Kenya

We must protect, promote and fulfil human rights if we are to achieve HIV and health targets on the African continent and ensure access to HIV prevention, treatment, care and support services for all. This was the main call to action during a recent regional consultation for national human rights institutions and parliamentarians held in Nairobi, Kenya.

“This conference is indeed very timely for Africa, as it offers an opportunity to deliberate on how best national human rights institutions can work with parliaments in fostering the right to health through building strong partnerships,” said Enid Muthoni, the International Development Law Organization’s Country Director in Kenya.

National human rights institutions play a key role in promoting and protecting HIV-related human rights, including the right to health, and in ensuring that these are effectively addressed at the local and national levels. They serve as an important bridge between government, civil society and other stakeholders, helping to empower duty-bearers to respond to issues related to the right to health and rights-holders to realize these rights.

“Human rights and health are inherent for everyone. National human rights institutions, parliament and civil society and everyone at an individual level has a role to play in promoting the right to health,” said Madeleine Nirere, Chair of the Network of African National Human Rights Institutions.

The right to health is especially important to promote among people being left behind by the AIDS response, including key populations—such as gay men and other men who have sex with men, sex workers, transgender people and people who inject drugs—to claim their rights to non-discrimination, HIV prevention and treatment services, information and education and freedom from sexual coercion and violence.

“If you have no health, you have nothing else. Everyone should therefore have a right to health,” said Miriam Were, former Chairperson of Kenya’s National AIDS Control Council and Champion for an AIDS-Free Generation.

The call to action from the consultation focused on a broad-reaching range of human rights issues, including promoting public–private partnerships and policies and actions to end stigma and discrimination in health-care settings and other institutional settings, such as schools and workplaces. The participants also called for the repeal of punitive laws, policies and practices that create barriers to access HIV and health services and appealed to countries to ratify and domesticate the many existing African human rights mechanisms.

“The call to action will enable national human rights institutions and parliamentarians to firmly express their determination to help achieve the health and HIV targets and operationalize the resolutions and mechanisms at our disposal,” said Jantine Jacobi, UNAIDS Country Director in Kenya.

A meeting at the 2018 International AIDS Conference, being held from 23 to 27 July in Amsterdam, Netherlands, has showcased how Kenya is responding to the challenges and opportunities on the way towards validation of the elimination of mother-to-child transmission of HIV in a high-burden context. 

Building on the Start Free Stay Free AIDS Free framework, specific attention is being given in Kenya to ensuring access to treatment for children and adolescents living with HIV, while addressing inequities, particularly among adolescent girls and young women.

The participants heard about the role of high-level champions—including community leaders, parents, religious leaders and other relevant stakeholders—highlighting the need for action at all levels, based on robust programmatic data.

Kenya has made significant progress in preventing new HIV infections among children, which fell from an estimated 13 000 in 2010 to 8000 in 2017. This has been possible through programmes such as the mentor mother initiative, which supports and cares for women living with HIV, the mother–baby pair approach, which synchronizes appointments for the mother and the child at the health facility, and audits of every child exposed to HIV in order to identify barriers in accessing health facilities.

The leadership of Margaret Kenyatta, the First Lady of Kenya, and her Beyond Zero Campaign have been instrumental in raising awareness on the importance of services to promote the health of mothers and children, including HIV prevention.

The participants heard, however, that more needs to be done to ensure that progress is equal across the country. Progress has been threatened by recent challenges, such as a health workers strike, which has affected antenatal care and testing coverage, and reduced community support, which has affected demand creation for HIV services.

The participants decided that there was an urgent need to scale up HIV programmes. This would be complemented by innovations in tracking the targets for paediatric and adolescent HIV and accounting for every mother and child. Furthermore, the resilience of the health system needs to be strengthened.

The meeting, held on 24 July, was jointly organized by the Ministry of Health of Kenya, UNAIDS and the Elizabeth Glaser Pediatric AIDS Foundation.

