Kenya

The process of developing realistic and adaptable NSPs needs to keep pace with an evolving epidemic and a changing environment.
Credit: UNAIDS

A high quality, rigorous and robust National AIDS Strategic Plan (NSP) that focuses attention on achieving results—including stopping HIV transmission and extending the quality of life of people with HIV—is critical to the success of every national HIV response. The process of developing realistic and adaptable NSPs needs to keep pace with an evolving epidemic and a changing environment.

In Nairobi this week, the World Bank in collaboration with UNAIDS, WHO, UNDP and the Global Fund brought together representatives of National authorities, civil society organisations including people living with HIV and development partners to build consensus on the role and nature of the next generation of National Strategic Plans (so called NSP-3G). 

Opening the meeting, the Kenyan Minister of State for Special Programmes, Honourable Esther Murugui, stressed the importance of reviewing National Strategic Plans as a critical means for refining the AIDS response. “As a Government, we recognize the need to develop and adopt systems and structures that match the complexities of the HIV epidemic,” said Minister Murugui. “We have reached a point where we have to change the way we have always done things to a way that focuses on results,” she added.

With a new landscape requiring innovative thinking and approaches, participants explored how new guidance, based on experiences in strategic planning thus far, can support countries in producing simpler, sharper, more effective NSPs that focus on results.

The Representative of the Office of the U.S. Global AIDS Coordinator for PEPFAR, Dr Mamadi Yilla said that “PEPFAR’s hope is that science and evidence drives the approach we take to strategic planning. That the Global AIDS community, that has witnessed constraints to HIV financing commitments, now ensures smarter investments are made.”

Speaking on behalf of the UNAIDS Executive Director, Dr Mbulawa Mugabe pointed out that the Strategic Plans should provide clarity on how to achieve results in line with the 2011 Political Declaration on AIDS goals and commitments. “In the coming years we need to be able to say that progress by 2015 and beyond was underpinned by the NSP-3G,” said Dr Mugabe. “The NSP-3G is the engine that will help countries focus, scale up and reach the 2011 Political Declaration on AIDS targets as well as the commitments made towards the elimination of new HIV infections among children,” he added.

Several key components of NSP-3G emerged during the meeting. This included a move towards a more flexible, adaptive approach to plans that could see HIV programmes integrated into wider health and development strategies. Such a move links closely with the way forward charted at the Fourth High Level Forum on Aid Effectiveness in Busan, Korea in 2011. “We recognise the importance of aligning NSPs more closely to national development planning process; NSPs need to consider decentralisation issues and they should not sit outside of national mechanisms,” explained Mr Daniel Marguari, Director of the Spirita Foundation—an organisation working to improve the quality of life of people living with HIV and their families in Indonesia. “At the same time, we do not want to loose the uniqueness, inclusiveness, partnership and multisectorality of the HIV response, especially when it comes to addressing the needs of key affected populations and communities.”

Participants discussed in detail how real and sustainable country ownership of an effective, multi-sectoral response, with nationally driven strategic plans, can be better achieved. Many national responses in low-and middle-income countries need strengthening. They are often influenced by external development agendas and are still largely funded by international donors. For example in sub-Saharan Africa two-thirds of AIDS expenditures come from external sources. 

In order to sustain the HIV response, countries need to make better use of evidence to guide where to invest precious financial and human resources to achieve the HIV targets. Participants explored how countries could mobilize additional funding to meet the financing gap, while increasing efficiencies in the face of declining resources. The UNAIDS Investment Framework was described as a radical and innovative way of looking at resource allocation and closing the funding gap. It sets out to match need with investment, streamlines current strategies to avoid duplication and promotes cost-effectiveness. It supports countries to focus on investment choices that produce results for people.

“Now that our understanding of the HIV epidemic is more scientific and evidence-based, we find ourselves at a stage where we could determine what the exact sets of interventions need to be in a given response to control the epidemic,” Mr Aeneas Chuma, the UN Resident and Humanitarian Coordinator for Kenya said. “This means we need to ask if our investment is directed to the right interventions to achieve the right results.’’

