Thursday, January 14, 2010

Kenya Makes a Start in Addressing the HIV Epidemic

For the first time, I have come across an official Kenyan Government publication relating to HIV that is readable, credible and well thought out. Their survey entitled'HIV Prevention Response and Modes of Transmission Analysis' is available now (despite being dated March 2009). It address many of the worries about Kenya's HIV epidemic that have only been briefly mentioned before, but never adequately dealt with.

For example, it questions the fact that a far larger percentage of HIV spending goes on treatment and care than on reducing transmission; it questions the fact that HIV prevention programmes are top down and the same everywhere, even though the HIV epidemic affects areas very differently; it questions the fact that much of the HIV prevention spending seems to go to those who are not most at risk of being infected with or of transmitting HIV; many of those who are most at risk or in need of specific prevention programming receive little or none.

At last, the fact that there are men who have sex with men in Kenya and that they contribute to the epidemic is admitted and it is concluded that they need to be targetted. A recent report (too recent for this survey) shows that men who have sex with men live in all provinces and in urban and rural areas. It also shows that the clients of male sex workers providing services for other men are predominantly Kenyan. Previously, it was said that men having sex with men was a foreign phenomenon and that it mostly occurred along the coast.

Indeed, HIV transmission by men who have sex with men may be even higher than estimated by the Modes of Transmission Survey. But it's good that the issue is being discussed, rather than denied or ignored. The paper also admits that much of the money that goes into prevention goes towards interventions that have not been shown to have any impact on transmission. It admits that specific interventions may not have had much impact yet, even though some indicators are positive. It acknowledges that programmes and services are concentrated in areas where the need is not greatest.

So, people who are most at risk of becoming infected and of infecting others, such as men who have sex with men, commercial sex workers (and those who engage in any kind of transactional sex), intravenous drug users, long distance drivers, members of the fishing community and others are being acknowledged as being in need of prevention services. Let's hope that will be translated into the provision of these services. This survey is a very important step in Kenya's approach to HIV prevention.

But before some of these groups can be targeted, there are other problems that need to be addressed. It is illegal for men to have sex with men, certain aspects of commercial sex work are illegal and intravenous drug use is illegal. Members of these groups are rightly afraid to identify themselves and to risk being identified because they are the victims of persecution by members of the public, clients, professionals, police and others. But the survey mentions these issues and makes recommendations relating to them.

It remains to be seen whether any of the improvements recommended by this survey are made by the current government. But reading this survey gives me hope because maybe now there are some people in a position to do something who are willing to even discuss phenomena that have so long been ignored.


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