Nairobi, Kisumu and Nakuru lead in new HIV infections

Kenya’s cities lead in new HIV cases, largely driven by infections among youths who comprise students, job seekers and young workers, new data has shown.

Nairobi leads the pack, followed by Kisumu and the recently crowned Nakuru City.

Most people in cities are youths and children, according to the Kenya National Bureau of Statistics.

Half of all people living in Nairobi are aged between 15 and 34 and this is the age most new infections happen.

The National Syndemic Diseases Control Council, which released the new HIV Situation in Kenya data, said about 16,752 Kenyans were newly diagnosed with HIV in 2023.

“At least 51 per cent of new HIV infections occur in nine counties,” NSDCC said.

These counties are Nairobi, Kisumu, Nakuru, Migori, Homa Bay, Uasin Gishu (home of Eldoret city), Siaya, Mombasa, Kakamega, Kericho and Kajiado.

There is a greater focus on new infections (also known as incidence) nowadays, because the trend reveals who is at the greatest risk of infection.

This helps in targeting the response more efficiently.

On the other hand, prevalence, which measures the fraction of Kenyans living with HIV at a given time, shows that Kisumu leads, followed by Homa Bay, Migori, Siaya, Busia, Mombasa, Nairobi and Uasin Gishu

. The new infections are a welcome reduction from 2022 when about 22,000 people were newly infected.

However, deaths rose from 18,473 in 2022 to 20,480 in 2023.

The increase was driven by rising deaths among men.

Ruth Laibon-Masha, the CEO of NSDCC, said the inordinate number of men and boys dying from Aids-related illnesses will be the focus of this year’s World Aids Day event on Sunday.

The event is themed, “It’s a race against time”. It will be marked with a marathon and other races at the Nyayo National Stadium in Nairobi.

“While HIV prevalence among men (2.2 per cent) is lower than that of females (4.5 per cent) in 2023, men experience a disproportionate burden of Aids related mortality,” Masha said in a speech read by NSDCC programmes officer Jenny Gakii.

While only three men have HIV among every 10 positive people, nearly half of those who die are male, she said. Among the 20,480 Kenyans who died from Aids-related illnesses last year, 41 per cent or 8,490 of the total were boys and men.

The rest were women and girls (9,382) and children (2,607). Masha said there are reasons why men are dying more from an infection which is treatable and manageable. Research shows that HIV-positive people who start antiretroviral therapy promptly and have good access to medical care live as long as their HIV-negative peers.

The only difference is that HIV-positive people are more likely to develop additional health problems for many of those years earlier than HIV-negative people.

Kenyan seeking testing men late, have poor adherence to ARVs and many continue with unhealthy habits such as tobacco smoking and alcohol abuse.

“Men exhibit poor health-seeking behaviour translating to poor health outcomes,” Masha said. “Between January 2023- April 2024, male adults above 15 years accounted for only 28 per cent of all [HIV] tests done (9,619,519) among adults 15 years and above.”

“ART initiation among men and boys remain sub-optimal although showing a positive trajectory between 2020 and 2023,” Masha said.

Other factors include high prevalence of violence among men and injecting drug use.

“Men and boys account for 89 per cent of all people who inject drugs,” she said.

NSDC has launched a six-year framework for ending Aids, TB and promoting access to prevention and treatment services for STIs, drugs, alcohol and substance abuse disorders among men and boys.

“There is need for more action centered on strategies that optimise and expand access to early intervention and quality treatment health services for men and boys as clients and supportive partners,” Masha said.

About 1.38 million Kenyans were living with HIV last year.  is means Kenya has the world’s seventh biggest HIV burden after South Africa, India, Mozambique, Tanzania, Nigeria, Zambia and Uganda.

The report says most people with new HIV infections are below 34 years.

The riskiest age appears to be 20- 24 – in colleges and universities.

“Adolescents and young adults aged 15-34 contributed to 73 per cent of all new adult HIV infections in 2023,” said Japheth Kioko, head of monitoring and evaluation at NSDCC.

However, most Kenyans with HIV are on ARVs, which means the country is on course is to end HIV/ Aids as a public health threat.

The drugs must be taken for life to suppress the virus because HIV has no cure. People easily develop Aids without treatment and after that they typically survive for about three years. 

The Sustainable Development Goals aim to end HIV/Aids as a public health threat by 2030.

This is generally considered by the UN as a 90 per cent reduction in new HIV infections and Aids-related deaths by 2030. President Ruto last year pushed Kenya’s goal to 2027.

The country’s efforts towards this goal are guided by the Kenya Aids Strategic Framework II, which aims to cut all new infections by 75 per cent by 2025 and reduce by half all Aids-related deaths, compared to 2019.

This means Kenya must also increase its funding for HIV response. Foreign donors currently finance at least 66 per cent of the HIV budget in Kenya, mostly buying ARVs and related supplies.

In 2020-21, public funds accounted for about 39 per cent of Kenya’s HIV-related expenditure. US Pepfar contributed 47.1 per cent, followed by Global Fund at 9.5 per cent and other donors at 5.1 per cent and 0.07 per cent from local non-governmental sources. 

The last few years, the US has been asking Kenya to diversify its donors and improve domestic financing.

“The need for signifi cantly greater domestic fi nancing for the health sector, including for the national HIV programme, has become more urgent,” a policy paper on Kenya commissioned by Pepfar last year said.

It cited the expected decline in donor funding as Kenya transitions into a lower-middle-income country.

“The government of Kenya should prioritise strategies that can potentially secure and sustain increased government financing for health and HIV,” the paper said.

It was titled, ‘Trends in Public Sector Investments in HIV in Kenya’. It was produced for Pepfar and USAid by policy think tank Health Policy Plus.