Youths aged between 15 and 24 have recorded the highest new HIV/Aids infections of over 40 per cent for the past three consecutive years since 2017.
According to data from the National Aids Control Council, two in five new infections is recorded in that age group. Last year, there were 184,719 HIV-positive youth (15-24 years), accounting for 17,667 of the total new infections, and 2,830 HIV-related deaths.
This is an indication that young people are engaging in unprotected sex with people whose status they do not know. At the same time, the youths are reluctant to go for HIV tests as they fear being stigmatised. Incidentally, infections are declining in other age groups.
It is because of this worrying trend and the benefits of early diagnosis that the government introduced a new method of self-testing in a bid to stem the tide.
By introducing the self-test kit, the government is aiming at targeted testing that will see those who test positive put on treatment.
Concerns have been raised over the effectiveness of self-testing without pre-test counselling. The need for lengthy pre-test counselling has always been considered necessary to ensure that people understood the implications of a positive HIV test. As the world marks World Aids Day today, the Sunday Nation sought the opinions of young people on the HIV self-test kit.
We spoke to three youths, one who went for a test at a local clinic and others who opted for self-testing. They had various concerns on self-testing, including the lack of counselling, the challenge of ensuring linkage to care, the potential for coercive use of self-testing devices, and their accuracy and even the pricing. This has led to a low uptake of the kit.
“So far, we have sold about 2,000 kits and the response, though lukewarm, has been encouraging. We now intend to roll them out to public health facilities by targeting at least 600,000 pregnant women,” head of Nascop Dr Martin Sirengo said.
“I was 25 when I first tested for HIV because I had unprotected sex with one of my classmates at the university and I wanted to know my status,” says Borvine Martin* He wanted to do a self-test but the fear of knowing his status without counselling and lack of Sh800 to buy the kit led him to the clinic.
At the facility, he was counselled by a nurse before the test. The whole testing process took about 45 minutes.
Pre- and post-counselling that goes with having an HIV test were mandatory. He was asked a stream of questions to test his knowledge of HIV and, to his surprise, there were things about HIV/Aids he hadn’t heard of.
“It takes about 10 minutes to see the results. The kit has three indicator lines. Two of the lines indicate one of two HIV strands, and the other is a control line,” he explained.
If a line appears on either the first or second HIV strand-line and the control line, one have tested positive for the screening test. However, this is just a screening test, which is not a 100 per cent positive. If there are no lines on the HIV indicators and only a line on the control, one is negative.
However, the test will have to be retaken if no line appears on the control line.
Millicent Onyango* and Shallyne* understand how the kit works without the support of anyone. Millicent walked into a pharmacy and bought a kit while Shallyne sent her sister.
“It is not easy. Deciding to take a self-test yourself requires one to be ready to accept the results either way,” Millicent says.
For Shallyne, the anxiety took a toll on her and she says she will never take the self-test ever again.
The idea that someone might learn that they have HIV when they are home alone, rather than from a trained health professional, remains troubling for many. The tests could also be misused. An abusive person could, for example, coerce a partner, child or other vulnerable adults to be tested against their will or without their consent. A negative result might also be used as a negotiating tool for unprotected sex.
While self-testing is not prohibited in Kenya and the kits are available in private hospitals and registered community pharmacies, influential stakeholders have warned against self-testing.
Researchers from Médecins Sans Frontières (MSF) wanted to better understand whether HIV self-testing could help more people to know their HIV status.
In-depth interviews and focus group discussions were conducted with nine individuals (mostly men) who had declined HIV testing as well as seven female healthcare workers (nurses, counsellors, community caregivers).
The OraQuick device was demonstrated during interviews and focus groups. In line with previous research, respondents shared the perception that the OraQuick device is easy to use, provides an alternative for people concerned about intimacy and confidentiality, and gives individuals control of when and where to test.