The main outcome of the meeting was the development of ten consensus points on NSP-3G. A support and review group has been established to develop, finalize and disseminate new guidance to countries by October 2012. ‘‘I take note that the current national strategic plan for Kenya comes to an end next year,” said Minister Murugui. “Kenya hereby pledges to lead the world by being the first country to develop a third generation National Strategic Plan that will be based on the guidance that will come out of this important meeting.”

Male and female sex workers marching through the Central Business District of Nairobi, Kenya claiming respect for their rights. 3 March 2012.

More than 150 male and female sex workers marched through the Central Business District (CBD) of Nairobi, Kenya on 3 March claiming respect for their rights. Participants wearing masks signifying the hidden nature of their work walked from Koinange Street—Nairobi’s leading venue for sex work—to the Mayor’s office at City Hall.

One of the main issues highlighted at the event was the stigma and discrimination sex workers face in their work and lives, including while accessing health care and other legal and social services. “If a sex worker goes into a hospital, he or she should be treated with dignity and respect, just like anyone else,” said Fabian who identifies himself as a gay sex worker.

Sex workers often report their difficult experiences with public health care providers. Poor interpersonal communication and even insults from health care providers together with inaccurate diagnoses are some of the problems they confront on a daily basis.

Fabian, who is also a peer support counsellor for the Sex Worker Outreach Programme in Nairobi, stressed that gay sex workers face a ‘double stigma’ that hinders them from accessing health care services. Most male sex workers opt for self-diagnosis and medication, further complicating their health conditions.

According to the 2009 Modes of Transmission Study done by the National AIDS Council, UNAIDS and the World Bank, 14% of new HIV infections in Kenya occur among female sex workers and their clients. Data from the Sex Workers Outreach Program (SWOP 2011) shows an estimated HIV prevalence of 30% among female sex workers and 40% among male sex workers on enrolment (first visit).

The national response to AIDS uses a public health approach to provide HIV services based on evidence. However, only a fraction of sex workers are reached. Fear of stigma and discrimination drive sex workers underground and makes it more difficult for them to access HIV prevention services.

Social and legal protection is critical

In Namibia, sex workers also joined forces to demand their rights through an advocacy event held in Windhoek. During the event, three reports were launched focusing on sex work, HIV and access to health services in Namibia. The reports had been produced by UNFPA and UNAIDS in partnership with the African Sex Workers Alliance (ASWA) in Namibia and the Society for Family Health (SFH).

The publications noted that sex workers are disproportionately affected by HIV due to the nature of their work—most of the time they can not negotiate the use condoms with their clients. They also highlighted that the attitudes and behaviours of health service providers, authorities and the wider community toward sex workers make them even more vulnerable.

The stigma and discrimination towards sex workers also extends to their children, exacerbating their health risks and isolation. Family members of sex workers suffer from negative attitudes by their communities, which often manifests through verbal and physical abuse, and deprivation of basic rights.

“Most of our children cannot be legally registered because they do not have fathers and they risk becoming street kids,” said Moreen Gaweses, a former sex worker affiliated with The King’s Daughters, an organization that aims to help women who wish to exit sex work.

The 2011 rapid assessment report—a study about sex work and HIV conducted in five towns of Namibia—shows that there are no national guidelines for effective, rights-based programming with sex workers in the country. “We have no place to go for help and the nation needs to recognize that we also have rights” said Ms Gaweses, who gave birth to a baby girl just a week ago.

The reports include recommendations for action by national and local stakeholders to address these challenges and protect the human rights of sex workers. Such recommendations include addressing violence, abuse and stigma towards sex workers as well as reducing legal and policy barriers that block their access to HIV services.

“Decriminalization is the only way to bring down the HIV and abuse of sex workers,” said Scholastica Goagoses, a former sex worker and Director of The Red Umbrella, an organization of sex workers. “Only rights can stop the wrongs in Namibia!”

Press conference to announce the swearing in of the HIV Equity Tribunal. Panelists from left to right: Prof Mary Getui, Chair of Kenya's National AIDS Control Council (NACC) board; Ambrose Rachier, Chair of the HIV Equity Tribunal in Kenya; Hon Esther Murigi , Minister of Special Programmes in Kenya; Hon Mohammed, Former Assistant Minister, Special Programmes.
Credit: UNAIDS

At the June 2011 High Level Meeting on AIDS, world leaders pledged to eliminate stigma and discrimination against people living with HIV by promoting laws and policies that advance human rights and fundamental freedoms. The recent creation of an HIV Equity Tribunal in Kenya—the first of its kind globally—represents a bold step towards achieving this goal.

An estimated 1.6 million people are living with HIV in Kenya. The seven-member Tribunal will provide access to justice for Kenyans who face stigma, discrimination or criminalization based on their HIV status. It will also seek to advance the rights of women and girls, who are disproportionately affected by the HIV epidemic in Kenya.

The Joint UN Team on HIV and AIDS in Kenya, through UNDP and UNAIDS, will support the Tribunal by building its capacity to operate effectively, providing technical support, and creating demand within communities through advocacy.

UNAIDS spoke with Ambrose Rachier, Chair of the Tribunal, about the opportunities and challenges that lie ahead.

What is the mandate of the Tribunal? How will the Tribunal carry out its mandate?

The mandate of the Tribunal is outlined in the 2006 HIV/ AIDS Prevention and Control Act.* The Tribunal has jurisdiction to hear and determine complaints arising out of any breach of the Act and any matter or appeal as may be made pursuant to the provisions of the Act. The Tribunal can also perform functions related to the Act, excluding criminal jurisdiction. 

Court proceedings can take years in Kenya.  The Tribunal can quicken access to justice for people living with HIV. What are the other expectations of the Tribunal?

The Tribunal has the power of a court and can receive evidence, hear witness accounts, conduct full hearings and pass judgments on the above matters. With this in mind, it is expected that the Tribunal will focus on the protection of human rights of people living with HIV.  It therefore encourages those infected with and affected by HIV that have been violated in any manner that is a breach of the HIV/AIDS Prevention and Control Act of 2006 to come forward and air their grievances. 

How do you plan to discharge your mandate?

The Tribunal has established a registry that receives complaints and grievances in writing. The different complaints are reviewed and assigned as appropriate.  The Tribunal also assists members of the public who may be illiterate to record their complaints.

What actions have been undertaken by the Tribunal so far?

Since the swearing in of the members, the Tribunal has received various matters, reviewed them and categorized them based on the general complaints as follows:

• A majority of the complaints received relate to workplace issues that discriminate and stigmatize employees on the basis of their real and/or perceived HIV status. These range from termination of employment, demotion and irregular transfer of employees based on their HIV-positive status.
• The second category of cases relate to denial of access and difficulty in access to HIV treatment, mainly arising from claims of persons being transferred to remote areas of the county where antiretrovirals, medications for opportunistic infection and HIV prevention services and commodities cannot be readily accessed.
• The last category involves cases that arise from family relations and primarily affect women who, on the grounds of their HIV-positive status, may have suffered domestic violence, abandonment or the disinheritance of property.

What are the immediate plans for the Tribunal?

The immediate plan is to build the capacity of Tribunal members to enable them hear and resolve matters, as only three of the seven members are officers of the court.  The Tribunal first sat and dealt with two complex cases on 31 January. A campaign to publicize the Tribunal and the access to social justice is planned so as to enlighten the public and create awareness of the services of the Tribunal.

How do you envision the Tribunal will contribute to the national response to HIV?

The Tribunal will help discourage discriminatory practices, encourage inclusivity and uphold involvement of people living with HIV. It will also increase the space for social dialogue on HIV-related stigma, increase knowledge and awareness, and reduce stigma. This will help increase access to HIV prevention services and practices, increase uptake of services, and create demand for HIV prevention, treatment, care and support services.

What opportunities lie within the Tribunal to address stigma and discrimination—a persistent bottleneck to achieving universal access?

The Tribunal will be an excellent vehicle for reaching out to other institutions that knowingly or unknowingly exacerbate stigma and discrimination, including the insurance sector, employers and even institutions of learning. The Tribunal can complement and provide awareness around ethical and legal issues surrounding HIV and on how to treat those in your charge that could be affected.

