HIV is no longer seen as the dreaded epidemic and global health threat it still is.
Yet, the disease continues to claim lives, drain community resources and rob families of breadwinners.
Emerging challenges, such as patients getting resistant to drugs or those with advanced disease having low access to treatment, call for an even stronger commitment to the fight against HIV.
In a recent study published in Nature mapping out prevalence rates in 2000-2017, researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington found that HIV estimates are declining in most of Africa.
However, they also noticed a steady increase in the number of people living with HIV.
But while prevalence rates have declined across sub-Saharan Africa, most of the continent’s population is living with HIV — and the numbers are increasing.
Early initiation of antiretroviral therapy (ART) enables people to live longer and healthier lives, according to World Health Organisation, and reduces the potential for transmitting the virus.
Despite the rapid scale-up of ART since 2000, and the WHO recommendation since 2015 to put all people infected on treatment, HIV/Aids is still the most common cause of death in sub-Saharan Africa.
In Kenya, the Global Burden Disease data show that HIV/Aids was responsible for 48,503 deaths in 2017 alone.
Some 5.6 per cent of Kenyans are infected with HIV, down from 8.9 per cent in 2000, with rates varying tremendously at the county level.
Homa Bay leads with 18.9 per cent, followed by Siaya (14.3), Migori (13.2) and Kisumu (12.6).
The highest estimated HIV prevalence in Kenya in 2017 was 23 per cent in Suba District of Homa Bay.
The lowest was 0.7 per cent in Tarbaj Constituency, Wajir. The largest number of people aged 15-49 living with HIV — more than 21,000 — live in Nyatike Constituency, Migori County.
The number of people aged 15-49 years living with HIV in sub-Saharan Africa has increased by three million, and five per cent in Kenya, in two decades.
The growing population size and continued high incidence of infection, coupled with increased life expectancy among people living with HIV, has led to an increase in the number of infected people.
UNAids targets that by 2020, countries should ensure that 90 per cent of their population are aware of the disease, 90 per cent of those infected be on treatment and 90 per cent of people living with HIV be virally suppressed.
About 90 per cent of Kenyans know about the disease and those in need of ART were 1,338,200 in 2017.
Health Cabinet Secretary Sicily Kariuki has previously noted that over 40 per cent of all new infections in Kenya occur among people aged 15 to 24 years.
She also confirmed that “attainment of 90:90:90 targets by 2020 may be an uphill task if interventions are not scaled up where new infections and stigma levels are concerned”.
Unicef estimates that 34 per cent of people living with HIV in East and Southern Africa, and 60 per cent in West and Central Africa, are not on treatment.
At the onset of the epidemic, countries committed to support one another in a global solidarity fight.
Rich countries less affected by the disease pledged to support those disproportionately hit by it. This appears to be changing.
“Global funding for HIV/Aids has declined since 2013, but our research shows the substantial burden that still exists and reveals where geographically targeted interventions might make a big difference,” said IHME’s Laura Dwyer-Lindgren, assistant professor of health metrics sciences, who was lead author of the study.
Kenya’s HIV response has been lauded as a success due to the overall declining prevalence rate.
But it needs to review the financing models to ensure a sustained resource base for the HIV/Aids response.
Focus has increasingly moved away from saving lives and alleviating suffering towards tackling transmission and epidemic control.
Though Kenya has made deliberate efforts towards HIV prevention over the past decade, the tide is not yet turned: HIV/Aids is not yet defeated and too many people are still left behind.
For an increasing number of people living with HIV, timely and uninterrupted treatment is still out of reach. Systemic barriers continue to delay, deter and discourage patients from accessing early ARV treatment or continuing it.
Fatigue in the HIV fight and lethargy in the response in Kenya are a harbinger of a disaster; images of people leading healthy lives with HIV will likely be replaced by severely ill patients on the verge of death.
With the re-emergence of these earlier challenges, transmission will continue to thrive.
Ms Waguma is a freelance journalist based in Nairobi. [email protected]