Kenya: Many Forces Conspire to Make Young People Most At Risk of HIV

1 December 2018

Health researchers and experts are marking the World's Aids Day today with a call for an extra focus on teenagers, who are contributing the largest portion of new HIV infections in Kenya.

Kenya's national HIV burden stands at 7.7 percent, making it one of the six high burden countries in Africa.

According to a report released last week by the National Aids Control Council (NACC), 17,667 young people aged between 15 and 24 were infected with HIV last year. They accounted for 40 percent of the 52,800 new infections in Kenya.

Dr Celestine Mugambi, the head of the technical support division at NACC, said apart from contributing to two in every five new infections, the leading cause of death in this age group is Aids-related illnesses, especially when those aged between 10 and 19 are added to the demographic.

"Many adolescents and young people do not know their HIV status and are also ill-informed on the basic facts about HIV and Aids," Dr Mugambi told the Saturday Nation.

STIGMA

Dr Patrick Oyaro, a researcher and Chief Executive Officer at RCTP-Faces, an NGO, which supports HIV research in western Kenya, said while young people are tested and put on treatment, they face challenges when it comes to adhering to the treatment regime.

He cited stigma as one of the reasons for their lack of adherence to medication.

Dr Abdhalah Ziraba, a public health expert at the African Population and Health Research Centre (APHRC), took a gendered approach, saying a little more focus should be directed towards girls and women.

He wrote: "A lot of new infections are happening in this age group for various reasons including social vulnerability."

He was referring to transactional sex where, due to poverty and other social challenges, young girls engage in intercourse hoping to get money or other forms of payment in return.

SEX EDUCATION

The "sponsor" factor, where young women engage in sexual relations with older men for money, was cited in a 2017 report by UNAids, the United Nations body responsible for managing Aids, as not only responsible for lower condom use, but also the difference between infections across genders.

Young women were almost twice as likely to acquire HIV compared to young men and accounted for 33 percent of the total number of new infections with young men accounting for 16 percent, according to the National Aids Control Council data.

With sex debuts among children as young as eight, there is a consensus that young people are at great risk of HIV infection, but the approach to save them has caused disagreement among all the concerned parties.

Experts advice age appropriate comprehensive sex education, which parents and religious leaders have opposed vehemently saying such teachings are unacceptable.

RATIONAL

Experts like Prof Ruth Nduati, a paediatrics at the University of Nairobi, cited magnetic resonance imaging (MRI) of the teenage brain to argue the portions associated with critical decision-making -- like whether or not to use protection during sex, or whether to seek contraception methods -- have not developed during teenage until early 20s.

Young people at this age are also vulnerable to abuse that could lead to infections. Marion (whose identity has been changed for legal reasons because she is now 16), told the Saturday Nation about a day in 2011 when she had went from school to the house she shared with her mother, a younger sibling and her stepfather.

"I dropped my bag and headed to my mother's room to alert her that I was back... My stepfather was alone in bed," she said.

The relationship between her and her stepfather was contentious and often hostile. "On this day, I was surprised to hear from him that he loved me the most," she said.

INFECTED

The teenager tearfully described how she was defiled and warned to keep quiet. It did not help that she told her mother, who was also enduring abuse from the same man.

The only response her mother gave was taking her to a boarding school, and it is in school, she said, that she started falling sick.

"I was in and out of school and when I was just about to sit for my Standard Eight examination -- that was in 2015 -- that I got seriously sick and the school administration requested that I go back home for treatment," she said.

During the treatment, she said she was surprised to learn she was HIV positive.

DENIAL

Her mother died shortly after, and she would learn the cause was Aids.

"At her funeral, I heard people say that my mum had died of Aids but she lived in denial and never wanted to take drugs, and that is how I connected the dots that the man infected me when he defiled me," she said.

It took patience and love from her godmother -- her late mother's friend -- to accept her status

"I am planning to join secondary school God willing," she said. Marion is now a peer educator and offers counsel to young girls her age. Many young girls share in Marion's pain.

COUNSEL

In 2017, Child Line -- an NGO that runs a child abuse helpline -- reported that 1,296 cases of child abuse were reported through more than 800 calls made to the helpline.

Thirty-three percent of the cases were sexual in nature and the rest were physical.

Whether sex with minors is consensual or not, Josephine Odoyo from the Kenya Medical Research Institute (KEMRI) said:

"Parents and guardians do not want to believe this (teenagers having sex) is happing... they are not giving direction, even support the HIV prevention products available like PrEP given to the young people".

The communication barrier is affecting the survival of those infected. Ms Odoyo said teenagers do not discuss their issues and dilemmas with adults but among themselves where they feel understood.

AWARENESS

When asked, Kenyan teenagers said they wished to know how to use contraceptives, including condoms, oral pills and injectables, as part of sexuality education in school and at home.

A 2017 study, Paper to Practice: Sexuality Education Policies and Their Implementation in Kenya by Guttmacher and African Population and Health Research Center, interviewed 2,484 teenagers aged between 15 and 17, and they said they wanted to know where to get contraceptives.

They also said they desired to protect themselves against sexually transmitted diseases and prevent unwanted pregnancies.

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