Kenya

A new book that tells the inspiring stories of 12 mothers living with HIV and their children born free of the virus has been launched at a community event near Polokwane in Limpopo province, South Africa, on the occasion of National Women’s Day (August 9). The book, Faces of an AIDS Free Generation in eastern and southern Africa, aims to promote the further uptake of mother-to-child transmission (PMTCT) services to help prevent the transmission of HIV to children during pregnancy and early motherhood.

In recent years, there has been a rapid scale-up of PMTCT services in the region that has produced significant results. By the end of 2014, an estimated 88% of pregnant women living with HIV in eastern and southern Africa were accessing services to stop them transmitting the virus to their children. This has resulted in a 60% decline in the number of HIV infections among children between 2009 and 2014, from 230 000 to 93 000.

Despite this progress, there is still work to be done to achieve the targets of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. High levels of gender inequality, including gender-based violence and stigma, continue to make it difficult for many women to access sexual and reproductive health care services.

The book highlights the urgent need to further expand PMTCT services to make pregnancy and breastfeeding safer for women living with HIV, as more than 90% of new HIV infections among children occur when women are inadequately supported during pregnancy and early motherhood.

It also stresses the need for the rapid scale-up of paediatric testing and treatment to prevent AIDS-related deaths among children. Without knowing the HIV status of a child it is impossible for them to receive life-saving treatment. Just 38% of children living with HIV in eastern and southern Africa had access to antiretroviral medicines in 2014. Without treatment, half of all children born with HIV will die by the age of two and the majority will die by the age of five.  

Faces of an AIDS Free Generation in eastern and southern Africa is published with the support of the Swedish International Development Cooperation (Sida) and the Norwegian Agency for Development Cooperation (Norad).

At the fifty-ninth session of the Commission on the Status of Women, being held in New York, United States of America, a Kenyan campaign to stop new HIV infections among children has been highlighted as an example of what committed political leadership can achieve in improving women’s access to health care.

The First Lady of Kenya, Margaret Kenyatta, launched her Beyond Zero campaign to improve maternal health and stop children being born with HIV in 2014. Less than a year later, 18 mobile health clinics are now serving some of the country’s most affected communities, with many more planned to open soon.

Ms Kenyatta raised some of the initial funding for the campaign by running in sponsored marathons. She inspired around 30 000 people to join her, propelling the elimination of mother-to-child transmission of HIV to the top of the country’s health agenda.

Last month, the President of Kenya, Uhuru Kenyatta, also pledged the country’s support and leadership for the global All In campaign to end adolescent AIDS, which was launched in Nairobi in March 2015.

More than 15 000 Kenyans, including the First Lady, Margaret Kenyatta, took part in the second First Lady’s Annual Half Marathon on International Women’s Day, 8 March, raising more than US$ 4 million.

The money raised will be donated to the Beyond Zero campaign, which aims to improve maternal and child health across Kenya. Since the campaign was launched in January 2014, Beyond Zero has made a significant impact by providing fully equipped mobile health clinics that bring essential services closer to vulnerable communities, including people living in informal settlements.

In recent years, Kenya has made notable progress in improving the health of mothers and children. New HIV infections among children declined from 21 000 in 2009 to 13 000 in 2013. An estimated 63% of pregnant women living with HIV accessed treatment services aimed at preventing mother-to-child transmission of HIV in 2013, but only 31% of children living with HIV had access to antiretroviral treatment in the same year. 

At the launch in Nairobi of All In, a new global initiative to end the AIDS epidemic among adolescents, President Uhuru Kenyatta announced that Kenya will lead by example by increasing domestic resources for the AIDS response and improving HIV prevention, treatment, essential health care and counselling services for adolescents.

President Kenyatta said the AIDS epidemic among adolescents threatened to rob Kenya of the promise of unprecedented growth and change in a context where Kenya has just reached middle-income country status.

He asked the Minister of Education to re-examine the national curriculum to better engage with young people living with HIV and to eliminate stigma and discrimination in schools.

He also asked for access to antiretroviral treatment for children and adolescents living with HIV to be improved rapidly. While 78% of adults living with HIV in Kenya have access to antiretroviral treatment, just 36% of children have access to the life-saving medicines.

The Deputy Executive Director of UNAIDS, Luiz Loures, who also attending the launch, said that UNAIDS is ready to work with Kenya to support its leadership on preventing new HIV infections among adolescents and ending the AIDS epidemic in Kenya. He emphasized that action has to be accelerated over the next five years if the AIDS epidemic is to be ended by 2030.

The First Lady of Kenya, Margaret Kenyatta, and UNAIDS Deputy Executive Director Luiz Loures visited a Beyond Zero mobile health clinic in Kibera, an unofficial settlement in Nairobi that is home to more than a million people.

The mobile clinic is one of 18 around the country opened as part of Ms Kenyatta’s Beyond Zero campaign, which aims to boost efforts to eliminate new HIV infections among children and improve maternal survival rates by the end of 2015 among some of Kenya’s most vulnerable communities. Beyond Zero provides comprehensive medical services to residents, complementing care received at other facilities.