Margaret Kenyatta, the First Lady of Kenya, reinforced her commitment to champion the elimination of mother-to-child transmission of HIV in a meeting with UNAIDS Deputy Executive Director Gunilla Carlsson in Nairobi, Kenya, on 29 May.

The First Lady and Ms Carlsson discussed the Beyond Zero platform, a groundbreaking initiative spearheaded by the First Lady. Through Beyond Zero, the First Lady has mobilized resources from the private sector to respond to the health and well-being of women and children, with a focus on HIV and sexual and reproductive health.

“There is so much momentum and support from Kenyans themselves for the Beyond Zero initiative. They feel that it is theirs and that they own it,” said Ms Kenyatta.

Beyond Zero has delivered 52 mobile clinics to every county in Kenya. The operationalization of the clinics has resulted in substantial community mobilization and demand creation for HIV services. Initiatives such as Beyond Zero have contributed to significant progress in the AIDS response in Kenya, with new HIV infections among children aged 0 to 14 years reducing from about 14 000 in 2013 to 6100 in 2016, while in the same period the percentage of mothers delivering without a skilled health provider decreased from 56% to 34%.

Building on those gains, the First Lady launched a new framework earlier this year to advance the Beyond Zero initiative. The framework adopts a life-cycle approach, addressing challenges, including HIV, at different stages of life. Ms Kenyatta’s championship for Kenya to reach validation by the World Health Organization for the pre-elimination of mother-to-child transmission of HIV is a core commitment of the framework.

“Beyond Zero is a powerful initiative. An advocacy platform that has fostered public–private partnership for the health agenda and the elimination of mother-to-child transmission of HIV in particular,” said Ms Carlsson.

Civil society has played an important role in the response to HIV since the very beginning of the epidemic, calling for access to life-saving medicines, demanding the rights of people living with and affected by HIV and providing critical HIV prevention, care and support. Without civil society, fewer HIV services would be available, particularly to marginalized populations and to people in remote areas.

On a recent visit to Kenya, the Executive Director of UNAIDS, Michel Sidibé, met with members of civil society organizations in Kenya to talk about how to support, reinforce and expand the contribution of civil society towards ending the AIDS epidemic.

“We need a new narrative, not only about HIV treatment but how to restore people’s dignity,” said Mr Sidibé. “We need to demonstrate that no one can better deliver on universal health care than civil society organizations.”

Community responses to HIV result in better health, foster community resilience and are cost-effective. Civil society also needs to be fully involved in decision-making processes to help its work in ensuring respect for human rights, achieving gender equality and diversity and ensuring that no one is left behind.

Wanjiru Mukoma, the Executive Director of Liverpool VCT Health, a Kenyan civil society organization that provides HIV prevention, testing, care and treatment services, facilitated the meeting. She said, “We are at the point where we must frame the HIV agenda. The HIV response cannot be effective without a vibrant civil society.”

The participants asserted that the focus must shift from building the capacity of civil society to meaningful investment in existing capacity in order to increase the impact of its work in the AIDS response.

“Civil society organizations have done a lot of work, but credit does not go to us. We need support to document our work and build our capacity to establish robust monitoring systems of our contribution to Fast-Track,” said Dorothy Onyango, the Executive Director of Women Fighting AIDS in Kenya.

Ensuring the meaningful participation of young people in civil society spaces was also stressed. “We do not want the young at heart to represent us; we are asking for spaces to represent ourselves. We have capacity,” said Joyce Amondi, a young person at the meeting.

During the day, Mr Sidibé also met with Sahle-Work Zewde, the Director-General of the United Nations Office at Nairobi, to discuss sustainability planning to maintain and accelerate the remarkable results that Kenya has achieved towards achieving the 90–90–90 targets, whereby, by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads. They agreed that decentralizing service delivery systems, cutting user fees and stopping the use of falsified medicines would be transformative for the AIDS response in Kenya.

UNAIDS is committed to the meaningful and inclusive participation of civil society at all levels of the AIDS response. By integrating community responses into national AIDS plans and Global Fund to Fight AIDS, Tuberculosis and Malaria concept notes, including budget allocations, UNAIDS supports the funding, development, implementation and monitoring of community service delivery programmes, civil society organizations, advocacy organizations and community networks.

