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Home , Baragoi, Bomet County, Bungoma County, Busia County, Dundori, Embu County

HIV County Profiles

ELIMINA TE NEW HIV INFECTION AMONG CHILDREN

PREVENT HIV AMONG ACCESSING DRUG USERS TRE ATMENT

CLOSING THE REOURCE GAP

2014

Contents

Preface...... 1 ...... 76 Background...... 6 County...... 79 National Overview of the Epidemic...... 8 County...... 82 Hiv and Aids County Profiles...... 9 ...... 85 ...... 10 County...... 88 County...... 13 County...... 91 County...... 16 Murang’a County...... 94 ...... 19 County...... 97 Elgeyo Marakwet County...... 22 County...... 100 ...... 25 ...... 103 County...... 28 County...... 106 County...... 31 County...... 109 County...... 34 ...... 112 County...... 37 County...... 115 County...... 40 ...... 118 County...... 43 County...... 121 County...... 46 Taita Taveta County...... 124 County...... 49 County...... 127 ...... 52 Tharaka Nithi County...... 130 ...... 55 Trans Nzoia County...... 133 County...... 58 ...... 136 County...... 61 ...... 139 County...... 64 County...... 142 ...... 67 County...... 145 County...... 70 ...... 148 County...... 73 596,228 The number of adults on treatment in Kenya in 2011. There has been a rapid scale up of treatment as is evidenced by over 1,000 treatment sites

Photo © IRIN News iv kenya HIV AND AIDS PROFILE by County preface

The National AIDS Control Council (NACC) as the coordinating body for the AIDS response is charged with the responsibility of coordinating the national AIDS response.

In order to effectively support county governments to implement successful programmes that are evidence based and take into account county heterogeneity, the NACC has profiled the status of the HIV epidemic of all counties.

We take this opportunity to launch the second edition of the HIV County Profiles. This document contains data based on 2014 HIV estimates that can be used to design county specific HIV and AIDS programmes that respond to the unique context of each of the 47 counties.

I would like to thank UNAIDS for technical and financial support to prepare the county profiles

Dr. Nduku Kilonzo Director, National AIDS Control Council

kenya HIV AND AIDS PROFILE by County 1 estimated adult (15+) HIV PREVALENCE by County

1.7

7.6

1.2

2.8 0.2

5.1 5.0

3.2 2.5 4.2 6.8 3.0 5.9 4.3 3.7 3.7 3.0 3.8 23.7

19.3 3.8 4.3 3.4 5.3 4.3 3.3 3.7 6.4 25.7 5.8 2.1 8.0 5.2 3.8 14.7 5.0 5.0 6.8 4.3 1.0 5.6 4.4 2.3

County HIV Prevalence 4.4 >15% Hyper endemic National 5-14.9% Average 6.1 1-4.9% Prevalence < 1% 6.04% 7.4 5.7

2 kenya HIV AND AIDS PROFILE by County estimated NEW HIV INFECTIONS among adults (15+) by County

Annual Infections

>5,000 1,000-4,999 <999

Counties New HIV Counties New HIV Counties New HIV Counties New HIV Counties New HIV Infections Infections Infections Infections Infections Homa Bay 12,279 Muranga 1,984 Kericho 1,214 West Pokot 576 Bungoma 83 Kisumu 10,349 Uasin Gishu 1,921 Makueni 1,193 Embu 518 Marsabit 81 Siaya 9,869 Bomet 1,875 Meru 1,090 Samburu 461 Busia 51 Migori 6,786 Trans Nzoia 1,867 Kitui 988 Tharaka 410 Lamu 44 Kisii 4,891 Narok 1,806 Nyandarua 899 Elgeyo Marakwet 400 Tana River 40 Nakuru 4,127 Mombasa 1,609 Kilifi 821 Taita Taveta 330 Vihiga 31 Nairobi 3,098 Kajiado 1,545 Kirinyaga 795 Kakamega 154 Wajir 18 Turkana 2,997 Machakos 1,463 Baringo 707 Isiolo 151 Kenya 88,622 Kiambu 2,931 Nyeri 1,307 Laikipia 692 Mandera 137 Nyamira 2,052 Nandi 1,253 Kwale 623 Garissa 116

kenya HIV AND AIDS PROFILE by County 3 estimated NEW HIV INFECTIONS among children (0-14) by County

Annual Infections >1,000 999-100 <99

County New County New County New County New County New Infections Infections Infections Infections Infections Homa Bay 2,700 Turkana 143 Kwale 65 Taita Taveta 35 Mandera 17 Kisumu 2,276 Kiambu 95 Makueni 64 Baringo 34 Garissa 14 Migori 1,492 Bungoma 93 Muranga 64 Laikipia 33 Isiolo 8 Siaya 2,170 Uasin Gishu 92 Nandi 60 Nyandarua 29 Lamu 5 Kisii 1,075 Trans Nzoia 89 Meru 59 Embu 28 Tana River 4 Nyamira 451 Bomet 89 Kericho 58 West Pokot 27 Marsabit 4 Nairobi 313 Narok 86 Busia 57 Kirinyaga 26 Wajir 2 Nakuru 197 Kilifi 86 Kitui 53 Samburu 22 Kenya 12,826 Kakamega 172 Machakos 79 Nyeri 42 Tharaka 22 Mombasa 169 Kajiado 74 Vihiga 35 Elgeyo Marakwet 19

4 kenya HIV AND AIDS PROFILE by County Total # adults living with HIV by County and % ART coverage for those in need (CD4 350)

Adults Living With HIV Adult Art Coverage >100,000 >80% 50,000-99,999 50% - 79% 20,000-49,999 20% - 49%

<19,999 <19%

County ART HIV+ County ART HIV+ County ART HIV+ County ART HIV+ County ART HIV+ Covearage Adults Covearage Adults Covearage Adults Covearage Adults Covearage Adults Mandera** 4% 3,928 Garissa* 48% 3,262 Bungoma 64% 26,093 Marsabit 86% 1,480 Mombasa 98% 47,751 Turkana** 20% 39,043 Kisii 48% 55,970 Kakamega 66% 48,533 Kitui 88% 18,328 Nyeri 99% 18,923 Samburu 24% 6,001 Taita Taveta 52% 9,781 Homa Bay 70% 140,629 Migori 89% 77,650 Kiambu 102% 42,425 Wajir* 26% 307 Baringo 53% 9,194 Kilifi 71% 24,413 Kirinyaga 91% 11,458 Kisumu 104% 118,538 West Pokot 29% 7,515 Kajiado 53% 20,080 Machakos 74% 27,063 Nairobi 92% 102,828 Kericho 120% 15,846 Kwale 31% 18,459 Laikipia 54% 8,963 Makueni 76% 22,110 Embu 93% 9,641 Uasin Gishu 144% 25,021 Bomet 38% 24,389 Trans Nzoia 56% 24,323 Nyandarua 77% 12,950 Lamu 95% 1,263 Busia 183% 16,065 Elgeyo Marakwet 38% 5,208 Nyamira 58% 23,493 Meru 82% 20,238 Tharaka 95% 7,603 Kenya 66% 1,345,785 Narok 38% 23,504 Isiolo 60% 2,822 Nandi 82% 16,281 Tana River 97% 1,161 Muranga 45% 28,721 Nakuru 62% 53,713 Siaya 82% 112,962 Vihiga 97% 9,853

kenya HIV AND AIDS PROFILE by County 5 1 Background

New HIV infections

12,940 New HIV infections among children (0-14 years) in 2013

88,620 new HIV infections occured among adults in 2013 21% of new adult HIV infections occur among young women aged 15-24 every year

2.5% Health Facility Related 14.1% Sex workers and Clients

3.8% Injecting Drug Use (IDU) 20.3% Casual heterosexual sex

15.2% MSM and Prison 44.1% Heterosexual sex within union

Sources: Kenya HIV Estimates Report, 2014 Modes of Transmission Study, 2009

6 kenya HIV AND AIDS PROFILE by County Kenya is one of the six HIV ‘high burden’ countries in Africa – about 1.6 million people were living with HIV The high burden of HIV and AIDS infection at the end of 2013. Women in Kenya are more vulnerable to HIV infection compared to Kenyan in Kenya accounts for an estimated men, with the national HIV prevalence at 7.6 per cent 29% of annual adult deaths, 20% for women and 5.6 per cent for men1. The epidemic is geographically diverse, ranging from a high prevalence per cent of maternal mortality, and of 25.7 per cent in in Nyanza region 15% of deaths of children under to a low of approximately 0.2 per cent in in North Eastern region. the age of five

The high burden of HIV and AIDS in Kenya accounts for an estimated 29 per cent of annual adult deaths, 20 per cent of maternal mortality, and 15 per cent of deaths of children under the age of five2. The epidemic has also negatively affected the country’s economy by lowering per capita output by 4.1 per cent3. Kenya has an estimated 88,620 new HIV infections among adults and about 12,940 new infections among children Kenya has a HIV-TB coefficient of annually. Stable and married couples are the most affected, as this group accounts for 44 per cent of the new adult infections (Figure 1)4.

Men who have sex with men, prisoners, sex workers and their clients, and injecting drug users contribute a third of all new infections in Kenya.

With growing evidence that they are key drivers of the national HIV epidemic – for instance, the alarmingly high HIV prevalence rates of 29.3 per cent5 among sex workers, 18.2 per cent among men who have sex with men, and 18.3 per cent among injecting drug users – the government has initiated a programme for these population groups.

1 Kenya HIV Estimates Report, 2014. 2 UNAIDS, Efficient and Sustainable HIV Responses: Case Studies on Country Progress, 2013. 3 National AIDS Control Council, Sustainable Financing of AIDS in Kenya, 2011. 4 National AIDS Control Council, Kenya HIV Prevention Response and Modes of Transmission Study, 2009. 5 Global AIDS Progress Report, Kenya, 2013.

kenya HIV AND AIDS PROFILE by County 7 national overview of the epidemic

596,228 The number of adults on treatment in Kenya in 2011. There has been a rapid scale up of treatment as is evidenced by over 1,000 treatment sites

10 Counties with the Largest Number of People Living with Hiv

County Estimated PLHIV Nairobi 177,552 Homabay 159,970 Kisumu 134,826 Siaya 128,568 Migori 88,405 Kisii 63,715 Nakuru 61,598 Kakamega 57,952 Mombasa 54,670 Kiambu 46,656

New HIV infections among children New HIV infections among adults

2007 23,000 2007 95,000 2013 12,940 2013 88,620 reduction in new 7% reduction in new 44% HIV infections HIV infections

Source: Kenya HIV Estimates Technical Report 2013

8 kenya HIV AND AIDS PROFILE by County HIV and aids 2 County Profiles

Monika Juma, a multi-drug resistant TB and HIV-positive patient waits to be treated at the Blue House Clinic in slum, Nairobi, Kenya, 5 February 07. Monika has been treated for TB for two months. © Siegfried/IRIN

kenya HIV AND AIDS PROFILE by County 9 baringo County

Section 1: HIV Burden in Baringo County

Table 1: HIV burden in Baringo Rank* Total population (2013) 632,588 17 HIV adult prevalence (overall) 3.0% 9 East Potok Number of adults living with HIV 9,200 13 Number of children living with HIV 1,353 15 Baringo North Total number of people living with HIV 10,553 13

*In this HIV burden and indicator ranking (Table 1), the highest burden county is 47 while the lowest burden county is 1. Marigat Baringo The HIV prevalence among women in Baringo County is higher (4.3%) than that of men (2.6%). Over the years, the women living in the county have been more Koibatek Timboroa Density people per km2 vulnerable to HIV infection than the men. Eldama Ravine 25 Maji Mazuri Mogotio 55 66 Figure 1: Prevalence of HIV by gender in Baringo 72 Urban centres with population County of more than 2,000 people

3.5 3.2 HIV counselling and testing and linkage to care and 3.0 2.9 treatment are important steps in reducing the sexual 2.5 transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and 2.0 treatment, about 73 per cent of people in Baringo Male County had never tested for HIV by 2009. 1.5 Female

1.0 There is a need to scale up HIV testing in the county, to counsel and reduce the risk for those who test

HIV prevalence (%) HIV prevalence 0.5 negative, and to link those who test positive to care and treatment programmes. 0 2009 Figure 2: Percentage of adults enrolling for HIV care Year of survey by entry point in Baringo County Source: Kenya Demographic and Health Survey 80 70 Section 2: Reducing Sexual 60 Transmission of HIV 50 40 Table 2: Baringo County HIV indicators 30 Annual County National 20 ranking estimates New adult HIV infections 707 20 88,620 10 annually 0 Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

10 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Baringo County, low condom use may pose a significant risk of HIV infection to the 25% 70% 66% 58% population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 per 60 cent. Most communities in Baringo County traditionally circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 carried out under safe and hygienic conditions and 75% 30% 34% 42% encouraged before sexual debut. Infant delivery Maternal

In Baringo County, approximately 55 per cent prophylaxis prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+ intercourse before the age of 15, an indication of early women pregnant No Yes sexual debut.

Section 3: Elimination of Mother-to- Child Transmission • 38 per cent of HIV-positive pregnant women in Baringo County do not deliver in a health facility There were about 406 HIV pregnant women living with HIV in Baringo County in 2013. HIV is most • Only 41 per cent of pregnant women attend the often transmitted from a mother to her child during recommended four antenatal visits in Baringo pregnancy, delivery, and breastfeeding. Breastfeeding County is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Section 4: Expanding Access to to significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV Treatment infections among children by 2015, while keeping their mothers alive. Table 3: Baringo County HIV treatment access annually

New HIV infections annually Indicator Adults in need of ART 4,498 among children Adults receiving ART 2,406 County ART adult coverage 53% National ART adult coverage 79% Baringo County County ranking of ART coverage among adults* 33 National County ranking estimates Indicator 34 Children in need of ART 952 16 Children receiving ART 345 12,940 County ART children coverage 36% Source: District Health Information System National ART children coverage 42% County ranking of ART coverage among children 26 *In this ART coverage ranking, the county with the highest coverage is 1 while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 11 Section 5: Orphans and Social Welfare Approximately 525 adults and 73 children died of AIDS-related Table 4: Baringo orphans and social welfare indicators conditions in 2013 in Baringo County. Antiretroviral drugs Orphans and vulnerable children beneficia- Estimates ries can substantially reduce AIDS- No. of households with an orphan* 11,249 related deaths. If used properly, Poor Households with an orphan** 5,512 2,241 antiretroviral therapy (ART) can an orphan *** Source:Cash TransferUNICEF, 2012; Beneficiary National Poor Census, Households 2009* with also lower a person’s viral load and Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** prevent onward transmission of HIV. • Only 41 per cent of poor households with orphans are beneficiaries of a cash transfer programme.

• Cash transfer programmes have been shown to reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

12 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Bomet County

Table 1: HIV burden in Bomet Buret Rank* Litein Total population (2013) 824,347 24 HIV adult prevalence (overall) 5.8% 35

Number of adults living with HIV 24,400 31 Sotik 3,589 33 Number of children living with HIV Sotik Total number of people living with HIV 27,989 32 Sotik

*In this HIV burden and indicator ranking (Table 1), the highest burden county is

47 while the lowest burden county is 1. Sotik

The HIV prevalence among women in Bomet County Density people is higher (8.2%) than that of men (4.9%). Over the per km2 years, the women living in the county have been more 256 348 vulnerable to HIV infection than the men. 378 Urban centres with population of more than 2,000 people Figure 1: Prevalence of HIV by gender in Bomet County

15 HIV counselling and testing and linkage to care and 12.6 treatment are important steps in reducing the sexual 12.5 transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and 10 8.8 8.7 8.2 Male treatment, about 46 per cent of people in Bomet 7.5 Female County had never tested for HIV by 2009.

5 4.5 There is a need to scale up HIV testing in the county, to counsel and reduce the risk for those who test HIV prevalence (%) HIV prevalence 2.5 1.5 negative, and to link those who test positive to care 0 and treatment programmes. 2003 2007 2009 Year of survey Figure 2: Percentage of adults enrolling for HIV care 80 Source: Kenya Demographic and Health Survey and KAIS by entry point in Bomet County 70 60 Section 2: Reducing Sexual 50 Transmission of HIV 40 30 Table 2: Bomet County HIV indicators 20 Annual County National 10 ranking estimates 0 New adult HIV infections 1875 35 88,620 annually Overall

Source: Kenya HIV Estimates Report, 2014 Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 13 Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Bomet County, low condom use may pose a significant risk of HIV infection to the population. 20% 67% 84% 61% 100 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 80 cent. Most communities in Bomet County traditionally 60 circumcise men, with over 95 per cent of men who participated in a national survey in 2009 reporting 40 that they had been circumcised. Even in traditionally 20 circumcising communities, the practice should be carried out under safe and hygienic conditions and 0 80% 33% 16% 39% encouraged before sexual debut. Infant delivery

In Bomet County, approximately 33 per cent of Maternal prophylaxis individuals had their first experience of sexual prophylaxis Medical facility intercourse before the age of 15, an indication of early Identi�ied HIV+ pregnant women pregnant sexual debut. No Yes Section 3: Elimination of Mother-to- Child Transmission • 84% of HIV-positive pregnant women in Bomet County do not deliver in a health facility There were about 1,141 pregnant women living with HIV in Bomet County in 2013. HIV is most • Only 45 per cent of pregnant women attend the often transmitted from a mother to her child during recommended four antenatal visits in Bomet pregnancy, delivery, and breastfeeding. Breastfeeding County is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Section 4: Expanding Access to rates. Kenya has committed to eliminating new HIV Treatment infections among children by 2015, while keeping their mothers alive. Table 3: Bomet County HIV treatment access annually

Indicator New HIV infections annually Adults in need of ART 11,930 among children Adults receiving ART 4,511 County ART adult coverage 38% National ART adult coverage 79% Bomet County County ranking of ART coverage among adults* 39 National County ranking estimates Indicator Children in need of ART 2,525 90 32 Children receiving ART 407 12,940 County ART children coverage 16% Source: District Health Information System National ART children coverage 42% County ranking of ART coverage among children 40 *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

14 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 1,393 adults and 195 children died of AIDS-related Table 4: Bomet orphans and social welfare indicators conditions in 2013 in Bomet Orphans and vulnerable children beneficiaries Estimates County. Antiretroviral drugs No. of households with an orphan* 16,664 Poor Households with an orphan** 8,165 can substantially reduce AIDS- 2,865 related deaths. If used properly, orphan *** Source:Cash TransferUNICEF, 2012; Beneficiary National Poor Census, Households 2009* with an antiretroviral therapy (ART) can Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and prevent onward transmission of • Only 35 per cent of poor households with orphans are beneficiaries of a cash transfer programme. HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 15

Section 1: HIV Burden in Bungoma County

Table 1: HIV burden in Bungoma Rank* Total population (2013) 1750,634 43 HIV adult prevalence (overall) 3.2% 11 Mt Elgon Number of adults living with HIV 26,100 34 Number of children living with HIV 5,086 37

Cheptais Total number of people living with 31,186 34 Kapsokwony Bungoma North HIV Kimilili Bungoma West *In this HIV burden and indicator ranking (Table 1), the highest burden county is Tongaren 47 while the lowest burden county is 1. Malakisi

Chwela Bungoma East Density people per km2 180 Bungoma 547 The HIV prevalence among women in Bungoma Bungoma South 570 County is higher (4%) than that of men (2.4%). Over 572 the years, the women living in the county have been 613 Urban centres with population more vulnerable to HIV infection than the men. of more than 2,000 people

Figure 1: Prevalence of HIV by gender in Bungoma County

HIV counseling and testing and linkage to care and 6 5.9 6 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 5 4.8 of HIV testing as a way to increase prevention and treatment, about 54 per cent of people in Bungoma 4 Male County had never tested for HIV by 2009. 3 Female 2.4 There is a need to scale up HIV testing in the county, 2 1.9 to counsel and reduce the risk for those who test 1.4 negative, and to link those who test positive to care HIV prevalence (%) HIV prevalence 1 and treatment programmes. 0 2003 2007 2009 Figure 2: Percentage of adults enrolling for HIV care Source: Kenya Demographic and Health Survey and KAIS by entry point in Bungoma County Year of survey 60 50 Section 2: Reducing Sexual 40 Transmission of HIV 30 20 Table 2: Bungoma County HIV indicators 10 Annual County National 0 ranking estimates

New adult HIV infections 83 7 88,620 Overall Voluntary and testing

annually counselling Tuberculosis transmission Prevention of Prevention Medical ward

Source: Kenya HIV Estimates Report, 2014 mother-to-child

Point of entry to care Source: District Health Information System

16 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Bungoma County, low condom use may pose a significant risk of HIV infection 0% 28% 79% 37% to the population. 100

80 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 60 per cent. Most communities in Bungoma County traditionally circumcise men, with over 99 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 should be carried out under safe and hygienic 100% 72% 21% 63% conditions and encouraged before sexual debut. Infant delivery In Bungoma County, there are indications of early Maternal prophylaxis prophylaxis

sexual debut. Voluntary medical male circumcision Medical facility Identi�ied HIV+ should be promoted for boys below 15 years of age women pregnant before their first sexual encounter. No Yes

Section 3: Elimination of Mother-to- • 79% of HIV-positive pregnant women in Bungoma Child Transmission County do not deliver in a health facility

There were about 1,689 pregnant women living • Only 29 per cent of pregnant women attend the with HIV in Bungoma County in 2013. HIV is most recommended four antenatal visits in Bungoma often transmitted from a mother to her child during County pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Section 4: Expanding Access to to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Bomet County HIV treatment access annually mothers alive. Indicator Adults in need of ART 17,164 New HIV infections annually Adults receiving ART 10,982 County ART adult coverage 64% among children National ART adult coverage 79% County ranking of ART coverage among adults* 27

Bungoma County Indicator National County ranking Children in need of ART 3,578 estimates Children receiving ART 1,140 93 35 County ART children coverage 32% National ART children coverage 42% 12,940 County ranking of ART coverage among children 28 Source: District Health Information System *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 17 Section 5: Orphans and Social Welfare Approximately 864 adults and 249 children died of AIDS-related Table 4: Bungoma orphans and social welfare indicators conditions in 2013 in Bungoma Orphans and vulnerable children beneficiaries Estimates County. Antiretroviral drugs No. of households with an orphan* 30,493 can substantially reduce AIDS- Poor Households with an orphan** 14,942 5,426 related deaths. If used properly, an orphan *** Source:Cash TransferUNICEF, 2012; Beneficiary National Poor Census, Households 2009* with antiretroviral therapy (ART) can Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and prevent onward transmission of • Only 36 per cent of poor households with orphans are beneficiaries of a cash transfer programme. HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

• Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

18 kenya HIV AND AIDS PROFILE by County Busia County

Section 1: HIV Burden in Busia County

Teso North Table 1: HIV burden in Busia Malaba Rank* Total population (2013) 523,875 12 Teso South HIV adult prevalence (overall) 6.8% 39 Number of adults living with HIV 16,100 20

Number of children living with HIV 3,138 27 Busia Nambale

Total number of people living with HIV 19,238 21 Busia

*In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1. Bumala

Samia Density people The HIV prevalence among women in Busia County Port Victoria per km2 is higher (8.4%) than that of men (5.1%). Over the 353 354 years, the women living in the county have been more 452 460 vulnerable to HIV infection than the men. 481 Bunyala Urban centres with population of more than 2,000 people Figure 1: Prevalence of HIV by gender in Busia County

16 13.9 14 HIV counselling and testing and linkage to care and 12 treatment are important steps in reducing the sexual 10 9.1 transmission of HIV. Despite the huge importance 8.5 Male of HIV testing as a way to increase prevention and 8 6.8 Female treatment, about 43 per cent of people in Busia 6 5.6 County had never tested for HIV by 2009. 4 2.6

HIV prevalence (%) HIV prevalence There is a need to scale up HIV testing in the county, 2 to counsel and reduce the risk for those who test 0 negative, and to link those who test positive to care 2003 2007 2009 and treatment programmes. Source: Kenya Demographic and Health Survey and KAIS Year of survey Figure 2: Percentage of adults enrolling for HIV care by entry point in Busia County

