Kenya, US give conflicting accounts of HIV/Aids war

Kenya and the US have released two sets of differing data on HIV/Aids in a row that may lead to Nairobi losing Sh2.27 billion in funding, thus heavily denting the war on the pandemic.

On Monday, US Chargé d’Affaires Eric Kneedler tweeted that Kenya has achieved the United Nations Programme on HIV/Aids (UNAIDS) 90: 90:90 goals while effectively controlling the HIV epidemic at the country level.

He attributed the achievement to the US President's Emergency Plan for Aids Relief (Pepfar).

“Kenya has achieved the UNAIDS 90-90-90 goals, effectively controlling the HIV epidemic at the country level. Hongera to the Pepfar team and all who made this possible!” he posted on his personal Twitter handle.

The donor has since announced plans to reduce its funding to Kenya by Sh2.27 billion, proposing to give Kenya $345 million (Sh39.17 billion), compared to $365 million (Sh41.44 billion) in 2021. In 2014, UNAIDS and partners launched the 90:90:90 target, whose aim was to diagnose 90 per cent of all HIV-positive persons, provide antiretroviral therapy for 90 per cent of those diagnosed and achieve viral suppression for 90 per cent of those treated by 2020.

The data obtained by Sunday Nation shows Kenya has yet to attain some of the key global targets set to bring the HIV/Aids scourge under control by 2020, despite the US position that the country was out of the woods.

Data from the National Aids Control Council expose stark disparities in HIV indicators among counties, children and adolescents, stressing the need for more efforts to meet all the targets. The data from the NACC also suggest that only 12 (25 per cent) of the 47 counties have achieved the 90-90-90 targets.

The remaining 35 counties (75 per cent) are lagging behind in either all or two targets and the 35 counties contribute 51 per cent of the estimated number of PLHIV in the country. The current data show Kenya has an unmet need of enrolling 224,004 patients on treatment. Only the first 90 have been met, with 96 per cent of people living with HIV knowing their status.

The country has yet to meet the two last 90 targets, with 86 per cent accessing HIV care and treatment and only 81 per cent attaining viral suppression.

The data indicates that about 14 per cent of HIV-positive Kenyans are not on treatment and one in 10 people who are HIV-positive is not accessing care and treatment, while two in 10 patients are not virally suppressed. “We are accelerating towards the achievement of the target, though we are not yet there. The current situation stands at 96-86-81. We need to find the 14 per cent of people who have yet to start their HIV treatment while intensifying measures to increase viral suppression,” reads a report.

Treatment

On gender, women seem to be doing better than men. The women have met the first two 90s, with only 14 per cent of the population struggling to achieve the last target, meaning they are not virally suppressed.

They are at 99:9:86. The data suggest men aged 15 years and above still lag behind on the path towards achieving the triple 90 target and about 23 per cent of the population with HIV are not on treatment, while 28 per cent are not virally suppressing.

The cohort’s targets stand at 92:77:72. This means most of them know their status but are not going for treatment, hence affecting their viral suppression.

Despite considerable progress in reaching patients with treatment, the biggest challenge for the country is keeping children born with HIV on treatment and suppressing the virus in their bodies, with only 73 per cent of them suppressing the virus compared with 81 per cent for adults.

Only 84 per cent of children have been identified and enrolled for treatment. However, 27 per cent are not virally suppressed, making children some of the most vulnerable groups in efforts to achieve the targets.

“There is a need to identify children living with HIV and address the viral suppression gap among them. By leaving them behind, we are likely not to achieve the target,” Dr Ruth Masha, NACC chief executive, said last year during the release of the HIV data.

The two countries are differing at a time when Pepfar is subjecting Kenya to a five per cent budget cut for HIV programmes, accusing the country of doing very little to increase its domestic funding to the HIV fight, yet it is one of the biggest beneficiaries for the last 18 years.

“Pepfar Kenya has one of the largest programmes and budgets, but falls in the bottom third when it comes to host country government co-financing. Kenya’s focus should shift to sustaining its HIV impact, the co-financing commitments and follow-through need to be a priority,” said Dr Angeli Achrekar, acting Pepfar boss, in a memo dated January 19.

Pepfar proud of progress

“Kenya should be proud of the progress made over the past 18 years of Pepfar implementation, Kenya has been especially successful and is one of a number of countries to have achieved the 90-90-90 goals and effective control of the HIV epidemic.”

Data seen by Sunday Nation, however, show Kenya has yet to attain the targets of testing, treating and virally suppressing HIV/Aids in 90 per cent of its population. Achrekar said the country must now work to sustain the HIV impact and begin the long-term, gradual transformation of the programme.

In a sensitive and unclassified email, Dr Acherekar said the pipeline of funds is now exhausted and funds for commodity gaps must come from a non-Pepfar source.

“Co-financing is not limited to health commodities; there is room for increased investments across the programme,” she said, adding Kenya must take up more responsibilities such as viral load tests for children to ensure they are virally suppressed.