HIV stigma lingers as rising youth infections in Kenya dim campaigns

Brenda Bakobye, 19, is among teenagers living with HIV/Aids in Kenya, but counts herself lucky. When she was in secondary school, the matron kept her anti-retroviral (ARV) drugs and reminded her to replenish. But the hardest part of living with HIV/Aids in school was stigma, she says.

“Students were constantly asking why I was taking medicine and they made my life their business until they finally found out that I was HIV-positive,” she says.

“Some girls began avoiding me, speaking in low tones when I walked past. Luckily, by the time they found out, I only had a few months to finish.’’

Despite the stigma, Ms Bakobye is grateful that the school had a well-thought out plan for students living with Aids.

However, Johnson Birgen and Jerry Kitiabi’s stories are different. In school, the two teenagers had to hide the ARVs in their desks. Their schools had little support for students living with HIV/Aids.

“I stored some pills in my desk and others in the dormitory. I used to restock them during the holidays and school mid-term breaks,” says Jerry.
“I was in charge of my own medicines. But I made sure I took them as prescribed,” adds Johnson.

Brenda, Johnstone and Jerry, members of Sauti Skika, an advocacy group for youths living with HIV/Aids that has more than 1,000 members, say adolescents living with HIV/Aids will benefit from the government plan to link schools with health facilities and readily access ARVs.

Africa has made great strides in reducing new HIV infections but the adolescents and youth still bear the brunt of the epidemic due to limited access to information and stigma.

Aids is the leading cause of death among adolescents in Kenya and the second primary cause of death among adolescents globally, according to the Health ministry.

About 1.8 million young people are living with HIV in Africa. About 9,720 adolescents and young people died of Aids in Kenya in 2014, due to delayed treatment, and stigma associated with being HIV-positive.

But it is the growing numbers of HIV infections among the youth and deaths associated to stigma that is worrying.

“For far too long, girls and boys in their adolescence, the critical period of growing up, have been invisible in national plans, policies and budget allocations. Adolescents are the only group where Aids-related deaths are not declining. HIV infections are reducing at a slower pace compared to other groups, and access to life-saving anti-retroviral treatment continues to be limited,” said Ulrike Gilbert–Nandra, the chief of the HIV/Aids programme at Unicef Kenya.

How did Kenya find itself with a growing numbers of youth with HIV as adult numbers drop?

Nelson Juma Otwoma, the executive director of the Network of People Living with HIV/Aids in Kenya (Nephak) says when HIV/Aids was declared a national disaster, former President Daniel Moi targeted adults and that is how adolescents and children were marginalised.

“The drugs that were available globally were meant for adults. Children on medication were given a fraction of the adult medication which posed the danger of under- or overdosing,” he says.

“It was only recently that children medication in syrup form was introduced in the market.”

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Although various measures were put in place by the government, notably the campaign to stop mother-to-child infection, it was only recently that the campaign to stop new infections among adolescents was launched.

“The high death rates among children and adolescents between 2004 and 2010 was alarming,” Dr Otwoma says.

The rising new infections among the youth is now a wake-up call. President Uhuru Kenya in February directed county commissioners to collect data on the number of youth and children living with HIV/Aids in a move aimed at increasing access to ARVs.

The data will include that of infected children, guardians taking care of HIV/Aids children, pregnant and breastfeeding mothers with the virus.

“This reality demands that very specific measures and strategies be put in place targeting this age group if the challenge of HIV/Aids is to be overcome,” said Mr Kenyatta.

The directive by the President will ensure that correct information about youth living with Aids is published, and that measures are put in place to make their lives comfortable.

The Health ministry launched a fast-track plan to reduce HIV/Aids among adolescents and young people last month. The ministry targets to reduce new infections among the target group by 40 per cent, HIV/Aids-related deaths by 15 per cent, and lower stigma and discrimination by 25 per cent by 2017.

