Kenya: No, Adolescents Don't Account for Half of New HIV Infections in Kenya

Nearly half of new HIV infections in Kenya are among adolescents, a major drugmaker claimed during an international conference focused on the wellbeing of girls and young women.

"In Kenya, 49% of new #HIV infections occur among adolescents," tweeted Johnson & Johnson, a sponsor of the June 2019 Women Deliver conference, held in Vancouver, Canada.

Is this claim accurate? We checked.

Statistic is a publicly available 'estimate'

The claims were direct quotes from a session on maternal and child survival, Nicole Araujo, a Johnson & Johnson spokesperson, told Africa Check.

They were said by Dr Violet Oramisi of Kenya's health ministry, Araujo said.

Oramisi is with the National AIDS and STI's Control Programme (Nascop), a state agency tasked with the country's response to HIV and Aids.

Oramisi told Africa Check that these were "our estimates and they are publicly available for your reference". She added that the data was also in "recently released HIV estimates" from 2018.

New infections in adolescents much lower

Launched in November 2018, the Kenya HIV estimates report 2018 was prepared by the National Aids Control Council (NACC), another state agency involved in the national response to HIV and Aids.

It shows that in 2017 there were 8,177 new infections nationally among adolescents, who it classified as being aged between 10 and 19. New infections could have been as low as 2,400 or as high as 15,900. (Note: Estimates are given as a range to reflect the quality of underlying data and the assumptions made when calculating them.)

These adolescent infections accounted for 15.48% of the country's total new HIV infections, which were estimated at 52,800. These could have been as low as 33,400 or as high as 77,500.

How are new infections counted?

The 2018 estimates report said it used modelling tools developed by UNAids to estimate new infections.

"Modelled estimates are required because it is impossible to count the exact number of people living with HIV, people who are newly infected with HIV or people who have died from Aids-related illnesses in any country," the UN agency said.

"Doing so would require regularly testing every person for HIV and investigating all deaths, which is logistically impossible and ethically problematic."

In its most recent global data, UNAids also gave 53,000 as the total new HIV infections in Kenya in 2017. This data was collected by NACC, Dr Vernon Mochache told Africa Check. He is an HIV/Aids researcher with the Institute of Human Virology, a University of Maryland programme which works in Kenya and former head of research at NACC.

Where does 49% statistic come from?

Dr Joshua Kimani is a senior researcher at the Sub Saharan African Network for TB/HIV Research Excellence, which is mainly located at the Nelson R. Mandela School of Medicine in South Africa's University of KwaZulu-Natal.

He told Africa Check that the 49% figure could refer to a combination of both adolescents and young adults, known as young people. This was also echoed by the University of Maryland's Mochache.

UNAids notes that the term "young people" is accepted by UN agencies to mean "persons between ages 10 and 24".

Using this approach, we looked at the statistics from the estimates report.

What do the numbers show?

Kenya annual new HIV infections, 2017

Age group Age New infections Share of total new infections

Children 0-14 8,000 15.2

Adolescents 10-19 8,200 15.5

Young adults (male) 15-24 5,200 9.8

Young adults (female) 15-24 12,500 23.7

Adults (15 and older) 15+ 44,800 84.5

All ages 52,800 100

Source: 2018 Kenya HIV estimates report, National Aids Control Council

Combining the new infections in adolescents (10-19) and young adults (15-24) resulted in a total of 25,900 - or 49% of the 52,800 new infections as Johnson & Johnson tweeted.

However, this approach includes the 15 to 19 age band twice, as there is an overlap between adolescents (ages 10 to 19) and young adults (ages 15 to 24). We asked Nascop for clarification on how they had come up with their figure.

Unclear where numbers for 10-24 years age gap originate

In March 2018, Nascop issued a major report on how prepared health facilities in Kenya were to offer antiretroviral drugs to prevent HIV infection.

This report noted that "the country still experiences a large number of new infections estimated at 52,800 in 2017, 49% of which occurred among adolescents and young persons aged between 10 and 24 years."

The statistic was attributed to a "Kenya HIV estimates report 2018". The report of the same name was however only published seven months later, in October 2018.

A statistician with the NACC, Kipkoech Mutai, told Africa Check that the agency only generates data for 10 to 19 years and 15 to 24 years and not the 10 to 24 years bracket as claimed.

Double counting caused inflated statistic

Franklyn Songok, who contributed to the Nascop report, told Africa Check that the 49% figure was indeed derived from totalling new infections for adolescents aged 10 to 19 and those of young adults aged 15 to 24. "That should not be the case. There is an overlap of [years] 15 to 19," Songok said.

Oramisi is also listed as a contributor to this report.

Dr Charles Wheelan, an economist and statistician at Dartmouth College in New Hampshire, USA, who reviewed the figures, told Africa Check it was likely there had been double counting..

"As far as I can tell, they have double counted. I cannot think of another way to get to the 49% figure," Wheelan told Africa Check.

Claim incorrect, but youth still at risk

In the absence of any data showing adolescent new infections higher than 16% of all new infections, we rate this claim as incorrect.

Despite this, adolescents are still at high risk. Kimani, from the Sub Saharan African Network for TB/HIV Research Excellence, said there are many reasons why adolescents and young women are particularly vulnerable to HIV infection.

"They feel indestructible... They don't perceive themselves to be at risk and the problem is, in our setting in Kenya, there is intergenerational sex," he said.

This meant they were having more sexual experiences, including with older people for economic reasons, and using protection inconsistently.

Is TB claiming young women disproportionately?

Johnson & Johnson also tweeted that "Worldwide, #TB is a top killer of young women". It did not give an age band for this.

In May 2018, the World Health Organization published the top 10 causes of death in the world. These were based on 2016 estimates. For people of all age groups, tuberculosis was the tenth biggest cause of death, killing 1.3 million people.

For young women aged 15 to 29, it was the fifth largest killer, causing 55,425 deaths. Only maternal conditions, self harm, road injuries and HIV/Aids outranked it.

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