What do you expect are the anticipated challenges for the Tribunal?

The Tribunal is currently experiencing a lack of goodwill and resistance by some parties with specific interests. This has hampered our work. The bureaucracy is also a hindrance affecting the optimal performance of the Tribunal, and it delays the legal redress that is needed. Those affected may continue to suffer as they await justice and may lose faith in the Tribunal. It is known that Justice Delayed is Justice Denied.  We do not want to set such precedence, but the bureaucracy is a big limiting factor.

The other challenge will be to operationalize the Tribunal and discharge our duties effectively in the coming devolved structure of governance. Currently the intention is for the Tribunal members to hold rotational sittings by province. However with the devolved structure, the seat of governance will be at the proposed 47 counties, and this may overwhelm our seven-member Tribunal to adequately discharge justice.

Despite these challenges, I am optimistic and proud to have been part of this unique Tribunal that is the first of its kind in the world. I hope that other countries will emulate our experiences and learn from our successes and challenges. 

Other countries may be interested in how this idea came about, and how long it took to bring to fruition.

In 1999, HIV was declared a national disaster. This led to the establishment of the National AIDS Control Council.  A taskforce on HIV and the law was also instituted.
The mandate of the taskforce was to provide legal guidance on what laws are necessary to facilitate HIV prevention, treatment and care.  I was the chair of that taskforce. In 2000, we began our work and completed a report in July 2002. At the time, we identified three key issues that could be addressed: i) Stigma and discrimination were factors that escalated the spread to HIV ii) There was a need to address issues of access to HIV prevention, treatment and care services iii) Access to justice for people living with and/or affected by HIV as a means to improve the national response. After the submission of the report, the drafting of the HIV/AIDS Prevention and Control Act began and was passed in 2006.  This Tribunal was enshrined in the said Act and, in June 2011, the Tribunal members were sworn in.

*Object and purpose of Kenya’s HIV and AIDS Prevention and Control Act of 2006:

(a) Promote public awareness about the causes, modes of transmission, consequences, means of prevention and control of HIV and AIDS;

(b) Extend to every person suspected or known to be infected with HIV and AIDS full protection of his human rights and civil liberties by:

• (i)   Prohibiting compulsory HIV testing save as provided in this Act;
• (ii)  Guaranteeing the right to privacy of the individual;
• (iii) Outlawing discrimination in all its forms and subtleties against persons with or persons perceived
  or suspected of having HIV and AIDS;
• (iv) Ensuring the provision of basic health care and social services for persons infected
  with HIV and AIDS;

(c) Promote utmost safety and universal precautions in practices and procedures that carry the risk of HIV transmission; and

(d) Positively address and seek to eradicate conditions that aggravate the spread of HIV infection.

Credit: UNAIDS

A delegation of the UNAIDS Programme Coordinating Board (PCB) has just concluded a field visit to Kenya. The delegation learned first hand about the government’s strong commitment to a multi-sectoral and integrated AIDS response, including working with civil society organizations in planning and delivering HIV services.

With 1.6 million people currently living with HIV out of a population of 40 million, Kenya has the second largest epidemic in East and Southern Africa and the fourth largest globally.

The PCB delegation included the chair (El Salvador), vice chair (Poland), representatives from Congo, Finland, Mexico, Thailand, PCB NGOs from Africa and Asia Pacific, UNHCR and the UNAIDS Deputy Executive Director, Management and External Relations.

The delegation met with government representatives, including from the Ministry of State for Special Programmes, the National AIDS Control Council (NACC) and the National AIDS and STI Control Program (NASCOP), and civil society organizations. 

“We have had the privilege of meeting with a range of institutions and individuals who have been the driving force behind Kenya’s progress in its national AIDS response,” said Jan Beagle, UNAIDS Deputy Executive Director, Management and External Relations. “While challenges remain, we are encouraged by the combination of political will at the highest level, grass-roots activism and support of all partners in advancing the response in Kenya.” 

