Eliminate bottlenecks to end mother-to-child HIV transmission -experts
Mary Wanjiku, 25, firmly holds that children should be protected from contracting HIV/Aids during pregnancy, birth and breastfeeding.
An HIV/Aids mentor from Machakos County, Wanjiku was born with the virus and has been under antiretroviral medication for 17 years now.
“My mother passed on when she was young. At the time, there was no proper medication for HIV, so she died due to complications of the disease in 2003. My younger brother also died of the disease,” she says.
Wanjiku adds that one of her biggest challenges was that nobody told her about her condition early enough until she completed Class Eight. She says the news was delivered to her while doing the mandatory HIV tests required when joining Form One. “The doctor asked whether I knew what the drugs I had been taking since I was a child were for. The life-changing news did not hit me immediately, I was in denial and numb for a while, and I never told anyone what had happened,” she recounts.
At Form Two, Wanjiku began experiencing stigma from her schoolmates after someone saw her drugs and started spreading word. She started secluding herself from the other students and teachers noticed. “I got into a lot of problems at school and my grades started going down. I even stopped taking my medication,” she recounts.
At some point, her body started getting reactions, which caused her scars to date.She realised she was harming herself and gradually started embracing her situation.
After completing secondary school, she joined college where she met her first love to whom she disclosed her status, and he was fine with it.
“When I got pregnant, I went to a medical facility immediately where they placed me on medication that would prevent me from transmitting the virus to my newborn baby. My child is turning three this month, and he is negative,” she offers.
Having gone through that phase, Wanjiku is a perfect example that a positive attitude goes a long way. She started helping other mothers to accept their situation and to protect their children.“My word to mothers is that it is not a sin to be HIV positive. You have to live your life…we have to get used to it and take medication as expected and life will run smoothly. The baby does not have to suffer because of your condition,” she says.
As a mentor, Wanjiku takes mothers through this journey because stigma is a huge barrier to access to HIV services, whether testing or treatment.
First of all, every pregnant woman who goes to the hospital should know their status and if found to be positive, they should undergo counseling.
“I encourage and show them that they can deliver a child who is HIV negative. I take them through the process of taking medication and attending clinics until delivery. I tell them that they should accept themselves first, so that they can love the child they are raising,” she explains.
“We have faced a lot of challenges with HIV positive mothers who come in during labour, not having attended even a single antenatal clinic,” she adds.
Statistics from the National Syndemic Disease Control Council (NSDCC) shows that Mother To Child Transmission (MTCT) of HIV has reduced from 14 per cent in 2013 to 8.6 per cent last year.
It, however, missed the less than five per cent validation target.
“Siaya County achieved MTCT rate of less than five per cent in 2022, recording 4.3 per cent, while Migori County had five per cent. Counties of Mandera, Wajir, Samburu and Narok had MTCT rates of above 20 per cent in the same year,” NSDCC says.
Similarly, cultural barriers and stigma have been identified as threats to eliminate HIV MTCT in Arid and Semi-Arid counties that bear the biggest burden of the transmission.
NSDCC says instances of ‘missed opportunities’ are reported time and again, where a pregnant mother goes to a facility once and only goes back there to deliver, which is one of the scenarios, which make mothers transmit.
“We should ensure we do not have missed opportunities, HIV positive pregnant mothers’ hands should be held all through until they deliver,” Japheth Kioko, a statistician at the NSDCC’s Monitoring and Evaluation Division says.
Kioko says transmission occurs in three phases; when a woman gets pregnant, during labour, as well as during breastfeeding.
NSDCC Officer in Charge of County Operations, Dr Douglas Bosire says increased cases of MTCT have posed a threat to zero rating cases of HIV by 2027.
Mandera is among counties with highest percentage at 38.8 per cent, Wajir at 29.6 per cent, Samburu (25.7 per cent) and Narok has 21.1 per cent MTCT rate while the national MTCT rate average stands at 8.6 per cent with significant geographical disparity ranging from five per cent to 38.8 per cent.
“Despite the gains in HIV response, Kenya is yet to meet the target required for the elimination of mother to child transmission of HIV. The cases of MTCT transmission remain high in the four counties,” says Bosire.
The 2023 World AIDS Day theme, ‘Let Communities Lead’, highlights the importance of community-led responses working alongside other public health systems in addressing HIV-related stigma, discrimination, and providing HIV prevention, education and interventions to support treatment adherence.
NSDCC Performance Management Head, Edwin Kimutai says the country has made good progress with HIV and Aids, but that does not mean it should relax.
He says the World Aids Day is the hallmark of what the organisation does to ensure that apart from commemoration, progress will also be measured.
“We have quite a number of programmes we have been running as an institution including the triple threat and we are seeing good progress. We are looking holistically at issues that contribute to HIV and Aids,” he explains.
During the 20th President’s Emergency Plan for AIDS Relief (PEPFAR) celebration recently, President William Ruto said HIV-related commodities are estimated to cost between Sh27 to Sh30 billion annually and owing to a decline in donor support, the funding gap now stands at Sh1.8 billion (US$11.75 million).
He, however, said the government is committed to progressively increasing domestic funding in order to sustain the gains made so far in partnership with PEPFAR.
“Over the past two years, we have increased our financial injection into the HIV commodity pipeline by Sh1 billion to prevent supply disruption. Additionally, we are committed to end Aids in children by 2027 as part of our commitment under the Global Alliance. Wakati ni Sasa: The Time is Now, to take a strong stand and make up for lost ground for the sake of Kenya’s children,” said the President.
Meanwhile, in observance of World Aids Day on Decemver 1, the Aids Healthcare Foundation (AHF) Kenya voiced deep concerns regarding the escalating number of HIV infections among adolescents and young people in the country.
Data from NSDCC paints a stark reality, revealing a troubling statistic of 62 new HIV infections per week among adolescents aged 10-19.
The intersection of risks faced by adolescents, encompassing new HIV infections, unintended pregnancies, and exposure to sexual and gender-based violence, presents a complex scenario of vulnerabilities in this age group. AHF Kenya is advocating for comprehensive strategies that encompass sexual health education, access to reproductive health services, HIV transmission prevention, and initiatives combatting gender-based violence.
Dr Jesse Kwatampora, Medical Director of AHF Kenya, underscored the imperative for targeted and collaborative efforts. “There is an urgent need for concerted and collaborative efforts between governmental bodies, NGOs, and local communities to address the underlying factors contributing to the rise in infections among adolescents, such as pregnancies and sexual and gender-based violence.”
New HIV infections
Kenya’s HIV landscape showcases progress, but with challenges. With 1.4 million people living with HIV, the nation reached 1,294,339 individuals on antiretroviral therapy in 2022. Despite this progress, there were 18,473 Aids-related deaths and 22,154 new HIV infections in the same year.
The commitment to increase domestic financing for the HIV response is apparent, targeting 50 per cent by the end of 2025, reaching 34 per cent by the close of 2022. Commodity security, especially contributing the required Sh25.8 billion, remains a crucial priority for the nation’s ongoing battle against HIV/Aids.