GETTING TO ZERO new HIV infections ARE WE THERE YET?

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“Getting to Zero” is the theme for this year’s World AIDS Day, which is marked on December 1 every year to raise awareness and show support for people living with HIV/AIDS. Over the years, many efforts and strides have been made to raise awareness on the condition and while this has been achieved, there are emerging issues that need to be tackled if we are to get to zero new HIV infections. ESTHER KIRAGU, LILY RONOH and ESTHER AKELLO examine what needs to be done to achieve this goal. 

In 1984, the first case of HIV case was identified in Kenya. This prompted the government to establish the National AIDS committee the following year to deal with the scourge. For the whole of 80s, 90s and even into the 2000, HIV incidence (the number of new infections per year) steadily rose. In 1998, the then president Daniel Moi declared AIDS a national disaster and in 2000, Kenya developed a five-year National AIDS Strategic Plan. HIV prevalence peaked at 10.5 per cent in 1996, and had fallen to six per cent by 2013 mainly due to the rapid scaling up of antiretroviral treatment (ART) and awareness campaigns. Between 2007 and 2013, there was a 44 per cent reduction in new HIV infections among children and seven per cent reduction in new HIV infections among adults. This is according to the 2014 Kenya HIV County Profile report by the National AIDS and STI Control Programme.

The World Health Organization (WHO) places 78 million as the number of people who have been infected with the HIV virus worldwide since the beginning of the epidemic. Sadly, out of these, about 39 million people have so far died of the scourge. Reports show that by 2013, 35 million people were living with HIV globally. Out of these, 0.8 per cent were adults in their prime years of between 15 and 49 worldwide. Sub-Saharan Africa remains the most severely affected, with nearly 1 in every 20 adults living with HIV/AIDS, accounting for nearly 71 per cent of the people living with HIV worldwide.

Following a study in 2009 by National Aids Control Council (NACC) and UNAIDS, it was identified that transmission between discordant couples, where one partner is positive and one partner is negative, accounted for the majority of new infections. As a result,HIV prevention approaches were to be adopted including couple-based testing, encouraging partner disclosure and use of condoms.

Over the years, HIV testing has widely expanded across Kenya with many voluntary counselling and testing (VCT) sites easily available. Alongside voluntary testing, comes counselling which is offered whenever individuals take an HIV test at a health facility. Counselling is crucial as it enables one to accept their HIV status and take adequate measures to avoid spreading the virus as well as ensure they live a quality life regardless of being HIV positive.

According to Michael Kimoyi, a project officer and community health specialist based in the department of counselling and social work at AMREF Health Centre in Kibera, sometime patients who test HIV positive are enrolled in the Kibera care and treatment programme only for them to default from treatment after a while and end up jeopardising their health. Treatment for persons living with HIV/AIDS is crucial as it enables them live a positive and long life.

“Absconding from treatment is often due to self-stigma where some patients have not fully come to terms and accepted their HIV status. Through counselling and follow up, we help patients accept their status and live a positive life,” says Michael.

In addition to treatment, nutrition is of equal importance to people living with HIV/AIDS and they are encouraged to eat a well balanced diet daily. However, in some instances especially in low economic societies such as Kibera, achieving this is a pipe dream.

“When we realise a person living with HIV within the Kibera locality we serve is lacking key nutrients and they cannot absolutely afford a balanced diet, we provide them with nutritional supplements to boost their health. However, we are only able to do this for persons in dire situations,” Michael explains

Condom use is yet another important variable in getting to zero new infections. Over the years, the Kenyan government has actively promoted condom use, with condoms now freely available in many public places. For those living with HIV/AIDS, condom use when engaging in sex is a must for the rest of their life to avoid re-infection, which weakens the immune system, therefore putting them at greater risk of dying from the condition.

Talking about HIV is also a powerful weapon against misinformation and stigma. Over the years, HIV/AIDS education has been incorporated in the Kenyan education system as part of the curriculum in both primary and secondary schools. As a result, awareness about HIV/AIDS in Kenya is high. Also, with time, a lot of people have openly declared their HIV status publicly in a bid to help end the stigma and create more awareness.