The delegation also met representatives of networks of people living with HIV, children heading households and HIV discordant couples (where only one partner is infected with HIV) during their field visit to Kibera—the largest informal settlement in Eastern Africa. They also visited a Millennium Village Project (MVP) in Nyanza Province, where the delegation witnessed an example of a community and family-centred integrated approach where peer mothers, male champions and community health workers each play a key role in preventing new HIV infections among children.

“The Gongo Health Centre in Sauri is a good example of comprehensive and integrated services being made accessible by trained personnel in an efficient manner to those most in need in a rural setting,” said Dr Nieto, Director of the National HIV/STI/AIDS Programme, from the Ministry of Health, El Salvador, current chair of the PCB. “It is a successful model that can and should be replicated in other countries,” she added.

The visit also addressed the crucial role of cultural and traditional leaders, as well as faith-based organizations, in responding to stigma and discrimination against people living with and affected by HIV. The delegation met with the Luo Council of Elders and participated in a meeting of faith-based organizations which focused on the role of these organizations in scaling up HIV prevention and addressing stigma and discrimination.

Kenya’s efforts in promoting a rights-based approach for people living with HIV was evident when the delegation met with the HIV Equity Tribunal that has been established to increase access to justice for people affected by HIV. The Tribunal takes on civil cases of HIV-related stigma and discrimination and is one of the first of its kind in the world.

The delegation also met with representatives of key populations at higher risk, which account for 30% of HIV transmission in the country. “Despite a restrictive legal environment for men who have sex with men, sex workers and people who inject drugs, Kenya has shown that programmes can be extended to key populations at higher risk with the commitment of national AIDS authorities,” said Nadia Rafif, the PCB NGO representative for Africa.

As Kenya’s AIDS response is reliant on external funding–more than 80%—the delegation welcomed the commitment of the Kenyan government to address the issue of sustainable financing and increase domestic resource allocation for HIV.

(L to R): The Vice-Chair of the Global Fund Policy and Strategy Committee, Todd Summers, UNAIDS Executive Director Michel Sidibé, Minister of Health of Eritrea, Amina Nurthussein Abdelkadir and Minister of Health of Ghana, Joseph Yieleh Chireh.

The Global Fund to fight AIDS, Tuberculosis and Malaria has initiated a number of actions and processes to strengthen its oversight and accountability mechanisms. These new processes will be discussed at the upcoming 25^th Global Fund Board meeting that will take place in Accra, Ghana from 21 – 22 November 2011.

Ahead of the Board meeting, UNAIDS, in collaboration with WHO and Stop TB Partnership, convened a two day consultation with implementers of Global Fund programmes in Nairobi, Kenya from 3 - 4 November. This consultation was called to create a platform for implementers to discuss the changes taking place within the Global Fund, to help shape this transformation and contribute to the increased ownership and effective implementation of the reforms.

In his opening speech, UNAIDS Executive Director Michel Sidibé stressed the need for a strong and vibrant Global Fund. “We live times of what can be considered turbulent change, but with change comes the opportunity,” said Mr Sidibé. “The opportunity to refine grant architecture, improve governance structures and prioritise activities to improve and accelerate results.”

During the meeting, participants considered the Global Fund 2012-2015 Strategy as well as the Consolidated Transformation Plan (CTP), which is a concrete set of actions developed from the High Level Panel report. Discussions and debates focused on how to input into these documents in order to maximize the Global Fund´s efficiency, enhance country ownership and establish effective systems for mutual accountability.

The meeting provided an opportunity for the implementers to develop an informed voice to influence processes as they move forward as well as to actively participate and contribute to the discussions around: Defining ownership; Simplifying the Global Fund’s architecture; Addressing prioritisation; and Improving accountability and effectiveness.

“Defining country ownership is key,” said Kandasi Walton-Levermore, Chair of the Jamaican Country Coordinating Mechanism. “It means owning all aspects of the national AIDS response, not just owning a Global Fund grant."

One of the outcomes of the meeting was a document capturing the common positions of the implementers, including recommendations on how to go forward.  This document will be used as the unifying voice of all implementing partners during the upcoming Global Fund Board meeting.

