KENYA COUNTRY

LANDSCAPE
ASSESSMENT

Photo credit: NTRI/Roshni Lodhia

HIV/STI
 Presentation Outline
• Country baseline data
• Progress towards 90, 90, 90 targets
• Priority areas
• SWOT analysis
• Competition and donor landscape

Photo credit: NTRI/Roshni Lodhia • Srategies

 COUNTRY
BASELINE DATA
• Kenya has an estimated 1.5 million people living with HIV corresponding to
a prevalence of 4.5% in 2020.
• Of those, only 1.1 million are taking life saving HIV treatment, leaving 26%
of people without access.
• Increased strategies to achieve the 1ST 90 have yielded positive results,
with 90% of all persons living with HIV knowing their status in 2019.
• Annual new infections among children aged 0-14years stood at 6,806 in
2019, a precipitous decline.
• In adults, the infections declined from 88,622 in 2013 to 34,610 in 2019. A
61% reduction in incidence.
Photo credit: NTRI/Roshni Lodhia
 COUNTRY
BASELINE DATA
• However, there still exists a disproportionate distribution in sex, with the
prevalence of HIV in females at 5.8%, to that of males at 3.1%
• A total of 59,304 positive women received ARV prophylaxis for prevention
of mother to child transmission in 2019, representing a 7% increase in
PMTCT coverage since 2013.
• Similarly, the MTCT declined by 3.1% from 13.9% in 2013 to 10.8% in
2019.
• AIDS related deaths recorded a 65% reduction from 58,446 deaths in 2013
to 20,897 in 2019.
• This trend indicative of improving viral suppression rates at 68%, though
Photo credit:short
NTRI/Roshniof the 90% target.
Lodhia
 COUNTRY
BASELINE DATA
• HIV prevalence
-Highest among 15-29 years old, 61.2% of new HIV infections
-High prevalence in females at 5.8%, compared to that of males at 3.1%
• Geographical disparity in prevalence
- high burden counties of , Homabay(19.6%), Kisumu(17.5%), Siaya(15.3%)
Migori(13%), Busia (9.9%) and Turkana(6.8%)
• Key populations have higher HIV prevalence compared to the general
population

Photo credit: NTRI/Roshni Lodhia

 COUNTRY
BASELINE DATA
Treatment with ART, disparities between adults and children
-80% ART coverage among adults,
-68% among children
Viral suppression, disparities between adults and children
- 90.6 % Adults
- 67.1% Children

Photo credit: NTRI/Roshni Lodhia

Photo credit: NTRI/Roshni Lodhia
 PRIORITY AREAS
1. Universal Access to HIV prevention and treatment.
• From its beginning, the HIV epidemic has represented an acute health inequality,
affecting some key populations much more disproportionately
• Unequal gender norms that limit the agency and voice of women and girls predisposes
them to a higher HIV risk
• Key populations are constantly subjected to discrimination, violence, and punitive
legal and social environments, each of which contributes to HIV vulnerability
• Young people (aged 15–24years) represent about 17% of the global population, but
accounted for and estimated 28% of new HIV infections in 2019.

Photo credit: NTRI/Roshni Lodhia

 PRIORITY AREAS
Universal Access to HIV prevention and treatment………….
• The HIV burden on poorer households has increased, due in part to the difficulties
poor people experience in obtaining the HIV services and social protection they
need.
• Stigma, discrimination, gender inequalities, age-of-consent laws that limit young
people’s access
• By the end of 2019, a total of 1,160,479 (1,087,511 adults and 72,968 children) were
on antiretroviral therapy, representing an estimated treatment coverage of 80%
among adults (68% among children).
• 11% of PLHIVs are without access to care, unaware of their status. There is a need to
enhance interventions to bridge gap to attain 1st 95
Photo credit: NTRI/Roshni Lodhia
 PRIORITY AREAS
2. EMTCT
• Seven countries and their territories have been certified as having eliminated vertical
HIV transmission; it is doable, but in 2019 Kenya;
 6% (102,000) of pregnant women do not attend at least one ANC visit
 8% (136,000) pregnant women do not know their HIV status
 In 2019, for every 100 pregnant women living with HIV, 12 children aged 0-4
became infected through mother to child transmission
 6% of pregnant women living with HIV do not receive lifelong ART
 33% of HIV-exposed infants do not get tested within two months of birth
• Stigma, discrimination and unequal gender norms that prevent pregnant and
breastfeeding women, from accessing HIV testing, prevention and treatment services
for themselves and their children
Photo credit: NTRI/Roshni Lodhia
 PRIORITY AREAS
3. Key Populations
• Almost half of key population members living with HIV do not know their HIV status and40% are
not receiving treatment, these populations and their sexual partners account for an estimated
62% of new infections globally
• Majority of people who are newly infected with HIV and who are not accessing lifesaving HIV
services belong to key populations and live in vulnerable contexts.
• key populations continue to face severe inequalities that limit their access to HIV
services, these populations often suffer from punitive laws or stigmatizing policies, and they are
among the most likely to be exposed to HIV.
• In East and Southern Africa, women comprised three in five new HIV infections among adults in
the region in 2019, and adolescent girls and young women (aged 15–24 years) are up to 5 times
more likely to acquire HIV than their male peers
• The KP mapping and estimation exercise conducted in 2018 estimated that there are 206,000
FSWs,50,000 MSM, 19,000 PWID, and 5,000 transgender people.
Photo credit: NTRI/Roshni Lodhia
 PRIORITY AREAS
4. CALHIV and OVCs
• Children have experienced much slower progress across the testing and treatment cascade than adults.
• 47% of children living with HIV globally who are not receiving access to treatment that will save their
lives.
• Children living with HIV have poorer HIV treatment coverage (Only 53% of children living with HIV are
accessing treatment) than adults and comprise a higher proportion of AIDS-related deaths.
• Although children accounted for 5% of people living with HIV in 2019, they represented 14% of all AIDS-
related deaths
• In Kenya, 67% of children living with HIV were virally suppressed in 2019, compared to 90 % of adults.
• There is an urgent need to scale-up of efforts to find, diagnose and link children living with HIV to
optimal child-friendly treatment and support services

