Alarm as more men die of advanced HIV disease in Kenya

In a worrying trend, men are leading in the number of individuals with newly-acquired HIV who present advanced levels of disease in Kenya. Data from the National Aids and STI Control Programme (Nascop), shows that at least 40 per cent of individuals with new infections are presenting with advanced HIV, previously known as Aids. Causes of advanced HIV disease include late diagnosis, when immunity is already compromised; and is occasioned by failure to enrol for treatment and interrupted treatment. Dr Lazarous Momanyi, a Technical Advisor at Nascop, says the individuals are presenting at clinical staging of 3 and 4, with opportunistic infections - including meningitis, Tuberculosis (TB), wasting, malnourishment and cancer. The opportunistic infections compromise immunity, causing death. In 2022, at least 18,473 people died from HIV/Aids related complications as a result of TB, diarrhea, malnutrition and other infections among children. "These deaths could have been prevented. One of the key questions we have been asking is what is the cause in this era of access to treatment?" Posed Momanyi. In children, those who are not put on treatment at birth after being infected with the virus develop advanced HIV. The drastic effect of children who default on treatment is death from HIV. The main contributor to advanced HIV disease in children includes failure by mothers to suppress their viral load before and during pregnancy, starting breastfeeding with a high viral load, home delivery and failure to know HIV status. "The health of children who get infected at birth and early years deteriorates so fast. Half of the children who acquire HIV die by their first birthday, 70 per cent die at their second birthday," said Momanyi. National Empowerment Network of People Living with HIV/Aids in Kenya (Nephak) chairperson, Nelson Otwoma, regretted that advanced HIV is reported despite the availability of free testing and treatment. "We are witnessing trends that we used to see a long time ago coming back. The fact that we have treatment, which is free, and free testing, we are seeing people who are not taking up the testing of HIV, delaying testing, and testing when it is too late, particularly men," said Otwoma. Data by the National Syndemic Disease Control Council (NSDCC) shows that 113,000 people interrupted treatment in 2023. "Let us know our HIV status, and if positive adhere to treatment which is a lifelong treatment. This is where we have a challenge with young people because they ask themselves what they are treating, and they are not sick," he said. To avert advanced HIV in children, the Health Ministry is emphasising on prevention of mother-to-child infection. Kenya targets to attain the World Health Organisation (WHO) to below five per cent mother-child transmission. Siaya is the only county that has attained the target in Kenya, with counties in North Eastern straggled at 20 per cent. Kenya targets to eliminate HIV transmission in children by 2027. Nephak, in partnership with Nascop, the Ministry of Health and partners, is seeking innovative approaches to working with communities, in its advocacy for people living with HIV with advanced disease. Meanwhile, Dr Momanyi regretted that stigma is also a contributing factor cresting advanced HIV disease. Some spouses do not disclose their status to their partners, and end up infecting them, only to have the disease discovered at an advanced stage. A number of people living with the disease also have strong faith convictions, like going to be prayed for by clergies who proclaim their healing despite science proving otherwise. "It is unfortunate that a number of people withdraw medication to be prayed for by faith leaders, an issue that is greatly affecting treatment. Sadly, these individuals come to hospital in a deteriorated state, and end up dying," said Dr Momanyi. Nascop and the ministry are building literacy among healthcare providers and caregivers to understand advanced HIV. Other measures are revamping diagnostic and mapping of advanced HIV centres. Individuals at greater risk of transmitting the disease are also put on PrEP (antiretroviral medication by HIV-negative people, which reduces the risk of HIV acquisition). Additionally, the ministry is working towards attaining U=U targets, through Operation Triple Zero (OTZ). U=U means undetectable equals untransmittable, whereby a person living with HIV who suppresses his/her viral load cannot infect HIV negative partner. Patricia Asero applauded the combination prevention approach adopted by the government through a biomedical model, where individuals have choices that work best for them. The methods include taking prophylaxis after sex, and the use of condoms during sex, all of which make them feel safe. Stigma, however, she said, is a contributor to advanced HIV disease, and interruption of treatment. "Stigma varies from self-stigma. Stigma can also be felt at home, facilities and institutions," said Asero. Karen Wamboi Omanga was optimistic that the integration of services will address stigma and discrimination and avert AIDS-related deaths. "If health workers are trained well and integrate services well, we will end advanced HIV. First health care provider a patient interacts with is key as such will determine on whether there will be treatment adherence," said Omanga who has lived with HIV for 27 years.

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