Kenyan Prime Minister Raila Odinga (left) shakes hands with UNAIDS Executive Director Michel Sidibé following a meeting at the Prime Minister’s office in Nairobi on 2 November.

In a meeting with Kenyan Prime Minister Raila Odinga on 2 November, UNAIDS Executive Director commended the Government of Kenya on progress in the country’s HIV response, including the significant scale-up in treatment access and expansion of services to prevent new HIV infections among children.

Over the past decade, Kenya has stabilized its rate of new HIV infections. National adult coverage of antiretroviral therapy has expanded from an estimated 4% in 2004 to 72% in 2010. About 78% of pregnant women living with HIV are now receiving antiretroviral treatment to prevent new HIV infections in their children, compared to 21% in 2006.

“Building on the momentum of this year’s High Level Meeting on AIDS, we are seeing unprecedented support for our vision of zero new HIV infections among children and keeping their mothers alive,” said Mr Sidibé, while meeting with the Prime Minister in Nairobi. “I congratulate the Government of Kenya for translating this goal into action on the ground.”

Prime Minister Odinga said that the Government of Kenya will pursue the initiation of a national declaration calling for the elimination of new HIV infections among children by the year 2015. “I will lead all line ministries to support this critical goal,” he said.

The Prime Minister underscored that Kenya’s new constitution, adopted in August 2010, is a model for equity and social inclusion. “This is a great opportunity for us to lead on HIV and human rights for the people of Kenya who need access to services and justice,” he said. Greater financial contributions from national sources will be critical to ensure the long-term sustainability of Kenya’s response to AIDS, he added.

The UNAIDS Executive Director commended the Government of Kenya for establishing the Kenya HIV/AIDS Tribunal under the Kenya HIV Prevention and Control Act—one of the first tribunals in the world aimed at increasing access to justice for people affected by HIV and addressing HIV-related stigma and discrimination.

Mr Sidibé’s meeting with Prime Minister Odinga launched his two-day official UNAIDS mission to Kenya. During the mission, the UNAIDS Executive Director will meet Kenya’s Minister of Special Programmes, the Minister of Public Health and Sanitation and the Minister for Medical Services. He will also deliver opening remarks at a consultation for Global Fund Implementers.

Minister for Special Programmes Esther Murugi (left) greeting Ms. Asunta Wagura, representative of women living with HIV and advocate for the elimination of vertical transmission of HIV.

More than 200 women living with HIV in Kenya committed to championing the response to AIDS in the country. The call for more involved action came at the end of a two-day National Leadership Conference for Women Living with HIV.

The purpose of the meeting was to reenergize women living with HIV towards strengthening their leadership roles in the HIV response. The conference was facilitated by the National AIDS Control Council and the Network of People Living with HIV in Kenya with support from the UN Joint Team on AIDS.

In her opening remarks, Minister for Special Programmes Esther Murugi reiterated “the urgent need to develop strong leadership of women living with HIV to take the reins to end the AIDS epidemic”.

With its theme of “Championing Women Leadership to AIDS”, the forum centred around three key thrusts: women’s leadership to create a social movement and community action for HIV prevention; women’s political leadership to develop opportunities offered by the new constitution; and women’s leadership to improve uptake and delivery of HIV services.

Kenyan government statistics indicate that national HIV prevalence is 6.3 %, compared to 8 % for women. HIV prevalence among women is nearly double the rate for men, which is 4.3 percent. HIV prevalence among young women aged 15 – 24 years is more than four times higher than men in the same age group at 4.5 and 1.1 percent, respectively.

Women have been pioneers in the AIDS response, as care providers but also as community leaders. The conference provided a forum for women to re-position the leadership of women living with HIV by building on the achievements of the earlier women movements. It also provided a platform to discuss advocacy efforts to influence policies, planning and budgeting processes in national AIDS programmes to respond to the needs of women and girls living with HIV.

“Women and girls living with HIV must be meaningfully engaged at every stage of national HIV responses to ensure that their needs are well addressed,” said UNAIDS Country Coordinator, Maya Harper.

