Polygamists, widowers,older women in Central region and Nyanza are drivers of new HIV infections
NAIROBI, KENYA: Polygamists, widowers and older women in Central region and a persistent epidemic in Nyanza are the hidden drivers of new HIV infections, according to the latest version of the Kenya Aids Indicator Survey (KAIS) completed last year.
In September, the Cabinet Secretary for Health, James Macharia, had released preliminary findings of the Kenya Aids Indicator Survey, 2012, promising a detailed public report by December.
But in what looks to be a departure from the past, the ministry with assistance from US agencies is to publish the detailed scholarly report through a special supplement in the May issue of the Journal of Acquired Immune Deficiency Syndromes.
The 137-page supplement from 16 distinct studies is generally in agreement with the earlier announcement by Mr Macharia indicating the national HIV prevalence rates have declined from 7.2 per cent in 2007 to 5.6 per cent in 2012.
The report also confirms that the disease has declined in Mombasa, Nairobi and parts of Rift Valley, as had been reported by Macharia in September.
The preliminary report had been criticised for not explaining what was driving these changes, especially in Nyanza.
The rise of infections in Nyanza to twice the national prevalence rates was confounding because the region has some of the biggest and most expensive control programmes including male circumcision.
An advance copy of the supplement hints at the possibility that the ministry will also be presenting its final version to the public soon.
“We are pleased to present this special supplement highlighting the key findings of KAIS 2012, which coincides with the release of the Kenya Ministry of Health’s definitive report for the survey,” wrote the three top doctors behind the supplement.
The three are Dr Kevin M De Cock of the US Centre for Disease Control and Prevention (Nairobi), Dr George W Rutherford, (University of California) and Dr Willis Akhwale of the Ministry of Health.
The report says well-known risk groups such as male and female prostitutes and drug injectors are still a major risk factor in the spread of HIV. “Prevalence among female sex workers has been estimated to range from 29.1 per cent in Nairobi to 56.5 per cent in Kisumu.”
To reduce the harm being done by these groups in the spread of the disease, the authors suggest they be given financial incentives to abandon the trade.
“Such incentives should include engaging them in small-scale businesses as well as giving them cash handouts to wean them from the streets,” recommends one of the papers.
The detailed report of the study that cost US$7.5 million attributes declines in Nairobi, Rift Valley and the Coast to lower infections among younger women in these regions. There was also a decline of infections among younger men at the Coast.
The second Kenya Aids Indicator Survey was conducted from October 2012 to February last year across the country apart from North Eastern and Tana River because of what authors say were security concerns. It covered 13,720 children and adults majority of whom provided blood samples.
The study attributes a spike in Central Kenya to middle-aged and older women, 35 years and above. “HIV prevalence, however, increased significantly among women residing in Central region, from 3.1 per cent in 2007 to 8.4 per cent 2012,” wrote the authors without explaining why this is happening.
Infection was also found to be high among widowers, separated persons and divorced women.
It emerged that widowers are behaving badly and present a significant threat in spreading the Aids causing virus. The report depicts this group of men as having a party after the death of their spouses and in the meantime liberally sharing out the virus.
“We have also demonstrated that widowers are more likely to engage in high-risk sexual behaviour after the death of their spouse and contribute significantly to new HIV infections in the population.”
Polygamy, recently made easier for men through the Marriage Bill, may turn out to be counterproductive for all parties presenting multiple threats of HIV infections.
While data shows seven per cent of those in monogamous relationships to be HIV-positive, this jumps to 11 per cent among those in polygamous relationships. About 1.8 million are wives who are living in polygamous marriages or unions compared to about 700,000 husbands in similar unions.
Even in Kisumu where the authors say male circumcision has taken off commendably, the study fails to show a direct link between the practice and a slowing down of infections.
The team wants more money to be put into scaled-up male circumcision programmes to cover more young men entering into adulthood as well as making infant circumcision a routine procedure in maternal and child healthcare.