60 Section 2: Reducing Sexual 50 Transmission of HIV 40

Table 2: Busia County HIV indicators 30 Annual County National 20 ranking estimates 10 New adult HIV infections 51 5 88,620 annually 0 Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 19 Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Busia County, low condom use may pose a significant risk of HIV infection to the 0% 0% 58% 2% population. 100 80 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 60 cent. Some communities in Busia County traditionally 40 circumcise men, with about 50 per cent of men who participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally 0 circumcising communities, the practice should be 100% 100% 42% 98% carried out under safe and hygienic conditions and

encouraged before sexual debut. Infant delivery Maternal prophylaxis In Busia County, approximately 43 per cent of prophylaxis Medical facility Identi�ied HIV+ individuals had their first experience of sexual women pregnant intercourse before the age of 15, an indication of early sexual debut No Yes

Section 3: Elimination of Mother-to- • 58% of HIV-positive pregnant women in Busia Child Transmission County do not deliver in a health facility

There were about 1,441 pregnant women living • Only 41 per cent of pregnant women attend with HIV in Busia County in 2013. HIV is most often the recommended four antenatal visits in Busia transmitted from a mother to her child during County pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Section 4: Expanding Access to to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Bomet County HIV treatment access annually mothers alive. Indicator New HIV infections annually Adults in need of ART 10,588 among children Adults receiving ART 19,398 County ART adult coverage 100% National ART adult coverage 79% Busia County County ranking of ART coverage among adults* 1 National County ranking estimates Indicator Children in need of ART 2,207 58 21 Children receiving ART 1,657 12,940 County ART children coverage 75% Source: District Health Infor- National ART children coverage 42% mation System County ranking of ART coverage among children 1 *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47 Source: Estimation and Projection Package

20 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 533 adults and 153 children died of AIDS-related Table 4: Bomet orphans and social welfare indicators conditions in 2013 in Busia County. Orphans and vulnerable children beneficiaries Estimates Antiretroviral drugs can substantially No. of households with an orphan* 27,068 Poor Households with an orphan** 13,263 reduce AIDS-related deaths. If used 6,867 properly, antiretroviral therapy an orphan *** Source:Cash TransferUNICEF, 2012; Beneficiary National Poor Census, Households 2009* with (ART) can also lower a person’s Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** viral load and prevent onward transmission of HIV. • Only 52 per cent of poor households with orphans are beneficiaries of a cash transfer programme.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 21 ELGEYO MARAKWET County

Section 1: HIV Burden in Elgeyo Marakwet County

Table 1: HIV burden in Elgeyo Marakwet

Rank* Marakwet Kapcherop Total population (2013) 421,282 9 Kapsowar HIV adult prevalence (overall) 2.5% 7 Number of adults living with HIV 5,200 8 Number of children living with HIV 765 6 Total number of people living with HIV 5,965 8

Iten/Tambach *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

The HIV prevalence among women in Elgeyo Marakwet Keiyo County is higher (3.5%) than that of men (2.1%). Over Density people perk m2 the years, the women living in the county have been 118 127 Urban centres with population more vulnerable to HIV infection than the men. of more than 2,000 people

Figure 1: Prevalence of HIV by gender in Elgeyo Marakwet County

8.3 8 HIV counselling and testing and linkage to care and 7 treatment are important steps in reducing the sexual

6 transmission of HIV. Despite the huge importance 5 5 of HIV testing as a way to increase prevention and 5 4.2 Male treatment, about 62 per cent of people in Elgeyo 4 Marakwet County had never tested for HIV by 2009. Female 3 2 There is a need to scale up HIV testing in the county, 2 1.5 to counsel and reduce the risk for those who test HIV prevalence (%) HIV prevalence 1 negative, and to link those who test positive to care and treatment programmes. 0 2003 2007 2009 Source: Kenya Demographic and Health Survey and KAIS Figure 2: Percentage of adults enrolling for HIV care by entry point in Elgeyo Marakwet County Year of survey 60 50 Section 2: Reducing Sexual 40 Transmission of HIV 30 20 Table 2: Busia County HIV indicators 10 Annual County National ranking estimates 0 New adult HIV infections 400 13 88,620

annually Overall Voluntary and testing counselling Tuberculosis Source: Kenya HIV Estimates Report, 2014 transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

22 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Elgeyo Marakwet County, low condom use may pose a significant risk of HIV 35% 59% 42% 87% infection to the population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 60 per cent. Most communities in Elgeyo Marakwet County traditionally circumcise men, with over 78 per 40 cent of men who participated in a national survey 20 in 2009 reporting that they had been circumcised. Even in traditionally circumcising communities, the 0 65% 41% 58% 13% practice should be carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Elgeyo Marakwet County, approximately 33 per prophylaxis Medical facility cent of individuals had their first experience of sexual Identi�ied HIV+ pregnant women pregnant intercourse before the age of 15, an indication of early sexual debut. No Yes

Section 3: Elimination of Mother-to- • 71% of HIV-positive pregnant women in Elgeyo Child Transmission Marakwet do not deliver in a health facility

There were about 200 pregnant women living with • Only 30 per cent of pregnant women attend the HIV in Elgeyo Marakwet County in 2013. HIV is recommended four antenatal visits in Elgeyo most often transmitted from a mother to her child Marakwet County during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Section 4: Expanding Access to to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Elgeyo Marakwet County HIV treatment mothers alive. access annually Indicator New HIV infections annually Adults in need of ART 2,542 Adults receiving ART 978 among children County ART adult coverage 38% National ART adult coverage 79% County ranking of ART coverage among adults* 40 Elgeyo County National Marakwet ranking Indicator estimates Children in need of ART 538 19 Children receiving ART 89 8 County ART children coverage 17% 12,940 National ART children coverage 42% Source: District Health Information System County ranking of ART coverage among children 38 *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 23 Section 5: Orphans and Social Welfare Approximately 297 adults and 42 children died of AIDS-related Table 4: Elgeyo Marakwet orphans and social welfare indicators conditions in 2013 in Elgeyo Orphans and vulnerable children beneficiaries Estimates Marakwet County. Antiretroviral No. of households with an orphan* 6,287 drugs can substantially reduce Poor Households with an orphan** 3,081 1412 AIDS-related deaths. If used an orphan *** Source:Cash TransferUNICEF, 2012; Beneficiary Poor Households with properly, antiretroviral therapy National Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** (ART) can also lower a person’s CT-OVC Households at July 2012 taken from CT-*** viral load and prevent onward • Only 46 per cent of poor households with orphans transmission of HIV. are beneficiaries of a cash transfer programme.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

24 kenya HIV AND AIDS PROFILE by County embu County

Section 1: HIV Burden in Embu County

Table 1: HIV burden in Embu Rank*

Runyenjes Total population (2013) 543,158 13 Embu HIV adult prevalence (overall) 3.7% 14

Embu Number of adults living with HIV 9,600 14

Number of children living with HIV 1,465 17 Siakago Total number of people living with HIV 11,065 14

*In this HIV burden and indicator ranking (Table 2), the highest burden county is Mbeere 47 while the lowest burden county is 1.

The HIV prevalence among women in Embu County is higher (5.0%) than that of men (2.2%). Over the Density people perk m2 years, the women living in the county have been more 105 409 Urban centres with population vulnerable to HIV infection than the men. of more than 2,000 people

Figure 1: Prevalence of HIV by gender in Embu County

7 HIV counselling and testing and linkage to care and 6 5.7 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 5 of HIV testing as a way to increase prevention and 4 treatment, about 54 per cent of people in Embu Male County had never tested for HIV by 2009. 3 2.8 Female There is a need to scale up HIV testing in the county, 2 1.5 to counsel and reduce the risk for those who test

HIV prevalence (%) HIV prevalence 1 negative, and to link those who test positive to care and treatment programmes. 0 2007 2009 Figure 2: Percentage of adults enrolling for HIV care Source: Kenya Demographic and Health Survey and KAIS by entry point in Embu County Year of survey

60 50 40 Section 2: Reducing Sexual 30 Transmission of HIV 20

Table 2: Embu County HIV indicators 10 Annual County National 0 ranking estimates Overall

New adult HIV infections 518 16 88,620 Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention annually Medical ward Source: Kenya HIV Estimates Report, 2014 mother-to-child Point of entry to care

Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 25 Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Embu County, low condom use may pose a significant risk of HIV infection to the 0% 17% 52% 10% population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 per 60 cent. Most communities in Embu County traditionally circumcise men, with almost 100 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 100% 83% 48% 90% carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Embu County, there are indications of early sexual prophylaxis Medical facility debut. Voluntary medical male circumcision should be Identi�ied HIV+ pregnant women pregnant promoted for boys below 15 years of age before their first sexual encounter. No Yes

Section 3: Elimination of Mother-to- • 52% of HIV-positive pregnant women in Embu Child Transmission County do not deliver in a health facility

There were about 581 pregnant women living with HIV • Only 52 per cent of pregnant women attend in Embu County in 2013. HIV is most often transmitted the recommended four antenatal visits in Embu from a mother to her child during pregnancy, County delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical to Section 4: Expanding Access to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Embu County HIV treatment access annually mothers alive. Indicator Adults in need of ART 5,540 Adults receiving ART 5130 New HIV infections annually County ART adult coverage 93% National ART adult coverage 79% among children County ranking of ART coverage among adults* 12

Indicator Embu County National Children in need of ART 1,046 County ranking Children receiving ART 513 estimates County ART children coverage 49% 28 12 National ART children coverage 42% 12,940 County ranking of ART coverage among children 17 *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Source: District Health Information System Package

26 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 326 adults and 63 children died of AIDS-related Table 4: Embu orphans and social welfare indicators Orphans and vulnerable children beneficiaries Estimates conditions in 2013 in Embu County. No. of households with an orphan* 12,808 Antiretroviral drugs can substantially Poor Households with an orphan** 6,276 reduce AIDS-related deaths. If used 3,638 an orphan *** properly, antiretroviral therapy Source:Cash TransferUNICEF, 2012; Beneficiary National Poor Census, Households 2009* with Assuming 49% of population living below poverty line (absolut poor)** (ART) can also lower a person’s CT-OVC Households at July 2012 taken from CT-*** viral load and prevent onward • Only 58 per cent of poor households with orphans are beneficiaries of a cash transfer programme. transmission of HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

• Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 27

Section 1: HIV Burden in Garissa County

Table 1: HIV burden in Garissa

Rank* Daadab Lagdera HIV adult prevalence (overall) 2.1% 5 Garissa Number of adults living with HIV 3,300 6 Garissa Number of children living with HIV 1,075 8 Total number of people living with HIV 4,375 6 Total number of people living with HIV 10,563 11 Density people *In this HIV burden and indicator ranking (Table 2), the highest burden county is per km2 47 while the lowest burden county is 1. 6 9 18 34 Urban centres with population The HIV prevalence among women in Garissa County of more than 2,000 people is higher (3.6%) than that of men (0.8%). Over the years, the women living in the county have been more vulnerable to HIV infection than the men.

Figure 1: Prevalence of HIV by gender in Garissa County

HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual 6 transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and 5 4.5 treatment, about 73 per cent of people in Garissa County had never tested for HIV by 2009. 4 Male 3 Female There is a need to scale up HIV testing in the county, to counsel and reduce the risk for those who test 2 negative, and to link those who test positive to care

HIV prevalence (%) HIV prevalence and treatment programmes. 1 0.7

0 Figure 2: Percentage of adults enrolling for HIV care 2007 by entry point in Garissa County Source: KAIS

Year of survey 60 50 Section 2: Reducing Sexual 40 Transmission of HIV 30 20 Table 2: Garissa County HIV indicators 10 Annual County National ranking estimates 0 New adult HIV infections 116 8 88,620

annually Overall Voluntary and testing Source: Kenya HIV Estimates Report, 2014 counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

28 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Garissa County, low condom use may pose a significant risk of HIV infection to the 73% 81% 52% 80% population. 100 80 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 60 cent. Most communities in Garissa County traditionally 40 circumcise men, with over 91 per cent of men who participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally 0 circumcising communities, the practice should be 27% 19% 48% 20% carried out under safe and hygienic conditions and

encouraged before sexual debut. Infant delivery Maternal prophylaxis In Garissa County, approximately 55 per cent of prophylaxis Medical facility Identi�ied HIV+ individuals had their first experience of sexual women pregnant intercourse before the age of 15, an indication of early No Yes sexual debut.

Section 3: Elimination of Mother-to- • 52% of HIV-positive pregnant women in Garissa Child Transmission County do not deliver in a health facility

There were about 60 pregnant women living with • Only 41 per cent of pregnant women attend the HIV in Garissa County in 2013. HIV is most often recommended four antenatal visits in Garissa transmitted from a mother to her child during County pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Section 4: Expanding Access to to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Garissa County HIV treatment access mothers alive. annually Indicator New HIV infections annually Adults in need of ART 1,649 Adults receiving ART 786 among children County ART adult coverage 48% National ART adult coverage 79% Garissa County County ranking of ART coverage among adults* 36 ranking National County Indicator estimates Children in need of ART 755 83 10 Children receiving ART 73 13,175 County ART children coverage 10% Source: District Health Infor- National ART children coverage 42% mation System County ranking of ART coverage among children 44 *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 29 Section 5: Orphans and Social Welfare Approximately 521 adults and 69 children died of AIDS-related Table 4: Embu orphans and social welfare indicators Estimates conditions in 2013 in Garissa

HouseholdsOrphans and with vulnerable an orphan* children beneficiaries 8,532 County. Antiretroviral drugs Poor households with an orphan** 4,181 can substantially reduce AIDS- 1,687

Source: UNICEF, 2012; National Census, 2009 related deaths. If used properly, Cash transfer beneficiary households*** • Only 40 per cent of poor households with orphans antiretroviral therapy (ART) can are beneficiaries of a cash transfer programme. also lower a person’s viral load and

• Cash transfer programmes have shown that they prevent onward transmission of can reduce HIV risk by delaying sexual debut, HIV. pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

30 kenya HIV AND AIDS PROFILE by County Homa Bay County

Section 1: HIV Burden in Homa Bay County Kendu Bay

Mbita Point

Table 1: HIV burden in Homa Bay Suba Rachuonyo

Oyungis Rank* Sindo Homa Bay Total population (2013) 1,053,465 35 Suba Homa Bay Density people HIV adult prevalence (overall) 25.7% 47 per km2 202 Number of adults living with HIV 140,600 46 313 403 Number of children living with HIV 19370 47 Urban centres with population of more than 2,000 people Total number of people living with HIV 159.970 46

*In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

The HIV prevalence among women in Homa Bay County is higher (27.4%) than that of men (23.7%). Over the years, the women living in the county have been more vulnerable to HIV infection than the men.

Figure 1: Prevalence of HIV by gender in Homa Bay County HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 32.2 30 28.6 29.1 of HIV testing as a way to increase prevention and treatment, about 31 per cent of people in Homa Bay 26 25 County had never tested for HIV by 2009.

20 17.8 Male There is a need to scale up HIV testing in the county, 14.7 to counsel and reduce the risk for those who test 15 Female negative, and to link those who test positive to care 10 and treatment programmes.

HIV prevalence (%) HIV prevalence 5 Figure 2: Percentage of adults enrolling for HIV care 0 by entry point in Homa Bay County 2003 2007 2009 60 Source: Kenya Demographic and Health Survey and KAIS 50 Year of survey 40 30 Section 2: Reducing Sexual 20 Transmission of HIV 10 0 Table 2: Homa Bay County HIV indicators

Annual County National esti- Overall

ranking mates Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention New adult HIV infec- 12,279 47 Medical ward 88,620 mother-to-child tions annually Source: Kenya HIV Estimates Report, 2014 Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 31 Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Homa Bay County, low condom use may pose a significant risk of HIV infection 21% 43% 64% 37% to the population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 per cent. 60 Few communities in Homa Bay County circumcise men, and only 13 per cent of men who participated in a national 40 survey in 2009 reporting that they had been circumcised. 20 Even in traditionally circumcising communities, the practice should be carried out under safe and hygienic conditions 0 79% 57% 36% 63% and encouraged before sexual debut. Infant delivery

In Homa Bay County, there are indications of early Maternal prophylaxis sexual debut. Voluntary medical male circumcision prophylaxis Medical facility should be promoted for boys below 15 years of age Identi�ied HIV+ pregnant women pregnant No before their first sexual encounter. Yes Section 3: Elimination of Mother- • 36% of HIV-positive pregnant women in Homa to-Child Transmission Bay County do not deliver in a health facility • Only 35 per cent of pregnant women attend the There were about 9,674 pregnant women living recommended four antenatal visits in Homa Bay with HIV in Homa Bay County in 2013. HIV is most County often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and Section 4: Expanding Access to development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Treatment to significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV Table 3: Homa Bay County HIV treatment access infections among children by 2015, while keeping their annually mothers alive. Indicator Adults in need of ART 70,837 New HIV infections annually among Adults receiving ART 46,738 County ART adult coverage 70% children National ART adult coverage 79% County ranking of ART coverage among adults* 25

Homa Bay County National Indicator County ranking Children in need of ART 15,235 estimates Children receiving ART 6,331 2,724 47 County ART children coverage 42% 12,940 National ART children coverage 42% Source: District Health County ranking of ART coverage among children 21 Information System *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

32 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 3,395 adults and 1,234 children died of AIDS- Table 4: Homa Bay orphans and social welfare indicators related conditions in 2013 in Orphans and vulnerable children beneficiaries Estimates Homa Bay County. Antiretroviral No. of households with an orphan* 60,958 drugs can substantially reduce Poor Households with an orphan** 29,896 8,107 AIDS-related deaths. If used an orphan *** Cash Transfer Beneficiary Poor Households with Source: UNICEF, 2012; National Census, 2009* A properly, antiretroviral therapy ssuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** (ART) can also lower a person’s • Only 27 per cent of poor households with orphans viral load and prevent onward are beneficiaries of a cash transfer programme. transmission of HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 33

Section 1: HIV Burden in Isiolo County

Table 1: HIV burden in Isiolo Rank* Total population (2013) 150,817 2 HIV adult prevalence (overall) 4.2% 20 Number of adults living with HIV 2,800 5 Merti Number of children living with HIV 427 5 Garbatulla Total number of people living with HIV 3,227 5 Archor post Garbatulla *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1. Isiolo Kinna

Density people The HIV prevalence among women in Isiolo County per km2 is higher (5.7%) than that of men (2.5%). Over the 4 6 years, the women living in the county have been more Urban centres with population of more than 2,000 people vulnerable to HIV infection than the men.

Figure 2: Prevalence of HIV by gender in Isiolo County HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 3.5 of HIV testing as a way to increase prevention and 3.0 treatment, about 71 per cent of people in Isiolo County had never tested for HIV by 2009. 2.5 2.3 There is a need to scale up HIV testing in the county, 2.0 Male to counsel and reduce the risk for those who test 1.5 Female negative, and to link those who test positive to care and treatment programmes. 1.0

HIV prevalence (%) HIV prevalence 0.5 Figure 3: Percentage of adults enrolling for HIV care by entry point in Isiolo County 0 2009 Year of survey 80 Source: Kenya Demographic and Health Survey 70 60 Section 2: Reducing Sexual 50 Transmission of HIV 40 30 Table 2: Isiolo County HIV indicators 20 Annual County National ranking estimates 10 New adult HIV infections 151 10 88,620 0 annually Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

34 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Isiolo County, low condom use may pose a significant risk of HIV infection to the population. 0% 5% 84% 15% 100 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 80 cent. Most communities in Isiolo County circumcise 60 men, with a majority of men who participated in a national survey in 2009 reporting that they had 40 been circumcised. Even in traditionally circumcising 20 communities, the practice should be carried out under safe and hygienic conditions and encouraged before 0 sexual debut. 100% 95% 85% 16 % Infant

In Isiolo County, there are indications of early sexual delivery Maternal prophylaxis debut. Voluntary medical male circumcision should be prophylaxis Medical facility promoted for boys below 15 years of age before their Identi�ied HIV+ pregnant women pregnant first sexual encounter. No Yes Section 3: Elimination of Mother-to- Child Transmission • 84% of HIV-positive pregnant women in Isiolo County do not deliver in a health facility There were about 237 pregnant women living with HIV • Only 40 per cent of pregnant women attend the in Isiolo County in 2013. HIV is most often transmitted recommended four antenatal visits in Isiolo County from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Section 4: Expanding Access to Providing antiretroviral medicines to mothers Treatment throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV Table 3: Isiolo County HIV treatment access annually infections among children by 2015, while keeping their Indicator mothers alive. Adults in need of ART 1,616 Adults receiving ART 969 New HIV infections annually among County ART adult coverage 60% children National ART adult coverage 79% County ranking of ART coverage among adults* 29

Isiolo County Indicator National Children in need of ART County ranking 305 estimates Children receiving ART 92 8 County ART children coverage 30% 5 National ART children coverage 42% 12,940 County ranking of ART coverage among 30 Source: District Health Infor- children mation System *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 35 Section 5: Orphans and Social Welfare Approximately 95 adults and 18

Table 4: Isiolo orphans and social welfare indicators children died of AIDS-related

Orphans and vulnerable children beneficia- Estimates conditions in 2013 in Isiolo County. ries Antiretroviral drugs can substantially No. of households with an orphan* 4,323 Poor Households with an orphan** 2,118 reduce AIDS-related deaths. If used 2,437 properly, antiretroviral therapy an orphan *** Cash Transfer Beneficiary Poor Households with Source: UNICEF, 2012; National Census, 2009* (ART) can also lower a person’s Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** viral load and prevent onward • All poor households with orphans are beneficiaries of a cash transfer programme. transmission of HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

36 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Kajiado County

Ngong Table 1: HIV burden in Kajiado Longata Rongai Rank*

Total population (2013) 782,409 23 Isinya

HIV adult prevalence (overall) 4.4% 25 Kajiado

Number of adults living with HIV 20,100 25 Sultan Hamud Bissil Emali Number of children living with HIV 2,965 25 Total number of people living with HIV 23,056 25

*In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

Density people The HIV prevalence among women in Kajiado County per km2 20 is higher (6.3%) than that of men (3.8%). Over the 21 years, the women living in the county have been more 52 Urban centres with population vulnerable to HIV infection than the men. of more than 2,000 people

Figure 2: Prevalence of HIV by gender in Kajiado County

HIV counseling and testing and linkage to care and 15 15.6 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 12.5 of HIV testing as a way to increase prevention and 10 9.5 treatment, about41 per cent of people in Kajiado Male County had never tested for HIV by 2009. 7.5 Female There is a need to scale up HIV testing in the county, 5 3.4 to counsel and reduce the risk for those who test 2.9 negative, and to link those who test positive to care HIV prevalence (%) HIV prevalence 2.5 and treatment programmes. 0 2003 2007 2009 Figure 3: Percentage of adults enrolling for HIV care by entry point in Kajiado County Year of survey Source: Kenya Demographic and Health Survey and KAIS 80 Section 2: Reducing Sexual 70 Transmission of HIV 60

Table 2: Kajiado County HIV indicators 50 Annual County National 40 rank- estimates 30 ing New adult HIV infections 1,545 31 88,620 20 annually 10 Source: Kenya HIV Estimates Report, 2014 0 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 37 Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Kajiado County, low condom use may pose a significant risk of HIV infection to the population. 1% 28% 73% 46% 100 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 80 cent. Most communities in Kajiado County circumcise 60 men, with over 87 per cent of men who participated in a national survey in 2009 reporting that they had 40 been circumcised. Even in traditionally circumcising 20 communities, the practice should be carried out under safe and hygienic conditions and encouraged before 0 99% 72% 27% 54% sexual debut. Infant delivery

In Kajiado County, approximately 34 per cent of Maternal prophylaxis individuals had their first experience of sexual prophylaxis Medical facility intercourse before the age of 15, an indication of early Identi�ied HIV+ pregnant women pregnant sexual debut. No Yes