Participants agreed to strengthen strategies to include women living with HIV in national AIDS response as well as to explore opportunities to mentor, empower and build capacity of young women and mentor young women living with HIV into leadership. Participants also resolved to develop advocacy groups at national level to drive the agenda for women living with HIV and increase domestic funding for HIV response.

One highlight of the event was an award ceremony to honour women living with HIV who have championed for and contributed towards Kenya’s HIV response. The awardees were drawn from all regions of the country and included people living with disabilities.

The Minister of Gender, Children and Social Development, Dr Naomi Shabaan, urged the awardees to “continue to mentor others and together we will end AIDS”.

A version of this story was first published at UNODC.org

The comprehensive HIV prevention package will include access to sterile needles and syringes
Credit: UNAIDS

The Kenyan government is taking an innovative approach to reducing HIV among injecting drug users. In a bold new initiative, the government is set to give drug users free access to HIV prevention and treatment services. Supplies of sterile needles and syringes, substitution treatment, social support and referral to other health services, including antiretroviral therapy, will be available.

In a pilot project, 12 primary health care centres in Mombasa are offering drug dependence treatment and psycho-social support in several communities on an out-patient basis. For the next three months, the Kenya Red Cross will provide support to the Ministry of Health. HIV voluntary counseling and testing are also offered. The Ministry of Medical Services is preparing a rapid capacity building plan and staff will receive additional training in the next few weeks and months.

It is expected that this model will be adopted in other regions.

The action plan to roll out the comprehensive HIV prevention package follows a recent national meeting on people who inject drugs convened by the National AIDS Control Council (NACC). The meeting’s resolutions were also endorsed by Members of Parliament during a subsequent leadership workshop on HIV.

The United Nations is playing a key role in the programme and the UNAIDS family has worked in close partnership with the National AIDS Control Council and many government agencies, to encourage the adoption of this comprehensive HIV prevention package.

The United Nations Office on Drugs and Crime is also joining the government in developing an intensive training programme for 700 health professionals and civil society actors to offer quality services for injecting drug users.

Kenya’s government has recognized the importance of addressing the needs of key populations such as people who inject drugs, sex workers and their clients, men who have sex with men, and people in prisons. This was reinforced by its Modes of Transmission Study published in March 2009 which indicated that such populations accounted for more than a third of all new HIV infections. The adoption of the comprehensive package for HIV prevention among people who inject drugs is seen as a significant step forward.

A version of this story has been published at unicef.org 

Credit: UNICEF/NYHQ2010-1057/Susan Markisz

UNICEF Executive Director Anthony Lake joined the Government of Kenya and other partners on 29 October to role out an innovative approach to prevent the transmission of HIV from mothers to their babies (PMTCT). The initiative includes a combination of activities and supplies including a “Mother-Baby-Pack” of antiretroviral drugs and antibiotics, which women can easily administer at home.

The “Mother-Baby-Pack” is part of the government’s Maisha mother-to-child transmission free Zone Initiative. This pioneering programme is designed to help virtually eliminate mother-to-child-transmission of HIV and paediatric AIDS by 2013 in Nyanza and Rift Valley provinces, where about half of all Kenyan children with HIV live, and by 2015 in the entire country. Without treatment, around half of all babies born with HIV will die before their second birthday
Mr Lake commended the Kenyan government for its commitment to take ground-breaking steps to expand and strengthen the quality of PMTCT services. “Maisha means ‘Life’ in Kiswahili, and I can think of no better way to describe a programme with the potential to save so many lives,” he said. “The Maisha Initiative is a significant step forward towards our common goal of virtually eliminating mother to child transmission in Kenya.”

The roll-out in Kenya of the “Mother-Baby-Pack” marks the beginning of a phased implementation in four countries, including Cameroon, Lesotho and Zambia. It is scheduled to run until mid-2011. During this initial phase, UNICEF and its partners will closely monitor the acceptance of the pack by women, as well as the quality of supply and distribution.