UNAIDS brings civil society organizations together with governments and donors to develop plans, strategies and programmes, review legal and policy environments and respond to emergency and human rights issues. UNAIDS supports civil society organizations to engage in the AIDS response in a coordinated way that respects diverse voices and actions, facilitating civil society advocacy and community-based service delivery.

Like many women in sub-Saharan Africa, women in Kenya are disproportionately affected by HIV. In 2016, 34 000 adult women became newly infected with HIV, compared with 22 000 adult men, and adult women accounted for 910 000 of the 1.6 million people living with HIV in the country.

Women also face challenges with sexual and reproductive health issues, such as limited access to family planning, as well as stigma and discrimination when they seek services.

To identify solutions to such challenges facing women in Kenya, the nongovernmental organization Women Fighting AIDS in Kenya (WOFAK) recently held a two-day workshop on 25 and 26 April in Nairobi, Kenya, on advancing the sexual and reproductive health and rights of women living with HIV. More than 30 women living with HIV from across the country met with representatives of the government, civil society and United Nations agencies to take stock and agree a pathway to implement the World Health Organization’s (WHO) Consolidated guideline on sexual and reproductive health and rights of women living with HIV.

“A woman-centered approach must guide a more responsive delivery of services for women living with HIV,” said Dorothy Onyango, co-founder of WOFAK, at the start of the meeting.

To guide effective implementation of the guideline at the country level, the Salamander Trust, with support from WHO, developed a checklist to support women living with HIV to organize and coordinate their own advocacy and ensure their meaningful engagement. The checklist was first used in Kenya and will be rolled out to other countries.

During the meeting, Rukia Ahmed, founder and chairperson of a support network for Kenyan Muslim women living with HIV in north-eastern Kenya, said, “Most women only find out about their HIV status when they are pregnant or very ill. Confidentiality is an issue. When their status is disclosed, some are not accepted by their family afterwards, leading to isolation.”

Ms Ahmed is now going to advocate for discrimination-free health-care settings. “I’m going to visit district hospitals and raise awareness among health-care workers and support groups on the right to stigma-free health care. Change is possible,” she said.

“What stood out for me was the message that as women living with HIV we need to accept ourselves and love ourselves first and as a result we will be able to fight for our rights,” said Joyce Ouma, from Sauti Skika, a network of young people living with HIV.

It is a message Ms Ouma hopes to bring to her peers. “Initially, I did my advocacy out of obligation. Now I want to do it because I have the drive and I know it is important for me first,” she said.

At the conclusion of the meeting, Jantine Jacobi, the UNAIDS Country Director for Kenya, said, “We need to listen to the lived experiences of women living HIV to ensure that services meet their needs.”

The 2030 Agenda for Sustainable Development takes ​to scale ​what the AIDS response has been working towards for 30 years—a multisectoral, rights-based, people-centred approach that addresses the determinants of health and well-being. The individual stories in this series highlight the linkages between HIV and related Sustainable Development Goals (SDGs), each told from the personal perspective of people affected by HIV. The series paints a picture of how interconnected HIV is with the SDGs and how interdependent the SDGs are with each other. Most importantly, the stories show us the progress we have achieved with the AIDS response and how far we have left to go with the SDGs.  

Eighteen years ago, at the age of 19, Florence Anam became pregnant. As a teenager she had been flattered by an older man showering her with attention. A good student in school and just about to start university, her parents told her that they were disappointed in her, but never brought up the subject again.

“When I was pregnant, there were never any questions of how I got in this situation or who was responsible,” Florence said. “Sex was a taboo topic and not a discussion that parents had with their children.”

Florence did not know of her HIV status until 2006. During a national Kenyan HIV prevention campaign, she and four other friends went to get tested. When the HIV tests confirmed she was living with HIV, she was shocked.

The reality hit when a year later Florence was dismissed from her job because of her HIV status. “Back then, there were no HIV networks for young people, neither was there as much information available, so I contacted a woman who had been featured in a newspaper and lashed out at her, asking, “Why am I not allowed to be productive if I am not sick yet?”” explains Florence.