Section 3: Elimination of Mother-to- • 73% of HIV-positive pregnant women in Kajiado Child Transmission County do not deliver in a health facility • Only 44 per cent of pregnant women attend the There were about 1,172 pregnant women living recommended four antenatal visits in Kajiado County with HIV in Kajiado County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and Section 4: Expanding Access to development. Providing antiretroviral medicines to Treatment mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Table 3: Kajiado County HIV treatment access rates. Kenya has committed to eliminating new HIV annually infections among children by 2015, while keeping their mothers alive. Indicator Adults in need of ART 9,827 New HIV infections annually among Adults receiving ART 5,219 County ART adult coverage 53% children National ART adult coverage 79% County ranking of ART coverage among adults* 34 Kajiado County National County ranking Indicator estimates Children in need of ART 2,080 74 28 Children receiving ART 372 12,940 County ART children coverage 18% Source: District Health Infor- mation System National ART children coverage 42% County ranking of ART coverage among children 37

38 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 1,147 adults and 161 children died of AIDS-related Table 4: Kajiado orphans and social welfare indicators conditions in 2013 in Kajiado County. Antiretroviral drugs Orphans and vulnerable children beneficiaries Estimates No. of households with an orphan* 15,482 can substantially reduce AIDS- Poor Households with an orphan** 7,586 related deaths. If used properly, 1,416 orphan *** antiretroviral therapy (ART) can Cash Transfer Beneficiary Poor Households with an Source: UNICEF, 2012; National Census, 2009* also lower a person’s viral load and Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** prevent onward transmission of HIV. • 19 per cent of poor households with orphans are beneficiaries of a cash transfer programme. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 39

Section 1: HIV Burden in Kakamega County Matunda Table 1: HIV burden in Kakamega Lugari

Lumakanda Rank* Total population (2013) 1,782,152 45

HIV adult prevalence (overall) 5.9% 36 Kakamega North Number of adults living with HIV 48,500 40 Malava Number of children living with HIV 9,452 16 Kakamega Central Mumias Total number of people living with HIV 57,952 40 Kakamega *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

Butere The HIV prevalence among women in Kakamega County is higher (7.3%) than that of men (4.4%). Over Density people the years, the women living in the county have been per km2 more vulnerable to HIV infection than the men. 358 437 480 609 667 709 729

Urban centres with population of more than 2,000 people

Figure 2: Prevalence of HIV by gender in Kakamega County HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and 6 treatment, about 41 per cent of people in Kakamega 5 5 5 County had never tested for HIV by 2009. 4.5 4 There is a need to scale up HIV testing in the county, 3.4 Male to counsel and reduce the risk for those who test 3 Female negative, and to link those who test positive to care and treatment programmes 2 1.5 1.2

HIV prevalence (%) HIV prevalence 1 Figure 3: Percentage of adults enrolling for HIV care by entry point in Kakamega County 0 2003 2007 2009 Year of survey 80 Source: Kenya Demographic and Health Survey and KAIS 70 60 Section 2: Reducing Sexual 50 Transmission of HIV 40 Table 2: Kakamega County HIV indicators 30 Annual County National 20 ranking estimates 10 New adult HIV infections 154 11 88,620 annually 0 Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

40 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Kakamega County, low 1% 28% 76% 27% condom use may pose a significant risk of HIV infection 100 to the population. 80

Male circumcision reduces the risk of female-to-male 60 transmission of HIV infection by approximately 60 per cent. Most communities in Kakamega County 40 circumcise men, with over 87 per cent of men who 20 participated in a national survey in 2009 reporting that they had been circumcised. Even in traditionally 0 99% 72% 24% 73% circumcising communities, the practice should be carried out under safe and hygienic conditions and Infant

encouraged before sexual debut. delivery Maternal prophylaxis prophylaxis Medical facility In Kakamega County, approximately 34 per cent Identi�ied HIV+ pregnant women pregnant No of individuals had their first experience of sexual intercourse before the age of 15, an indication of early Yes sexual debut.

• 76% of HIV-positive pregnant women in Section 3: Elimination of Mother-to- Kakamega County do not deliver in a health Child Transmission facility • Only 44 per cent of pregnant women attend the There were about 2,754 pregnant women living recommended four antenatal visits in Kakamega with HIV in Kakamega County in 2013. HIV is most County often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Section 4: Expanding Access to to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Kakamega County HIV treatment access mothers alive. annually

New HIV infections annually Indicator Adults in need of ART 31,896 among children Adults receiving ART 21,014 County ART adult coverage 66% Kakamega County National ART adult coverage 79% National County ranking of ART coverage among adults* 26 County ranking estimates Indicator 173 39 Children in need of ART 6,648 12,940 Children receiving ART 2,224 Source: District Health Infor- mation System County ART children coverage 33% National ART children coverage 42% County ranking of ART coverage among chil- 27 dren

kenya HIV AND AIDS PROFILE by County 41 Section 5: Orphans and Social Welfare Approximately 1,605 adults and 462 children died of AIDS-related Table 4: Kakamega orphans and social welfare indicators conditions in 2013 in Kakamega County. Antiretroviral drugs Orphans and vulnerable children beneficiaries Estimates No. of households with an orphan* 47,914 can substantially reduce AIDS- Poor Households with an orphan** 23,478 related deaths. If used properly, 7,818 orphan *** antiretroviral therapy (ART) can Cash Transfer Beneficiary Poor Households with an Source: UNICEF, 2012; National Census, 2009* also lower a person’s viral load Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** and prevent onward transmission • 33 per cent of poor households with orphans are of HIV. beneficiaries of a cash transfer programme. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

42 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Kericho County

Table 1: HIV burden in Kericho Rank* Total population (2013) 863,222 26 HIV adult prevalence (overall) 3.4% 13 Number of adults living with HIV 15,800 19 Londiani

Number of children living with HIV 2,324 20 Kipkelion Kabuti Total number of people living with HIV 18,124 19

*In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

Kericho

The HIV prevalence among women in Kericho County Kericho is higher (4.8%) than that of men (2.9%). Over the years, the women living in the county have been more Density people vulnerable to HIV infection than the men. per km2 187 366 Urban centres with population Figure 2: Prevalence of HIV by gender in Kericho of more than 2,000 people County

6 HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual 5 5 5 4.5 transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and 4 3.4 Male treatment, about 73 per cent of people in Kericho County had never tested for HIV by 2009. 3 Female

2 There is a need to scale up HIV testing in the county, 1.2 to counsel and reduce the risk for those who test HIV prevalence (%) HIV prevalence 1 negative, and to link those who test positive to care and treatment programmes. 0 2003 2007 2009 Year of survey Source: Kenya Demographic and Health Survey and KAIS Figure 3: Percentage of adults enrolling for HIV care by entry point in Kericho County

80 Section 2: Reducing Sexual Transmission of HIV 70 Table 2: Kericho County HIV indicators 60 Annual County National 50 ranking estimates 40 New adult HIV infections annually 1,214 27 88,620 Source: Kenya HIV Estimates Report, 2014 30 20 10 0 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 43 Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Kericho County, low condom use may pose a significant risk of HIV infection to the 0% 10% 68% 0% population. 100 80 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 60 cent. Most communities in Kericho County traditionally circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 carried out under safe and hygienic conditions and 100% 90% 32% 100% encouraged before sexual debut. Infant delivery In Kericho County, approximately 55 per cent of Maternal prophylaxis individuals had their first experience of sexual prophylaxis Medical facility Identi�ied HIV+ No intercourse before the age of 15, an indication of early women pregnant sexual debut. Yes

Section 3: Elimination of Mother-to- Child Transmission • 68% of HIV-positive pregnant women in Kericho County do not deliver in a health facility There were about 1411 pregnant women living • Only 41 per cent of pregnant women attend the with HIV in Kericho County in 2013. HIV is most recommended four antenatal visits in Kericho County often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Section 4: Expanding Access to to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Kericho County HIV treatment access mothers alive. annually

New HIV infections annually Indicator among children Adults in need of ART 7,725 Adults receiving ART 9,299 County ART adult coverage 100% Kericho County National ART adult coverage 79% National County ranking County ranking of ART coverage among adults* 3 estimates 58 22 Indicator 12,940 Children in need of ART 1,635

Source: District Health Infor- Children receiving ART 832 mation System County ART children coverage 51% National ART children coverage 42% County ranking of ART coverage among children 16

44 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 902 adults and 126 children died of AIDS-related Table 4: Kericho orphans and social welfare indicators conditions in 2013 in Kericho County. Antiretroviral drugs Orphans and vulnerable children beneficiaries Estimates Households with an orphan* 20,345 can substantially reduce AIDS- Poor households with an orphan** 9,969 related deaths. If used properly, 1,383 antiretroviral therapy (ART) can Source:Cash TransferUNICEF, 2012; Beneficiary National households*** Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and prevent onward transmission • Only 14 per cent of poor households with orphans are beneficiaries of a cash transfer programme. of HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 45

Section 1: HIV Burden in Kiambu County

Table 1: HIV burden in Kiambu East Rank*

Total population (2013) 1760692 44

HIV adult prevalence (overall) 3.8% 17 Thika Number of adults living with HIV 42,400 38 Thika West Number of children living with HIV 4,256 36 Ruiru

Total number of people living with HIV 46,656 38 Density people per km2 *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden 187 county is 1. Gatundu 282 Kiambu 466 Kiambu Githunguri 668 The HIV prevalence among women in Kiambu East 852 Urban centres with population County is higher (5.6%) than that of men (2.0%). of more than 2,000 people Over the years, the women living in the county have Lari Kikuyu been more vulnerable to HIV infection than the men.

Kiambu Kikuyu West

Figure 2: Prevalence of HIV by gender in Kiambu County

8.5 HIV counseling and testing and linkage to care and 8 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 7 6.7 of HIV testing as a way to increase prevention and 6 treatment, about 73 per cent of people in Kiambu 5 County had never tested for HIV by 2009. Male 4 3.5 3.3 Female There is a need to scale up HIV testing in the county, 3 to counsel and reduce the risk for those who test 2.2 2.3 negative, and to link those who test positive to care 2 and treatment programmes. HIV prevalence (%) HIV prevalence 1

0 2003 2007 2009 Figure 3: Percentage of adults enrolling for HIV care Year of survey by entry point in Kiambu County Source: Kenya Demographic and Health Survey and KAIS 80 70 Section 2: Reducing Sexual 60 Transmission of HIV 50 40 Table 2: Kiambu County HIV indicators 30 Annual County National ranking estimates 20 New adult HIV infections 2,931 39 88,620 10 annually 0 Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

46 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Kiambu County, low condom use may pose a significant risk of HIV infection to the population. 0% 0% 61% 1% 100 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 80 cent. Most communities in Kiambu County traditionally 60 circumcise men, with over 91 per cent of men who participated in a national survey in 2009 reporting 40 that they had been circumcised. Even in traditionally 20 circumcising communities, the practice should be carried out under safe and hygienic conditions and encouraged 0 100% 100% 39% 99% before sexual debut. Infant delivery

In Kiambu County, approximately 55 per cent of Maternal prophylaxis individuals had their first experience of sexual intercourse prophylaxis Medical facility before the age of 15, an indication of early sexual debut. Identi�ied HIV+ pregnant women pregnant No Yes

Section 3: Elimination of Mother-to- • 61% of HIV-positive pregnant women in Kiambu Child Transmission County do not deliver in a health facility • Only 41 per cent of pregnant women attend the There were about 2,252 pregnant women living with recommended four antenatal visits in Kiambu County HIV in Kiambu County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical to significantly reducing Section 4: Expanding Access to mother-to-child transmission rates. Kenya has committed Treatment to eliminating new HIV infections among children by 2015, while keeping their mothers alive. Table 3: Kiambu County HIV treatment access annually

New HIV infections annually Indicator Adults in need of ART 23,747 among children Adults receiving ART 24,104 County ART adult coverage 100% Kiambu County National ART adult coverage 79% National County ranking of ART coverage among adults* 5 County ranking estimates 96 36 Indicator 12,940 Children in need of ART 3,041 Children receiving ART 2,011 Source: District Health Infor- mation System County ART children coverage 66% National ART children coverage 42% County ranking of ART coverage among children 6

kenya HIV AND AIDS PROFILE by County 47 Section 5: Orphans and Social Welfare Approximately 1,207 adults and 180 children died of AIDS-related Table 4: Kiambu orphans and social welfare indicators conditions in 2013 in Kiambu

Orphans and vulnerable children beneficia- Estimates County. Antiretroviral drugs ries can substantially reduce AIDS- Households with an orphan* 41,068 Poor households with an orphan** 20,123 related deaths. If used properly, 2,906 antiretroviral therapy (ART) can Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** also lower a person’s viral load and CT-OVC Households at July 2012 taken from CT-*** prevent onward transmission of HIV. • Only 14 per cent of poor households with orphans are beneficiaries of a cash transfer programme. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

48 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Kilifi County

Table 1: HIV burden in Kilifi Rank* otal population (2013) 1262127 41 HIV adult prevalence (overall) 4.4% 26 Number of adults living with HIV 24,400 32 Magarini Number of children living with HIV 3,507 31 Total number of people living with HIV 27,907 31 Malindi *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden Marereni county is 1. Watamu

The HIV prevalence among women in Kilifi County Kilifi is higher (6.3%) than that of men (2.7%). Over the years, the women living in the county have been Kilifi Density people per km2 more vulnerable to HIV infection than the men. Kaloleni 51 116 Kaloleni 284 Majengo Urban centres with population Figure 2: Prevalence of HIV by gender in Kilifi County of more than 2,000 people

7.7 8 7.4 7 HIV counseling and testing and linkage to care and 6.2 6 treatment are important steps in reducing the sexual 5 transmission of HIV. Despite the huge importance 5 4.3 Male of HIV testing as a way to increase prevention and 4 treatment, about 73 per cent of people in Kilifi County Female had never tested for HIV by 2009. 3

2 There is a need to scale up HIV testing in the county, HIV prevalence (%) HIV prevalence 1 to counsel and reduce the risk for those who test negative, and to link those who test positive to care 0 and treatment programmes. 2003 2007 2009 Source: Kenya Demographic and Health Survey and KAIS Figure 3: Percentage of adults enrolling for HIV care Year of survey by entry point in Kilifi County 80 Section 2: Reducing Sexual 70 Transmission of HIV 60 50 Table 2: Kilifi County HIV indicators 40 Annual County National rank- esti- 30 ing mates 20 New adult HIV infections annually 821 22 88,620 Source: 10 Source: Kenya HIV Estimates Report, 2014 0 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 49 Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Kilifi County, low condom use may pose a significant risk of HIV infection to the 0% 0% 72% 18% population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 per 60 cent. Most communities in Kilifi County traditionally circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 carried out under safe and hygienic conditions and 100% 100% 28% 82% encouraged before sexual debut. Infant delivery Maternal prophylaxis In Kilifi County, approximately 55 per cent of prophylaxis Medical facility individuals had their first experience of sexual Identi�ied HIV+

pregnant women pregnant No intercourse before the age of 15, an indication of early sexual debut. Yes

Section 3: Elimination of Mother-to- • 72% of HIV-positive pregnant women in Kilifi County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Kilifi County There were about 1585 pregnant women living with HIV in Kilifi County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding Section 4: Expanding Access to is crucial for children’s survival, growth, and development. Providing antiretroviral medicines Treatment to mothers throughout the breastfeeding period is cr3tical to significantly reducing mother-to-child Table 3: Kilifi County HIV treatment access annually transmission rates. Kenya has committed to eliminating new HIV infections among children by 2015, while Indicator keeping their mothers alive. Adults in need of ART 13,868 Adults receiving ART 9,884 New HIV infections annually County ART adult coverage 71% among children National ART adult coverage 79% County ranking of ART coverage among adults* 24

Kilifi County National Indicator County ranking estimates Children in need of ART 2,459 87 Children receiving ART 1,087 30 County ART children coverage 44% 12,940 National ART children coverage 42% Source: District Health Infor- mation System County ranking of ART coverage among 19 children

50 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Approximately 1,021 adults Welfare and 179 children died of AIDS- Table 4: Kilifi orphans and social welfare indicators related conditions in 2013 in

Orphans and vulnerable children Estimates Kilifi County. Antiretroviral drugs beneficiaries can substantially reduce AIDS- Households with an orphan* 26,702 Poor households with an orphan** 13,084 related deaths. If used properly, *** 4,747 S antiretroviral therapy (ART) can

Source:Cash transferUNICEF, 2012; beneficiary National households Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** also lower a person’s viral load CT-OVC Households at July 2012 taken from CT-*** and prevent onward transmission • Only 36 per cent of poor households with orphans are of HIV. beneficiaries of a cash transfer programme. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 51 Kirinyaga County

Section 1: HIV Burden in Kirinyaga County

Table 1: HIV burden in Kirinyaga Rank* Total population (2013) 572,889 14 HIV adult prevalence (overall) 3.3% 12 Number of adults living with HIV 11,500 17

Number of children living with HIV 1,154 10 Kagumo

Total number of people living with HIV 12,654 17 Source: UNICEF, 2012; National Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** Kirinyaga

Kagio The county had about 795 new adult infections in 2013. Kenya aims to reduce new HIV infections by at least 50% in all counties by 2015 Density people per km2 357 Urban centres with population Figure 2: Prevalence of HIV by gender in Kirinyaga of more than 2,000 people County 8.5

8 HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual 7 6.4 transmission of HIV. Despite the huge importance 6 5.4 of HIV testing as a way to increase prevention and 5 treatment, about 73 per cent of people in Kirinyaga Male County had never tested for HIV by 2009. 4 Female 2.8 3 2.5 There is a need to scale up HIV testing in the county, to counsel and reduce the risk for those who test 2 negative, and to link those who test positive to care HIV prevalence (%) HIV prevalence 1 and treatment programmes. 0 2003 2007 2009 Source: Kenya Demographic and Health Survey and KAIS Figure 3: Percentage of adults enrolling for HIV care Year of Survey by entry point in Kirinyaga County 80 70 Section 2: Reducing Sexual 60 Transmission of HIV 50 40 Table 2: Kirinyaga County HIV indicators 30 Annual County National ranking estimates 20 New adult HIV infections 795 21 88,620 10 annually Source: Kenya HIV Estimates Report, 2014 0 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

52 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Kirinyaga County, low condom use may pose a significant risk of HIV infection to the population. 13% 23% 53% 35% 100 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 80 per cent. Most communities in Kirinyaga County traditionally circumcise men, with over 91 per cent 60 of men who participated in a national survey in 2009 40 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 20

should be carried out under safe and hygienic 0 conditions and encouraged before sexual debut. 87% 77% 47% 65%

In Kirinyaga County, approximately 55 per cent Infant delivery of individuals had their first experience of sexual Maternal prophylaxis intercourse before the age of 15, an indication of early prophylaxis Medical facility Identi�ied HIV+

sexual debut. women pregnant No Yes

Section 3: Elimination of Mother-to- • 53% of HIV-positive pregnant women in Kirinyaga Child Transmission County do not deliver in a health facility • Only 41 per cent of pregnant women attend the There were about 355 pregnant women living recommended four antenatal visits in Kirinyaga County with HIV in Kirinyaga County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Section 4: Expanding Access to to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Kirinyaga County HIV treatment access mothers alive. annually

Indicator New HIV infections annually Adults in need of ART 6,441 among children Adults receiving ART 5,831 County ART adult coverage 91% National ART adult coverage 79% County ranking of ART coverage among adults* 14 Kirinyaga County National County ranking estimates Indicator 26 11 Children in need of ART 825 12,940 Children receiving ART 559 County ART children coverage 68% Source: District Health Infor- mation System National ART children coverage 42% County ranking of ART coverage among 4 children

Source: District Health Infor- mation System kenya HIV AND AIDS PROFILE by County 53 Section 5: Orphans and Social Welfare Approximately 327 adults and 49 children died of AIDS-related Table 4: Kirinyaga orphans and social welfare indicators conditions in 2013 in Kirinyaga

Orphans and vulnerable children beneficia- Estimates County. Antiretroviral drugs ries can substantially reduce AIDS- Households with an orphan* 12,364 Poor households with an orphan** 6,059 related deaths. If used properly, 1,302 antiretroviral therapy (ART) can Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** also lower a person’s viral load CT-OVC Households at July 2012 taken from CT-*** and prevent onward transmission • Only 22 per cent of poor households with orphans are beneficiaries of a cash transfer programme. of HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

54 kenya HIV AND AIDS PROFILE by County Kisii County

Section 1: HIV Burden in Kisii County

Table 1: HIV burden in Kisii Density people per km2 Rank* 769 779 846 Total population (2013) 1259489 40 902 Kisii Central 1009 HIV adult prevalence (overall) 8.0% 42 Urban centres with population of more than 2,000 people

Number of adults living with HIV 56,000 42 Kisii South Kisii Number of children living with HIV 7,715 40 Suneka Total number of people living with HIV 63,715 42

*In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden Keroka county is 1. Ogembo

Gucha south The HIV prevalence among women in Kisii County is higher (8.5%) than that of men (7.3%). Over the Mogonga years, the women living in the county have been more vulnerable to HIV infection than the men.