The packs were developed by UNICEF in collaboration with the World Health Organization (WHO), UNITAID, and other partners. Health workers in antenatal clinics will distribute them to pregnant women living with HIV, but who do not yet need antiretroviral treatment for their own health.  The initiative is designed to reach pregnant women who have tested positive for HIV, but who might not otherwise return to a clinic following their diagnosis.

Mother-Baby Packs arrive in Nairobi. They are then loaded onto a UNICEF truck for distribution to other parts of Kenya. Credit: UNICEF Kenya/2010/Joseph Munga

The initiative is supported financially by a number of partners including the US Government, UNICEF National Committees, the Clinton Health Access Initiative (CHAI) and the Mothers-to-Mothers (M2M) programme.

While adult HIV prevalence in Kenya has declined steadily, there are still some 22,000 new infections annually among infants through mother-to-child transmission. Overall, an estimated 1.4 million people are living with HIV in the country, including around 81,000 pregnant women.

Mother and baby in Lesotho Credit: UNAIDS/M. Hamman

In sub-Saharan Africa an estimated 60% of people living with HIV are women, mostly in the reproductive age group. In the absence of appropriate interventions, HIV infection in women translates directly to infant and child infections.

Each year approximately 1.4 million women living with HIV become pregnant. Among antenatal clients in sub-Saharan Africa, the proportion of women living with HIV ranges from 5% to as high as 30%—and HIV among childbearing women is the main cause of infection among children.

More than 90% of infant and young child infections occur through mother-to-child transmission, either during pregnancy, labour and delivery, or breastfeeding. Without intervention, about one in three children born to mothers living with HIV will become infected.

In 2008, 430,000 children were newly infected with HIV, 90% of whom lived in sub-Saharan Africa. Most of these children, in the absence of access to antiretroviral treatment will die within one year of birth. Those who survive often lose their parents, if they too do not have access to antiretroviral therapy.

However the lives - of mothers and their babies—can be saved, through a combination of HIV testing and counselling, access to effective antiretroviral prophylaxis and treatment, safer delivery practices, family planning, and safe use of breast-milk substitute.

UNAIDS Executive Director Mr Michel Sidibé has called for the elimination of mother-to-child transmission of HIV by 2015. Africa is responding to this call. This week more than 200 participants from 20 countries with the highest burden of infections among pregnant women are meeting in Nairobi to chart out a a course of action to the needed HIV services.

At the heart of the plan is to mobilize resources. UNAIDS, UNFPA, WHO, UNICEF and the Global Fund to Fight AIDS, TB and Malaria (Global Fund) are co-convenors of this meeting will be providing technical support to these countries in building their capacities to develop sound business plans that can be funded.

“Africa‘s leaders are becoming serious about protecting their future generations,” said Michel Sidibé. “Investments made to protect mothers from HIV and babies from becoming infected is a moral responsibility of all governments.”

The Global Fund is an important source for these resources. It has committed to working with countries and other partners to ensure that at least 80% of Global Fund supported prevention of mother-to-child transmission (PMTCT) programmes meet the requisite levels of efficacy and quality by December 2010. The Global Fund has also committed to accelerate the scale up of PMTCT programmes and extend coverage to at least 60 per cent of women in need globally by the end of 2010.

A first step is to help countries reprogramme their existing grants to improve the effectiveness of the current programme strategies as well re-direct resources from savings and efficiency gains. The second step is preparing countries to make quality submissions to the Global Fund’s round 10 call for applications.

Many countries are already doing so. Ethiopia, having identified low antenatal coverage as a bottleneck to PMTCT utilization, is using its US$ 600 million grant to strengthen its maternal and child health services. South Africa has used the reprogramming opportunity to strengthen the participation of civil society in the PMTCT reprogramming exercise. Nigeria is using its reprogramming opportunity to strengthen broad program coverage and set more ambitious targets, much needed as Nigeria has the largest PMTCT burden globally. Zambia and Ghana also raised US$ 3 million from the Global Fund.

UNAIDS together with its Cosponsors UNICEF and WHO have facilitated such reprogramming in Tanzania which helped the country to mobilize an additional US$ 2.2 million for the country’s PMTCT programme. As a result the country increased its target coverage to 70%.