Kenya losing the fight against HIV after all, experts warn

Tuesday July 29 2008

Prime Minister Raila Odinga receives

Prime Minister Raila Odinga receives preliminary results of the Kenya Aids Indicator Survey 2007 from Public Health and Sanitation minister Beth Mugo in Nairobi. Photo/HEZRON NJOROGE  

By GATONYE GATHURA and ARTHUR OKWEMBA

The new Aids statistics released Tuesday by the Government are bound to disappoint Kenyans who in the last few years have been made to believe that the virus was on the retreat.

A three per cent rise in prevalence rates announcement came as a shock because Kenyans were of the opinion that Aids control agencies had finally found a formula to contain the pandemic.

In the last three years Kenya has come in for special praise from global Aids agencies for managing to bring down prevalence rates from a high of 10 per cent in the 1990s to about 7 per cent in 2003 and 5.1 per cent last year.

But now according to the 2007 Kenya Aids Indicator Survey (KAIS) released on Tuesday prevalence rates in the national population stands at 8 per cent, indicating an almost four point increase.

Controversy over Aids statistics is not new and can be traced back six years ago with the launch of the Kenya Demographic and Health Survey – 2003 which indicated that HIV prevalence rates was 6.7 per cent.

Unreliable measurement

Before then, the National Aids Control Council and other Aids organisations were working on the assumption that the HIV prevalence rates were at 10 + per cent. It was then explained that the 10+ figure was wrong and arrived at through the use unreliable measurement tools – use of prenatal clinics as sentinel sites.

Consequently, the Kenya Demographic and Health Surveys (KDHS) data, indicating a 6.7 prevalence rate was adopted as the correct position then. Realizing the unreliability of the earlier figures the UN also revised its figures for some 15 countries including Kenya downwards.

Now the KAIS study used similar assessment tools to the KDHS 2003 survey and came out with similar trends and more believable figures. If the new figures are correct, then NACC and other government officials will be hard put to explain whether they deliberately misled Kenyans that the country was winning the war against the virus or the other factors at play.

Faced with this predicament, it was understood that Tuesday’s launch was not without acrimony, with some government officials refusing to be part of the process.

It is well understood that for close to a month, since the completion of the KAIS study, the Government has been discussing and agonising on the authenticity of the results and how to make them public.

The Board of the National AIDS Control Council had expressed reservations about the study, which was funded by the United States government to a tune of US$ 6 million.

When the results were first released by the team of researchers, the board is understood to have asked one of its senior epidemiologist – expert in the causes, spread, and control of diseases — to scrutinize the study and see if it was scientifically arrived at.

The scientist returned a clean bill of health about the findings. External scientists who had participated in the study are understood to have applied pressure on the government to have the report released.

At this point, this matter was referred to the Cabinet and other senior government officials for direction. After several meetings and discussions, it was agreed that National Aids Control Council and National Aids and STD Control Programme, come up with a logical answer for the public, explaining away the new 7.8 per cent prevalence rate.

One of the explanations the government officials are to put forward is that as more people access anti-retroviral drugs, lives are prolonged, with the number of deaths decreasing.

And since prevalence measures the number of people living with HIV and Aids at a particular point in time, then the high prevalence is justified.

The other reason is that those taking ARVs have regained their health and are having more sexual partners than before.

Indeed, experiences from elsewhere are showing that some of those on these drugs and good nutrition have very low viral loads, which make them think they have low chances of HIV transmission, hence engaging in unprotected sex.

Even with these explanations, the Government is not done yet. It is understood the United States through Usaid, which funds the production of the KDHS, will not finance the HIV component of the next study after spending over Sh400 million on KAIS.

From the donor’s point of view, the KAIS findings should be sufficient for the 2008 KDHS.

But the Government insists they have to undertake another similar study to, among many other things, confirm if indeed the KAIS study findings are correct.

Senior government officials and the ministries of Health, Special Programme and Finance have been asked to source funding from donors and other sources to finance this study expected to start in October.

For now, the KAIS findings raise some pertinent questions about what is really going in the HIV and Aids field. A Global Aids report was also being launched in New York last evening but the United Nations and was not expected to differ from the KAIS.

Gradually decreased

The United Nations started to revise its estimates in light of the new studies in its 2004 report, reducing the number of infections in Africa by 4.4 million. It also gradually decreased the overall infection rate for working-age adults in sub-Saharan Africa from nine per cent in a 2002 report to 7.2 per cent in its latest report.

The warning on reliance on ambiguous statistics was raised much earlier by the Kenya Aids Watch Institute. In its web site, it argues: “Listen carefully to the statisticians, who always insist that it is impossible to know the exact number of people living with HIV and Aids, and that the best use for surveillance statistics is identification of trends over time, rather than ‘correction’ of prevalence levels.

“The war on Aids must move from rhetoric over erroneous prevalence figures. A real solution will be built on the solid foundation of truth,” says KAWI director Francis Kajumo.

Some experts say that tallying HIV cases is not as important as finding the resources to fight the disease. But to researchers who drive Aids policies, differences in infection rates are not merely academic.

Programmes deemed successful are urged on and funded lavishly by international donors, often to the exclusion of other projects. Hence the need to be seen to be succeeding.