Figure 2: Prevalence of HIV by gender in Kisii County

8 7.2 6.8 7 HIV counseling and testing and linkage to care and 6.2 treatment are important steps in reducing the sexual 6 transmission of HIV. Despite the huge importance 5 of HIV testing as a way to increase prevention and 4 4 Male treatment, about 73 per cent of people in Kisii 4 Female County had never tested for HIV by 2009. 3 1

2 There is a need to scale up HIV testing in the county,

HIV prevalence (%) HIV prevalence to counsel and reduce the risk for those who test 1 negative, and to link those who test positive to care 0 and treatment programmes. 2003 2007 2009 Year of survey

Source: Kenya Demographic and Health Survey and KAIS Figure 3: Percentage of adults enrolling for HIV care by entry point in Kisii County

80 Section 2: Reducing Sexual 70 Transmission of HIV 60

Table 2: Kisii County HIV indicators 50 Annual County National 40 ranking estimates 30 New adult HIV 4,891 43 88,620 20 infections annually Source: Kenya HIV Estimates Report, 2014 10 0 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 55 Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Kisii County, low condom use may pose a significant risk of HIV infection to the population. 46% 68% 73% 61% 100 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 80 cent. Most communities in Kisii County traditionally 60 circumcise men, with over 91 per cent of men who participated in a national survey in 2009 reporting 40 that they had been circumcised. Even in traditionally 20 circumcising communities, the practice should be carried out under safe and hygienic conditions and 0 54% 32% 27% 39% encouraged before sexual debut. Infant delivery

In Kisii County, approximately 55 per cent of Maternal prophylaxis individuals had their first experience of sexual prophylaxis Medical facility intercourse before the age of 15, an indication of early Identi�ied HIV+ pregnant women pregnant No sexual debut. Yes

• 73% of HIV-positive pregnant women in Kisii County Section 3: Elimination of Mother-to- do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Kisii County There were about 2,094 pregnant women living with HIV in Kisii County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding Section 4: Expanding Access to is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to Treatment mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Table 3: Kisii County HIV treatment access annually rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Indicator mothers alive. Adults in need of ART 28,214 New HIV infections annually Adults receiving ART 13,629 County ART adult coverage 48% among children National ART adult coverage 79% County ranking of ART coverage among adults* 37 Kisii County National County ranking Indicator estimates Children in need of ART 6,068 1,085 43 Children receiving ART 1,169 12,940 County ART children coverage 19% Source: District Health Infor- mation System National ART children coverage 42% County ranking of ART coverage among children 35

56 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 1,352 adults and 492 children died of AIDS- Table 4: Kisii orphans and social welfare indicators related conditions in 2013 Orphans and vulnerable children Estimates in Kisii County. Antiretroviral beneficiaries Households with an orphan* 37,838 drugs can substantially reduce Poor households with an orphan** 18,541 AIDS-related deaths. If used 5,089 properly, antiretroviral therapy Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** (ART) can also lower a person’s viral load and prevent onward • Only 27 per cent of poor households with orphans are beneficiaries of a cash transfer programme. transmission of HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 57

Section 1: HIV Burden in Kisumu County

Table 1: HIV burden in Kisumu Muhoroni

Rank* Chemelil Total population (2013) 1059053 36 Awasi HIV adult prevalence (overall) 19.3% 45

Number of adults living with HIV 118,500 45 Nyando

Number of children living with HIV 16,326 46 Ahero Total number of people living with HIV 134,826 45 Kisumu East *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1. Kisumu Density people per km2 300 The HIV prevalence among women in Kisumu 404 County is higher (20.6%) than that of men (17.8%). 847 Urban centres with population Over the years, the women living in the county have Maseno of more than 2,000 people been more vulnerable to HIV infection than the men. Kisumu West

Figure 2: Prevalence of HIV by gender in Kisumu County HIV counseling and testing and linkage to care and 21 20.3 21.1 20.5 20 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 17.5 of HIV testing as a way to increase prevention and 14.4 14.2 15 treatment, about 73 per cent of people in Kisumu

12.5 County had never tested for HIV by 2009. Male 10 Female There is a need to scale up HIV testing in the 7.5 county, to counsel and reduce the risk for those who test negative, and to link those who test positive to 5 care and treatment programmes. HIV prevalence (%) HIV prevalence 2.5

0 Figure 3: Percentage of adults enrolling for HIV care 2003 2007 2009 by entry point in Kisumu County Source: Kenya Demographic and Health Survey and KAIS

Year of survey 80 70 60 Section 2: Reducing Sexual 50 Transmission of HIV 40 30 Table 2: Kisumu County HIV indicators 20 Annual County National rank- estimates 10 ing 0 New adult HIV infections annually 10,349 46 88,620

Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

58 kenya HIV AND AIDS PROFILE by County Figure 4: Prevention of mother-to-child transmission Consistent and proper use of condoms can reduce the uptake risk of HIV and other sexually transmitted infections by more than 90 per cent. In Kisumu County, low condom use may pose a significant risk of HIV infection to the population. 16% 27% 55% 14% 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 per cent. Most communities in Kisumu County traditionally 60 circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting that they had been circumcised. Even in traditionally 20 circumcising communities, the practice should be carried 0 out under safe and hygienic conditions and encouraged 84% 73% 45% 86% before sexual debut. Infant delivery In Kisumu County, approximately 55 per cent of Maternal prophylaxis individuals had their first experience of sexual intercourse prophylaxis Medical facility Identi�ied HIV+ before the age of 15, an indication of early sexual debut. women pregnant No Yes

• 55% of HIV-positive pregnant women in Kisumu Section 3: Elimination of Mother-to- County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Kisumu County There were about 6,817 pregnant women living with HIV in Kisumu County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing Section 4: Expanding Access to antiretroviral medicines to mothers throughout the breastfeeding period is critical to significantly reducing Treatment mother-to-child transmission rates. Kenya has committed to eliminating new HIV infections among children by Table 3: Kisumu County HIV treatment access 2015, while keeping their mothers alive. annually

Indicator New HIV infections annually Adults in need of ART 59,703 among children Adults receiving ART 62,280 County ART adult coverage 100% National ART adult coverage 79% Kisumu County County ranking of ART coverage among adults* 4 National County ranking estimates Indicator 2,296 46 Children in need of ART 12,840 12,940 Children receiving ART 6,881 Source: District Health Infor- County ART children coverage 54% mation System National ART children coverage 42% County ranking of ART coverage among 14 children

kenya HIV AND AIDS PROFILE by County 59 Section 5: Orphans and Social 2,861 Welfare Approximately adults and 1,040 children died Table 4: Kisumu orphans and social welfare of AIDS-related conditions indicators in 2013 in Kisumu County. Orphans and vulnerable children Estimates beneficiaries Antiretroviral drugs can Households with an orphan* 56,795 substantially reduce AIDS- Poor households with an orphan** 27,830 related deaths. If used 6,331

Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009* properly, antiretroviral Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** therapy (ART) can also lower • Only 23 per cent of poor households with orphans a person’s viral load and are beneficiaries of a cash transfer programme. prevent onward transmission • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, of HIV. and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

60 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Kitui County

Nyuso Table 1: HIV burden in Kitui Rank* Total population (2013) 1065329 37 Mwingi HIV adult prevalence (overall) 4.3% 21 Kitui Number of adults living with HIV 18,300 22 Kitui Number of children living with HIV 2,792 23 Density people 2 Total number of people living with HIV 21,092 per km 23 14 29 *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 47 while the lowest burden county is 1. 59 Urban centres with population of more than 2,000 people The HIV prevalence among women in Kitui County is higher (5.8%) than that of men (2.5%). Over the years, the women living in the county have been more vulnerable to HIV infection than the men.

Figure 2: Prevalence of HIV by gender in Kitui County

8 HIV counseling and testing and linkage to care and 7 6.6 treatment are important steps in reducing the sexual 6 transmission of HIV. Despite the huge importance 5 5.3 4.7 of HIV testing as a way to increase prevention and 4 4.3 Male treatment, about 73 per cent of people in Kitui 3 County had never tested for HIV by 2009. 2 Female 1 There is a need to scale up HIV testing in the county,

HIV prevalence (%) HIV prevalence 0 1.4 to counsel and reduce the risk for those who test negative, and to link those who test positive to care and treatment programmes.

2003 2007 2009 Source: Kenya Demographic and Health Survey and KAIS Figure 3: Percentage of adults enrolling for HIV care by entry point in Kitui County Year of survey

80 Section 2: Reducing Sexual 70 Transmission of HIV 60 50 Table 2: Kitui County HIV indicators 40 Annual County National ranking estimates 30 New adult HIV 988 24 88,620 20 infections annually 10 Source: Kenya HIV Estimates Report, 2014 0 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 61 Consistent and proper use of condoms can reduce Figure 4: Prevention of mother-to-child transmission the risk of HIV and other sexually transmitted uptake infections by more than 90 per cent. In Kitui County, low condom use may pose a significant risk of HIV infection to the population. 0% 18% 83% 6% 100 Male circumcision reduces the risk of female-to- male transmission of HIV infection by approximately 80 60 per cent. Most communities in Kitui County 60 traditionally circumcise men, with over 91 per cent of men who participated in a national survey in 2009 40 reporting that they had been circumcised. Even in 20 traditionally circumcising communities, the practice should be carried out under safe and hygienic 0 100% 82% 17% 94% conditions and encouraged before sexual debut. Infant delivery

In Kitui County, approximately 55 per cent of Maternal prophylaxis individuals had their first experience of sexual prophylaxis Medical facility intercourse before the age of 15, an indication of Identi�ied HIV+ pregnant women pregnant No early sexual debut. Yes

Section 3: Elimination of Mother-to- • 83% of HIV-positive pregnant women in Kitui County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Kitui There were about 1,603 pregnant women living County with HIV in Kitui County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral Section 4: Expanding Access to medicines to mothers throughout the breastfeeding period is critical to significantly reducing mother- Treatment to-child transmission rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their mothers alive. Table 3: Kitui County HIV treatment access annually

Indicator New HIV infections annually Adults in need of ART 10,561 Adults receiving ART 9,273 among children County ART adult coverage 88% National ART adult coverage 79% Kitui County County ranking of ART coverage among adults* 16 National County ranking Indicator estimates Children in need of ART 1,994 54 20 Children receiving ART 1,269 12,940 County ART children coverage 64% Source: District Health Infor- National ART children coverage 42% mation System County ranking of ART coverage among children 8 *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

62 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 622 adults and 120 children died of AIDS-related Table 4: Kitui orphans and social welfare indicators conditions in 2013 in Kitui County.

Orphans and vulnerable children beneficiaries Estimates Antiretroviral drugs can substantially Households with an orphan* 30,859 reduce AIDS-related deaths. If used Poor households with an orphan** 15,121 properly, antiretroviral therapy 5,422 Source: UNICEF, 2012; National Census, 2009* (ART) can also lower a person’s AssumingCash transfer 49% of beneficiary population living households*** below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** viral load and prevent onward • Only 36 per cent of poor households with orphans transmission of HIV. are beneficiaries of a cash transfer programme.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 63

Section 1: HIV Burden in Kwale County

Table 1: HIV burden in Kwale Rank* Total population (2013) 739,435 21 Mariakani

HIV adult prevalence (overall) 5.7% 34 Kinango Number of adults living with HIV 18,500 23

Number of children living with HIV 2,659 22 Kinango Kwale Total number of people living with HIV 21,159 24

*In this HIV burden and indicator ranking (Table 2), the highest burden county is Kwale 47 while the lowest burden county is 1.

Density people The HIV prevalence among women in Kwale County per km2 Msambweni 52 is higher (8.1%) than that of men (3.5%). Over the 89 years, the women living in the county have been 147 Urban centres with population more vulnerable to HIV infection than the men. of more than 2,000 people

Figure 2: Prevalence of HIV by gender in Kwale County HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual 8 transmission of HIV. Despite the huge importance 7 of HIV testing as a way to increase prevention and 5.8 6 treatment, about 73 per cent of people in Kwale County had never tested for HIV by 2009. 5 4.4 Male 4 3.5 There is a need to scale up HIV testing in the county, 3.1 3.1 Female 3 to counsel and reduce the risk for those who test 2.2 negative, and to link those who test positive to care 2 and treatment programmes. HIV prevalence (%) HIV prevalence 1

0 Figure 3: Percentage of adults enrolling for HIV care 2003 2007 2009 by entry point in Kwale County Source: Kenya Demographic and Health Survey and KAIS Year of survey 80 70 Section 2: Reducing Sexual 60 Transmission of HIV 50 40 Table 2: Kwale County HIV indicators 30 Annual County National 20 ranking estimates New adult HIV infections 623 18 88,620 10 annually 0 Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

64 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Kwale County, low condom 27% 19% 58% 36% use may pose a significant risk of HIV infection to the 100 population. 80 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 60 cent. Most communities in Kwale County traditionally 40 circumcise men, with over 91 per cent of men who participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 73% 81% 42% 64% carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery In Kwale County, approximately 55 per cent of Maternal prophylaxis prophylaxis individuals had their first experience of sexual Medical facility Identi�ied HIV+ intercourse before the age of 15, an indication of early women pregnant No sexual debut. Yes

• 58% of HIV-positive pregnant women in Kwale Section 3: Elimination of Mother- County do not deliver in a health facility to-Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Kwale There were about 1,300 HIV-positive pregnant women County in Kwale County in 2011. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing Section 4: Expanding Access to antiretroviral medicines to mothers throughout the breastfeeding period is critical to significantly reducing Treatment mother-to-child transmission rates. Kenya has committed to eliminating new HIV infections among children by Table 3: Kwale County HIV treatment access annually 2015, while keeping their mothers alive. Indicator Adults in need of ART 10,515 Adults receiving ART 3,227 New HIV infections annually County ART adult coverage 31% among children National ART adult coverage 79% County ranking of ART coverage among adults* 42

Kwale County National Indicator County ranking estimates Children in need of ART 1,864 Children receiving ART 292 66 27 County ART children coverage 16% 12,940 National ART children coverage 42% Source: District Health Infor- mation System County ranking of ART coverage among children 41 *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 65 Section 5: Orphans and Social Approximately 774 adults and Welfare 136 children died of AIDS-related Table 4: Kwale orphans and social welfare indicators conditions in 2013 in Kwale County.

Orphans and vulnerable children beneficia- Estimates Antiretroviral drugs can substantially ries reduce AIDS-related deaths. If used Households with an orphan* 17,309 Poor households with an orphan** 8,481 properly, antiretroviral therapy 2,253 (ART) can also lower a person’s Source: UNICEF, 2012; National Census, 2009* AssumingCash transfer 49% of beneficiary population living households*** below poverty line (absolut poor)** viral load and prevent onward CT-OVC Households at July 2012 taken from CT-*** transmission of HIV. • Only 27 per cent of poor households with orphans are beneficiaries of a cash transfer programme.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

66 kenya HIV AND AIDS PROFILE by County LAIKIPIA County

Section 1: HIV Burden in Laikipia County

Table 1: HIV burden in Laikipia Rank*

Total population (2013) 454,412 11 Laikipia West Laikipia North HIV adult prevalence (overall) 3.7% 15

Number of adults living with HIV 9,000 12

Number of children living with HIV 1,324 14 Laikipia East

Total number of people living with HIV 10,324 12 Kinamba *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

Density people per km2 The HIV prevalence among women in Laikipia County 13 48 is higher (5.3%) than that of men (3.2%). Over the 58 Urban centres with population years, the women living in the county have been more of more than 2,000 people vulnerable to HIV infection than the men.

Figure 2: Prevalence of HIV by gender in Laikipia County HIV counseling and testing and linkage to care and 8 treatment are important steps in reducing the sexual 7 transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and 6 5.4 treatment, about 73 per cent of people in Laikipia 5 County had never tested for HIV by 2009. 3.8 Male 4 Female 3 There is a need to scale up HIV testing in the county, 3 2.5 to counsel and reduce the risk for those who test 2 negative, and to link those who test positive to care HIV prevalence (%) HIV prevalence 1 and treatment programmes.

0 2003 2007 2009 Figure 3: Percentage of adults enrolling for HIV care Source: Kenya Demographic and Health Survey and KAIS by entry point in Laikipia County Year of survey

105 90 Section 2: Reducing Sexual 75 Transmission of HIV 60 45 Table 2: Laikipia County HIV indicators 30 Annual County National ranking estimates 15 New adult HIV infections 692 19 88,620 0 annually

Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 67 Figure 4: Prevention of mother-to-child transmission Consistent and proper use of condoms can reduce the uptake risk of HIV and other sexually transmitted infections by more than 90 per cent. In Laikipia County, low condom use may pose a significant risk of HIV infection to the 34% 65% 44% 61% population. 100

80 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 60 cent. Most communities in Laikipia County traditionally circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 carried out under safe and hygienic conditions and 66% 35% 56% 39% encouraged before sexual debut. Infant delivery In Laikipia County, approximately 55 per cent of Maternal prophylaxis prophylaxis

individuals had their first experience of sexual Medical facility Identi�ied HIV+ intercourse before the age of 15, an indication of early women pregnant No sexual debut. Yes

Section 3: Elimination of Mother- • 44% of HIV-positive pregnant women in Laikipia County do not deliver in a health facility to-Child Transmission • Only 41 per cent of pregnant women attend the There were about 348 pregnant women living with recommended four antenatal visits in Laikipia HIV in Laikipia County in 2013. HIV is most often County transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to Section 4: Expanding Access to mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV Table 3: Laikipia County HIV treatment access infections among children by 2015, while keeping their mothers alive. annually Indicator Adults in need of ART 4,400 New HIV infections annually among Adults receiving ART 2,391 County ART adult coverage 54% children National ART adult coverage 79% County ranking of ART coverage among adults* 32 County Laikipia Indicator ranking National County Children in need of ART 931 estimates Children receiving ART 161 33 15 County ART children coverage 17% 12,940 National ART children coverage 42% Source: District Health Information System County ranking of ART coverage among children 39 *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

68 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 514 adults and 72 children died of AIDS-related Table 4: Laikipia orphans and social welfare indicators conditions in 2013 in Laikipia County. Antiretroviral drugs Orphans and vulnerable children beneficiaries Estimates Households with an orphan* 10,488 can substantially reduce AIDS- Poor households with an orphan** 5,139 related deaths. If used properly, 1,718 antiretroviral therapy (ART) can Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** also lower a person’s viral load and CT-OVC Households at July 2012 taken from CT-*** prevent onward transmission of • Only 33 per cent of poor households with orphans are beneficiaries of a cash transfer programme. HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 69

Section 1: HIV Burden in Lamu County

Table 1: HIV burden in Lamu

Rank* Lamu Total population (2013) 115,520 1 HIV adult prevalence (overall) 2.3% 6 Lamu Number of adults living with HIV 1,300 3

Density people Number of children living with HIV 187 3 per km2 16 Total number of people living with HIV 1,487 3 Urban centres with population of more than 2,000 people *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

The HIV prevalence among women in Lamu County is higher (3.2%) than that of men (1.4%). Over the years, the women living in the county have been more vulnerable to HIV infection than the men.

HIV counseling and testing and linkage to care and Figure 2: Prevalence of HIV by gender in Lamu County treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and 3.5 treatment, about 73 per cent of people in Lamu 3.0 County had never tested for HIV by 2009.

2.5 2.2 There is a need to scale up HIV testing in the county, to counsel and reduce the risk for those who test 2.0 Male negative, and to link those who test positive to care lence (%) lence 1.5 Female and treatment programmes. 1.0

0.5 Figure 3: Percentage of adults enrolling for HIV care HIV preva by entry point in Lamu County 0

80 Source: Kenya Demographic and Health Survey 70 60 Section 2: Reducing Sexual 50 Transmission of HIV 40 30 Table 2: Lamu County HIV indicators 20 Annual County National ranking estimates 10 New adult HIV infec- 44 4 88,620 0 tions annually

Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

70 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Lamu County, low condom use may pose a significant risk of HIV infection to the 0% 0% 91% 0% population. 100

80 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 60 cent. Most communities in Lamu County traditionally circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 carried out under safe and hygienic conditions and 100% 100% 9% 100% encouraged before sexual debut. Infant delivery In Lamu County, approximately 55 per cent of Maternal prophylaxis individuals had their first experience of sexual prophylaxis Medical facility Identi�ied HIV+ intercourse before the age of 15, an indication of early women pregnant No sexual debut. Yes

Section 3: Elimination of Mother- • 91% of HIV-positive pregnant women in Lamu to-Child Transmission County do not deliver in a health facility

There were about 173 pregnant women living with HIV • Only 41 per cent of pregnant women attend in Lamu County in 2013. HIV is most often transmitted the recommended four antenatal visits in Lamu from a mother to her child during pregnancy, County delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers Section 4: Expanding Access to throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Lamu County HIV treatment access annually mothers alive. Indicator Adults in need of ART 739 New HIV infections annually among Adults receiving ART 700 County ART adult coverage 95% children National ART adult coverage 79% County ranking of ART coverage among adults* 10 Lamu County National County ranking estimates Indicator Children in need of ART 131 5 4 Children receiving ART 80 12,940 County ART children coverage 61% Source: District Health Information System National ART children coverage 42% County ranking of ART coverage among children 10

*In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 71 Section 5: Orphans and Social Welfare Very few adults and approximately 10 children died of AIDS-related Table 4: Lamu orphans and social welfare indicators conditions in 2011 in Lamu County.

Orphans and vulnerable children beneficiaries Estimates Antiretroviral drugs can substantially Households with an orphan* 2,380 reduce AIDS-related deaths. If used Poor households with an orphan** 1,166 properly, antiretroviral therapy 557 Source: UNICEF, 2012; National Census, 2009 (ART) can also lower a person’s Cash transfer beneficiary households*** viral load and prevent onward • Only 48 per cent of poor households with orphans transmission of HIV. are beneficiaries of a cash transfer programme.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

72 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Machakos County

Table 1: HIV burden in Machakos Rank* Yatta Total population (2013) 1155957 39 HIV adult prevalence (overall) 5.0% 27 Matuu

Number of adults living with HIV 27,100 35

Number of children living with HIV 4,135 35 Kangundo-Tala Total number of people living with HIV 31,235 35

*In this HIV burden and indicator ranking (Table 2), the highest burden county is Kathiani Mwala 47 while the lowest burden county is 1. Mavoko Machakos The HIV prevalence among women in Machakos Machakos County is higher (6.8%) than that of men (2.9%). Density people per km2 Over the years, the women living in the county have 111 160 been more vulnerable to HIV infection than the men. 224 460 Urban centres with population Figure 2: Prevalence of HIV by gender in Machakos of more than 2,000 people County

8.4 HIV counseling and testing and linkage to care and 8 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 7 of HIV testing as a way to increase prevention and

6 5.6 treatment, about 73 per cent of people in Machakos 4.9 County had never tested for HIV by 2009. 5 Male 4 There is a need to scale up HIV testing in the county, Female to counsel and reduce the risk for those who test 3 2.6 2.3 negative, and to link those who test positive to care 2 and treatment programmes. HIV prevalence (%) HIV prevalence 1 Figure 3: Percentage of adults enrolling for HIV care 0 2003 2007 2009 by entry point in Machakos County Source: Kenya Demographic and Health Survey and KAIS Year of survey 80 70 Section 2: Reducing Sexual 60 Transmission of HIV 50 40 Table 2: Machakos County HIV indicators 30 Annual County National 20 ranking estimates New adult HIV infections 1,463 30 88,620 10 annually 0 Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 73 Consistent and proper use of condoms can reduce the Section 4: Expanding Access to risk of HIV and other sexually transmitted infections Treatment by more than 90 per cent. In Machakos County, low condom use may pose a significant risk of HIV infection to the population. Figure 4: Prevention of mother-to-child transmission uptake Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 2% 14% 64% 16% per cent. Most communities in Machakos County 100 traditionally circumcise men, with over 91 per cent of men who participated in a national survey in 2009 80 reporting that they had been circumcised. Even in 60 traditionally circumcising communities, the practice should be carried out under safe and hygienic 40 conditions and encouraged before sexual debut. 20

In Machakos County, approximately 55 per cent 0 98% 86% 36% 84% of individuals had their first experience of sexual intercourse before the age of 15, an indication of early Infant

sexual debut. delivery Maternal prophylaxis prophylaxis Medical facility Identi�ied HIV+ Section 3: Elimination of Mother-to- women pregnant No Child Transmission Yes

There were about 1,757 HIV-positive pregnant women in Machakos County in 2011. HIV is most often • 64% of HIV-positive pregnant women in Machakos transmitted from a mother to her child during pregnancy, County do not deliver in a health facility delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing • Only 41 per cent of pregnant women attend the antiretroviral medicines to mothers throughout the recommended four antenatal visits in Machakos County breastfeeding period is critical to significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their mothers alive. Section 4: Expanding Access to Treatment New HIV infections annually Table 3: Machakos County HIV treatment access among children annually

Indicator Machakos County Adults in need of ART 15,640 National County ranking Adults receiving ART 11,542 estimates County ART adult coverage 74% 80 29 National ART adult coverage 79% 12,940 County ranking of ART coverage among adults* 23 Source: District Health Information System Indicator Children in need of ART 2,953 Children receiving ART 1,609 County ART children coverage 54% National ART children coverage 42% County ranking of ART coverage among children 15

*In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

74 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 921 adults and 177 children died of AIDS- Table 4: Machakos orphans and social welfare related conditions in 2013 in indicators

Orphans and vulnerable children beneficiaries Estimates Machakos County. Antiretroviral Households with an orphan* 33,380 drugs can substantially reduce Poor households with an orphan** 16,356 AIDS-related deaths. If used 5,001 properly, antiretroviral therapy Source:Cash TransferUNICEF, 2012; Beneficiary National households*** Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** (ART) can also lower a person’s

• Only 31 per cent of poor households with orphans viral load and prevent onward are beneficiaries of a cash transfer programme. transmission of HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 75 MAKUENI County

Section 1: HIV Burden in Makueni County

Mbooni Table 1: HIV burden in Makueni Rank* Makueni Total population (2013) 930,630 28 Nzaui HIV adult prevalence (overall) 5.6% 33 Number of adults living with HIV 22,100 27

Number of children living with HIV 3,372 29

Total number of people living with HIV 25,472 27 Kibwezi *In this HIV burden and indicator ranking (Table 2), the highest burden county is Machinery 47 while the lowest burden county is 1. Density people per km2 62 144 The HIV prevalence among women in Makueni County 148 is higher (7.6%) than that of men (3.3%). Over the 199 Urban centres with population years, the women living in the county have been more of more than 2,000 people vulnerable to HIV infection than the men.

Figure 1: Prevalence of HIV by gender in Makueni County HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual 8.7 8.8 transmission of HIV. Despite the huge importance

8 of HIV testing as a way to increase prevention and 7.1 treatment, about 73 per cent of people in Makueni 7 County had never tested for HIV by 2009. 6 There is a need to scale up HIV testing in the county, 5 4.5 4.1 Male to counsel and reduce the risk for those who test 4 Female negative, and to link those who test positive to care 3 2.7 and treatment programmes.

