves from HIV.47
Antiretroviral treatment (ART) in Kenya
In 2003, only 6,000 people living with HIV were accessing ART, but by 2013 this had increased to 596,000 adults and 60,000 children. This equates to 42% of adults who are in need of treatment receiving it, and 31% of children.48
Kenya previously announced universal access to treatment in 2013, when 80% of those in need were on treatment. However, the amendments to the WHO treatment guidelines in the same year means that access is now much lower due to more people being eligible for treatment.49
In Kenya, up to 38% of people with tuberculosis (TB) are co-infected with HIV. It is reported that 83% of people with a co-infection are being treated for both illnesses which is high and shows commitment to tackling both public health issues.50
HIV stigma and discrimination in Kenya
Though awareness of HIV and AIDS is comparatively high in Kenya, many people living with HIV face high levels of stigma and discrimination. This deters many people living with HIV, particularly vulnerable groups, from seeking vital HIV services.51
For example, many reports from Kenya have shown how pregnant women often do not test for HIV because they fear stigmatisation from their family or healthcare workers.52
Accepting attitudes among the general population towards people living with HIV increased in Kenya between 2003 and 2009, rising from 27% to 33% among men, and from 39.4% to 47% among women. However, levels of stigma and discrimination remain too high to foster an environment for a more effective national HIV response.53
Funding the HIV response in Kenya
A lot of money has been spent in Kenya in recent years to combat HIV, particularly through the scaling up of ART. Between 2009 and 2013, external funding from donors accounted for over 70% of HIV expenditure. The Kenyan government has contributed 17% of funding with private and household spending making up the remaining 13%. Since 2010, government spending has remained stable (at 17%).54
As in many countries, the scaling up of antiretroviral treatment means that spending on HIV treatment and care accounted for the majority of HIV expenditure (52%) between 2009 and 2013. Prevention, which includes the provision of HIV testing services, accounted for 21%.55
The cost of the HIV response in Kenya is expected to increase by 114% between 2010 and 2020 representing a funding gap of $1.75 billion. In order to plug this gap, Kenya has established a High Level Steering Committee for Sustainable Financing, which has proposed the establishment of an HIV and Non-Communicable Diseases Trust Fund to pool additional and private resources.56
The future of HIV and AIDS in Kenya
In recent years, Kenya has made huge strides in tackling its HIV epidemic and has been pioneering in the provision of HIV prevention, particularly the implementation of VMMC.
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.
Moreover, 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.
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- 2. UNAIDS (2013) 'Kenya'
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- 4. IOM (2010) 'Integrated Biological and Behavioural Surveillance Survey among Migrant Female Sex Workers in Nairobi, Kenya'
- 5. National AIDS Control Council of Kenya (2014) 'Kenya AIDS Response Progress Report 2014: Progress towards Zero'
- 6. ILGA (2014) 'State-sponsored homophobia 2014'
- 7. United Nations (2011) 'International Covenant on Civil and Political Rights: List of issues to be taken up in connection with the consideration of the third periodic report of Kenya (CCPR/C/KEN/3)'
- 8. Kenya Human Rights Commission (2011) 'The Outlawed Among Us'
- 9. IBBS (2012) 'Implementing Integrated Bio-Behavioral Surveys among Key Populations at Higher Risk of HIV Exposure with an Emphasis in Respondent Driven Sampling'
- 10. National AIDS Control Council of Kenya (2014) 'Kenya AIDS Response Progress Report 2014: Progress towards Zero'
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- 13. National AIDS Control Council of Kenya (2014) 'Kenya AIDS Response Progress Report 2014: Progress towards Zero'
- 14. UNAIDS (2012, 12 March) 'Sex workers advocate for access to health care and legal services'
- 15. National AIDS Control Council of Kenya (2014) 'Kenya AIDS Response Progress Report 2014: Progress towards Zero'
- 16. National AIDS Control Council (NACC) (2014) 'Kenya AIDS Indicator Survey (KAIS 2012)'
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- 20. Kenya National Bureau of Statistics (2015) 'Kenya Demographic and Health Survey 2014'
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- 22. National AIDS Control Council of Kenya (2014) 'Kenya AIDS Response Progress Report 2014: Progress towards Zero'
- 23. Kenya National Bureau of Statistics (2015) 'Kenya Demographic and Health Survey 2014'
- 24. UNAIDS (2012) 'World AIDS Day Report - Results'
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- 26. UNAIDS (2013) 'Kenya'
- 27. UNAIDS (2014) 'The Gap Report'
- 28. Kenya National AIDS Control Council (2014) 'Kenya AIDS Strategic Framework 2014/2015-2018/2019'
- 29. BBC News (2001, 11 July) 'Kenyan condom imports to rise'
- 30. National AIDS Control Council of Kenya (2010) 'Country progress report - Kenya'
- 31. IRIN (2011, 29 March) 'KENYA: Condom recycling highlights gaps in HIV prevention programming'
- 32. Kenya National Bureau of Statistics (2015) 'Kenya Demographic and Health Survey 2014'
- 33. National AIDS Control Council of Kenya (2014) 'Kenya AIDS Response Progress Report 2014: Progress towards Zero'
- 34. National AIDS Control Council of Kenya (2014) 'Kenya AIDS Response Progress Report 2014: Progress towards Zero'
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- 36. Capital News (2010, 25 November) 'Sh240m campaign to fight paediatric HIV'
- 37. National AIDS Control Council of Kenya (2014) 'Kenya AIDS Response Progress Report 2014: Progress towards Zero'
- 38. CDC (2012) 'Progress in Voluntary Medical Male Circumcision Service Provision — Kenya, 2008–2011'
- 39. National AIDS Control Council of Kenya (2014) 'Kenya AIDS Response Progress Report 2014: Progress towards Zero'
- 40. IRIN (2012, 6 November) 'KENYA: Push to meet 2013 male circumcision targets'
- 41. Harm Reduction International (2014) 'Global State of Harm Reduction 2014'
- 42. National AIDS Control Council of Kenya (2014) 'Kenya AIDS Response Progress Report 2014: Progress towards Zero'
- 43. CSIS (2011) 'HIV Prevention Among Injection Drug Users in Kenya and Tanzania'
- 44. Government of Kenya (2013) 'Education Sector Policy on HIV and AIDS'
- 45. Kenya National Bureau of Statistics (2015) 'Kenya Demographic and Health Survey 2014'
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- 47. Mwamwenda, T.S. (2014) 'Education level and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) knowledge in Kenya' Journal of AIDS and HIV Research 6(2):28-32
- 48. UNAIDS (2014) 'The Gap Report'
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- 56. UNAIDS (2013) 'Efficient and Sustainable HIV Responses: Case studies on country progress'