That woman, Asunta Wagura, was the Director of the Kenya Network of Women with AIDS. Asunta asked Florence to come in and see the organization, for which she then started volunteering. She describes the experience as a serious reality check. She heard other women’s stories, of how many of them lived in poverty and dealt with violence. “It was like plunging into this world that as a protected child I never even knew existed; all of a sudden my problems became trivial and I knew I needed to let other people know what I was seeing every day.”

She also became more vocal about HIV, bringing a lot of attention to herself and her status.
“I was done with having people dictate to me what their opinions about my life were, I missed the girl that I was and I desperately needed to get out that hole,” she says.

Part of Florence’s advocacy and communications work with the International Community of Women Living with HIV involves monthly mentoring meetings with girls and young women living with HIV. “I want to raise their consciousness regarding their life 20 years down the road,” Ms Anam says.

Florence considers that her life is full. Her 17-year-old son and 11-year-old adopted daughter affectionately chide her for bringing up sex and other “awkward” subjects at the dinner table.
“I am like the weird mother speaking about sex and responsible sexual behaviour in the most insane places,” Ms Anam says. “I keep repeating to them that decisions you make now, however immature, will have a long-term impact.”

SDG 5: Achieve gender equality and empower all women and girls

Gender inequality, discrimination and harmful practices create a culture that negatively impact women, girls, men and boys. Girls and women are disproportionately vulnerable to and impacted by HIV infection. Frequently they do not have the ability to control or determine their own life choices, such as going to school, who they marry or have sex with, the number of children they have, the health-care services they access, their employment options, or their ability to voice an opinion and be respected.

Programmes designed to educate and inform girls and women about the risks of HIV and provide some means of protecting themselves are essential building blocks of the AIDS response. And yet, however necessary, they are insufficient. Access to comprehensive sexuality education and sexual and reproductive health services can only ever be partially successful in protecting girls and young women from HIV if their potential male partners remain unaware of or unwilling to change their behaviour. Increasing male awareness of the risks of HIV, providing men and boys with the means of prevention, and enabling them to change their own behaviour and see the benefits of a balanced and respectful relationship are essential to decreasing the number of new HIV infections and increasing gender equity.

Like many young women, Florence grew up without comprehensive sexuality education or access to sexual and reproductive health services. She has made it her life’s work to expand youth-friendly HIV and health services and to mentor young women living with HIV, giving them hope for the future. Florence’s story encapsulates how important progress on SDG 5—achieve gender equality and empower all girls and women—is to enabling young women and men to make informed decisions on protecting themselves from HIV infection.

Naomi Watts, UNAIDS Goodwill Ambassador, visited Nyumbani Children’s Home in Kenya on 11 July to learn about Kenya’s prevention of mother-to-child transmission of HIV programme and the work done in the home to care for children living with HIV.

In the space of just a few years, as the result of a strong partnership between political leadership, programme implementers and the community, new HIV infections among children aged 0–14 years in Kenya have fallen from 12 000 in 2013 to 6600 in 2015. In June, under the leadership of the First Lady, Margaret Kenyatta, Kenya launched a new framework to accelerate the country’s efforts towards elimination of mother-to-child transmission of HIV and syphilis. The framework calls for the elimination of stigma and discrimination and the creation of an environment that empowers women living with HIV.

Nyumbani Children’s Home opened in 1992 and is currently home to 124 children living with HIV. The home provides nutritional, medical, psychosocial and spiritual care to the children and to the surrounding community, providing a place of safety in Nairobi for abandoned children living with HIV. In addition, the organization has a community- based programme that supports more than 3100 children living with HIV who reside in the informal settlements of Nairobi and 1000 orphans in Nyumbani villages.

Mss Watts and her two sons visited several facilities in the home, including its state-of-art laboratory equipped to undertake early infant diagnosis and viral load testing. Ms Watts congratulated Nyumbani Children’s Home for the impact it makes on a daily basis in the lives of so many remarkable and empowered children. She committed to continue to create awareness of the need to ensure that children living with HIV remain AIDS-free. 