Also on top of the agenda is that by the end of two years, 80 per cent of adolescents and young people will have known their HIV status, 90 per cent of whom will be retained on anti-retroviral therapy as 90 per cent of those on ART achieve viral suppression.

“Unicef supports and looks forward to the implementation of a national fast-track plan to end HIV/ Aids among adolescents and young people launched in September this year,” says Ms Gilbert-Nandra.

Besides getting data and supplying schools with the medication, through local health facilities, the ministry of Health will ensure that schools establish health clubs for teachers and learners living with HIV/Aids.

Schools will also be expected to hold annual HIV and health education days. HIV/Aids as a subject will fully be incorporated in the syllabus and messages on the disease displayed in schools.

Learners living with the virus will be expected to spearhead advocacy against children’s stigma and discrimination.

At least 20 adolescents and youth champions in each county will be trained to provide support and mentorship to young people.

There will also be channels to seek legal redress following discrimination and psychological and social support to those who experience stigma.

“All adolescents... have a right to the information and services that will empower them to protect themselves from HIV,” said Dr Mariângela Simão of UNAids, during the launch of new standards to improve adolescent care two weeks ago.

As the government banks on data collection to increase access to ARVs, the affected youth see it as a move that will further fuel stigma.

“The method employed by government officials when collecting data from school is instigating stigma,” Johnson says.

“We have received complaints from Skika members about the way chiefs are doing it. They are separating the sickly children from the healthy looking ones. There is also one school where children were told to raise their hands if they took medication every day or if their parents had died of Aids,” he says.

The member of the Skika group that was started by Unicef says there has to be a better option to the data collection.

“How about carrying out the tests after educating the children on why it is important to know their status?”

The stigma rate in Kenya remains high because HIV/Aids is associated with immoral behaviour.

“I wish health officials can be trained to handle us better,” says Johnson. “They always lecture us when we want to learn more on reproductive health. We even had an instance where a pregnant member of the group was questioned by nurses after she went to get her ARVs. Are we not supposed to live a normal life?”

Dr Otwoma says linking HIV/Aids to immoral behaviour has to end for Kenya to win this gruelling war.

Milestones in fight against the disease since 1999

New HIV/Aids infections have significantly gone down since the disease was declared a national disaster in 1999.

The latest report by the National Aids Control Council (NACC) shows that new infections among children dropped by 44 per cent to 12,940 in 2013 from 23,400 in 2007. In adults, the rate dropped to 88,620 from 95,000, over the same period, indicating a seven per cent decline.

But, despite curbing the rate of new infections, the country is grappling with the economic burden that comes with treating and caring for persons living with HIV/Aids.

The total expenditure on HIV/Aids interventions in Kenya increased from Sh64.3 billion ($826 million) in 2009/10 to Sh70.3 billion ($853 million) in 2010/11, according to the Kenya National Aids spending report for the financial years 2009/10–2011/12 released in August last year by UNAids.

Although the report noted that the bulk of the budget, at 62 per cent, during that period was supported by external funders, the government was second largest source of financing, contributing 16 per cent.

“The bulk of the expenditure went to care and treatment (54 per cent), followed by prevention (20 per cent) and programme management and administration (12 per cent) and orphans and other vulnerable children (six per cent),” read the report in part.

The government allocated Sh2.6 billion in the current financial year to fighting HIV, TB and malaria. This amount is expected to increase following Mr Kenyatta’s strategy targeting adolescents and reduction of new infections.

More than 800,000 Kenyans are on ARVs. About 600,000 more Kenyans living with HIV will be put on anti-retroviral treatment by 2017 following an additional Sh21.9 billion funding from donors.

This will bring the number of people on treatment to about 1.4 million. Kenya has 1.6 million people living with HIV.

The president said that Kenya’s fast-track plan to end adolescent Aids initiative will ensure that lives are saved and that young people take up the responsibility of reducing the prevalence of the disease.

“The government will enroll an additional 130,000 children into anti-retroviral therapy and scale up implementation of the HIV curriculum in all secondary schools,” said Mr Kenyatta.