In a troubling revelation, health officials have reported alarmingly high HIV prevalence rates among sex workers and men who have sex with men (MSM) in various counties across Kenya. This issue is especially pronounced in regions where the general population’s HIV prevalence is relatively low. The findings highlight significant disparities and call for targeted interventions to address the epidemic among these high-risk groups.
Disparities in HIV Prevalence
Kiambu County exemplifies this disparity. While the general HIV prevalence in the county stands at 2.27%, the prevalence among female sex workers (FSW) is 19.5%, and among MSM, it is 18.6%. These figures starkly contrast with the general population, underscoring the need for targeted health strategies.
Similarly, in Garissa County, the general population’s HIV prevalence is 0.17%, yet 18% of FSW and 10.6% of MSM are living with HIV. Wajir County presents a comparable situation, with a general HIV prevalence of 0.16% and significantly higher rates among FSW (18.8%) and MSM (9.9%).
Nairobi County, with a general population HIV prevalence of 4.3%, sees even higher rates among FSW and MSM, at 23% and 28% respectively. These statistics were compiled from the 2021 routine programme monitoring data by researchers aiming to understand the epidemic and transmission dynamics at a subnational level, facilitating targeted responses for specific populations.
Concentrated Epidemic in 24 Counties
The study revealed that 24 counties in Kenya exhibit a concentrated epidemic pattern, characterized by low prevalence in the general population but high prevalence among key populations such as FSW and MSM. These counties include Baringo, Bomet, Elgeyo Marakwet, Tana River, Isiolo, Laikipia, Lamu, Machakos, Makueni, Mandera, Marsabit, Trans Nzoia, and Uasin Gishu.
A concentrated HIV epidemic is defined by rapid HIV spread within specific subpopulations, without widespread transmission in the general population. The report, authored by Dr. Ruth Masha, head of the National Syndemic Diseases Control Council (NSDCC), and researchers from the National Aids and STI Control Programme (Nascop), emphasizes the need for targeted interventions in these high-prevalence groups.
The Need for Targeted Interventions
According to the report, titled “A sub-national HIV epidemic appraisal in Kenya: a new approach for identifying priority geographies, populations and programmes for optimising coverage for HIV prevention,” published in the Journal of the International Aids Society, a one-size-fits-all approach to HIV cannot work in Kenya. The researchers advocate for prioritizing programmes based on disease burden, epidemic typology, and coverage gaps to reduce inequities in HIV prevention and treatment.
The officials highlighted that in a concentrated epidemic, there is an opportunity to focus HIV prevention, treatment, care, and support efforts on the most affected populations while recognizing that no subpopulation is fully self-contained. This nuanced approach is essential to address the specific needs of high-risk groups effectively.
Mixed Epidemics in Other Counties
The remaining 19 counties in Kenya are classified as having mixed epidemics, where both general and high-risk population infections contribute significantly to the overall HIV burden. These counties require a blended approach to address the diverse transmission dynamics and ensure comprehensive HIV prevention and treatment coverage.
Gaps in Key Population Programmes
The report identifies gaps in key population programmes, particularly in counties with concentrated epidemics. From October to December 2021, key population programmes reached 91% of the estimated 197,096 FSW, all of the estimated 61,650 MSM, and 83% of the estimated 27,056 persons who inject drugs (PWID). However, the coverage was lowest among the 24 counties with concentrated epidemics, indicating the need for enhanced efforts in these regions.
The researchers also noted the likelihood of underestimating the MSM population in Kenya, suggesting that actual prevalence rates and the need for targeted interventions could be even higher than reported.
Implementing a Mix of Prevention Strategies
In response to these findings, health officials are implementing a mix of prevention strategies tailored to the epidemic typology of each county. This approach aims to optimize HIV prevention and treatment efforts by addressing the specific needs and transmission dynamics of different populations.
For example, counties with high HIV prevalence among FSW and MSM are focusing on increasing access to testing, treatment, and prevention services for these groups. This includes expanding outreach programmes, enhancing education and awareness campaigns, and improving access to pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART).
The high HIV prevalence among sex workers and MSM in Kenya underscores the urgent need for targeted interventions and tailored prevention strategies. By understanding the unique transmission dynamics and addressing the specific needs of high-risk populations, health officials can more effectively combat the epidemic and reduce HIV incidence in these vulnerable groups. The findings call for a concerted effort to bridge gaps in programme coverage and ensure comprehensive, equitable access to HIV prevention and treatment services across all counties.