GRASSROOT HERO SERIES
UNAIDS brings you stories of people on the ground bringing about change in the AIDS response. We thank them for being unsung heroes. AIDS is not over, but it can be.

A gaggle of girls shuffle into Florence Anam’s office for their monthly mentoring chat. She has put out snacks and assembled chairs in a circle. To get the conversation started, she asks the 16 girls to describe their happiest memory and their saddest moment and what their actions were at both of those times. A few describe their carefree childhoods and their world crumbling when they found out they were living with HIV.

Ms Anam, who works for the International Community of Women Living with HIV in Kenya, sees a pattern after about five responses and asks, “Who has felt so low that they wondered if they could carry on?”

Fifteen of the 16 girls raise their hands.

“I am so disturbed to see how young people are so depressed and how this will affect them in their adulthood,” she says. “We need to give our kids a reason for living.”

Her determination is deeply rooted.

Eighteen years ago, at the age of 19, Ms Anam became pregnant. As a teenager she had been flattered by an older man showering her with attention. A good student in school and just about to start university, her parents told her that they were disappointed in her, but never brought up the subject again.

“When I was pregnant, there were never any questions of how I got in this situation or who was responsible,” Ms Anam said. “Sex was a taboo topic and not a discussion that parents had with their children.”

Her mother took her to a clinic, and she describes being stared at. At the time, she thought the doctor was probably wondering how such a young woman could be pregnant, but she now thinks they were hiding things from her.

“The health system, I believe, was not equipped to deal with young people like me at the time. I remember the staff talked to my mother more than me,” Ms Anam says.

Ms Anam thinks the doctors informed her mother that she was HIV-positive, although they didn’t tell Ms Anam that she was. She recalls her mother telling her to stop breastfeeding her baby son, although the teenage girl just thought it was because she had to go back to school, which she did seven days after delivering her baby.

In 2006, during a national Kenyan HIV prevention campaign, she and four other friends went to get tested. “I wanted to prove people wrong and wanted to just come out of that testing centre and scream I was HIV-free,” she says. When the HIV tests confirmed she was living with HIV, she was shocked.

Ms Anam says the real impact of her HIV-positive status came a year later, when she needed to get an HIV test to qualify for health insurance at a new job. The day the results came back, she had a termination letter on her desk.

“It hit me that I would not achieve my dreams, I felt really sad that all the dreams my parents had for me could not come to pass because I was not going to be able to work,” Ms Anam says. “I sank into a hole.”

She stopped socializing, distanced herself from her family and felt utterly lost and angry.

“Back then, there were no HIV networks for young people, neither was there as much information available, so I contacted a woman who had been featured in a newspaper and lashed out at her, asking, “Why am I not allowed to be productive if I am not sick yet?”” explains Ms Anam.

The woman, Asunta Wagura, happened to be the Director of the Nairobi-based Kenya Network of Women with AIDS. Ms Wagura asked her to come in and see the organization, for which Ms Anam then started volunteering. She describes the experience as a serious reality check. She heard other women’s stories, of how many of them lived in poverty and dealt with violence.

“It was like plunging into this world that as a protected child I never even knew existed; all of a sudden my problems became trivial and I knew I needed to let other people know what I was seeing every day.”

She also became more vocal about HIV, bringing a lot of attention to herself and her status.

“I was done with having people dictate to me what their opinions about my life were, I missed the girl that I was and I desperately needed to get out that hole,” she says.

Over time, she learned to take control of her life.

“Part of my family was supportive, but another looked down upon my decision,” Ms Anam explains. “When my sister said to me that I had found a purpose, I did my first media interview.”

And she never looked back.

The turning point for Ms Anam came when she realized that she too had a story to tell and so she started writing. It was not only therapeutic—it inspired others.

She accompanied Ms Wagura and spoke to her peers.

It is that mentorship that Ms Anam says enabled her to grow to be the person she is today.

She started a support group of young people in 2008 and the members continue to be a part of her life.