2

HIV prevalence (%) HIV prevalence 1 Figure 2: Percentage of adults enrolling for HIV care by entry point in Makueni County 0 2003 2007 2009 Source: Kenya Demographic and Health Survey and KAIS 105 Year of survey 90 75 Section 2: Reducing Sexual 60 Transmission of HIV 45 30 Table 2: Makueni County HIV indicators 15 Annual County National ranking estimates 0 New adult HIV infections 1,193 26 88,620 annually Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Source: Kenya HIV Estimates Report, 2014 Medical ward mother-to-child

Point of entry to care Source: District Health Information System

76 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Makueni County, low condom use may pose a significant risk of HIV infection 3% 20% 77% 8% to the population. 100

Male circumcision reduces the risk of female-to- 80 male transmission of HIV infection by approximately 60 60 per cent. Most communities in Makueni County traditionally circumcise men, with over 91 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 should be carried out under safe and hygienic 97% 80% 23% 92% conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Makueni County, approximately 55 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+

pregnant women pregnant No intercourse before the age of 15, an indication of early sexual debut. Yes

• 77% of HIV-positive pregnant women in Makueni Section 3: Elimination of Mother-to- County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Makueni There were about 991 pregnant women living with County HIV in Makueni County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and Section 4: Expanding Access to development. Providing antiretroviral medicines to Treatment mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Table 3: Makueni County HIV treatment access rates. Kenya has committed to eliminating new HIV annually infections among children by 2015, while keeping their Indicator mothers alive. Adults in need of ART 12,754 Adults receiving ART 9,705 County ART adult coverage 76% New HIV infections annually among National ART adult coverage 79% County ranking of ART coverage among adults* 22 children Indicator Makueni County Children in need of ART 2,408 National County ranking Children receiving ART 1,480 estimates County ART children coverage 61% 65 25 National ART children coverage 42% 12,940 County ranking of ART coverage among children 11 Source: District Health *In this ART coverage ranking, the county with the highest coverage is 1, while Information System the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 77 Section 5: Orphans and Social Welfare Approximately 751 adults and 145 children died of AIDS-related Table 4: Makueni orphans and social welfare indicators conditions in 2013 in Makueni Orphans and vulnerable children Estimates County. Antiretroviral drugs can beneficiaries Households with an orphan* 27,305 substantially reduce AIDS-related Poor households with an orphan** 13,380 deaths. If used properly, antiretroviral 4,528 Source: UNICEF, 2012; National Census, 2009* therapy (ART) can also lower a AssumingCash transfer 49% of beneficiary population living households*** below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** person’s viral load and prevent

• Only 34 per cent of poor households with orphans onward transmission of HIV. are beneficiaries of a cash transfer programme.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

78 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Mandera County

Rhamu Mandera Table 1: HIV burden in Mandera Rank* Mandera East Total population (2013) 673,356 20 Mandera Central Takata HIV adult prevalence (overall) 1.7% 4 Number of adults living with HIV 3,900 7 Number of children living with HIV 1,271 12 Mandera Central Elwak Total number of people living with HIV 5,171 7 Density people per km2 *In this HIV burden and indicator ranking (Table 2), the highest burden county is 36 47 while the lowest burden county is 1. 39 47 Urban centres with population of more than 2,000 people The HIV prevalence among women in Mandera County is higher (2.9%) than that of men (0.6%). Over the years, the women living in the county have been more vulnerable to HIV infection than the men.

Figure 1: Prevalence of HIV by gender in Mandera HIV counseling and testing and linkage to care and County treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 3.5 of HIV testing as a way to increase prevention and 3.0 treatment, about 73 per cent of people in Mandera County had never tested for HIV by 2009.

2.5 2.3 2 There is a need to scale up HIV testing in the county, 2.0 Male to counsel and reduce the risk for those who test negative, and to link those who test positive to care 1.5 1.4 Female and treatment programmes. 1.0

HIV prevalence (%) HIV prevalence 0.5 Figure 2: Percentage of adults enrolling for HIV care by entry point in Mandera County 0 2009 2009 Source: Kenya Demographic and Health Survey 80 Year of survey 70 60 Section 2: Reducing Sexual 50 Transmission of HIV 40

Table 2: Mandera County HIV indicators 30 Annual County National 20 ranking estimates 10 New adult HIV infections 137 9 88,620 annually 0

Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 79 Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Mandera County, low condom use may pose a significant risk of HIV infection 85% 96% 95% 98% to the population. 100

Male circumcision reduces the risk of female-to- 80 male transmission of HIV infection by approximately 60 60 per cent. Most communities in Mandera County traditionally circumcise men, with over 91 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 should be carried out under safe and hygienic 15% 4% 5% 2% conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Mandera County, approximately 55 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+ intercourse before the age of 15, an indication of early women pregnant sexual debut.

• 95% of HIV-positive pregnant women in Mandera Section 3: Elimination of Mother-to- County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Mandera There were about 40 pregnant women living with County HIV in Mandera County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and Section 4: Expanding Access to development. Providing antiretroviral medicines to Treatment mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Table 3: Mandera County HIV treatment access rates. Kenya has committed to eliminating new HIV annually infections among children by 2015, while keeping their Indicator mothers alive. Adults in need of ART 1,948 Adults receiving ART 77 New HIV infections annually among County ART adult coverage 4% National ART adult coverage 79% children County ranking of ART coverage among adults* 47

Mandera County Indicator Children in need of ART 892 ranking National County Children receiving ART 27 estimates County ART children coverage 3% 17 7 National ART children coverage 42% 12,940 County ranking of ART coverage among children 47 Source: District Health *In this ART coverage ranking, the county with the highest coverage is 1, while Information System the county with the lowest coverage is 47. Source: Estimation and Projection Package

80 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 615 adults and 81 children died of AIDS-related Table 4: Mandera orphans and social welfare indicators conditions in 2013 in Mandera Orphans and vulnerable children Estimates County. Antiretroviral drugs beneficiaries Households with an orphan* 13,208 can substantially reduce AIDS- Poor households with an orphan** 6,472 related deaths. If used properly, 1,650 Source: UNICEF, 2012; National Census, 2009* antiretroviral therapy (ART) can AssumingCash transfer 49% of beneficiary population living Households*** below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and

• Only 26 per cent of poor households with orphans prevent onward transmission of are beneficiaries of a cash transfer programme. HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25. •

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 81

Section 1: HIV Burden in Marsabit County

Table 1: HIV burden in Marsabit Chalbi Sololo Rank* Total population (2013) 306,471 5 HIV adult prevalence (overall) 1.2% 3 Moyale Number of adults living with HIV 1,500 4 Number of children living with HIV 229 4 Marsabit

Total number of people living with HIV 1,729 4 Marsabit *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1. Density people per km2 Laisamis 2 The HIV prevalence among women in Marsabit County 3 11 is higher (1.6%) than that of men (0.7%). Over the 23 Urban centres with population years, the women living in the county have been more of more than 2,000 people vulnerable to HIV infection than the men.

Figure 1: Prevalence of HIV by gender in Marsabit County HIV counseling and testing and linkage to care and 3.5 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 3.0 of HIV testing as a way to increase prevention and 2.5 Male treatment, about 73 per cent of people in Marsabit 2.0 County had never tested for HIV by 2009. Female 1.4 1.5 There is a need to scale up HIV testing in the county, 1.0 to counsel and reduce the risk for those who test

HIV prevalence (%) HIV prevalence negative, and to link those who test positive to care 0.5 and treatment programmes. 0 2009 Source: Kenya Demographic and Health Survey Figure 2: Percentage of adults enrolling for HIV care by entry point in Marsabit County Year of survey 80 70 Section 2: Reducing Sexual 60 Transmission of HIV 50 40 Table 2: Marsabit County HIV indicators 30 Annual County National ranking estimates 20 New adult HIV infections 81 6 88,620 10 annually Source: Kenya HIV Estimates Report, 2014 0 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

82 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Marsabit County, low condom use may pose a significant risk of HIV infection 0% 0% 86% 0% to the population. 100

Male circumcision reduces the risk of female-to- 80 male transmission of HIV infection by approximately 60 60 per cent. Most communities in Marsabit County traditionally circumcise men, with over 91 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 100% 100% 24% 100% should be carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Marsabit County, approximately 55 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+ pregnant women pregnant No intercourse before the age of 15, an indication of early sexual debut. Yes

• 76% of HIV-positive pregnant women in Marsabit Section 3: Elimination of Mother-to- County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the There were about 120 pregnant women living with recommended four antenatal visits in Marsabit HIV in Marsabit County in 2013. HIV is most often County transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to Section 4: Expanding Access to mothers throughout the breastfeeding period is critical Treatment to significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV Table 3: Marsabit County HIV treatment access infections among children by 2015, while keeping their annually mothers alive. Indicator Adults in need of ART 866 Adults receiving ART 746 New HIV infections annually among County ART adult coverage 86% National ART adult coverage 79% children County ranking of ART coverage among adults* 17

Indicator Marsabit County National Children in need of ART 163 County ranking Children receiving ART 93 estimates County ART children coverage 57% 4 2 National ART children coverage 42% 12,940 County ranking of ART coverage among children 12 Source: District Health *In this ART coverage ranking, the county with the highest coverage is 1, while Information System the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 83 Section 5: Orphans and Social Welfare Approximately 100 adults and 10 children died of AIDS-related Table 4: Marsabit orphans and social welfare indicators conditions in 2011 in Marsabit Orphans and vulnerable children Estimates County. Antiretroviral drugs beneficiaries Households with an orphan* 8,844 can substantially reduce AIDS- Poor households with an orphan** 4,333 related deaths. If used properly, 1,930 Source: UNICEF, 2012; National Census, 2009* antiretroviral therapy (ART) can AssumingCash transfer 49% of beneficiary population living households*** below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load

• Only 45 per cent of poor households with orphans and prevent onward transmission are beneficiaries of a cash transfer programme. of HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

84 kenya HIV AND AIDS PROFILE by County Meru County

Section 1: HIV Burden in Meru County

Table 1: HIV burden in Meru Lare Rank* Igembe Tigania Maua Total population (2013) 1427135 42

Iment North HIV adult prevalence (overall) 3% 10 Timau Iment North Number of adults living with HIV 20,200 26 Nkubu Mitunguu Number of children living with HIV 3,082 26 Iment South Density people per km2 Maara Total number of people living with HIV 23,282 26 168 171 *In this HIV burden and indicator ranking (Table 2), the highest burden county is Meru South 179 47 while the lowest burden county is 1. 200 261 272 Urban centres with population The HIV prevalence among women in Meru County of more than 2,000 people is higher (4.1%) than that of men (1.8%). Over the years, the women living in the county have been more vulnerable to HIV infection than the men.

Figure 1: Prevalence of HIV by gender in Meru County HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual 5 5 transmission of HIV. Despite the huge importance 5 4.5 of HIV testing as a way to increase prevention and treatment, about 73 per cent of people in Meru 4 3.4 County had never tested for HIV by 2009. 3 Male There is a need to scale up HIV testing in the county, 2 1.5 Female to counsel and reduce the risk for those who test 1.2 negative, and to link those who test positive to care 1 and treatment programmes.

HIV prevalence (%) HIV prevalence 0 Figure 2: Percentage of adults enrolling for HIV care 2003 2007 2009 by entry point in Meru County

Year of survey 80 Source: Kenya Demographic and Health Survey and KAIS 70 60 Section 2: Reducing Sexual 50 Transmission of HIV 40

Table 2: Meru County HIV indicators 30 Annual County National 20 ranking estimates 10 New adult HIV infections 1,090 25 88.620 annually 0 Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 85 Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Meru County, low condom use may pose a significant risk of HIV infection to the 0% 44% 68% 0% population. 100

80 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 60 cent. Most communities in Meru County traditionally circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally 0 circumcising communities, the practice should be 100% 56% 32% 100% carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Meru County, approximately 55 per cent of prophylaxis Medical facility Identi�ied HIV+ individuals had their first experience of sexual women pregnant No intercourse before the age of 15, an indication of early Yes sexual debut.

Section 3: Elimination of Mother-to- • 68% of HIV-positive pregnant women in Meru Child Transmission County do not deliver in a health facility

There were about 1202 pregnant women living • Only 41 per cent of pregnant women attend the with HIV in Meru County in 2013. HIV is most often recommended four antenatal visits in Meru County transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Section 4: Expanding Access to to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Meru County HIV treatment access annually mothers alive. Indicator Adults in need of ART 11,658 Adults receiving ART 9,615 New HIV infections annually County ART adult coverage 82% National ART adult coverage 79% among children County ranking of ART coverage among adults* 18

Indicator Meru County National Children in need of ART 2,201 County ranking Children receiving ART 1,052 estimates County ART children coverage 48% 59 23 National ART children coverage 42% 12,940 County ranking of ART coverage among children 18 Source: District Health *In this ART coverage ranking, the county with the highest coverage is 1, while Information System the county with the lowest coverage is 47. Source: Estimation and Projection Package

86 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 686 adults and 132 children died of AIDS-related Table 4: Meru orphans and social welfare indicators Orphans and vulnerable children Estimates conditions in 2013 in Meru County. beneficiaries Antiretroviral drugs can substantially Households with an orphan* 27,080 Poor households with an orphan** 13,269 reduce AIDS-related deaths. If used 2,936 properly, antiretroviral therapy Source: UNICEF, 2012; National Census, 2009* AssumingCash transfer 49% of beneficiary population living households*** below poverty line (absolut poor)** (ART) can also lower a person’s CT-OVC Households at July 2012 taken from CT-*** viral load and prevent onward • Only 22 per cent of poor households with orphans are beneficiaries of a cash transfer programme. transmission of HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 87

Section 1: HIV Burden in Migori

County Rongo

Table 1: HIV burden in Migori Sori Rank* Rongo Awendo Total population (2013) 1002499 32

HIV adult prevalence (overall) 14.7% 44 Muhuru Bay Migori Number of adults living with HIV 77,700 43 Migori Number of children living with HIV 10,705 43

Total number of people living with HIV 88,405 43 Density people Kehancha per km2 Kuria West *In this HIV burden and indicator ranking (Table 2), the highest burden county is 288 47 while the lowest burden county is 1. 384 435 442 Kuria East Urban centres with population The HIV prevalence among women in Migori County of more than 2,000 people is higher (15.7%) than that of men (13.6%). Over the years, the women living in the county have been more vulnerable to HIV infection than the men.

Figure 1: Prevalence of HIV by gender in Migori County

19.5 HIV counseling and testing and linkage to care and 20 18.5 treatment are important steps in reducing the sexual 17.5 17.5 16.6 15.9 transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and 15 treatment, about 73 per cent of people in Migori 12.5 County had never tested for HIV by 2009. 10 Male 10 Female There is a need to scale up HIV testing in the county, 7.5 to counsel and reduce the risk for those who test 5 negative, and to link those who test positive to care

HIV prevalence (%) HIV prevalence 2.5 and treatment programmes.

0 2003 2007 2009 Figure 2: Percentage of adults enrolling for HIV care Source: Kenya Demographic and Health Survey and KAIS by entry point in Migori County Year of survey 175 Section 2: Reducing Sexual 150 Transmission of HIV 125 100 Table 2: Migori County HIV indicators 75 Annual County National ranking estimates 50 New adult HIV infections 6,786 44 88,620 25 annually Source: Kenya HIV Estimates Report, 2014 0 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

88 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Migori County, low condom use may pose a significant risk of HIV infection to the 2% 30% 57% 25% population. 100 80 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 60 cent. Most communities in Migori County traditionally 40 circumcise men, with over 91 per cent of men who participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally 0 circumcising communities, the practice should be 98% 70% 43% 75% carried out under safe and hygienic conditions and

encouraged before sexual debut. Infant delivery Maternal prophylaxis In Migori County, approximately 55 per cent of prophylaxis Medical facility Identi�ied HIV+ individuals had their first experience of sexual women pregnant No intercourse before the age of 15, an indication of early Yes sexual debut.

• 57% of HIV-positive pregnant women in Migori Section 3: Elimination of Mother-to- County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Migori County There were about 5,262 pregnant women living with HIV in Migori County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and Section 4: Expanding Access to development. Providing antiretroviral medicines to Treatment mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Table 3: Migori County HIV treatment access annually rates. Kenya has committed to eliminating new HIV Indicator infections among children by 2015, while keeping their mothers alive. Adults in need of ART 39,147 Adults receiving ART 34,927 County ART adult coverage 89% National ART adult coverage 79% New HIV infections annually County ranking of ART coverage among adults* 15 among children Indicator Children in need of ART 8,419 Children receiving ART 3,136 Migori County County ART children coverage 37% National National ART children coverage 42% County ranking estimates County ranking of ART coverage among children 25 1,506 44 *In this ART coverage ranking, the county with the highest coverage is 1, while 12,940 the county with the lowest coverage is 47. Source: Estimation and Projection Package Source: District Health Infor- mation System

kenya HIV AND AIDS PROFILE by County 89 Section 5: Orphans and Social Welfare Approximately 1,876 adults and 682 children died of AIDS- Table 4: Migori orphans and social welfare indicators Orphans and vulnerable children Estimates related conditions in 2013 in beneficiaries Migori County. Antiretroviral drugs Households with an orphan* 44,951 Poor households with an orphan** 22,026 can substantially reduce AIDS- 6,135 related deaths. If used properly, Source: UNICEF, 2012; National Census, 2009* AssumingCash transfer 49% of beneficiary population living households*** below poverty line (absolut poor)** antiretroviral therapy (ART) can CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and

• Only 28 per cent of poor households with orphans prevent onward transmission of are beneficiaries of a cash transfer programme. HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

90 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Mombasa County

Table 1: HIV burden in Mombasa Mtwapa Kilindini Rank* Mombasa Total population (2013) 1,068,307 38

HIV adult prevalence (overall) 7.4% 40 Kilindini Number of adults living with HIV 47,800 39 Number of children living with HIV 6,870 39 Mombasa Total number of people living with HIV 54,670 39 *In this HIV burden and indicator ranking (Table 2), the highest burden county is Mombasa Density people 47 while the lowest burden county is 1. per km2 4144

Kilindini 4493 Urban centres with population The HIV prevalence among women in Mombasa of more than 2,000 people County is higher (10.5%) than that of men (4.5%). Over the years, the women living in the county have been more vulnerable to HIV infection than the men.

Figure 1: Prevalence of HIV by gender in Mombasa HIV counseling and testing and linkage to care and County treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 20 of HIV testing as a way to increase prevention and 17.5 treatment, about 73 per cent of people in Mombasa

15 13.8 County had never tested for HIV by 2009.

12.5 There is a need to scale up HIV testing in the county, 10.5 9.2 10 8.6 to counsel and reduce the risk for those who test 8.1 negative, and to link those who test positive to care 7.5 5.4 and treatment programmes. 5 4.5

HIV prevalence (%) HIV prevalence 1.9 2.5 Figure 2: Percentage of adults enrolling for HIV care 0 by entry point in Mombasa County 2003 2007 2009 2013 Source: Kenya Demographic and Health Survey and KAIS 60 Year of survey Male Female 50

Section 2: Reducing Sexual 40 Transmission of HIV 30

Table 2: Mombasa County HIV indicators 20 Annual County National ranking estimates 10 New adult HIV infections 1,609 32 88,620 annually 0 Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 91 Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Mombasa County, low condom use may pose a significant risk of HIV infection 36% 76% 38% 78% to the population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 60 per cent. Most communities in Mombasa County traditionally circumcise men, with over 91 percent of 40 men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 64% 24% 62% 22% should be carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Mombasa County, approximately 55 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+ pregnant women pregnant intercourse before the age of 15, an indication of early No Yes sexual debut.

• 71% of pregnant women living with HIV in Mombasa Section 3: Elimination of Mother-to- County did not deliver in a health facility Child Transmission • Only 56 per cent of pregnant women attend the recommended four antenatal visits in Mombasa There were about 2,586 pregnant women living County with HIV in Mombasa County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and Section 4: Expanding Access to development. Providing antiretroviral medicines to Treatment mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Table 3: Mombasa County HIV treatment access rates. Kenya has committed to eliminating new HIV annually infections among children by 2015, while keeping their Indicator mothers alive. Adults in need of ART 27,168 Adults receiving ART 26,490 County ART adult coverage 98% New HIV infections annually National ART adult coverage 79% among children County ranking of ART coverage among adults* 7

Indicator Mombasa County National Children in need of ART 4,817 County ranking Children receiving ART 1,995 estimates County ART children coverage 41% 171 38 National ART children coverage 42% 12,940 County ranking of ART coverage among children 22 Source: District Health Infor- *In this ART coverage ranking, the county with the highest coverage is 1, while mation System the county with the lowest coverage is 47. Source: Estimation and Projection Package

92 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 2,000 adults and 351 children died of AIDS-related Table 4: Mombasa orphans and social welfare indicators conditions in 2013 in Mombasa Orphans and vulnerable children Estimates County. Antiretroviral drugs beneficiaries Households with an orphan* 21,546 can substantially reduce AIDS- Poor households with an orphan** 10,557 related deaths. If used properly, 1,905 Source: UNICEF, 2012; National Census, 2009* antiretroviral therapy (ART) can AssumingCash Transfer 49% of beneficiarypopulation living households*** below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load

• Only 18 percent of poor households with orphans and prevent onward transmission are beneficiaries of a cash transfer programme. of HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 93 Murang’a County

Section 1: HIV Burden in Murang’a County Kiriaini

Sagana Table 1: HIV burden in Murang’a Murang’a North Murang’a Rank*

Maragua Total population (2013) 1022427 34 Kangari HIV adult prevalence (overall) 5.2% 31 Murang’a South Gatanga Number of adults living with HIV 28,700 36

Number of children living with HIV 2,881 24 Total number of people living with HIV 31,581 36 Density people *In this HIV burden and indicator ranking (Table 2), the highest burden county is per km2 47 while the lowest burden county is 1. 362 370 The HIV prevalence among women in Murang’a 422 Urban centres with population County is higher (7.7%) than that of men (2.8%). Over of more than 2,000 people the years, the women living in the county have been more vulnerable to HIV infection than the men.

HIV counseling and testing and linkage to care and Figure 1: Prevalence of HIV by gender in Murang’a treatment are important steps in reducing the sexual County transmission of HIV. Despite the importance of HIV testing as a way to increase prevention and treatment, 9.8 about 73 per cent of people in Murang’a County had 9 never tested for HIV by 2009.

8 There is a need to scale up HIV testing in the county, 7 to counsel and reduce the risk for those who test 6 negative, and to link those who test positive to care

5 4.6 and treatment programmes. 4.3 Male 4 Female 3 Figure 2: Percentage of adults enrolling for HIV care by entry point in Murang’a County 2 1.4 1.2

HIV prevalence (%) HIV prevalence 0.7 1

0 105 2003 2007 2009 90 Source: Kenya Demographic and Health Survey and KAIS Year of survey 75 60 Section 2: Reducing Sexual 45 Transmission of HIV 30 15

Table 2: Murang’a County HIV indicators 0 Annual County National Overall

ranking estimates Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention New adult HIV infections 1,984 37 88,620 Medical ward mother-to-child annually Source: Kenya HIV Estimates Report, 2014 Point of entry to care Source: District Health Information System

94 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Murang’a County, low condom use may pose a significant risk of HIV infection 16% 54% 88% 58% to the population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 60 per cent. Most communities in Murang’a County traditionally circumcise men, with over 91 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 84% 46% 22% 42% should be carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Murang’a County, approximately 55 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+ pregnant women pregnant No intercourse before the age of 15, an indication of early Yes sexual debut.

