The AIDS Epidemic in Kenya

In 1986, the first case of HIV in Kenya was identified (KAIS, 2007). Initially the highest rates of infection were concentrated in marginalized and special risk groups. For more than a decade now Kenya has faced a mixed HIV/AIDS epidemic where new infections are occurring in both the general population and vulnerable, high-risk groups (Refer to Annexes 5 and 6). Since 1999, the Government of Kenya declared the HIV epidemic a national disaster and concerted effort to coordinate the HIV/AIDS response. In the past four years, Kenya has witnessed considerable growth in funding of its HIV/AIDS national program from major global initiatives (ROK, 2005a). Thanks to interventions then, because the HIV prevalence rate begun to show a decline. But the HIV epidemic is complex and dynamic. A number of factors such as food insecurity which is currently hitting the population hard can impact a lot on how the HIV prevalence rises and falls, including new infections and HIV-related illness.

In line with the global requirements to fight the epidemic, the government is committed to the

‘Three Ones’ principle and has instituted:

one National HIV/AIDS Action Framework - KNASP,

one National AIDS Co-ordinating Authority – NACC

one National HIV/AIDS Monitoring and Evaluation Framework (ROK, 2004)

This principle provides an opportunity for CDA in trying to establish partnerships in the response to food insecurity.

Results from Kenya AIDS Indicator Survey (KAIS, 2007) indicate that 7.4% of Kenyan adults aged between 15-64 years are infected with HIV, the virus that causes AIDS. More than 1.4million adults are living with HIV/AIDS. About three quarters of Kenyans live in rural areas of the country. Among those ages of 15-64 years, 7% of the rural population are infected with HIV. In urban areas, the prevalence is 9%. Though the prevalence in rural areas is lower than in urban areas, the greatest burden of disease is in rural areas since most Kenyans live in rural areas. The HIV infection has a gender dimension. A higher proportion of women in the same age category 15-64 (8.7 percent) than men (5.6 percent) are infected with HIV according to KAIS (2007). Figure 1.1 below shows the HIV prevalence rates per province.

7 Quality criteria refers to: (1) one national multisectoral strategy and operational plan with goals, targets, costing, and identified funding per programmatic area, and a monitoring and evaluation framework; (2) one national coordinating body with terms of reference, a defined membership, an action plan, a functional secretariat, and regular meetings; (3) one national M&E plan which is costed and for which funding is secured, a functional national monitoring and evaluation unit or technical working group, and central national database with AIDS data (UNGASS Country Progress Reports 2008, cited in UNAIDS, 2008)

8Available at http://www.un.org/millenniumgoals/aids.shtml Accessed on 28th/o8/2009

Figure 1.1: HIV prevalence in Kenya by province Source: KAIS, (2007)

It should be noted from the above figure that the prevalence estimates may not provide the complete picture of HIV burden in a province. This is because of different population sizes across the provinces. For example, there are higher proportions of infected adults in Coast and Nairobi than that of the Rift Valley. Yet the estimated number of infected adults in Rift Valley (322,000) was greater than in Coast (135,000) or Nairobi (176,000). Together, Nyanza and Rift Valley are the home to half of all HIV-infected adults in Kenya.

There is a strong co-relation of the above stated determinants which is illustrated with data from a desk study where Kenyan prevalence rate and gender (Figure 1.2) as well as prevalence rates and place of residence (Table 1.1) vary as presented below.

Figure 1.2: Kenya National HIV prevalence among females and males age 15-49 in KAIS, 2007 and KDHS, 2003 within 95% CI

Source: KDHS, (2003) and KAIS, (2007)

From the figure above, prevalence is high in women because of their physiological differences that increases the likelihood of infection once exposed to the virus (Barnett and Whiteside, 2006). Women also have low control over their sexuality and that of their partners as was recorded by Holden (2004). The table below shows an indication of the HIV prevalence rate for men and women between the rural and urban residences in Kenya in 2007.

Table 1.1: Kenya National HIV Prevalence for men and women by Residence.

Age (15 – 64) yrs Urban Rural Total

Women 10.8 8.2 8.7

Men 6.2 5.5 5.6

Total 8.9 7.0 7.4

Source: KAIS, (2007)

The high levels of the prevalence rates in the urban areas could be explained by the fact that the residents are usually ‘migratory populations’ who have higher risky behaviour of having multiple partners (Barnett and Whiteside, 2006) after all they have money to trade for sex.

Rural areas on the other hand have low prevalence and this could be because most of the prime age people who are the sexual active have migrated to towns and also as a result of AIDS related deaths (UNAIDS, 2008). A consideration of the poverty levels for the residences is shown in Table 1.2 below.

Table 1.2: Kenya National Poverty Levels National Poverty

line

National Urban Rural

1992 44.8 29.3 47.9

1994 40.3 28.9 46.8

1997 52.3 49.2 52.9

2006 45.9 33.7 49.1

Source: KNBS, 2006

As shown in Table 1.2 above rural areas have high levels of poverty as compared with the urban areas. Rural areas on the other hand have low HIV prevalence rate (Table 1.1). This implies that most of the rural residents are already facing the brunt of being resource poor

and when AIDS sets in it worsens their livelihoods situation (Rau, 2006). It is feared that because of rural to urban migrations in coping strategies, the two populations mix and this would fuel the AIDS epidemic. With these determining factors in mind the study is geared to counteract the spread of the disease among the smallholder farmers who are the rural residents by appropriately responding to food insecurity.