Care programme for persons living with HIV…

In the online edition of the Journal of Acquired Immune Deficiency Syndromes, it was reported that HIV incidence and prevalence rates in Kenya were on the decline. Surveys conducted in 2007 and again in 2012 indicated that HIV prevalence fell from 7.2 to 5.6 per cent and the incidence rate from 0.7 to 0.2 per cent. This decline was linked to improvements in care and the roll out of antiretroviral therapy.

Michael says that the importance of care to a person living with HIV/AIDS cannot be underscored enough. He explains, “At the AMREF Kibera Health Centre, persons who test HIV positive are immediately enrolled in the care and treatment regimen, where they access not only treatment and medical advice, but are also linked to a support group where they get to share their experiences, learn from each other and get empowered on how to live positively despite having HIV/AIDS. Additionally, they get to be part of income generating projects such as table banking and merry-go-rounds where they can get soft loans to empower themselves economically.”

In June 2011, the then President of Kenya Mwai Kibaki joined other heads of states and governments to review the progress achieved in realising the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS. The leaders expressed concern regarding the inability of majority of low and middle income countries to meet universal access to HIV treatment targets despite the major achievement of expansion in providing access to anti-retroviral treatment. Concern was also expressed that the number of new HIV infections was outpacing the number of people starting HIV treatment. Statistics show that in 2014, there were roughly 2 million new HIV infections globally, 220,000 of which were among children, most of who live in Sub-Saharan Africa

Michael says that the care and treatment programme in Kibera currently has around 4,000 people ranging from the ages of 20 to 60 years. This number also includes around 600 children who are HIV positive. Every month, the programme enrolls an estimate of 60 people into the care programme, majority of who are people with new infections.

The AMREF Kibera Health Centre has partnered with the Nairobi County government who support them with staff to attend to patients. For this year’s Worlds AIDS Day programme, plans are underway to carry out a youth sports symposium that will encourage the youth to come and get tested to know their HIV status.

Criminal transmission of HIV…

The strides made so far in the fight against the pandemic are impressive. However, there is a growing concern over cases where individuals who are aware of their HIV status, recklessly or intentionally infect another person with the virus. According to international media reports, in June 2008, a 34-year-old man, from Iowa, US who is HIV positive and on antiretroviral medications, admitted to having sex with his partner without disclosing his HIV status despite knowing he was HIV positive.

The man, however, used a condom. His partner, a man, nevertheless sued him for not disclosing his HIV status. His partner said that although he went for a HIV test that came out negative, he was severely depressed and suffered panic attacks while waiting to find out if he was infected during the six-month window period before one can conclusively know their HIV status.

In 2010, there was yet another incidence reported in the media where an HIV-positive man was arrested in Indiana, US for knowingly and intentionally exposing more than 100 women to the virus over a period of five years. And in 2012, a Michigan man admitted to police that he was trying to infect as many people as possible and told authorities that over the past three years, he had had unprotected sex with thousands of people. In July 2015, Michael Johnson, a former Lindenwood University wrestler in the US, was sentenced to at least 30 years in prison and may serve up to 60 years after being convicted on all five counts of infecting and exposing his partners to HIV.

In December 2014, police in Kakamega County arrested a pastor for allegedly raping and infecting a six-year-old girl with HIV. The Kenyan law forbids one from knowingly spreading HIV to others. The Sexual Offences Act and the HIV Prevention and Control Act passed in 2006, under sections 26 and 24 provides grounds for conviction of anyone who knowingly transmits HIV to others.

A victim’s ordeal…

Twenty-three-year-old Yvonne Atieno from Mashimoni in Kibera is living with HIV/AIDS. The mother of two – an eight-year-old daughter and a nine-month-old son, lost her husband early this year to the scourge.

Yvonne and her now late husband met in 2014 and after dating for a few months, they moved in together. “I came into the marriage with a daughter from a previous relationship, whom my husband loved and accepted. After a while, I got pregnant with my now second-born and began attending pre-natal clinic at AMREF Kibera Health Centre. As is the norm of prenatal care, I took a HIV test. To my disbelief, I tested positive and underwent counselling,” she explains

Yvonne took the HIV test results to her husband whom, to her surprise, did not seem shocked at all. Many thoughts crossed her mind and she wondered if all along he was aware of his HIV status and had knowingly infected her.

