Kenya: Aids Council Changes Tact in New Strategy to Fight Scourge
By Ben Omondi
NAIROBI---The Kenya National AIDS Control Council (NACC) has realized the need to change its focus and realign its strategies to be responsive to and address emerging realities in order to win the war against the spread of HIV/AIDS in the country.
As the country marks a quarter of a century (25 years) since the first HIV/AIDS was diagnosed in the country, NACC’s newly launched Kenya National AIDS Strategic Plan, which runs from 2009/2010-2012/2013, has been developed to focus on and address new challenges and trends in the spread of the disease.
The current strategic plan, also called Kenya National AIDS Strategic Plan III (KNASP III) has been launched a year early as it was developed after a synthesized review of KNASP II.
In this regard, the new strategic plan is meant to address emerging changes in the spread of HIV/AIDS as indicated by the country’s two HIV/AIDS studies – the Modes of Transmission (MoT) in 2008 and the Kenya AIDS Indicator Survey (KAIS) of 2007.
The MoT study found new patterns of infections, with majority of the new cases occurring in couples while KAIS showed that HIV prevalence had risen slightly from the 6.7 per cent rate (reported in the 2003 Kenya Demographic and Health Survey) and stabilized at 7.1 per cent in 2007.
Prof Alloys Orago, the NACC director said that the two studies - MoT and KAIS - indicated that the prevalence rates of the disease had not gone down but just stabilized.
“The surveys also showed that NACC was not focusing on the right population segments leading to the question of who should be targeted with which and what kind of interventions,” said Prof Orago, adding that MoT showed that couples and people in stable relationships are still more vulnerable and prone to new HIV/AIDS infections with prevalence rates of 44.1 per cent.
“The problem of new infections among couples is not only for men but also women in marriages who are also vulnerable due to concurrent relationships while heterosexual casual sex accounts for 20 per cent of new infections,” said Prof Orago.
Heterosexual casual sex results when people move out of their normal environments (like workstations or away from spouses). Commercial sex workers accounted for 14 per cent of new infections while a new category of men having sex with men (MSM) was found to be contributing for 15.2 per cent of new infections.
Other modes of HIV/AIDS transmission responsible for new infections was injecting drug use (IDU) at 3.5 per cent while infections from health facilities (from use of unsterilized and unsafe clinical equipment) accounted for 2.5 per cent of new infections.
The studies showed that even at 50 years, men were still prone to new infections than women and also lead to the realization that there was need for capacity building of women and the older population that was taking care of orphaned children and other dependents.
The NACC director said that after analysis of the two surveys, the timeframe of the previous national AIDS strategic plan was cut by two years, leading to the development of the KNASP III whose timeframe is 2009/2010 to 2012/2013.
“The current strategic plan is linked to Kenya’s Vision 2030 and focuses on service delivery and empowerment of people and not abstracts like prevention. In health care service delivery we emphasise the need to ensure provision of services to all people across the board,” said Prof Orago.
The NACC boss said that the body currently engages with people living with HIV/AIDS, inviting them to share their experiences and testimonies with the uninfected in a bid to avoid new infections.
Even though the country has recorded several successes in the fight against the disease, with the number of people on anti-retrovirals (ARV) increasing from only two in 2000 to over 360,000 currently, various challenges still need addressing, according to Prof Orago.
“People need to be sensitised on the need to come out, be tested and know their HIV/AIDS status to help in planning. The government also needs to provide more money for HIV/AIDS interventions from its domestic resources even if means increasing the amount of contributions to the National Health Insurance Fund (NHIF),” urged Prof Orago.
He further supported the new increased NHIF fees as proposed by the ministry of medical services, saying some of the funds would be used to support HIV/AIDS interventions in the country.
Ms Alice Natecho, the information, education and communication programme officer at NACC said that the other challenges facing the body, whose mandate is to provide policy and strategic framework for mobilizing and coordinating resources for prevention of HIV transmission, is management of HIV/AIDS commodities like testing kits and condoms.
“The management of HIV/AIDS commodities needs to be streamlined and perfected to ensure availability of supplies. Currently the government provides about 70 per cent of condoms used in the country with other organisations and private sector accounting for the remaining 30 per cent,” said Ms Natecho, adding that this calls for better planning and management of the commodities to ensure availability.
The other challenges for NACC, whose other mandate is provision of care and support to those infected and the affected by HIV/AIDS in Kenya, are lack of adequate personnel and skills as there are not enough that can run programmes in areas like health facilities, said Ms Natecho.
“There is also competition among calamities for funds an example being catastrophes brought about by climate change and HIV/AIDS,” she said, adding that the other concern is the fact that TB rides over HIV/AIDS as “TB looks for those whose immunity has been compromised by HIV/AIDS to bring down.”
An indication of this is the rising incidences of TB among those with HIV/AIDS, with TB being recognized by health professionals as a major cause of death for people already infected with HIV/AIDS.
But NACC has also recorded significant successes even as it grapples with increasing challenges. Among this is the fact that its efforts to influence behavior change have borne positive results, leading Kenya to be recognized in 2005 by UNAIDS as being among the two countries to show behaviour change within its population.
The country’s behaviour change has been noticed from the age of first sexual debut among young people and school children. Statistics indicate that where as in 2001 children used to have their first sexual encounter at around 14 years, the age had increased to above 18 years in 2009.
“The number of young people having sex before 18 years is currently very low. Condom use, which was initially very low as it was seen mainly as a family planning method, is now very high among casual heterosexual partners,” noted Natecho.
Prevention of mother to child transmission (PMTCT) has also recorded positive results, from an adoption rate of only 20 per cent in 2003 to above 80 per cent for those mothers who deliver in health facilities. This is an improvement considering that Kenya had no PMTCT programme in 2001, with the first concept only being developed in 2002.
“To ensure that PMTCT was successful, HIV/AIDS positive mothers were urged not to breastfeed their new born babies,” said Natecho, adding that the success of PMTCT is due to the fact that HIV positive expectant mothers are put on ARVs to prevent them from infecting their new born babies with the virus and also allowing them to breastfeed.
“Mothers who are taking ARVs are able to breastfeed their babies safely without infecting them because the drugs cause the virus not to multiply thereby reducing their load in the body. Mothers on ARVs can even record not having any HIV on testing making it safe to breastfeed,” said Natecho.
She however stressed that ARVs only reduce multiplication of the HIV but do not cure those infected with the disease as the virus looks for safer environs within the patient’s body to hide with the possibility to reappear and become active again when a patient stops taking ARVs.
The other success for the council is that its coordination and mobilization of national response to HIV/AIDS has improved as more people have been brought onboard the programme to boost and play a role in awareness creation, prevention and management efforts.