Experts concerned over rise in new HIV infections among young people

This year alone, about 11,300 new HIV cases have been recorded among those aged 15 to 24 and another 5,300 among those aged 10 to 19.

This, according to the recently released data by the National Aids Control Council on World Aids Day, contributed to 61 per cent of all new cases among adolescents and young adults.

The data also revealed that between the months of January and October 2021, there were 274,510 adolescent (10-19 years) pregnancies recorded, of which five per cent were among those aged 10 to14.

Nairobi, Homa Bay, Uasin Gishu and Meru counties had the highest number of new HIV cases among young people, accounting for 42 per cent of new infections among adolescents and young people aged 15 to 24.

The data imply that adolescents are having unprotected sex, which results in high HIV incidence and the rise in pregnancies. Aids is the leading cause of death and morbidity among adolescents and young people in Kenya.

This year alone, 16,393 adolescents and young people died of Aids, despite the country registering a 43 per cent drop in Aids-related deaths between 2015 and 2021.

Another study by Nacc also revealed that more girls than boys were using condoms at their first sexual encounter.

But as sexual relationships build, 89 per cent of girls aged 15-24 years abandon condoms, despite not knowing the status of their partners, it adds. This means of 10 girls aged 15 to 24, nine dropped condom and had unprotected sex with partners of unknown status and only one insisted of using a condom.

Peak of sexual activity

“Kenya has a predominantly young population, with 67 per cent aged 29 and below. Despite the significant reduction in new HIV infection among adolescents and young people, the country did not meet the target of 75 per cent reduction,” said Dr Ruth Masha, Nacc chief executive officer.

The young adults fall under the bracket that’s at the peak of sexual activity. It’s a tough life of hard choices: satisfying their sexual curiosity or celibacy. To feed their sexual drive or to suppress their viral load. 

Theirs are inspiring stories of rejection and acceptance, defiance and flirting with death, but mostly of finding hope amid darkness and forging forward.

On finding out that she was HIV positive, EAE lost hope in life and all she wanted was to die. She did not understand why she had to take the drugs every day. Given the way the disclosure was done by her mother without counselling, she has several unanswered questions. All she got from health workers and her mother are threats that she would die if she did not religiously take her drugs.

“I did not ask to be born with the virus and it is not my fault that I am HIV-positive. This is my mother’s fault and all she does is to quarrel with me to take the drugs,” she says.

She says that at the hospital, healthcare workers “do not know how to talk to people. They are shouting and everyone looks at me when I am taking my drugs”.

She dropped her drugs and it took the intervention of counsellors and peer drug educators to bring her back to medication, this is after she was bedridden for two months. She lives with regrets and until she accepts her status and takes her drugs, it might not be easy for her to virally suppress.

For LAL, tired of drugs that had been her routine since she was nine, she decided enough was enough. It was 2015, and she had just completed Standard Eight.

Endured untold pain

‘‘I couldn’t keep close friends because I didn’t want them to know I was on ARVs. Some of them wondered why I was always going to hospital. I couldn’t disclose my status to them,” the 23-year-old recounts.

At the time, the young woman from was living with her father and stepmother in Nairobi. With her mother dead, she says she didn’t have anything to live for. She stopped taking her ARVs – the second time in five years.

“It took encouragement from peer group meetings to get me back on the drugs. I’d given up.” 

By the time she resumed the regimen in 2018, she had already had a baby with a man she has since parted ways with. She’s now married. 

“My husband is HIV-negative. We got married last year.”

From learning about her status as a teenager to losing her father and being abandoned by her lover, IAA has endured untold pain for a 23-year-old. The young woman from Ndhiwa is the only positive child among her siblings.

“I’ve had many unanswered questions in life. Why me? Why me alone? “I was put on drugs before I could understand what they were. My mother lied to me that I had TB. I got tired and quit them.”
Her viral load shot through the roof. Frequent bouts of illness took over, consigning her to hospital.  

