Unpacking challenges contributing to new HIV infections and poor treatment outcomes in Kenya

September 5, 2023


Magdaline Kusuna

Program Administrative Assistant


Kenya has made significant progress toward HIV epidemic control. By the end of December 2019, there were 1.16 million PLHIV on ART nationally, of whom 1,137,111 were enrolled in PEPFAR-supported facilities. However, there is an uptick in new infections, particularly among adolescent girls and young women (AGYW) aged 15-24 years. In 2019, there were over 133,000 individuals living with HIV/AIDS in Kenya. Of these were 18,000 new infections and about 3,000 deaths among adolescents aged 10-19 years.

Preventing the spread of HIV/AIDS among adolescents in Kenya is, therefore, a top public health priority. The uptake of HIV interventions has been low in this age group due to their vulnerability, poverty, and multi-faced transitions. For example, in 2018, HIV testing stood at 81% among young people aged 20-24 years, but among those aged 15-19 years, testing was at 50%. However, investments and advocacy in the HIV response have made some progress. For example, the age of sexual debut has increased from 14 years in 2008 to a median age of 15 years as of 2020. This progress has been modest, and there is a need to understand and address the underpinning issues to curb HIV among adolescents.

Implementing effective HIV/AIDS prevention and treatment programs requires adequate financial resources. Kenya has successfully implemented highly effective HIV prevention interventions at scale, including immediate antiretroviral therapy to all who are HIV-infected, voluntary medical male circumcision, prevention of mother-to-child transmission services, and large-scale HIV testing programs. However, limited funding can hinder the scale-up and sustainability of interventions targeted at adolescents. The lack of domestic financing posed a key challenge in the sustainability of the Pre-exposure prophylaxis (PrEP) program, and hence resource mobilization across all 47 counties with different levels of incidence and epidemic required significant negotiations and a differentiated approach.

Factors like limited awareness, cultural barriers, and stigma and accessibility issues may hinder the uptake of these preventive measures. The inequitable distribution of health services in Kenya, especially in marginalized communities, makes it challenging to deliver HIV management services to adolescents. The COVID-19 pandemic worsened the situation by affecting the supply of key commodities in Kenya. The disruption of global supply chains and restrictions on movement in the country made it difficult to procure and distribute PrEP in a timely manner. The number of people accessing healthcare facilities for services like HIV testing also decreased, hence the high risk of exposure and more infections.

Adolescents living with HIV/AIDS require continuous access to antiretroviral therapy (ART). However, health system challenges such as medication stockouts, limited healthcare infrastructure, and long distances to healthcare facilities can hinder treatment adherence.

In addition, stigmatization still poses a great challenge in HIV programming, especially among adolescents. Stigma and discrimination act as a barrier for adolescents from accessing testing, treatment and support. For instance, adolescents in boarding schools may fear rejection and social isolation, preventing them from taking medication, seeking emotional support, accessing support groups, or sharing their experiences openly. This lack of social support can negatively affect their mental health, adherence to treatment, and overall well-being, leading to poorer treatment outcomes.

Unprotected sexual behavior remains the most common route of HIV transmission in Kenya. Every adolescent will, at one point, have life-changing decisions to make about their sexual and reproductive health. As such, providing comprehensive sexual education is essential in preventing the spread of HIV/AIDS among adolescents. However, sociocultural norms, as well as resistance from conservative groups, are stifling the implementation of comprehensive sexual education programs. This is turning out to be a missed opportunity to engage this vulnerable population early enough before exposure to risk of sexually transmitted HIV.

If we are to make progress in the fight against HIV, we must be deliberate in ensuring that AGYW, get the necessary proven interventions to protect them against HIV. This will require a collaborative approach between the government, development partners, religious and learning institutions, health system and the community to address these challenges. Sustained awareness campaigns to address misconceptions and HIV-related stigma and discrimination will be needed to cater for new cohorts of young adults growing into this high-risk bracket. The government also needs to improve on the domestic budget allocations to ensure quality and adequate distribution of products like PrEP and condoms to avoid interruptions in the prevention efforts.