• 78% of HIV-positive pregnant women in Murang’a Section 3: Elimination of Mother-to- County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Murang’a County There were about 851 pregnant women living with HIV in Murang’a County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and Section 4: Expanding Access to development. Providing antiretroviral medicines to Treatment mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Table 3: Murang’a County HIV treatment access rates. Kenya has committed to eliminating new HIV annually infections among children by 2015, while keeping their Indicator mothers alive. Adults in need of ART 16,074 Adults receiving ART 7,177 County ART adult coverage 45% New HIV infections annually National ART adult coverage 79% among children County ranking of ART coverage among adults* 38

Indicator Murang’a County Children in need of ART 2,058 County ranking National Children receiving ART 656 estimates County ART children coverage 32% 65 26 National ART children coverage 42% County ranking of ART coverage among children 29 Source: District Health 12,940 *In this ART coverage ranking, the county with the highest coverage is 1, while Information System the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 95 Section 5: Orphans and Social Welfare Approximately 817 adults and 122 children died of AIDS-related Table 4: Murang’a orphans and social welfare indicators conditions in 2013 in Murang’a Orphans and vulnerable children Estimates County. Antiretroviral drugs beneficiaries Households with an orphan* 27,992 can substantially reduce AIDS- Poor households with an orphan** 13,716 related deaths. If used properly, 4,799 Source: UNICEF, 2012; National Census, 2009* antiretroviral therapy (ART) can AssumingCash Transfer 49% of Beneficiarypopulation living households*** below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and prevent onward transmission of • Only 35 percent of poor households with orphans HIV. are beneficiaries of a cash transfer programme.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

96 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Nairobi County

Nairobi North

Table 1: HIV burden in Nairobi Westlands

Nairobi East Rank* Nairobi Total population (2013) 3781394 47 Nairobi West HIV adult prevalence (overall) 8% 43 Number of adults living with HIV 164,658 47 Number of children living with HIV 12,894 44 Total number of people living with HIV 177,552 47

*In this HIV burden and indicator ranking (Table 2), the highest burden county is Density people 47 while the lowest burden county is 1. per km2 2538 2616 The HIV prevalence among women in Nairobi County 5048 is higher (8.4%) than that of men (5.3%). Over the 5048 Urban centres with population years, the women living in the county have been more of more than 2,000 people vulnerable to HIV infection than the men.

Figure 1: Prevalence of HIV by gender in Nairobi County HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual

10.5 transmission of HIV. Despite the huge importance 9.7 of HIV testing as a way to increase prevention and 10 9 treatment, about 73 per cent of people in Nairobi 9 County had never tested for HIV by 2009. 8 6.9 7 There is a need to scale up HIV testing in the county, 6.1 5.9 6 to counsel and reduce the risk for those who test negative, and to link those who test positive to care 5 Male and treatment programmes. 4 Female

3 Figure 2: Percentage of adults enrolling for HIV care 2 by entry point in Nairobi County HIV prevalence (%) HIV prevalence 1

0 80 2003 2007 2009 70 Source: Kenya Demographic and Health Survey and KAIS Year of survey 60 50 40 Section 2: Reducing Sexual 30 Transmission of HIV 20

Table 2: Nairobi County HIV indicators 10 Annual County National 0 ranking estimates

New adult HIV infections 3,098 41 88,620 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention annually Medical ward

Source: Kenya HIV Estimates Report, 2014 mother-to-child Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 97 Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Nairobi County, low condom use may pose a significant risk of HIV infection to the 0% 0% 67% 0% population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 per 60 cent. Most communities in Nairobi County traditionally circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 100% 100% 33% 100% carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Nairobi County, approximately 55 per cent of prophylaxis Medical facility individuals had their first experience of sexual Identi�ied HIV+ pregnant women pregnant No intercourse before the age of 15, an indication of early Yes sexual debut.

• 67% of HIV-positive pregnant women in Nairobi Section 3: Elimination of Mother-to- County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Nairobi County There were about 9,807 pregnant women living with HIV in Nairobi County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and Section 4: Expanding Access to development. Providing antiretroviral medicines to Treatment mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Table 3: Nairobi County HIV treatment access rates. Kenya has committed to eliminating new HIV annually infections among children by 2015, while keeping their Indicator mothers alive. Adults in need of ART 102,103 Adults receiving ART 93,714 County ART adult coverage 92% New HIV infections annually National ART adult coverage 79% among children County ranking of ART coverage among adults* 13

Indicator Nairobi County National Children in need of ART 9,398 County ranking Children receiving ART 6,988 estimates County ART children coverage 74% 316 41 National ART children coverage 42% 12,940 County ranking of ART coverage among children 2 Source: District Health *In this ART coverage ranking, the county with the highest coverage is 1, while Information System the county with the lowest coverage is 47. Source: Estimation and Projection Package

98 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 3,579 adults and 448 children died of AIDS-related Table 4: Nairobi orphans and social welfare indicators conditions in 2013 in Nairobi Orphans and vulnerable children Estimates County. Antiretroviral drugs beneficiaries Households with an orphan* 69,730 can substantially reduce AIDS- Poor households with an orphan** 34,168 related deaths. If used properly, 2,534 antiretroviral therapy (ART) can Source: UNICEF, 2012; National Census, 2009 Cash transfer beneficiary households*** also lower a person’s viral load and

• Only 9 per cent of poor households with orphans prevent onward transmission of are beneficiaries of a cash transfer programme. HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 99

Section 1: HIV Burden in Nakuru County

Table 1: HIV burden in Nakuru Subukia Nakuru Rank* Rongai Bahati Total population (2013) 1825229 46 Nakuru Salgaa North Molo HIV adult prevalence (overall) 5.3% 32 Nakuru Number of adults living with HIV 53,700 41 Molo

Number of children living with HIV 7,898 41 Olenguruone Mau Narok Total number of people living with HIV 61,598 41 *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1. Naivasha

Density people per km2 The HIV prevalence among women in Nakuru County 124 229 is higher (7.5%) than that of men (4.5%). Over the Mai Mahiu 317 years, the women living in the county have been more 357 vulnerable to HIV infection than the men. Urban centres with population of more than 2,000 people

Figure 1: Prevalence of HIV by gender in Nakuru HIV counseling and testing and linkage to care and County treatment are important steps in reducing the sexual 8.5 8.3 8.5 transmission of HIV. Despite the importance of HIV 8 testing as a way to increase prevention and treatment, 7.1 7 about 73 per cent of people in Nakuru County had never tested for HIV by 2009. 6

5 There is a need to scale up HIV testing in the county, Male to counsel and reduce the risk for those who test 4 3.5 3.3 Female negative, and to link those who test positive to care 3 and treatment programmes. 2

HIV prevalence (%) HIV prevalence 1 Figure 2: Percentage of adults enrolling for HIV care

0 by entry point in Nakuru County 2003 2007 2009 Source: Kenya Demographic and Health Survey and KAIS 80 Year of survey 70 60 Section 2: Reducing Sexual 50 Transmission of HIV 40

Table 2: Nakuru County HIV indicators 30 Annual County National 20 ranking estimates 10 New adult HIV infections 4,127 42 88,620 annually 0 Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

100 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Nakuru County, low condom use may pose a significant risk of HIV infection to the 23% 46% 53% 32% population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 per 60 cent. Most communities in Nakuru County traditionally circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 carried out under safe and hygienic conditions and 77% 54% 47% 68% encouraged before sexual debut. Infant delivery Maternal prophylaxis In Nakuru County, approximately 55 per cent of prophylaxis Medical facility individuals had their first experience of sexual Identi�ied HIV+

pregnant women pregnant No intercourse before the age of 15, an indication of early sexual debut. Yes

• 53% of HIV-positive pregnant women in Nakuru Section 3: Elimination of Mother-to- County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the There were about 2,438 pregnant women living recommended four antenatal visits in Nakuru County with HIV in Nakuru County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to Section 4: Expanding Access to mothers throughout the breastfeeding period is critical Treatment to significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV Table 3: Nakuru County HIV treatment access infections among children by 2015, while keeping their annually mothers alive. Indicator Adults in need of ART 26,255 Adults receiving ART 16,345 New HIV infections annually among County ART adult coverage 62% children National ART adult coverage 79% County ranking of ART coverage among adults* 28

Nakuru County Indicator ranking National Children in need of ART 5,558 County Children receiving ART 1,677 estimates County ART children coverage 30% 199 40 National ART children coverage 42% 12,940 County ranking of ART coverage among children 31 Source: District Health Infor- *In this ART coverage ranking, the county with the highest coverage is 1, while mation System the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 101 Section 5: Orphans and Social Welfare Approximately 3,065 adults and 429 children died of AIDS-related Table 4: Nakuru orphans and social welfare indicators conditions in 2013 in Nakuru Orphans and vulnerable children beneficia- Estimates County. Antiretroviral drugs ries Households with an orphan* 41,771 can substantially reduce AIDS- Poor households with an orphan** 20,468 related deaths. If used properly, 3,859 Source: UNICEF, 2012; National Census, 2009* antiretroviral therapy (ART) can AssumingCash transfer 49% of beneficiary population living households*** below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and prevent onward transmission of • Only 19 per cent of poor households with orphans are beneficiaries of a cash transfer programme. HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

102 kenya HIV AND AIDS PROFILE by County Nandi County

Section 1: HIV Burden in Nandi County

Nandi North Table 1: HIV burden in Nandi Rank* Total population (2013) 857,207 25 HIV adult prevalence (overall) 3.7% 16 Nandi Central Number of adults living with HIV 16,300 21 Number of children living with HIV 2,397 21

Total number of people living with HIV 18,697 20 Nandi Hills Nandi East *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1. Nandi South

Tinderet The HIV prevalence among women in Nandi County Density people is higher (5.2%) than that of men (3.1%). Over the per km2 203 years, the women living in the county have been more 223 228 vulnerable to HIV infection than the men. 301 328 Urban centres with population Figure 1: Prevalence of HIV by gender in Nandi of more than 2,000 people County

10.6 HIV counseling and testing and linkage to care and 10.1 10 treatment are important steps in reducing the sexual transmission of HIV. Despite the importance of HIV 9 testing as a way to increase prevention and treatment, 8 about 73 per cent of people in Nandi County had 7 never tested for HIV by 2009. 6

5 4.5 Male There is a need to scale up HIV testing in the county, to counsel and reduce the risk for those who test 4 Female 2.9 negative, and to link those who test positive to care 3 and treatment programmes. 2 HIV prevalence (%) HIV prevalence 1 Figure 2: Percentage of adults enrolling for HIV care 0 by entry point in Nandi County 2003 2007 2009 Source: Kenya Demographic and Health Survey and KAIS 80 Year of survey 70 60 Section 2: Reducing Sexual 50 Transmission of HIV 40 30 Table 2: Nandi County HIV indicators 20 Annual County National ranking estimates 10 New adult HIV infections 1,253 28 88,620 0 annually

Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 103 Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Nandi County, low condom use may pose a significant risk of HIV infection to the 34% 43% 86% 58% population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 per 60 cent. Most communities in Nandi County traditionally circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 carried out under safe and hygienic conditions and 66% 57% 14% 42% encouraged before sexual debut. Infant delivery Maternal prophylaxis In Nandi County, approximately 55 per cent of prophylaxis Medical facility individuals had their first experience of sexual Identi�ied HIV+ intercourse before the age of 15, an indication of early women pregnant No sexual debut. Yes

• 86% of HIV-positive pregnant women in Nandi Section 3: Elimination of Mother-to- County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the There were about 632 pregnant women living with HIV recommended four antenatal visits in Nandi County in Nandi County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers Section 4: Expanding Access to throughout the breastfeeding period is critical to Treatment significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV Table 3: Nandi County HIV treatment access annually infections among children by 2015, while keeping their Indicator mothers alive. Adults in need of ART 7,969 Adults receiving ART 6,507 County ART adult coverage 82% New HIV infections annually National ART adult coverage 79% County ranking of ART coverage among adults* 19 among children Indicator Nandi County Children in need of ART 1,687 National Children receiving ART 664 County ranking estimates County ART children coverage 39% 60 24 National ART children coverage 42% 12,940 County ranking of ART coverage among children 23 *In this ART coverage ranking, the county with the highest coverage is 1, while Source: District Health Infor- the county with the lowest coverage is 47. mation System Source: Estimation and Projection Package

104 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 930 adults and 130 children died of AIDS-related Table 4: Nandi orphans and social welfare indicators Orphans and vulnerable children Estimates conditions in 2013 in Nandi County. beneficiaries Antiretroviral drugs can substantially Households with an orphan* 17,156 Poor households with an orphan** 8,407 reduce AIDS-related deaths. If used 2,474 properly, antiretroviral therapy Source:Cash TransferUNICEF, 2012; beneficiary National households*** Census, 2009 (ART) can also lower a person’s viral load and prevent onward • Only 29 per cent of poor households with orphans are beneficiaries of a cash transfer programme. transmission of HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 105

Section 1: HIV Burden in Narok County

Table 1: HIV burden in Narok

Rank* Njabini Total population (2013) 968,390 30 HIV adult prevalence (overall) 5% 28 Narok North Nairagie Narok Number of adults living with HIV 23,500 28 Transmara Number of children living with HIV 3,456 30 Lolgorian Total number of people living with HIV 26,956 29 Narok South *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

Density people per km2 The HIV prevalence among women in Narok County 31 is higher (7.1%) than that of men (4.3%). Over the 55 96 years, the women living in the county have been more Urban centres with population vulnerable to HIV infection than the men. of more than 2,000 people

HIV counseling and testing and linkage to care and Figure 1: Prevalence of HIV by gender in Narok treatment are important steps in reducing the sexual County transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and treatment, about 73 per cent of people in Narok 17.5 County had never tested for HIV by 2009. 15 12.5 There is a need to scale up HIV testing in the county, 12.5 Male to counsel and reduce the risk for those who test 10 Female negative, and to link those who test positive to care 7.5 6.3 and treatment programmes. 5 4.6 3.2

HIV prevalence (%) HIV prevalence 2.2 2.5 Figure 2: Percentage of adults enrolling for HIV care by entry point in Narok County 0 2003 2007 2009 Source: Kenya Demographic and Health Survey and KAIS 80 Year of survey 70 60 Section 2: Reducing Sexual 50 Transmission of HIV 40 30 Table 2: Narok County HIV indicators 20 Annual County National ranking estimates 10 New adult HIV infections 1,806 33 88,620 0 annually

Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

106 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Narok County, low condom use may pose a significant risk of HIV infection to the 7% 68% 80% 66% population. 100 80 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per 60 cent. Most communities in Narok County traditionally 40 circumcise men, with over 91 per cent of men who participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally 0 circumcising communities, the practice should be 93% 32% 20% 34% carried out under safe and hygienic conditions and

encouraged before sexual debut. Infant delivery Maternal prophylaxis In Narok County, approximately 55 per cent of prophylaxis Medical facility Identi�ied HIV+ individuals had their first experience of sexual women pregnant No intercourse before the age of 15, an indication of early Yes sexual debut.

• 80% of HIV-positive pregnant women in Narok Section 3: Elimination of Mother-to- County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the There were about 1279 pregnant women living recommended four antenatal visits in Narok County with HIV in Narok County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to Section 4: Expanding Access to mothers throughout the breastfeeding period is critical Treatment to significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV Table 3: Narok County HIV treatment access annually infections among children by 2015, while keeping their Indicator mothers alive. Adults in need of ART 11,490 Adults receiving ART 4,351 County ART adult coverage 38% New HIV infections annually among National ART adult coverage 79% children County ranking of ART coverage among adults* 41

Indicator Narok County Children in need of ART 2,432 National Children receiving ART 296 County ranking estimates County ART children coverage 12% 87 31 National ART children coverage 42% 12,940 County ranking of ART coverage among children 43 *In this ART coverage ranking, the county with the highest coverage is 1, while Source: District Health Infor- the county with the lowest coverage is 47. mation System Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 107 Section 5: Orphans and Social Welfare Approximately 1,341 adults and 188 children died of AIDS- Table 4: Narok orphans and social welfare indicators Orphans and vulnerable children Estimates related conditions in 2013 in beneficiaries Narok County. Antiretroviral drugs Households with an orphan* 18,021 Poor households with an orphan** 8,830 can substantially reduce AIDS- 3,058 related deaths. If used properly, Source: UNICEF, 2012; National Census, 2009* AssumingCash Transfer 49% of Beneficiarypopulation living Households*** below poverty line (absolut poor)** antiretroviral therapy (ART) can CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and • Only 35 per cent of poor households with orphans prevent onward transmission of are beneficiaries of a cash transfer programme. HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

108 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Nyamira County

Table 1: HIV burden in Nyamira Rank* Nyamira Total population (2013) 653,914 19 Nyamira

HIV adult prevalence (overall) 6.4% 38

Number of adults living with HIV 23,500 29

Number of children living with HIV 3,238 28

Total number of people living with HIV 26,738 28 Manga *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

Borabu Keroka

The HIV prevalence among women in Nyamira County Density people is higher (6.8%) than that of men (5.8%). Over the per km2 296 Nyansiongo years, the women living in the county have been more 789 818 vulnerable to HIV infection than the men. Urban centres with population of more than 2,000 people Figure 1: Prevalence of HIV by gender in Nyamira County HIV counseling and testing and linkage to care and

17.5 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 15 of HIV testing as a way to increase prevention and 12.5 11.1 treatment, about 73 per cent of people in Nyamira Male County had never tested for HIV by 2009. 10 7.5 Female 7.5 There is a need to scale up HIV testing in the county, 5.3 5 to counsel and reduce the risk for those who test

HIV prevalence (%) HIV prevalence 2.3 negative, and to link those who test positive to care 2.5 and treatment programmes. 0 2003 2007 2009 Source: Kenya Demographic and Health Survey and KAIS Figure 2: Percentage of adults enrolling for HIV care by entry point in Nyamira County Year of survey

100 Section 2: Reducing Sexual 80 Transmission of HIV 60 40 Table 2: Nyamira County HIV indicators 20 Annual County National 0 ranking estimates New adult HIV infections 2,052 38 88,620 Overall

annually Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Source: Kenya HIV Estimates Report, 2014 Medical ward mother-to-child Point of entry to care

Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 109 Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Nyamira County, low condom use may pose a significant risk of HIV infection 42% 51% 64% 50% to the population. 100

Male circumcision reduces the risk of female-to- 80 male transmission of HIV infection by approximately 60 60 per cent. Most communities in Nyamira County traditionally circumcise men, with over 91 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 58% 49% 36% 50% should be carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Nyamira County, approximately 55 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+ pregnant women pregnant No intercourse before the age of 15, an indication of early sexual debut. Yes

Section 3: Elimination of Mother-to- • 64% of HIV-positive pregnant women in Nyamira Child Transmission County do not deliver in a health facility

There were about 942 pregnant women living with • Only 41 per cent of pregnant women attend the HIV in Nyamira County in 2013. HIV is most often recommended four antenatal visits in Nyamira County transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Section 4: Expanding Access to to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Nyamira County HIV treatment access mothers alive. annually Indicator Adults in need of ART 11,840 New HIV infections annually among Adults receiving ART 6,886 County ART adult coverage 58% children National ART adult coverage 79% County ranking of ART coverage among adults* 30

Nyamira County Indicator National Children in need of ART 2,546 County ranking estimates Children receiving ART 972 County ART children coverage 38% 455 42 National ART children coverage 42% 12,940 County ranking of ART coverage among children 24

Source: District Health Infor- *In this ART coverage ranking, the county with the highest coverage is 1, while mation System the county with the lowest coverage is 47. Source: Estimation and Projection Package

110 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 567 adults and 206 children died of AIDS-related Table 4: Nyamira orphans and social welfare indicators conditions in 2013 in Nyamira Orphans and vulnerable children beneficia- Estimates County. Antiretroviral drugs ries Households with an orphan* 19,416 can substantially reduce AIDS- Poor households with an orphan** 9,514 related deaths. If used properly, 2,081 antiretroviral therapy (ART) can Source: UNICEF, 2012; National Census, 2009 Cash Transfer Beneficiary households*** also lower a person’s viral load and • Only 22 per cent of poor households with orphans are beneficiaries of a cash transfer programme. prevent onward transmission of HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 111 Nyandarua County

Section 1: HIV Burden in Nyandarua County

Mairo-inya Table 1: HIV burden in Nyandarua Rank* Nyandarua North Total population (2013) 646,876 18

HIV adult prevalence (overall) 3.8% 18 Ol kalau Number of adults living with HIV 13,000 18 Number of children living with HIV 1,305 13 Total number of people living with HIV 14,305 18 *In this HIV burden and indicator ranking (Table 2), the highest burden county is Nyandarua South 47 while the lowest burden county is 1. Engineer

Population Density per km2 The HIV prevalence among women in Nyandarua 29 55 County is higher (5.6%) than that of men (2.0%). Over 66 the years, the women living in the county have been 72 Urban centres with population more vulnerable to HIV infection than the men. of more than 2,000 people

Figure 1: Prevalence of HIV by gender in Nyandarua County HIV counseling and testing and linkage to care and

8 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 7 of HIV testing as a way to increase prevention and 6 treatment, about 73 per cent of people in Nyandarua County had never tested for HIV by 2009. 5 4.1 3.8 4 Male 4 3.3 There is a need to scale up HIV testing in the county, 2.9 Female 3 2.6 to counsel and reduce the risk for those who test negative, and to link those who test positive to care 2 and treatment programmes. HIV prevalence (%) HIV prevalence 1

0 Figure 2: Percentage of adults enrolling for HIV care 2003 2007 2009 by entry point in Nyandarua County Source: Kenya Demographic and Health Survey and KAIS Year of survey 40 35 Section 2: Reducing Sexual 30 Transmission of HIV 25 20 Table 2: Nyandarua County HIV indicators 15 Annual County National ranking estimates 10 New adult HIV infections 899 23 88,620 5 annually 0 Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

112 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Nyandarua County, low condom use may pose a significant risk of HIV infection 0% 45% 66% 36% to the population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 60 per cent. Most communities in Nyandarua County traditionally circumcise men, with over 91 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 should be carried out under safe and hygienic 100% 55% 34% 64% conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Nyandarua County, approximately 55 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+

pregnant women pregnant No intercourse before the age of 15, an indication of early Yes sexual debut.

Section 3: Elimination of Mother-to- • 66% of HIV-positive pregnant women in Nyandarua Child Transmission County do not deliver in a health facility

There were about 478 pregnant women living with • Only 41 per cent of pregnant women attend the HIV in Nyandarua County in 2013. HIV is most recommended four antenatal visits in Nyandarua often transmitted from a mother to her child during County pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Section 4: Expanding Access to to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Nyandarua County HIV treatment access mothers alive. annually Indicator Adults in need of ART 7,281 New HIV infections annually among Adults receiving ART 5,596 County ART adult coverage 77% children National ART adult coverage 79% County ranking of ART coverage among adults* 21

Nyandarua County Indicator National County ranking Children in need of ART 932 estimates Children receiving ART 592 29 14 County ART children coverage 63% 12,940 National ART children coverage 42% County ranking of ART coverage among children 9

Source: District Health Infor- *In this ART coverage ranking, the county with the highest coverage is 1, while mation System the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 113 Section 5: Orphans and Social Welfare Approximately 370 adults and 55 children died of AIDS-related Table 4: Nyandarua orphans and social welfare indicators conditions in 2013 in Nyandarua Orphans and vulnerable children Estimates County. Antiretroviral drugs beneficiaries Households with an orphan* 17,030 can substantially reduce AIDS- Poor households with an orphan** 8,345 related deaths. If used properly, 2,081 Source: UNICEF, 2012; National Census, 2009* antiretroviral therapy (ART) can AssumingCash transfer 49% of beneficiary population living households*** below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and

• Only 25 per cent of poor households with orphans prevent onward transmission of are beneficiaries of a cash transfer programme. HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

114 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Nyeri County

Naro Moru Table 1: HIV burden in Nyeri Rank*

Total population (2013) 752,469 22 Nyeri North HIV adult prevalence (overall) 4.3% 22 Endarasha Mweiga Number of adults living with HIV 18,900 24 Number of children living with HIV 1,897 18 Nyeri

Total number of people living with HIV 20,797 22

*In this HIV burden and indicator ranking (Table 2), the highest burden county is Nyeri South 47 while the lowest burden county is 1. Othaya

Density people The HIV prevalence among women in Nyeri County per km2 142 is higher (6.3%) than that of men (2.3%). Over the 351 years, the women living in the county have been more Urban centres with population of more than 2,000 people vulnerable to HIV infection than the men.