The clinic was established with the support of National Youth Service workers and young volunteers from the community itself. Half of Kibera’s residents are under 15 years old and youth unemployment rates are extremely high. Most residents of the settlement earn less than a dollar a day.

Oral pre-exposure HIV prophylaxis (PrEP) has been shown to be up to 90% effective in preventing HIV infection among people who take it consistently. However, the United States of America is the only country in which PrEP is licensed and recommended for use within HIV prevention programmes. 

In order to find ways to bridge the gaps between evidence and policy-making processes, UNAIDS, AVAC and WHO organized a meeting during the 2014 HIV Research for Prevention (HIV R4P) conference, which is taking place from 28 to 31 October in Cape Town, South Africa. HIV R4P is the world’s first scientific meeting dedicated exclusively to biomedical HIV prevention research.

Participants

The meeting brought together representatives of ministries of health and national AIDS councils from Kenya, Mozambique, South Africa, Uganda and Zimbabwe, PrEP researchers and participants from research and demonstration sites where PrEP is currently being delivered, funders and drug manufacturers, and HIV activists.

Key messages

• PrEP is being used in several demonstration projects across eastern and southern Africa, covering a wide range of populations, including serodiscordant couples in Kenya and Uganda, sex workers in Zimbabwe and men who have sex with men in Kenya and South Africa.
• In order to be used more widely, PrEP must be part of a comprehensive prevention strategy with associated milestones and success indicators that have been defined with policy-makers. The Kenyan Prevention Roadmap already includes the possibility of PrEP.
• Costs and cost-effectiveness models remain key, as are the selection of populations for which PrEP should be offered and the choice of an appropriate delivery model. The Sisters clinics, which provide a dedicated service for sex workers in Zimbabwe, are acceptable to many sex workers and fit within a government strategy.
• The early stopping of the PROUD PrEP study demonstrates that within the sexual health services of the United Kingdom of Great Britain and Northern Ireland there is a strong demand for PrEP and that it is feasible to identify people at greatest risk.
• Demand is now beginning to grow in African communities and needs to be stimulated among those who would most benefit and would be most likely to use PrEP.
• Policy-makers in health and other government departments need more information on PrEP presented in a way that they can use, as well as opportunities to discuss their specific concerns, for example on PrEP safety studies or measures to improve adherence.
• More needs to be understood about the costing of PrEP. This demands greater understanding of who would use PrEP, how they would use it and where they would access it.

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

The Government of Kenya launched its new Kenya HIV Prevention Revolution Road Map on 20 August. The road map, developed by the Ministry of Health, through the leadership of the National AIDS Control Council and the National AIDS and STI Control Programme, with support from cross-sector and international partners, presents new strategic, programmatic and financial approaches to achieving zero new HIV infections in Kenya.

In 2013, an estimated 1.6 million people were living with HIV in Kenya, and 92 000 fewer AIDS-related deaths were recorded in 2013 than in 2005. Although annual new HIV infections declined by 20 000 between 2005 and 2013, an estimated 100 000 new HIV infections occurred in Kenya in 2013.

Comprised of evidence-based and strategic guidelines for investment at the county level, the road map aims to assist coordinated, targeted and high-impact campaigns to reduce the number of new HIV infections in Kenya. Outlining ambitious and actionable targets, it paves the way for Kenya to move from a specific nationwide AIDS response to a more comprehensive and population-based approach that packages biomedical, behavioural and structural HIV programmes targeting various populations at higher risk.

The President of Kenya, Uhuru Kenyatta, pledged to continue working with the United Nations for the effective utilization of available resources in the national AIDS response during a meeting with UNAIDS Executive Director Michel Sidibé on 7 July in his office at Harambee House in Nairobi, Kenya.

President Kenyatta also discussed the importance of supporting local production of HIV medicines and commodities at the regional level in line with the African Union Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa, which African Heads of States adopted in July 2012. He said Africa should leverage AIDS as an entry point for building its own pharmacy to ensure sustainability of the AIDS response on the continent. The President also stressed that his government will continue to increase its budgetary allocations to the health sector in the current financial year, focusing on preventive health measures to ensure the well-being of its citizens.

During his visit, Mr Sidibé also met with First Lady Margaret Kenyatta to discuss successes and challenges of the First Lady’s Beyond Zero initiative, which aims at accelerating progress in saving the lives of women and children in Kenya. He commended the First Lady for her steadfast commitment to eliminating mother-to-child transmission of HIV and keeping mothers alive. Mr Sidibé reiterated UNAIDS’ commitment to support the Office of the First Lady achieve its vision that no mother die of an AIDS-related illness and that no child is orphaned or left vulnerable.

President Uhuru Kenyatta and First Lady Margaret Kenyatta also joined the UNAIDS Protect the Goal Campaign by adding their signatures on the Protect the Goal campaign ball. The global campaign was launched in Brazil on 9 June on the side-lines of the 2014 FIFA World Cup and aims to galvanize young people to commit to HIV prevention efforts and ensure universal access to HIV treatment and care services for all eligible people living with HIV by 2015.

During his visit, the UNAIDS Executive Director took the opportunity to introduce the new UNAIDS Country Director for Kenya, Jantine Jacobi, to key political and civil society leaders and partners in Kenya’s AIDS response.