Ms Anam worked in the private sector in an HIV workplace programme, where she implemented strategies for HIV prevention and expanding health services. “These were the best years, because I was able to go back to the system that had shown me what stigma could lead to and I helped fix things.”

She then joined the Kenya Empowerment Network of People Living with HIV to coordinate a national advocacy and communication portfolio. Now working in advocacy and communications for the International Community of Women Living with HIV, she considers that she lives a full life and is bringing up her 17-year-old son and 11-year-old adopted daughter. They chide her for bringing up sex and other “awkward” subjects at the dinner table.

“I am like the weird mother speaking about sex and responsible sexual behaviour in the most insane places,” Ms Anam says. “I keep repeating to them that decisions you make now, however immature, will have a long-term impact.”

“I want to raise their consciousness regarding their life 20 years down the road,” Ms Anam says. She tells young people that she is one of the lucky ones, because she bounced back.

She also believes that families and communities need to better address the needs of 19–24-year-olds and encourage an open dialogue and mentorship.

Ms Anam thinks that parents believe that once their children get to 18 they are okay and do not need any guidance and support, yet many mistakes are made after that age. Ms Anam explains that young people need to love themselves and appreciate that, whatever experiences they go through, it’s a lesson for life.

Helping others gives her a purpose. In addition, she adds, “I want to stop one more person going through what I went through, and if they have gone through the same thing, then I want to help them get their life back on track.” 

There are around 1.5 million people living with HIV in Kenya, around 400 000 of whom are unaware that they have the virus. If people do not know their status, it is impossible for them to access life-saving treatment.

There are also high numbers of new HIV infections, particularly among young people and among key populations. In 2015, there were an estimated 78 000 new HIV infections in Kenya. And testing rates are low, especially among men, meaning they are not able to benefit from treatment.  

In response, the Government of Kenya has launched two innovative technologies that it hopes will bring ending the AIDS epidemic one step closer: self-testing for HIV and pre-exposure prophylaxis (PrEP) to prevent HIV infection.

The Kenyan Ministry of Health has launched the Be Self Sure campaign to encourage people to get tested for HIV. As part of the campaign, the government is making HIV self-test kits available through public and private health facilities and selected pharmacies for around US$ 8 each, a low price which was negotiated in a partnership between government of Kenya and the private sector. From July 2017 the government hopes to make the test kits available for free in public health facilities.

PrEP is pre-exposure prophylaxis—the use of antiretroviral medicines to prevent HIV among people who are HIV-negative. 

The campaign website includes an interactive map to let people know where to get the testing kits from and plays videos demonstrating how to use the kits and tells people what to do if they are HIV-positive or if they are HIV-negative. A helpline, open for 12 hours a day, is also available.

For people testing negative for HIV, the site urges people to talk to their health providers about HIV prevention options, including PrEP, a medicine that people at higher risk of HIV infection can take to prevent becoming infected with the virus. PrEP is being rolled out as part of the campaign, with the Government of Kenya offering it free of charge in selected public health facilities as part of a combination HIV prevention programme for people most at risk of HIV infection, including young people, serodiscordant couples, people who inject drugs and sex workers. The medicine will also be available for around US$ 36 dollars a month at private hospitals and pharmacies for anyone wishing to use it.

Around 10 countries and the European Medicines Agency have now approved the use of antiretroviral medicines for HIV prevention, with more set to follow. The implementation of PrEP strategies follows the guidelines established by the World Health Organization in 2015, which recommend the use of PrEP by members of key populations. The number of people using PrEP to prevent HIV is now thought to have risen to around 120 000 people, the majority in the United States of America. The roll out of PrEP in Kenya is a major advance in efforts to stop new HIV infections in the countries most affected by HIV.

By launching this new initiative, Kenya is continuing to affirm its position as a leader and innovator in efforts to end the AIDS epidemic by 2030.

UNAIDS is working closely with Kenya to prevent new HIV infections and to ensure that, by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads. By achieving these targets, Kenya will be able to end its AIDS epidemic by 2030.