Figure 1: Prevalence of HIV by gender in Nyeri County HIV counseling and testing and linkage to care and 10.2 treatment are important steps in reducing the sexual 10 transmission of HIV. Despite the huge importance 9 of HIV testing as a way to increase prevention and 8 treatment, about 73 per cent of people in Nyeri

7 County had never tested for HIV by 2009.

6 5.5 There is a need to scale up HIV testing in the county, Male 5 to counsel and reduce the risk for those who test 4 3.2 Female negative, and to link those who test positive to care 3 3 2.5 2.3 and treatment programmes. 2 HIV prevalence (%) HIV prevalence 1 Figure 2: Percentage of adults enrolling for HIV care 0 by entry point in Nyeri County 2003 2007 2009 Source: Kenya Demographic and Health Survey and KAIS 80 Year of survey 70 60 Section 2: Reducing Sexual 50 Transmission of HIV 40 30

Table 2: Nyeri County HIV indicators 20 Annual County National 10 ranking estimates 0 New adult HIV infections 1,307 29 88,620 annually Overall

Source: Kenya HIV Estimates Report, 2014 Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 115 Consistent and proper use of condoms can reduce the Figure 3: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Nyeri County, low condom use may pose a significant risk of HIV infection to the 0% 31% 66% 16% population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 per 60 cent. Most communities in Nyeri County traditionally circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 carried out under safe and hygienic conditions and 100% 69% 34% 84% encouraged before sexual debut. Infant delivery Maternal prophylaxis In Nyeri County, approximately 55 per cent of prophylaxis Medical facility individuals had their first experience of sexual Identi�ied HIV+ pregnant women pregnant No intercourse before the age of 15, an indication of early sexual debut. Yes

• 66% of HIV-positive pregnant women in Nyeri Section 3: Elimination of Mother-to- County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the There were about 982 pregnant women living with HIV recommended four antenatal visits in Nyeri County in Nyeri County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers Section 4: Expanding Access to throughout the breastfeeding period is critical to Treatment significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV Table 3: Nyeri County HIV treatment access annually infections among children by 2015, while keeping their Indicator mothers alive. Adults in need of ART 10,586 Adults receiving ART 10,471 County ART adult coverage 99% New HIV infections annually National ART adult coverage 79% among children County ranking of ART coverage among adults* 6

Indicator Children in need of ART 1,355 Nyeri County Children receiving ART 924 National County ranking County ART children coverage 68% estimates National ART children coverage 42% 43 19 County ranking of ART coverage among children 5 12,940 *In this ART coverage ranking, the county with the highest coverage is 1, while Source: District Health the county with the lowest coverage is 47. Information System Source: Estimation and Projection Package

116 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 538 adults and 80 children died of AIDS-related Table 4: Nyeri orphans and social welfare indicators Orphans and vulnerable children beneficia- Estimates conditions in 2013 in Nyeri County. ries Antiretroviral drugs can substantially Households with an orphan* 19,948 Poor households with an orphan** 9,774 reduce AIDS-related deaths. If used 3,052 properly, antiretroviral therapy Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009 (ART) can also lower a person’s viral load and prevent onward • Only 31 per cent of poor households with orphans are beneficiaries of a cash transfer programme. transmission of HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 117 Samburu County

Section 1: HIV Burden in Samburu County

Table 1: HIV burden in Samburu

Rank* Samburu North Total population (2013) 254,997 3 HIV adult prevalence (overall) 5.0% 29 Number of adults living with HIV 6,000 9 Number of children living with HIV 883 7 Total number of people living with HIV 6,883 9

Samburu East *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1. Samburu Central Wamba

The HIV prevalence among women in Samburu County Density people Archers Post is higher (7.1%) than that of men (4.3%). Over the per km2 6 years, the women living in the county have been more 9 vulnerable to HIV infection than the men. 27 Urban centres with population of more than 2,000 people Figure1: Prevalence of HIV by gender in Nyeri County

10.2 10 HIV counseling and testing and linkage to care and 9 treatment are important steps in reducing the sexual 8 transmission of HIV. Despite the huge importance

7 of HIV testing as a way to increase prevention and treatment, about 73 per cent of people in Samburu 6 5.5 County had never tested for HIV by 2009. 5 Male

4 3.2 Female There is a need to scale up HIV testing in the county, 3 3 2.5 2.3 to counsel and reduce the risk for those who test 2 negative, and to link those who test positive to care HIV prevalence (%) HIV prevalence 1 and treatment programmes.

0 2003 2007 2009 Figure 2: Percentage of adults enrolling for HIV care Source: Kenya Demographic and Health Survey and KAIS by entry point in Samburu County Year of survey

Section 2: Reducing Sexual 100 Transmission of HIV 80 60 Table 2: Samburu County HIV indicators Annual County National 40 ranking estimates 20 New adult HIV infections 461 15 88,620 0 annually Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care

Source: District Health Information System

118 kenya HIV AND AIDS PROFILE by County Figure 3: Prevention of mother-to-child transmission Consistent and proper use of condoms can reduce the uptake risk of HIV and other sexually transmitted infections by more than 90 per cent. In Samburu County, low condom use may pose a significant risk of HIV infection 70% 86% 66% 83% to the population. 100

Male circumcision reduces the risk of female-to- 80 male transmission of HIV infection by approximately 60 60 per cent. Most communities in Samburu County traditionally circumcise men, with over 91 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 should be carried out under safe and hygienic 30% 14% 34% 17% conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Samburu County, approximately 58 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+ intercourse before the age of 15, an indication of early women pregnant No Yes sexual debut.

Section 3: Elimination of Mother-to- • 74 % of HIV-positive pregnant women in Samburu Child Transmission County do not deliver in a health facility

There were about 344 HIV-positive pregnant women in • Only 43 per cent of pregnant women attend the Samburu County in 2011. HIV is most often transmitted recommended four antenatal visits in Samburu from a mother to her child during pregnancy, County delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical to Section 4: Expanding Access to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Samburu County HIV treatment access mothers alive. annually Indicator Adults in need of ART 2,934 New HIV infections annually among Adults receiving ART 700 County ART adult coverage 24% children National ART adult coverage 79% County ranking of ART coverage among adults* 45 Samburu County National Indicator County ranking estimates Children in need of ART 621 Children receiving ART 55 51 6 County ART children coverage 9% 13,175 National ART children coverage 42% Source: District Health Infor- mation System County ranking of ART coverage among children 45

*In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 119 Section 5: Orphans and Social Welfare Approximately 200 adults and 50 children died of AIDS-related Table 4: Samburu orphans and social welfare indicators conditions in 2011 in Samburu Orphans and vulnerable children Estimates County. Antiretroviral drugs beneficiaries Households with an orphan* 7,757 can substantially reduce AIDS- Poor households with an orphan** 3,801 related deaths. If used properly, 2,197 Source: UNICEF, 2012; National Census, 2009* antiretroviral therapy (ART) can AssumingCash transfer 49% of beneficiary population living households*** below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and

• Only 58 per cent of poor households with orphans prevent onward transmission of are beneficiaries of a cash transfer programme. HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

120 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Siaya County

Table 1: HIV burden in Siaya Ukwala Rank* Siaya Total population (2013) 920,671 27 Yala Siaya HIV adult prevalence (overall) 23.7% 46 Number of adults living with HIV 113,000 44

Number of children living with HIV 15,568 45 Usenge Ndori Total number of people living with 128,568 44 Bondo Bondo HIV

*In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

Rarieda Density people per km2 The HIV prevalence among women in Siaya County 266 is higher (25.3%) than that of men (21.8%). Over the 334 359 years, the women living in the county have been more Urban centres with population of more than 2,000 people vulnerable to HIV infection than the men.

Figure 2: Prevalence of HIV by gender in Siaya County

HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual 30 transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and 25 24.4 23.3 treatment, about 73 per cent of people in Siaya 20.7 19.7 County had never tested for HIV by 2009. 20 Male 15.9 14.6 15 Female There is a need to scale up HIV testing in the county, to counsel and reduce the risk for those who test 10 negative, and to link those who test positive to care

HIV prevalence (%) HIV prevalence 5 and treatment programmes.

0 2003 2007 2009 Figure 3: Percentage of adults enrolling for HIV care Source: Kenya Demographic and Health Survey and KAIS by entry point in Siaya County

Year of survey 120

100 Section 2: Reducing Sexual 80 Transmission of HIV 60 Table 2: Siaya County HIV indicators 40 Annual County National 20 ranking estimates 0 New adult HIV 9,869 45 88,620 infections annually Overall

Source: Kenya HIV Estimates Report, 2014 Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 121 Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Siaya County, low condom use may pose a significant risk of HIV infection to the population. 14% 29% 55% 21% 100 Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 per cent. Most communities in Siaya County traditionally 60 circumcise men, with over 91 per cent of men who participated in a national survey in 2009 reporting 40 that they had been circumcised. Even in traditionally 20 circumcising communities, the practice should be carried out under safe and hygienic conditions and 0 86% 71% 45% 79% encouraged before sexual debut. Infant

In Siaya County, approximately 55 per cent of delivery Maternal prophylaxis individuals had their first experience of sexual prophylaxis Medical facility intercourse before the age of 15, an indication of early Identi�ied HIV+ sexual debut. women pregnant No Yes

Section 3: Elimination of Mother- • 55% of HIV-positive pregnant women in Siaya to-Child Transmission County do not deliver in a health facility • Only 41 per cent of pregnant women attend There were about 6,692 pregnant women living the recommended four antenatal visits in Siaya with HIV in Siaya County in 2013. HIV is most often County transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to Section 4: Expanding Access to mothers throughout the breastfeeding period is critical Treatment to significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV Table 3: Siaya County HIV treatment access annually infections among children by 2015, while keeping their mothers alive. Indicator Adults in need of ART 56,932 New HIV infections annually Adults receiving ART 46,413 among children County ART adult coverage 82% National ART adult coverage 79% County ranking of ART coverage among adults* 20 Siaya County County National Indicator ranking Children in need of ART 12,244 estimates Children receiving ART 5,285 2,190 45 County ART children coverage 43% 12,940 National ART children coverage 42% Source: District Health County ranking of ART coverage among children 20 Information System *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

122 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Approximately 2,728 adults and Welfare 992 children died of AIDS-related

Table 4: Siaya orphans and social welfare indicators conditions in 2013 in Siaya County. Antiretroviral drugs can substantially Orphans and vulnerable children beneficiaries Estimates Households with an orphan* 54,323 reduce AIDS-related deaths. If used Poor households with an orphan** 26,618 properly, antiretroviral therapy 6,249 (ART) can also lower a person’s Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** viral load and prevent onward CT-OVC Households at July 2012 taken from CT-*** transmission of HIV.

• Only 24 per cent of poor households with orphans are beneficiaries of a cash transfer programme.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25. Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 123 TAITA TAVETA County

Section 1: HIV Burden in Taita Taveta County

Table 1: HIV burden in Taita Taveta Rank* Total population (2013) 323,867 6 HIV adult prevalence (overall) 6.1% 37 Number of adults living with HIV 9,800 15 Taveta Taveta Mwatate Number of children living with HIV 1,409 16 Total number of people living with HIV 11,209 15 Taita *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1. Density people per km2

16 The HIV prevalence among women in Taita Taveta 19 Urban centres with population County is higher (8.7%) than that of men (3.7%). Over of more than 2,000 people the years, the women living in the county have been more vulnerable to HIV infection than the men.

Figure 2: Prevalence of HIV by gender in Taita Taveta County HIV counseling and testing and linkage to care and 10.6 treatment are important steps in reducing the sexual 10 transmission of HIV. Despite the huge importance 9 of HIV testing as a way to increase prevention and 7.8 8 7.3 treatment, about 73 per cent of people in Taita Taveta 7.1 6.9 7 County had never tested for HIV by 2009. 5.9 6 There is a need to scale up HIV testing in the county, 5 Male to counsel and reduce the risk for those who test 4 Female negative, and to link those who test positive to care 3 and treatment programmes. 2 HIV prevalence (%) HIV prevalence 1 Figure 3: Percentage of adults enrolling for HIV care by 0 entry point in Taita Taveta County 2003 2007 2009 Year of survey 60

Source: Kenya Demographic and Health Survey and KAIS 50 40 Section 2: Reducing Sexual 30 Transmission of HIV 20

Table 2: Taita Taveta County HIV indicators 10 Annual County National 0 ranking estimates

New adult HIV infections 330 12 88,620 Overall

annually Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Source: Kenya HIV Estimates Report, 2014 Medical ward mother-to-child

Point of entry to care Source: District Health Information System

124 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Taita Taveta County, low condom use may pose a significant risk of HIV infection to the population. 35% 39% 65% 50% 100 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 80 per cent. Most communities in Taita Taveta County 60 traditionally circumcise men, with over 91 per cent of men who participated in a national survey in 2009 40 reporting that they had been circumcised. Even in 20 traditionally circumcising communities, the practice should be carried out under safe and hygienic 0 65% 61% 35% 50% conditions and encouraged before sexual debut. Infant delivery

In Taita Taveta County, approximately 55 per cent Maternal prophylaxis of individuals had their first experience of sexual prophylaxis Medical facility intercourse before the age of 15, an indication of early Identi�ied HIV+ pregnant women pregnant sexual debut. No Yes Section 3: Elimination of Mother-to- Child Transmission • 65% of HIV-positive pregnant women in Taita There were about 360 pregnant women living with Taveta do not deliver in a health facility HIV in Taita Taveta County in 2013. HIV is most often transmitted from a mother to her child during • Only 41 per cent of pregnant women attend the pregnancy, delivery, and breastfeeding. Breastfeeding recommended four antenatal visits in Taita Taveta is crucial for children’s survival, growth, and County development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV Section 4: Expanding Access to infections among children by 2015, while keeping their Treatment mothers alive. Table 3: Taita Taveta County HIV treatment access New HIV infections annually annually among children Indicator Adults in need of ART 5,570 Adults receiving ART 2,903 Taita Taveta County National County ART adult coverage 52% County ranking National ART adult coverage 79% 35 estimates County ranking of ART coverage among adults* 35 17 12,940 Source: District Health Indicator Information System Children in need of ART 988 Children receiving ART 194 County ART children coverage 20% National ART children coverage 42% County ranking of ART coverage among children 34

*In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 125 Section 5: Orphans and Social Approximately 410 adults and Welfare 72 children died of AIDS-related Table 4: Taita Taveta orphans and social welfare conditions in 2013 in Taita Taveta indicators County. Antiretroviral drugs Orphans and vulnerable children beneficiaries Estimates can substantially reduce AIDS- Households with an orphan* 8,645 Poor households with an orphan** 4,236 related deaths. If used properly, 2,205 antiretroviral therapy (ART) can Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** also lower a person’s viral load and CT-OVC Households at July 2012 taken from CT-*** prevent onward transmission of • Only 52 per cent of poor households with orphans are beneficiaries of a cash transfer programme. HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

126 kenya HIV AND AIDS PROFILE by County

Section 1: HIV Burden in Tana River County

Table 1: HIV burden in Tana River Madogo Rank* Total population (2013) 273,205 4 HIV adult prevalence (overall) 1% 2 Tana River Number of adults living with HIV 1,200 2 Number of children living with HIV 172 2 Hola Masalani Total number of people living with HIV 1,372 2

*In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

Garsen Tana Delta The HIV prevalence among women in Tana River County is higher (1.5%) than that of men (0.6%). Over the years, the women living in the county have been Density people per km2 more vulnerable to HIV infection than the men. 29 Urban centres with population of more than 2,000 people Figure 2: Prevalence of HIV by gender in Tana River County 2.8 2.4

2 1.9 HIV counseling and testing and linkage to care and treatment are important steps in reducing the sexual 1.6 Male transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and Female 1.2 treatment, about 73 per cent of people in Tana River 0.8 County had never tested for HIV by 2009.

HIV prevalence (%) HIV prevalence 0.4 There is a need to scale up HIV testing in the county, to counsel and reduce the risk for those who test 0 2007 negative, and to link those who test positive to care Year of survey and treatment programmes.

Source: KAIS Figure 3: Percentage of adults enrolling for HIV care by entry point in Tana River County

Section 2: Reducing Sexual 60 Transmission of HIV 50

Table 2: Tana River County HIV indicators 40 Annual County National 30 ranking estimates New adult HIV 40 3 88,620 20 infections annually 10 Source: Kenya HIV Estimates Report, 2014 0 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 127 Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Tana River County, low condom use may pose a significant risk of HIV infection 0% 11% 78% 47% to the population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 60 per cent. Most communities in Tana River County traditionally circumcise men, with over 91 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 100% 89% 22% 53% should be carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Tana River County, approximately 55 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+ pregnant women pregnant intercourse before the age of 15, an indication of early sexual debut. No Yes

• 78% of HIV-positive pregnant women in Tana Section 3: Elimination of Mother- River do not deliver in a health facility to-Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Tana River There were about 128 pregnant women living County with HIV in Tana River County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and Section 4: Expanding Access to development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical Treatment to significantly reducing mother-to-child transmission Table 3: Tana River County HIV treatment access rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their annually mothers alive. Indicator Adults in need of ART 682 Adults receiving ART 660 New HIV infections annually County ART adult coverage 97% National ART adult coverage 79% among children County ranking of ART coverage among adults* 8

Tana River County Indicator National County ranking Children in need of ART 121 estimates Children receiving ART 31 4 3 County ART children coverage 26% 12,940 National ART children coverage 42% County ranking of ART coverage among children 33 Source: District Health Information System *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

128 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Approximately 50 adults and 9 Welfare children died of AIDS-related

Table 4: Tana River orphans and social welfare conditions in 2013 in Tana River indicators County. Antiretroviral drugs

Orphans and vulnerable children beneficiaries Estimates can substantially reduce AIDS- Households with an orphan* 5,789 related deaths. If used properly, Poor households with an orphan** 2,837 antiretroviral therapy (ART) can 2,033 also lower a person’s viral load and Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009 prevent onward transmission of • Only 72 per cent of poor households with orphans are beneficiaries of a cash transfer programme. HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 129 THARAKA NITHI County

Section 1: HIV Burden in Tharaka Nithi County

Table 1: HIV burden in Tharaka Nithi

Rank* Tharaka

Total population (2013) 384,379 7 Chogoria HIV adult prevalence (overall) 4.3% 23 Maara Number of adults living with HIV 7,600 11 Chuka Meru South Density people Number of children living with HIV 1,160 11 per km2 Total number of people living with 8,760 11 84 230 HIV 205 *In this HIV burden and indicator ranking (Table 2), the highest burden county is Urban centres with population of more than 2,000 people 47 while the lowest burden county is 1.

The HIV prevalence among women in Tharaka Nithi County is higher (5.8%) than that of men (2.5%). Over the years, the women living in the county have been more vulnerable to HIV infection than the men.

HIV counseling and testing and linkage to care and Figure 2: Prevalence of HIV by gender in Tharaka treatment are important steps in reducing the sexual Nithi County transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and 8 treatment, about 73 per cent of people in Tharaka 7 6.5 6.4 Nithi County had never tested for HIV by 2009. 6 5.5 There is a need to scale up HIV testing in the county, 5 4.6 to counsel and reduce the risk for those who test 4 negative, and to link those who test positive to care 2.8 3 and treatment programmes. 2.1 2

HIV prevalence (%) HIV prevalence Figure 3: Percentage of adults enrolling for HIV care by 1 entry point in Tharaka Nithi County 0 2003 2007 2009 Year of survey Male Female 120 Source: Kenya Demographic and Health Survey and KAIS 100 Section 2: Reducing Sexual 80 Transmission of HIV 60 40 Table 2: Tharaka Nithi County HIV indicators 20 Annual County National 0 ranking estimates

New adult HIV 410 14 88,620 Overall

infections annually Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward

Source: Kenya HIV Estimates Report, 2014 mother-to-child

Point of entry to care Source: District Health Information System

130 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Tharaka Nithi County, low condom use may pose a significant risk of HIV infection 0% 51% 81% 36% to the population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 60 per cent. Most communities in Tharaka Nithi County traditionally circumcise men, with over 91 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 100% 49% 19% 64% should be carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Tharaka Nithi County, approximately 55 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+ pregnant women pregnant intercourse before the age of 15, an indication of early No Yes sexual debut.

• 81% of HIV-positive pregnant women in Tharaka Section 3: Elimination of Mother- Nithi do not deliver in a health facility to-Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Tharaka There were about 672 pregnant women living with Nithi County HIV in Tharaka Nithi County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding Section 4: Expanding Access to is crucial for children’s survival, growth, and Treatment development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Table 3: Tharaka Nithi County HIV treatment access rates. Kenya has committed to eliminating new HIV annually infections among children by 2015, while keeping their mothers alive. Indicator Adults in need of ART 4,386 Adults receiving ART 4,177 New HIV infections annually County ART adult coverage 95% among children National ART adult coverage 79% County ranking of ART coverage among adults* 11

County Indicator Tharaka Nithi ranking National Children in need of ART 828 County estimates Children receiving ART 538 22 10 County ART children coverage 65% 12,940 National ART children coverage 42% County ranking of ART coverage among children 7 Source: District Health Information System *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 131 Section 5: Orphans and Social Welfare Approximately 258 adults and 50 children died of AIDS-related Table 4: Tharaka Nithi orphans and social welfare indicators conditions in 2013 in Tharaka Nithi County. Antiretroviral drugs Orphans and vulnerable children beneficiaries Estimates Households with an orphan* 7,464 can substantially reduce AIDS- Poor households with an orphan** 3,657 related deaths. If used properly, 2,354 antiretroviral therapy (ART) can Source: UNICEF, 2012; National Census, 2009* AssumingCash transfer 49% of beneficiary population living households*** below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and prevent onward transmission of • Only 34 per cent of poor households with orphans are beneficiaries of a cash transfer programme. HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

132 kenya HIV AND AIDS PROFILE by County TRANS NZOIA County

Section 1: HIV Burden in Trans Nzoia County

Table 1: HIV burden in Trans Nzoia Kwanza Rank* Total population (2013) 932,223 29 Trans Nzoia East HIV adult prevalence (overall) 5.1% 30 Trans Nzoia West Number of adults living with HIV 24,300 30 Kiminini Number of children living with HIV 3,574 32 Density people per km2 Total number of people living with HIV 27,874 30 211 310 *In this HIV burden and indicator ranking (Table 2), the highest burden county is 520 47 while the lowest burden county is 1. Urban centres with population of more than 2,000 people The HIV prevalence among women in Trans Nzoia County is higher (7.3%) than that of men (4.4%). Over the years, the women living in the county have been more vulnerable to HIV infection than the men.