“The doctor warned that if I stopped taking the drugs, I would die. I was put on second line.”

To disclose or not?

The struggle the three are going through represents what thousands of adolescents in the country have to endure every day to live a normal life.

Finding love has been a slippery affair. Whenever IAA meets a potential suitor, for instance, she’s conflicted between revealing her status, hence risking losing him, and keeping it a secret and being haunted by guilt.

“One man told me he couldn’t date a corpse after I told him about my status. That hurt badly and for long,” she says wistfully, carried away in thought. 

Her eyes welled up. After composing herself moments later, she adds: “I take my time to see if the person is serious with me. Usually, I’ll let on after six months.”

Still, some people seduce her for sex only.  “To such men, there’s no use revealing my status. I simply ignore them.”

Keeping her HIV status from her partner to salvage the relationship is to walk a tightrope, she says.

“You can’t hide your sickness for long. What happens when he discovers I’ve been taking ARVs secretly?”

Whether she chooses to state her health status at the outset or later in the relationship, the end is always the same — a break-up.

Sex among young persons below 25 is as rampant in Pala as it is in Kachuth, a situation replicated across the country. It’s for this reason that new cases are highest among adolescents, according to the Ministry of Health.

Indulging in unsafe sex

Infection is also high among people indulging in unsafe sex, especially sex workers, says Dorothy Esonwune, the project coordinator at Doctors Without Borders (MSF) in Homa Bay County.

Ndhiwa, in particular, has been on the radar of the government given its high HIV incidence and prevalence. In 2012, for instance, the sub-county had the highest incidence in the world at two per cent, according to Ndhiwa HIV Impact in Population Survey (NHIPS-1) conducted by MSF.

But why is the cohort a worrying lot despite all the programmes, efforts and resources being channelled towards them? 

Sunday Nation spoke to the experts to explain why the numbers are not reducing, the way forward and the adolescents living with the virus on the trauma of coming to terms with the disease as young adults.

According to Dr Esonwune, extreme poverty among residents, unavailability of management kit and even drugs at hospitals hamper the fight against the disease. 

“Some young people can’t afford bus fare to go to hospital to collect their drugs. It becomes difficult to take the drugs consistently,” she says.

Whatever they decide, these youngsters must consider the implications to their health. They may have made peace with their status, but they wish they were as healthy and as free as their age-mates.

IAA says: ‘‘Having to take ARVs isn’t an easy lifestyle. The best thing is to stay negative. It worries me when I see my friends engaging in casual sex during parties despite their condition.’’

As much as the trio have partly accepted their status, they say some of their friends never recovered from the trauma of their initial stigma and many others were driven to the edge. 

HIV-related deaths

“They stopped taking ARVs and turned to drugs. Some have been reckless, having intercourse with multiple partners. These are now sicker and hopeless.”

IAA says she’s confident of finding a loving partner, positive or negative.

“Maybe I’ll be lucky one day to find a man who’s willing to love me despite my status.”

LAL says: ‘‘I’m living a normal life today. I wish I’d started taking my drugs earlier.” To millennial HIV/Aids patients, she adds: “Use protection at all times. Take your drugs as instructed. Be with one person.”

Dr Momanyi Ogeto, technical lead, care and treatment at the Centre for Health Solutions, Kenya, says the country must use a multisectoral approach to reduce the numbers.

“These are one of the most complicated cohorts, we just need to understand them, talk to them, come up with a multisector intervention from school-based, health facility, population-specific, community-based to reduce the new infections and HIV-related deaths. It is a journey that we must start to win,” Dr Momanyi says.

He urged parents and healthcare workers to talk to the adolescents and have a conversation rather than shouting at them.

“Let’s start having different conversation with the adults on sex and HIV education in schools prior to the onset of sexual activity, this will reduce stigma, delay first sex,” he says.

Dr Masha said Kenyan HIV gains are fragile because the country does not concentrate on children.

She urged Kenyans to stop condemning those giving HIV and sex education to young people.