Stigma and sexual violence hinder progress in the fight against HIV

Stigma and sexual violence are among the major issues that continue to hamper the fight against HIV.

According to Dr. Samuel Kinyanjui, national director of the Aids HealthCare Foundation (AHF), other issues are derailing progress, including ignorance and policy gaps. He was speaking during World AIDS Day celebrations in Rachuonyo South, Homa Bay County.

Compared to the 1990s when one in 10 Kenyans had HIV, only five in 100 people are currently living with it, Dr Kinyanjui noted.

Despite the progress made, the disease weighs heavily on some groups and spreads to the next. A typical example is the high rate of infections among men over 50 in Makueni and girls between 15 and 24 years old.

Dr Kinyanjui said irrational attitudes and the perpetuation of negative judgments against people living with or at risk of HIV discourage them from getting tested, accessing health care and adhering to treatment.

“It is in everyone’s interest to positively support those at risk and those living with HIV,” he said.

Normalizing conversations about HIV, the doctor said, encourages drug testing and adherence, halting the spread of infections.

“For example, people who inject drugs have a 53% risk of contracting HIV. Men who sleep with other men have a 20% risk.”

“Society often chooses to isolate these people, compromising their well-being. Out of fear of judgement, many members of the marginalized population do not disclose their challenges and end up remaining in denial,” he explained. “Ultimately, the risk trickles down to the general population.”

Mary Nyaguthii, prevention program manager at AHF in Kenya, said that even though the community prefers abstinence and fidelity as a silver bullet against HIV, people still have extramarital affairs and school children still have sex.

“The whole population is in denial. A study we are doing in the suburbs already reveals that the average middle-class woman has four or five sexual partners,” she said.

The aim of the study was to uncover the evolution of sex work and why middle-class married women were increasingly testing positive.

But according to Nyaguthii, a registered nurse, using condoms, ARVs and PrEP could help reduce infections.

“Recently, data revealed that out of four new HIV infections among young people between the ages of 15 and 24, three are girls,” said Dr Kinyanjui.

“This number has skyrocketed during the Covid-19 pandemic and should show us the importance of keeping our girls in school,” he said. The fact that more girls than boys in this age group are infected, the doctor said, is perpetrated by gender inequalities.

“That number matches infections in men over 35, meaning many are attracting school-going girls with the promise of an improved life,” he said.

Organizations such as Aids Healthcare Foundation are working to fight vice in the South Nyanza region by putting young girls and teenage mothers in school, university and setting up businesses.

In central Kenya, where boys are more at risk than girls, their program called boys to men helps boys identify job opportunities and school fees.

According to Nyaguthii, men generally don’t like hospitals.

“Unlike men, women have unique needs that lead them to combine health care and help. Women go to hospitals to give birth, have their children vaccinated, plan their families and seek treatment when their children fall ill,” she said.

“Men, on the other hand, associate hospitals with pain. The only time they need a hospital is when they are in pain.

To bridge the gap, AHF has partnered with Huduma centers in Kisii and Mombasa counties to set up testing, counseling and treatment centres. She said their clientele is 90% male.

The success of the two counties, Nyaguthii hopes, will compel other Huduma centers to formalize such partnerships.

Dr. Oliver Mito, AHF Western Regional Director, said there needs to be a multi-sectoral approach to developing policy rather than each department working and implementing its own policy.

“In most cases, it is the chiefs and deputy chiefs who deal with cases of SGBV at the community level. Many choose to reconcile the community but forget the victim. To ensure justice and proper healing for the entire community, the county commissioner should issue an executive order that restricts chiefs and co-chiefs from dealing with SGBV cases at the community level,” he said.

Dr. Mito said all of these departments could collaboratively identify, document and charge all perpetrators. They can also obtain data on all victims of SGBV and work to provide targeted education, health care and psychosocial support, all under one policy.

“The fragmented way of dealing with and documenting these cases allows perpetrators to take advantage of the system by bribing chiefs and parents, and helps ignore survivors of SGBV,” Dr Mito said.

Condoms, Kinyanjui notes, are also heavily taxed. “Condoms are classified as medical devices and are therefore heavily taxed. A policy change is long overdue to include them in medical supplies to exempt taxes.

As a result, there has been a growing shortage of condoms in the country.

“A month’s supply of condoms would cost the government 120 shillings per month per person,” he said.

“Conversely, the direct cost of ARVs per person costs the government 2,000 shillings per person,” Dr Kinyanjui said.

“These figures show that there is still a long way to go before the virus is brought under control.”

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