Drop in HIV prevalence rate laudable

The recent announcement that the HIV prevalence rate in Kenya has reduced to 5.6 per cent in 2012 down from 7.2 per cent in 2007 is a sigh of relief in the fight against this disease that was once declared a national disaster.

The disease was declared a national disaster by former president Daniel arap Moi in 1999, which led to the establishment of the National AIDS Control Council.

In a survey released by the Kenya National AIDS and STI Control Program (NASCOP) under the Ministry of Health, the total number of people living with HIV is now estimated at 1.2 million down from 1.4 million in 2007.

The preliminary results in the report entitled “Kenya AIDS Indicator Survey (KAIS) 2012”, which was released on September 10, 2013 also notes that the prevalence rate among children aged between 18 months to 15 years was estimated at 0.9 per cent.

SH40 BILLION ANNUAL INVESTMENT

With close to Sh40 billion being spent annually in the fight against the epidemic, the huge investments are now paying off.

The KAIS preliminary report also notes that more people now know their status with 72 per cent of respondents being tested for HIV up from 34 per cent in 2007. Also, the number of people who are aware they have been infected with the virus has increased from 16 per cent to 47 per cent.

The survey further states that nearly 90 per cent of those who know their HIV status and are eligible for treatment are on medication.

However, only 60 per cent of people living with HIV and are eligible for treatment were actually on medication.

Other major achievements include awareness of HIV in the general population and uptake of Prevention of Mother-to-Child Transmission (PMTCT) services, estimated at about 88 per cent among HIV positive pregnant women who know their status.

Uptake has also increased for other services such as Voluntary Counselling and Testing (VCT) care and treatment and Voluntary Medical Male Circumcision (VMMC).

A particular noteworthy feature is that the peak of the epidemic has shifted from the 25-34 year age group to a 45-54 year age group. This is a significant shift that has happened in just 5 years.

Overall, huge improvements have been made despite the remaining challenges in the gender, age group and geographical disparities that have persisted.

UPHOLD ACHIEVEMENTS
The KAIS survey has implications for future HIV programming in Kenya. While the current strategies appear to be working, the HIV epidemic in Kenya has reached a point when incremental improvements will become even harder. It is critical that the achievements outlined in the

KAIS survey are not reversed as has been the case in a few other African states.

Therefore, new ways of delivering interventions that have proven successful in the Kenyan environment must be devised to engage the harder to reach groups so as to change their attitudes and practices. The future should not be business as usual.
For example, targeted and yet larger scale interventions should become even more focused to bring about further change and addressing HIV as part of a wider health need context of the Kenyan people 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 counselling that should become even more available outside formal institutional settings.

Early treatment initiation such as the Option B+ PMTCT should be adopted countrywide. 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.

DEVOLVING HEALTH SERVICES

Devolution of health service management poses new opportunities as well as challenges for the country to make new leaps in the fight against the epidemic.

While devolution offers opportunities for more precise targeting of resource allocation and closer monitoring of their use, the inadequate experience and even 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 integrate institutional capacity development in service delivery especially at subnational levels is what is likely to separate this potential from actual achievement.