Republic of Kenya Ministry of Health AIDS in Kenya Trends, Interventions and Impact 7th edition, 2005 NATIONAL AIDS AND STI CONTROL PROGRAMME (NASCOP) Ministry of Health © Kenya Ministry of Health 2005 National AIDS and STI Control Programme (NASCOP) Kenya Ministry of Health PO Box 19361 – 00200 Nairobi, Kenya tel: +254 20 272 9549 or 272 9502 fax: +254 20 271 0518 email: [email protected] website: www.aidskenya.org edited by Helen van Houten design and layout by Damary Odanga graphics by Philip Miyare Correct citation: National AIDS and STI Control Programme, Ministry of Health, Kenya. AIDS in Kenya, 7th ed. Nairobi: NASCOP; 2005. Contents List of tables ..................................................................................................................iv List of figures .................................................................................................................. v List of boxes ...................................................................................................................v Abbreviations ................................................................................................................ vi Foreword...................................................................................................................... vii Acknowledgements ..................................................................................................... viii 1HIV and AIDS in Kenya today ................................................................................. 1 Levels and trends of HIV infection and AIDS ............................................................1 Institutional and policy responses .............................................................................3 HIV prevention services............................................................................................3 Care and treatment for HIV infection ........................................................................4 Tuberculosis and HIV ...............................................................................................5 Socio-economic costs of AIDS ..................................................................................6 2Prevalence and trends of HIV in Kenya ...................................................................7 How many Kenyans are infected with HIV? ..............................................................7 Sentinel surveillance of HIV in pregnant women ......................................................7 Kenya Demographic and Health Survey 2003...........................................................8 Regional and sociodemographic distribution of HIV infection in Kenya ..................10 HIV prevalence in couples .....................................................................................10 Comparison of ANC sentinel surveillance and KDHS .............................................11 Trends in HIV prevalence .......................................................................................12 Estimating the number of Kenyans infected with HIV ..............................................13 3 Knowledge, attitudes and behaviour relating to HIV/AIDS .................................. 15 Second-generation HIV surveillance .......................................................................15 Sources of information ............................................................................................15 Survey findings .......................................................................................................17 Drugs and HIV/AIDS in Kenya ................................................................................26 4HIV prevention services ....................................................................................... 27 Voluntary counselling and testing ...........................................................................28 Medical transmission of HIV infection ....................................................................36 Safe blood ..............................................................................................................36 Prevention of mother-to-child transmission .............................................................39 Workplace-based programmes ...............................................................................42 Condom promotion, distribution and use ...............................................................42 5 Care for people with HIV and treatment for those with AIDS .............................. 46 Living positively....................................................................................................446 Role of nutrition in comprehensive HIV/AIDS care .................................................48 Preventing and treating opportunistic iillnesses.......................................................50 Treating sexually transmitted infections...................................................................51 Treating HIV infection with antiretroviral drugs.......................................................51 Home-based care ...................................................................................................56 AIDS IN KENYA: TRENDS, INTERVENTIONS AND IMPACT iii 6HIV and children....................................................................................................58 Care of the HIV-infected child ................................................................................58 Orphanhood and children’s living arrangements .....................................................60 Broader than health—orphans and other children made vulnerable by HIV/AIDS...61 Structures to manage OVC issues in Kenya .............................................................62 7The burden of tuberculosis disease in Kenya ..........................................................65 National TB control strategy....................................................................................66 Tuberculosis treatment outcomes ............................................................................67 TB/HIV collaborative activities................................................................................69 8Impact and costs of AIDS .......................................................................................71 Demographic impact ..............................................................................................71 Impact on households ............................................................................................71 Impact on industry and the business sector .............................................................72 Impact on agriculture .............................................................................................73 Impact on education...............................................................................................73 Impact on the health sector ....................................................................................74 Impact on economic growth ...................................................................................75 Appendixes ..................................................................................................................77 1Percentage of HIV prevalence in pregnant women attending antenatal clinics in sentinel sarveillance sites ........................................................................................77 2 Registered VCT sites, as at end 2004.......................................................................79 3 PMCT sites, as at end 2004.....................................................................................84 4NASCOP-registered ARV sites, April 2005 ..............................................................89 References and additional sources of information ..................................................... 93 Government of Kenya publications .........................................................................95 Tables Table 2.1 HIV prevalence among adults, age 15–49 (%) ........................................ 9 Table 2.2 HIV prevalence among couples (%) ..................................................... 10 Table 2.3 Estimated numbers of HIV-infected adults in Kenya, 2003 .................... 14 Table 3.1 Kenya behavioural surveillance survey study populations, sites and samples, 2002/03................................................................................. 16 Table 3.2 General knowledge about HIV/AIDS among youth and adult groups (%)................................................................................... 17 Table 3.3 Perceptions of HIV prevention and transmission (%) ............................ 19 Table 3.4 Knowledge of mother-to-child transmission (MTCT) of HIV (%)............ 19 Table 3.5 Sexual and HIV testing behaviour among in-school and out-of-school youth (%) ............................................................................................. 20 Table 3.6 Multiple sex partnerships among adult respondents who had sex in the last 12 months and HIV testing behaviour (%) ............................ 21 Table 3.7 Indicators of sexual behaviour and HIV/AIDS knowledge in 1993, 1998 and 2003 (%) ....................................................................................... 23 Table 3.8 Acceptance of people living with HIV/AIDS, Behavioural Surveillance Survey (%) ........................................................................................... 25 AIDS IN KENYA: