HIV patients worry about funding gap, call for local interventions

People living with HIV believe the government is not taking HIV financing gap seriously after the stop-work order by US government, risking new infections and deaths.

They propose establishment of a high level task force and presidential working team to guide HIV response towards 2030 and beyond in line with the country’s commitment to end AIDS as a public health threat.

Nelson Otwoma, Executive Director, National Empowerment Network of People Living with HIV/Aids in Kenya (NEPHAK), said that the stop-work order has disrupted HIV programmes, potentially reversing the progress made over the years.

With delayed release of medicines by the USAID supported Mission for Essential Drugs (MEDS), some counties are already experiencing stock-out of Nevirapine prophylaxis for children, exposing them to HIV infections.

When USAID terminated contracts of employees who have been working in HIV spaces, the Ministry of Health asked for a Supplementary Budget, but a waiver was issued and termination of USAID contract rescinded.

No progress has been registered, and a budget is yet to be released.

Data from PEPFAR indicates a total of 41,547 staff who provide HIV services, including clinical services, community support, and programme management across 47 counties, from health facilities at level II to VI, consumed a total cost of Sh17,376,505,147 annually.

“When USAID said they are back, nobody has even followed up the budget. It should be noted that keeping Kenyans with HIV alive beyond 2030 needs much more than ARVs. Trained health care workers are urgently needed,” Otwoma said.

According to a document released by the Global Health Security and Diplomacy which is under the US Department of State, activities approved under the PEPFAR 90-Day Limited Waiver include, HIV Testing Services for all populations, HIV Care and Treatment Services for All PLHIV, Laboratory support, Supply Chain Management for Procurement of HIV medicines and other commodities to prevent stock-outs in national HIV programmes.

HIV Pre-exposure Prophylaxis (PrEP) is only offered to pregnant and breastfeeding women during the pause of U.S. Foreign Assistance.

People other than pregnant and breastfeeding women who may be at high risk of HIV infection can not be offered PEPFAR-funded PrEP until further notice.

In the meantime, salaries for health workers, laboratory, and supply chain staff necessary to carry out the specific activities is also included in the waiver. 

“With 90-days waiver, the Kenyan Government is monitoring with the hope that US support comes back," said Otwoma.

Last Wednesday, a high-level meeting was convened in Nairobi bringing together Ministry of Health, Council of Governors and National Assembly Parliamentary Departmental Committee on Health to find a solution to the funding gap.

However, National Treasury and Economic Planning CS John Mbadi skipped the event and  send a junior officer to shed light on Kenya’s funding preparedness.

It emerged that the US move has left a funding gap of Sh30.9 billion - money expected to manage Health Products and Technologies (HPTs), Human Resource in Health (HRH), Health Management Information System (HIMIS) and Health System Strengthening (HSS).

Of the Sh30.9 billion, at least Sh5.8 billion is required between now and June to spend on various activities.

Health Cabinet Secretary Deborah Barasa acknowledged that funding has been instrumental in the lifesaving ARVS, essential diagnostic tool of people living with HIV and malaria programmes.

“It is our roles to sustain gains made in the years,” said Dr Barasa, urging county governments to allocate resources for HIV programs and critical health programs.

Her sentiments were echoed by Nyeri Governor Mutahi Kahiga who said Kenya has made progress in the last 40 years in eliminating HIV/Aids, and the gains should not be lost with a cut in funding.

The US government pause on foreign aid is a test to Kenya’s commitment to end AIDS among children by 2027.

Since 2010, Kenya has gradually reduced new HIV infections by more than 67 per cent, decreasing from 101,000 cases in 2010 to approximately 16,752 infections in 2024.

At least 1,378,457 Kenyans are living with HIV, of whom 1,336,681 are on treatment, with seven per cent mother to child transmission, shy of by per cent to reach the global target of below five per cent.

In addition to significant progress in HIV diagnostic, treatment and suppression of viral load that stands at 98, 98 and 94 per cent respectively.

Counties with the highest burden of HIV include Kisumu, Homa Bay, Migori, Naiorbi, Nakuru, Mombasa, Kiambu, Kakamega, Kisii, Machakos, Uasin Gishu, Busia, Kilifi and Kitui.