Divine Intervention

Published — November 30, 2006 Updated — May 19, 2014 at 12:19 pm ET

Kenya

HIV rates are declining in Kenya, but poverty remains one of the biggest barriers

Introduction

Background

Kenya lies on the eastern coast of Africa, bordered by Ethiopia, Somalia, Tanzania, Uganda, Sudan and the Indian Ocean.

Germany colonized parts of Kenya in the mid-1880s. After the arrival of the Imperial British East Africa Company in 1888, Germany leased its holdings to Britain. Europeans began to settle the interior regions of Kenya in the first part of the 20th century and numbered nearly 30,000 by the 1930s. They farmed tea and coffee and became increasingly wealthy and politically powerful, while subjugation of the indigenous inhabitants grew.

From 1952 until 1956, the Kikuyu tribe revolted against the white settlers in what is known as the Mau Mau Uprising. The rebellion, though not a military success, helped to set the stage for Kenyan independence, attained in 1963.

The first president of Kenya was Jomo Kenyatta, a jailed nationalist leader during the Mau Mau Uprising who led the country from its independence in 1963 until his death in 1978. His successor was Daniel Toroitich arap Moi, who led the country until he peacefully stepped down after being voted out of office in 2002. The current president is Mwai Kibaki.

The face of HIV

The first diagnosed case of AIDS in Kenya was in 1984. Infection rates peaked in the 1990s at 10 percent. Today, 22 years after the first official diagnosis, 300 Kenyans die each day of AIDS-related causes. The U.N. estimates the number of children living with HIV/AIDS at 55,000 to 290,000.

But Kenya is one of the few sub-Saharan African countries where HIV rates have consistently declined in recent years. The decline is attributed to such factors as behavior change and condom use, as well as increased death rates.

According to UNAIDS, the Joint United Nations Program on HIV/AIDS, women in Kenya have an infection rate of 8.3 percent, almost twice as high as the 4.3 percent rate for men. Urban areas have infection rates as high as 10 percent, while the rates in rural areas are much lower — around 6 percent.

Challenges to fighting the HIV epidemic

As in all 15 “focus countries” receiving funds from the U.S. through PEPFAR, the President’s Emergency Plan for AIDS Relief, poverty is perhaps the greatest barrier to preventing the spread of HIV in Kenya. Nearly 60 percent of the population lives on less than $2 a day. On the U.N. Development Program’s Human Development Index, a scale based on economic and social factors, Kenya ranks 152 out of 177.

Lack of knowledge of prevention measures is a problem in Kenya. For example, less than 40 percent of Kenyan women and less than 50 percent of men ages 15-24 can correctly identify ways of preventing the sexual transmission of HIV.

Gender issues that inhibit the rights of women, such as commercial sex work and wife inheritance — a traditional practice in which a deceased man’s wife becomes the property of his brother — contribute to the spread of HIV.

Kenyan government response

Political will to fight the HIV epidemic is strong. President Kibaki declared a “total war” on HIV/AIDS in 2003. The National AIDS Control Council was created in 1999 to organize a coordinated response to the HIV epidemic.

In October 2000, the council issued the Kenya National HIV/AIDS Strategic Plan, which called for “prevention and advocacy; treatment, and continuum of care and support; mitigation of the socioeconomic impact of AIDS; monitoring, evaluation and research; and management and coordination.”

Along with other PEPFAR “focus countries” Tanzania, South Africa, Botswana, Uganda, Zambia, Mozambique and Namibia, Kenya is part of a 14-country collaboration called the East, Central and Southern Africa (ECSA) Health Community. It was formed in 1974 to strengthen the capacity of the health sectors in the member states. ECSA’s HIV/AIDS program, established in 2001 to improve access to HIV/AIDS care and treatment and effectively reduce HIV infections, has created curricula and guidelines, as well as a regional advisory committee.

U.S. government response

The U.S. government works with the National AIDS Control Council and “directly funds the National AIDS and Sexually Transmitted Infection Control Programme, which is part of the Ministry of Health.”

For fiscal 2005, treatment received the most PEPFAR dollars — 46.2 percent of the funding for prevention, care and treatment, or $57.9 million. Prevention received 28.2 percent of that funding, or $35.4 million, including $9.3 million for abstinence programming. Care received $32.1 million, or 25.6 percent of the prevention, care and treatment funding.

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