“I was very disturbed at the turn of events but counselling played a huge role in helping me come to terms with my new status. When I first met my husband, I had insisted that we take a HIV test but he shrugged off the idea and reassured me that he was HIV negative. I believed him. In retrospect, I can now connect the dots regarding the puzzle surrounding my HIV status,” says Yvonne.

She adds, “At one time, while we were relaxing at home, I recall my husband receiving a call and the manner in which he behaved attracted my attention. The person on the other end introduced himself as a doctor who was doing follow-ups on his patients. I could tell my husband was very uneasy and kept the conversation short devoid of details. When he hung up the phone, I enquired what that call was about but I did not get a convincing explanation,” she recounts.

Yvonne was put under medication to prevent her from infecting her unborn baby with the virus. Initially, her body reacted badly to the medication and she would throw up but with time, she got used to it. She continued attending prenatal clinic and two days after giving birth to her son, her husband passed away. It was only after his death that she found out that her late husband’s family was aware of his HIV status. Although her child is still under observation and his HIV status can only be conclusively determined once he turns two, so far, he is well and healthy.

Angry, Yvonne confronted her in-laws about keeping such crucial information from her. “In their defense, they said that they assumed my husband had divulged his HIV status to me and that they didn’t want to interfere with our marriage. The truth is, my husband had not fully accepted his status because although he was on treatment, he kept it a secret. I later learnt that he had begun treatment at AMREF Kibera Health Centre and defaulted at some point hence his poor health and ultimately death,” she says.

Life was difficult. In addition to dealing with the shock of accepting her HIV status, Yvonne also had to come to terms with the death of her husband. Also, with a newborn, it was impossible to find time to work and fend for her young family, as she had no one to leave her baby with.

“My mum has been my biggest support system throughout this difficult time. I have joined a support group of other people living with HIV/AIDS where we get to share information and discuss some of the challenges we go through, as well as encourage one another. There are also the mentor mothers who walk with pregnant mothers who have newly tested positive, as was my case, and they provided me with great support and guidance,” she explains.

Now wiser, Yvonne understands the importance of having a HIV test prior to getting into a committed relationship especially if one is sexually active. As a person living with HIV/AIDS, she has learnt to embrace medication and good nutrition as well as keep stress at bay in order to lead a fruitful life.

“My life may have totally changed but I am determined to make the best of it as I have children who look up to me. I hope to get married again someday to a man who will love and accept my children and me. I am young and have a long life ahead of me, and I am determined to live it fully,” she concludes.

What everyone needs to know…

The reality is that anyone can get HIV and therefore we all need to take deliberate steps if we are to get to zero HIV new infections and zero HIV-related death. The following are guideline to help us achieve this goal:

  You must get tested and know your partner’s HIV status before you engage sexually with them. This should be non-negotiable. A healthy-looking person could be infected with HIV so do not be deceived by looks. Insist that the person gets tested before you have any sexual contact.

  Protect yourself by using condoms, especially when you have multiple sexual partners. Also, if you have already contracted HIV, correct condom use is a must whenever you engage in sex even if you are taking ARVs, to avoid spreading it to others. Do not engage in unprotected sex unless you are certain that your partner is not infected with HIV.

  Stick to one sexual partner because the more sexual partners you have, the higher your chances are of getting infected with HIV.

  If you use injectable drugs you are at a higher risk of contracting HIV. Therefore, always sterilise your injectable equipment and never share your equipment with others.

  If pregnant, attend antenatal clinics as this can identify if you are HIV positive and take measures to help prevent your unborn child from becoming infected. In many instances, children in sub-Saharan Africa are infected via their HIV-positive mothers during pregnancy, childbirth or breastfeeding. Therefore, it is important that you attend antenatal clinics, as this is the best time to prevent mother to child transmission.

The goal of getting to zero new HIV infections and HIV-related deaths may seem like a tall order but it is not impossible. Great strides have so far been made. Information from the UNAIDS website on the 2011-2015 UNAIDS strategy show unprecedented acceleration in the AIDS response is producing results.

There is a decline in new HIV infections in children with statistics showing that half of the global reductions in new HIV infections in the last two years have been among newborn children. Although more effort needs to be made to achieve this year’s World AIDS Day theme, it will take each one of us to play their role in attaining this target.

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Published in December 2015

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