Figure 2: Prevalence of HIV by gender in Trans Nzoia HIV counseling and testing and linkage to care and County treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 11.1 of HIV testing as a way to increase prevention and 11 10 9.7 treatment, about 73 per cent of people in Trans 10 9.3 Nzoia County had never tested for HIV by 2009. 9 8.1 7.8 8 There is a need to scale up HIV testing in the county, 7 to counsel and reduce the risk for those who test 6 Male negative, and to link those who test positive to care 5 Female and treatment programmes. 4

3

2 Figure 3: Percentage of adults enrolling for HIV care HIV prevalence (%) HIV prevalence 1 by entry point in Trans Nzoia County

0 2003 2007 2009 Source: Kenya Demographic and Health Survey and KAIS 120 Year of survey 100 80 Section 2: Reducing Sexual 60 Transmission of HIV 40 20 Table 2: Trans Nzoia County HIV indicators 0 Annual County National ranking estimates Overall

New adult HIV 1,867 34 88,620 Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention infections annually Medical ward Source: Kenya HIV Estimates Report, 2014 mother-to-child Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 133 Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Trans Nzoia County, low condom use may pose a significant risk of HIV infection to the population. 64% 67% 45% 79% 100 Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 80 per cent. Most communities in Trans Nzoia County 60 traditionally circumcise men, with over 91 per cent of men who participated in a national survey in 2009 40 reporting that they had been circumcised. Even in 20 traditionally circumcising communities, the practice should be carried out under safe and hygienic 0 conditions and encouraged before sexual debut. 36% 33% 15% 21% Infant

In Trans Nzoia County, approximately 55 per cent delivery Maternal prophylaxis of individuals had their first experience of sexual prophylaxis Medical facility intercourse before the age of 15, an indication of early Identi�ied HIV+ sexual debut. women pregnant No Yes

Section 3: Elimination of Mother- • 85% of HIV-positive pregnant women in Trans to-Child Transmission Nzoia do not deliver in a health facility • Only 41 per cent of pregnant women attend the There were about 514 pregnant women living with recommended four antenatal visits in Trans Nzoia HIV in Trans Nzoia County in 2013. HIV is most County often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to Section 4: Expanding Access to mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Table 3: Trans Nzoia County HIV treatment access mothers alive. annually

New HIV infections annually Indicator Adults in need of ART 11,881 among children Adults receiving ART 6,618 County ART adult coverage 56% National ART adult coverage 79% Trans Nzoia County County ranking of ART coverage among adults* 31 National County ranking estimates Indicator 90 32 Children in need of ART 2,515 12,940 Children receiving ART 725 Source: District Health County ART children coverage 29% Information System National ART children coverage 42% County ranking of ART coverage among children 32

*In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

134 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 1,387 adults and 194 children died of Table 4: Trans Nzoia orphans and social welfare indicators AIDS-related conditions in 2013 in Trans Nzoia County. Orphans and vulnerable children beneficiaries Estimates Households with an orphan* 18,492 Antiretroviral drugs can Poor households with an orphan** 9,061 substantially reduce AIDS- 3,021 related deaths. If used properly, Source: UNICEF, 2012; National Census, 2009 Cash transfer beneficiary households*** antiretroviral therapy (ART) • Only 33 per cent of poor households with orphans can also lower a person’s viral are beneficiaries of a cash transfer programme. load and prevent onward • Cash transfer programmes have shown that they transmission of HIV. can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 135 TURKANA County

Section 1: HIV Burden in Turkana County

Table 1: HIV burden in Turkana

Rank* Turkana North Total population (2013) 973,742 31 HIV adult prevalence (overall) 7.6% 41 Number of adults living with HIV 39,000 37 Number of children living with HIV 5,736 38 Total number of people living with HIV 44,736 37 Turkana Central *In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

The HIV prevalence among women in Turkana Density people Turkana South County is higher (10.8%) than that of men (6.5%). per km2 Over the years, the women living in the county have 11 12 been more vulnerable to HIV infection than the men. 17 Urban centres with population of more than 2,000 people Figure 2: Prevalence of HIV by gender in Turkana County

HIV counseling and testing and linkage to care and 30 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 25 of HIV testing as a way to increase prevention and 20.7 treatment, about 73 per cent of people in Turkana 20 Male County had never tested for HIV by 2009. 15 Female 12.8 There is a need to scale up HIV testing in the county, 10 10 to counsel and reduce the risk for those who test 7.1 negative, and to link those who test positive to care

HIV prevalence (%) HIV prevalence 4.2 5 and treatment programmes. 0 2003 2007 2009 Figure 3: Percentage of adults enrolling for HIV care Year of survey by entry point in Turkana County Source: Kenya Demographic and Health Survey and KAIS

Section 2: Reducing Sexual 120 Transmission of HIV 100 80 Table 2: Turkana County HIV indicators 60 Annual County National ranking estimates 40 New adult HIV 2,997 40 88,620 20 infections annually 0 Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

136 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Turkana County, low condom use may pose a significant risk of HIV infection 64% 82% 74% 78% 100 to the population. 80 Male circumcision reduces the risk of female-to-male 60 transmission of HIV infection by approximately 60 per cent. Most communities in Turkana County traditionally 40 circumcise men, with over 91 per cent of men who participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally 0 circumcising communities, the practice should be 36% 18% 26% 22% carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis prophylaxis Medical facility

In Turkana County, approximately 55 per cent Identi�ied HIV+ of individuals had their first experience of sexual women pregnant No intercourse before the age of 15, an indication of early Yes sexual debut.

• 74% of HIV-positive pregnant women in Turkana County do not deliver in a health facility Section 3: Elimination of Mother-to- Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Turkana County There were about 835 pregnant women living with HIV in Turkana County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding Section 4: Expanding Access to is crucial for children’s survival, growth, and Treatment development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Table 3: Turkana County HIV treatment access rates. Kenya has committed to eliminating new HIV annually infections among children by 2015, while keeping their mothers alive. Indicator Adults in need of ART 19,068 Adults receiving ART 3,791 New HIV infections annually County ART adult coverage 20% National ART adult coverage 79% among children County ranking of ART coverage among adults* 46

Indicator Turkana County National Children in need of ART 4,036 County ranking Children receiving ART 778 estimates County ART children coverage 19% 144 37 National ART children coverage 42% 12,940 County ranking of ART coverage among children 36 Source: District Health Information System *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 137 Section 5: Orphans and Social Welfare Approximately 2,226 adults and 311 children died of AIDS-related Table 4: Turkana orphans and social welfare indicators conditions in 2013 in Turkana County. Antiretroviral drugs Orphans and vulnerable children beneficiaries Estimates Households with an orphan* 17,901 can substantially reduce AIDS- Poor households with an orphan** 8,772 related deaths. If used properly, 1,468 antiretroviral therapy (ART) can Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** also lower a person’s viral load and CT-OVC Households at July 2012 taken from CT-*** prevent onward transmission of • Only 17 per cent of poor households with orphans are beneficiaries of a cash transfer programme. HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

138 kenya HIV AND AIDS PROFILE by County UASIN GISHU County

Section 1: HIV Burden in Uasin Gishu County

Table 1: HIV burden in Uasin Gishu Rank* Total population (2013) 1017723 33

HIV adult prevalence (overall) 4.3% 24 West Number of adults living with HIV 25,000 33 Eldoret Number of children living with HIV 3,677 34 Eldoret East Total number of people living with 28,677 33 HIV

*In this HIV burden and indicator ranking (Table 2), the highest burden county is Wareng 47 while the lowest burden county is 1. Density people per km2 192 The HIV prevalence among women in Uasin Gishu 262 Burnt Forest County is higher (6.1%) than that of men (3.7%). Over 359 Urban centres with population the years, the women living in the county have been of more than 2,000 people more vulnerable to HIV infection than the men.

Figure 2: Prevalence of HIV by gender in Uasin Gishu

County 20

17.5 HIV counseling and testing and linkage to care and 15 13.4 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 12.5 of HIV testing as a way to increase prevention and 10 8.6 treatment, about 73 per cent of people in Uasin Gishu County had never tested for HIV by 2009. 7.5 6.6

5 3.4 There is a need to scale up HIV testing in the county, 2.7 HIV prevalence (%) HIV prevalence 2.5 to counsel and reduce the risk for those who test negative, and to link those who test positive to care 0 2003 2007 2009 and treatment programmes. Year of survey Figure 3: Percentage of adults enrolling for HIV care Male Female by entry point in Uasin Gishu County Source: Kenya Demographic and Health Survey and KAIS 60 50 Section 2: Reducing Sexual Transmission of HIV 40 30 Table 2: Uasin Gishu County HIV indicators 20 Annual County National ranking estimates 10 New adult HIV 1,921 36 88,620 0 infections annually

Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 139 Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In Uasin Gishu County, low condom use may pose a significant risk of HIV infection 4% 68% 72% 80% to the population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 60 per cent. Most communities in Uasin Gishu County traditionally circumcise men, with over 91 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 96% 32% 28% 20% should be carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Uasin Gishu County, approximately 55 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+ pregnant women pregnant intercourse before the age of 15, an indication of early No Yes sexual debut.

Section 3: Elimination of Mother-to- • 72% of HIV-positive pregnant women in Uasin Gishu do not deliver in a health facility Child Transmission • Only41 per cent of pregnant women attend the There were about 1,415 pregnant women living recommended four antenatal visits in Uasin Gishu with HIV in Uasin Gishu County in 2013. HIV is County most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, Section 4: Expanding Access to and development. Providing antiretroviral medicines to Treatment mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission rates. Kenya has committed to eliminating new HIV Table 3: Uasin Gishu County HIV treatment access infections among children by 2015, while keeping their annually mothers alive. Indicator Adults in need of ART 12,223 New HIV infections annually Adults receiving ART 17,614 County ART adult coverage 100% among children National ART adult coverage 79% County ranking of ART coverage among adults* 2 Uasin Gishu County National County ranking Indicator estimates Children in need of ART 2,587 92 34 Children receiving ART 1,895 12,940 County ART children coverage 73% Source: District Health National ART children coverage 42% Information System County ranking of ART coverage among children 3

*In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

140 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Welfare Approximately 1,427 adults and 200 children died of AIDS-related Table 4: Uasin Gishu orphans and social welfare indicators conditions in 2013 in Uasin Gishu County. Antiretroviral drugs Orphans and vulnerable children beneficiaries Estimates Households with an orphan* 19,015 can substantially reduce AIDS- Poor households with an orphan** 9,317 related deaths. If used properly, 2,080 antiretroviral therapy (ART) can Source: UNICEF, 2012; National Census, 2009 Cash transfer beneficiary households*** also lower a person’s viral load and • Only 22 per cent of poor households with orphans prevent onward transmission of are beneficiaries of a cash transfer programme. HIV. • Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 141

Section 1: HIV Burden in Vihiga County

Table 1: HIV burden in Vihiga Rank* Hamisi Total population (2013) 595,301 16 HIV adult prevalence (overall) 3.8% 19 Number of adults living with HIV 9,900 16

Number of children living with HIV 1,929 19 Vihiga

Total number of people living with 11,829 16 Vihiga HIV

*In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1.

Emuhaya The HIV prevalence among women in Vihiga County

Density people is higher (4.7%) than that of men (2.8%). Over the per km2 Luanda years, the women living in the county have been more 948 1067 vulnerable to HIV infection than the men. 1101 Urban centres with population of more than 2,000 people Figure 2: Prevalence of HIV by gender in Vihiga County HIV counseling and testing and linkage to care and

12 11.8 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 10 of HIV testing as a way to increase prevention and treatment, about 73 per cent of people in Vihiga 8 6.9 6.6 6.7 County had never tested for HIV by 2009. 6 5.9 There is a need to scale up HIV testing in the county, 4 to counsel and reduce the risk for those who test 2.7 negative, and to link those who test positive to care HIV prevalence (%) HIV prevalence 2 and treatment programmes. 0 2003 2007 2009 Figure 3: Percentage of adults enrolling for HIV care Year of survey by entry point in Vihiga County Source: Kenya Demographic and Health Survey and KAIS

Male Female 60 50 Section 2: Reducing Sexual Transmission of HIV 40 30 Table 2: Vihiga County HIV indicators 20 Annual County National ranking estimates 10 New adult HIV 31 2 88,620 0 infections annually

Source: Kenya HIV Estimates Report, 2014 Overall Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child Point of entry to care Source: District Health Information System

142 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections by uptake more than 90 per cent. In Vihiga County, low condom use may pose a significant risk of HIV infection to the 0% 0% 68% 0% population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 per 60 cent. Most communities in Vihiga County traditionally circumcise men, with over 91 per cent of men who 40 participated in a national survey in 2009 reporting 20 that they had been circumcised. Even in traditionally circumcising communities, the practice should be 0 100% 100% 32% 100% carried out under safe and hygienic conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In Vihiga County, approximately 55 per cent of prophylaxis Medical facility individuals had their first experience of sexual Identi�ied HIV+ pregnant women pregnant intercourse before the age of 15, an indication of early sexual debut. No Yes

• 68 per cent of HIV-positive pregnant women in Section 3: Elimination of Mother-to- Vihiga County do not deliver in a health facility Child Transmission • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Vihiga There were about 956 pregnant women living with HIV County in Vihiga County in 2013. HIV is most often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Section 4: Expanding Access to Providing antiretroviral medicines to mothers Treatment throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Table 3: Vihiga County HIV treatment access annually rates. Kenya has committed to eliminating new HIV infections among children by 2015, while keeping their Indicator mothers alive. Adults in need of ART 6,511 Adults receiving ART 6,324 County ART adult coverage 97% National ART adult coverage 79% New HIV infections annually County ranking of ART coverage among adults* 9 among children Indicator Children in need of ART 1,357 Children receiving ART 769 Vihiga County County ART children coverage 57% National County ranking National ART children coverage 42% estimates 35 18 County ranking of ART coverage among children 13 12,940 *In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package Source: District Health Information System

kenya HIV AND AIDS PROFILE by County 143 Section 5: Orphans and Social Approximately 328 adults and Welfare 94 children died of AIDS-related Table 4: Vihiga orphans and social welfare indicators conditions in 2013 in Vihiga Orphans and vulnerable children beneficiaries Estimates County. Antiretroviral drugs Households with an orphan* 19,628 can substantially reduce AIDS- Poor households with an orphan** 9,618 3,956 related deaths. If used properly,

Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009* antiretroviral therapy (ART) can Assuming 49% of population living below poverty line (absolut poor)** CT-OVC Households at July 2012 taken from CT-*** also lower a person’s viral load and prevent onward transmission of • Only 41 per cent of poor households with orphans are beneficiaries of a cash transfer programme. HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

144 kenya HIV AND AIDS PROFILE by County WAJIR County

Section 1: HIV Burden in Wajir County

Table 1: HIV burden in Wajir Wajir North Rank* Total population (2013) 434,524 10 HIV adult prevalence (overall) 0.2% 1

Number of adults living with HIV 500 1 Wajir East

Number of children living with HIV 163 1 Wajir West Hebaswein Total number of people living with 663 1 HIV

*In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1. Wajir South Hebaswein

The HIV prevalence among women in Wajir County Density people per km2 is higher (0.3%) than that of men (0.1%). Over the 29 years, the women living in the county have been more 55 66 vulnerable to HIV infection than the men. 72 Urban centres with population of more than 2,000 people

Section 2: Reducing Sexual Figure 3: Percentage of adults enrolling for HIV care Transmission of HIV by entry point in Wajir County

Table 2: Wajir County HIV indicators Annual County National 60 ranking estimates 50 New adult HIV 18 1 88,620 infections annually 40 Source: Kenya HIV Estimates Report, 2014 30 HIV counseling and testing and linkage to care and 20 treatment are important steps in reducing the sexual transmission of HIV. Despite the huge importance 10 of HIV testing as a way to increase prevention and treatment, about 73 per cent of people in Wajir 0 County had never tested for HIV by 2009. Overall Voluntary and testing counselling Tuberculosis There is a need to scale up HIV testing in the county, transmission Prevention of Prevention Medical ward to counsel and reduce the risk for those who test mother-to-child negative, and to link those who test positive to care Point of entry to care and treatment programmes. Source: District Health Information System

Consistent and proper use of condoms can reduce the risk of HIV and other sexually transmitted infections by more than 90 per cent. In Wajir County, low condom use may pose a significant risk of HIV infection to the population.

Male circumcision reduces the risk of female-to-male transmission of HIV infection by approximately 60 per cent. Most communities in Wajir County traditionally circumcise men, with over 91 per cent of men who participated in a national survey in 2009 reporting

kenya HIV AND AIDS PROFILE by County 145 that they had been circumcised. Even in traditionally Figure 4: Prevention of mother-to-child transmission circumcising communities, the practice should be uptake carried out under safe and hygienic conditions and encouraged before sexual debut. 28% 100% 92% 97% 100 In Wajir County, approximately 55 per cent of individuals had their first experience of sexual 80 intercourse before the age of 15, an indication of early 60 sexual debut. 40

20

0 Section 3: Elimination of Mother-to- 72% 0% 8% 3% Child Transmission Infant delivery Maternal prophylaxis There were about 24 pregnant women living with HIV prophylaxis Medical facility in Wajir County in 2013. HIV is most often transmitted Identi�ied HIV+ from a mother to her child during pregnancy, women pregnant No Yes delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission • 92 per cent of HIV-positive pregnant women in rates. Kenya has committed to eliminating new HIV Wajir County do not deliver in a health facility infections among children by 2015, while keeping their mothers alive. • Only 41 per cent of pregnant women attend the recommended four antenatal visits in Wajir County New HIV infections annually among children Section 4: Expanding Access to Treatment Wajir County National Table 3: Wajir County HIV treatment access annually County ranking estimates Indicator 2 1 Adults in need of ART 250 12,940 Adults receiving ART 66

Source: District Health County ART adult coverage 26% Information System National ART adult coverage 79% County ranking of ART coverage among adults* 44

Indicator Children in need of ART 114 Children receiving ART 5 County ART children coverage 4% National ART children coverage 42% County ranking of ART coverage among children 46

*In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

146 kenya HIV AND AIDS PROFILE by County Section 5: Orphans and Social Approximately 79 adults and 10 Welfare children died of AIDS-related Table 4: Wajir orphans and social welfare indicators conditions in 2013 in Wajir County. Orphans and vulnerable children beneficiaries Estimates Antiretroviral drugs can substantially Households with an orphan* 9,707 reduce AIDS-related deaths. If used Poor households with an orphan** 4,756 1,649 properly, antiretroviral therapy

Source:Cash transfer Kenya HIV beneficiary Estimates Report, households*** 2014 (ART) can also lower a person’s

• Only 35 per cent of poor households with orphans viral load and prevent onward are beneficiaries of a cash transfer programme. transmission of HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

kenya HIV AND AIDS PROFILE by County 147 WEST POKOT County

Section 1: HIV Burden in West Pokot County

Table 1: HIV burden in West Pokot Rank* Density people per km2 39 Pokot North Total population (2013) 583,767 15 61 HIV adult prevalence (overall) 2.8% 8 78 Urban centres with population Number of adults living with HIV 7,500 10 of more than 2,000 people Number of children living with HIV 1,103 9 Total number of people living with 8,603 10 HIV

*In this HIV burden and indicator ranking (Table 2), the highest burden county is 47 while the lowest burden county is 1. Pokot Central

West Pokot The proportion of women living with HIV in West Pokot County is significantly higher than that of men (Figure 2). Over the years, the women living in the county have been more vulnerable to HIV infection than the men.

Figure 2: Prevalence of HIV by gender in West Pokot County HIV counseling and testing and linkage to care and 3.5 treatment are important steps in reducing the sexual 3.0 3 transmission of HIV. Despite the huge importance of HIV testing as a way to increase prevention and 2.5 treatment, about 73 per cent of people in West Pokot County had never tested for HIV by 2009. 2.0 1.7 Male 1.5 There is a need to scale up HIV testing in the county, Female to counsel and reduce the risk for those who test 1.0 negative, and to link those who test positive to care and treatment programmes.

HIV prevalence (%) HIV prevalence 0.5

0 Figure 3: Percentage of adults enrolling for HIV care by entry point in West Pokot County 2007 Year of survey 60 Source: KAIS 50 Section 2: Reducing Sexual 40 Transmission of HIV 30 20 Table 2: West Pokot County HIV indicators Annual County National 10 ranking estimates 0 New adult HIV 576 17 88,620 infections annually Overall

Source: Kenya HIV Estimates Report, 2014 Voluntary and testing counselling Tuberculosis transmission Prevention of Prevention Medical ward mother-to-child

Point of entry to care Source: District Health Information System

148 kenya HIV AND AIDS PROFILE by County Consistent and proper use of condoms can reduce the Figure 4: Prevention of mother-to-child transmission risk of HIV and other sexually transmitted infections uptake by more than 90 per cent. In West Pokot County, low condom use may pose a significant risk of HIV infection 49% 79% 80% 55% to the population. 100

Male circumcision reduces the risk of female-to-male 80 transmission of HIV infection by approximately 60 60 per cent. Most communities in West Pokot County traditionally circumcise men, with over 91 per cent 40 of men who participated in a national survey in 2009 20 reporting that they had been circumcised. Even in traditionally circumcising communities, the practice 0 should be carried out under safe and hygienic 51% 21% 20% 45% conditions and encouraged before sexual debut. Infant delivery Maternal prophylaxis In West Pokot County, approximately 55 per cent prophylaxis Medical facility of individuals had their first experience of sexual Identi�ied HIV+ intercourse before the age of 15, an indication of early women pregnant sexual debut. No Yes

Section 3: Elimination of Mother-to- • 80 per cent of HIV-positive pregnant women in Child Transmission West Pokot do not deliver in a health facility • Only 41 per cent of pregnant women attend the There were about 224 pregnant women living with recommended four antenatal visits in West Pokot HIV in West Pokot County in 2013. HIV is most County often transmitted from a mother to her child during pregnancy, delivery, and breastfeeding. Breastfeeding is crucial for children’s survival, growth, and development. Providing antiretroviral medicines to Section 4: Expanding Access to mothers throughout the breastfeeding period is critical to significantly reducing mother-to-child transmission Treatment rates. Kenya has committed to eliminating new HIV Table 3: West Pokot County HIV treatment access infections among children by 2015, while keeping their mothers alive. annually Indicator New HIV infections annually Adults in need of ART 3,667 Adults receiving ART 1,062 among children County ART adult coverage 29% National ART adult coverage 79% County ranking of ART coverage among adults* 43 West Pokot County National Indicator County ranking estimates Children in need of ART 776 28 13 Children receiving ART 121 12,940 County ART children coverage 16% National ART children coverage 42% Source: District Health Information System County ranking of ART coverage among children 42

*In this ART coverage ranking, the county with the highest coverage is 1, while the county with the lowest coverage is 47. Source: Estimation and Projection Package

kenya HIV AND AIDS PROFILE by County 149 Section 5: Orphans and Social Welfare Approximately 428 adults and 60 children died of AIDS-related Table 4: West Pokot orphans and social welfare indicators conditions in 2013 in West Pokot County. Antiretroviral drugs Orphans and vulnerable children beneficiaries Estimates Households with an orphan* 8,684 can substantially reduce AIDS- Poor households with an orphan** 4,255 related deaths. If used properly, 1,344 antiretroviral therapy (ART) can Source:Cash transferUNICEF, 2012; beneficiary National households*** Census, 2009* Assuming 49% of population living below poverty line (absolut poor)** also lower a person’s viral load and CT-OVC Households at July 2012 taken from CT-*** prevent onward transmission of • Only 32 per cent of poor households with orphans are beneficiaries of a cash transfer programme. HIV.

• Cash transfer programmes have shown that they can reduce HIV risk by delaying sexual debut, pregnancy, and marriage among beneficiaries aged between 15 and 25.

Messages Priority areas Improve access to and uptake of sexual and Strong county political and community leadership reproductive health services for girls and women for a multisectoral HIV response • • Improve education among young people to reduce Mobilizing additional local resources to increase sexual risks by delaying sexual intercourse and sustain the HIV response • • Keep girls in school to help delay sexual debut, Expanding HIV treatment programmes and pregnancy, and marriage increasing community involvement in driving • • demand for increased uptake and adherence Promote and scale up universal access to voluntary among both adults and children medical male circumcision for HIV-negative men • and boys Increasing social welfare services to HIV-positive persons and others affected by HIV Mobilize the community and peer support to • create demand for and increase women’s access to • and uptake of antenatal care, as well as delivery in health facilities Mobilize the community and partners to scale up access to pediatric antiretroviral therapy •

150 kenya HIV AND AIDS PROFILE by County

Resources and Methodology This brief is a county-specific HIV and AIDS profile. A secondary analysis of data from four national HIV surveys and the District Health Information System available by the end of 2013, as well as outputs from the Estimation and Projection Package modelling tool, were used to derive the county specific information.

NATIONAL AIDS CONTROL COUNCIL Landmark Plaza, 9th Floor, Argwings Kodhek Road | P.O. Box 61307 - 00200 Nairobi, Kenya Tel: 254 (020) 2896000, 2711261 Fax: 254 (020) 2711231, 2711072 | E-mail: communication @ nacc.or.ke