Photo credit: NTRI/Roshni Lodhia

 PRIORITY AREAS
5. Robust health systems.
• Financial barriers cause health systems to fail poor people and low-income
communities
• The focus of many health services on curative interventions also diminishes attention
and funding for preventive interventions that could help reduce inequalities in HIV and
other health outcomes
• Key health system functions, including health information, procurement and supply
chain should be strengthened to support the effective delivery of HIV and integrated
services
• Strengthening of measures geared towards improved health outcomes contributes
greatly towards improving adherence and viral suppression.
Photo credit: NTRI/Roshni Lodhia
SWOT ANALYSIS
STRENGTHS
• Strong in-country competence and expertise in HIV
programming
• Dedicated, highly skilled, and hard-working staff within P I
• Strong support from Pathfinder HQ
• Over 50 years of In-country experience with impressive
performances in multisectoral programs
• Strong collaboration and relationship with MOH and other
key stakeholders, including the donor community
OPPORTUNITES
• Work with private health sector and private companies
• Pathfinder’s HSS strengths
• Pathfinder’s strength in youths, women and key
stakeholder engagements.
• Other funding opportunities e.g DFID, CIFF, Foreign
commonwealth and development ,William and Florah
Hewlett foundation
• Devolved governance system which allows for direct
engagement with end users via county structures. Political
will from governors
WEAKNESSES
• Overdependence on few donors funding, mostly
PEPFAR.
• Inadequate PLHIV participation and involvement in
programming and decision making due to nature of
contracts
• Sub-Optimal community-led initiatives
• Leadership and Implementation of HIV/STI programs
left to IPs
THREATS
• Competition from other organizations offering same
services.
• HIV/STI donor funding shifts to local NGOs and direct
funding to County governments.
• Top-down approach by donor agencies in HIV/STI
program development, implementation and monitoring
• Cyclic nature of the COVID epidemic which keeps
disrupting service delivery in supported counties
COMPETITION AND DONOR LANDSCAPE
• The global health landscape disrupted by the COVID-19 pandemic has also
resulted in refocus of mobilization of resources.
• Programmatic priorities too have seen a paradigm shift.
• There has been a change of award mechanism with donor funding prioritized
to local partners and local governments.
• Increasing partnerships with local universities strengthening their research
departments are forming fodder for program implementation.
• Any funding cuts adversely affect the human resource component.
STRATEGIES
1. Maximize equitable and equal access to HIV services and solutions;
 Primary HIV prevention for key populations, adolescents and other priority populations, including
adolescents and young women and men in locations with high HIV incidence
 Adolescents, youth and adults living with HIV, especially key populations and other priority populations,
know their status
 Integrated and differentiated service delivery for women and children, particularly for adolescent girls and
young women in locations with high HIV incidence

2. Break down barriers to achieving HIV outcomes;

 Fully resourced and integrated community-led HIV responses for a transformative and sustainable HIV
response
 Human rights approach; People living with HIV and key populations enjoy human rights, equality and dignity,
free of stigma and discrimination
 Promote gender-equitable social norms and gender equality
STRATEGIES
3. Adequate resources and sustainable efficient HIV responses;
 Shifting spending to increase impact
 Essential investments by non-health sectors
 Lobbying for increased domestic HIV funding to ensure fully funded and efficient HIV response to achieve
the 2025 targets

4. Social Protection in HIV response;

 Integrated systems for health and social protection schemes

5. Leadership, country ownership and advocacy

 Partnerships and multisectoral collaboration
 Data, science, research and innovation use
 Human rights, gender equality and reduction of stigma and discrimination
Dimensions to be considered during implementation of strategies.
Scale; scale-up of proven HIV interventions. focus on closing the gaps in HIV prevention,
through combination HIV prevention packages and services that can sharply reduce HIV
infection rates among KPs and priority populations. promote integration of health and
social services, community engagement for peer support and addressing stigma and
discrimination, strengthening linkages between HIV services and other diseases at facility
level.
Quality; Expanding access to high-quality medicines(TLD) and adopting differentiated
approaches and support to ensure quality and continuity of care
Gender; prioritizing resources for the empowerment of women and girls, guaranteeing
their rights so that they can protect themselves from acquiring HIV, overcome stigma and
gain greater access to HIV testing, treatment, care and support as well as to sexual and
reproductive health services
Dimensions cont…
Sustainability; leveraging system integration with enhanced domestic funding, in order
to fully fund the HIV response, and using technology, positioned within Universal Health
Coverage.

Equity; prioritizing interventions to first benefit the people who are not being reached.
Provision of combined HIV treatment and prevention, scaling and strengthening community-
led responses, such as comprehensive sexual and reproductive health (including FP)
education, harm reduction services e.g condoms. Geographical focus in the country and
within counties.
 THANK YOU
For more information contact: vrono@Pathfinder.org | pathfinder.org

@PATHFINDERINT @PATHFINDERINTERNATIONAL @PATHFINDERINT