HIV is an abbreviation for Human Immunodeficiency Virus. It suppresses the immunity of the host leading to a disease condition called AIDS (Acquired Immune Deficiency Syndrome). AIDS is the last stage of HIV infection when the immunity is severely compromised leading to increased vulnerability to diseases.
In Kenya, the first case of AIDS was described in 1984(NASCOP, 2002). The virus has since then spread to epidemic levels with its effect felt in all sectors of the economy and all parts of the country. According to the latest Kenya AIDS Indicator Survey (KAIS), HIV prevalence among adults aged 15- 64 years was 7.1%. There are marked gender and regional variations. The prevalence in women was 8.4% compared to men at 5.4%. The Province with the highest prevalence was Nyanza at 14.9% while North Eastern Province had the lowest prevalence at 0.8%. The population living with AIDS is 1.42 million people (NASCOP, 2009).
The modes of spread of the virus include; heterosexual, mother to child transmission (MTCT), injection drug use, men having sex with men (MSM).
The impact of the pandemic is enormous in all sectors of social and economic development .The cumulative AIDS deaths are over 1.5 million since the first case with the annual deaths of 71 000 people (NACC,2009). The number of AIDS orphans aged between 0- 17 years currently stands at average of 1 million (UNAIDS, 2008). Number of people on ARVs are 138,000 (NASCOP, 2009). The deaths have resulted in loss of skilled and unskilled work force. There is the added cost of treatment and loss of time in sick offs. The illness has decreased productivity of the workers in virtually all sectors of the economy.
Objective
This article examines how the various factors determine the spread, progression of the disease and the outcome of HIV/AIDS in Kenya.
Method
I compiled this article through literature search in websites of Pubmed, WHO, UNAIDS, Ministry of Health, NASCOP, NACC using key words. The key words are listed below.
HIV/AIDS
Kenya
Determinants for example
Socio-economic status
Gender
Poverty
Education and literacy levels
Culture
Healthcare
Globalization
Lifestyle
Social support networks
Employment and working conditions
I used the key words in combination to find the articles.
I also did literature search at KIT library and V University library. The references from the articles assisted in my further searches for the original articles in Google scholar, Web of Science and Science Direct.
The following are the factors that influence the spread, morbidity and outcome of HIV/AIDS in Kenya.
Socio-economic status
This is a fundamental determinant of health status of individuals and population. It determines the living conditions, nutritional status, health behavior and access to health care. The poverty level in Kenya is over 50% (KNBS, 2007). Low socio-economic status has lead to risky behavior leading to infection and worsening the outcome for the infected. Poverty is a contributing factor to malnutrition. The micronutrient deficiency disrupts the integrity of vaginal epithelium increasing permeability to HIV (Stillwaggon, 2002). The poor can not afford better healthcare to treat the ailments like sexually transmitted infections (STIs). The sexually transmitted infections are risk factor to HIV transmission.
The women of low socioeconomic status rely on their male partners for all their needs and can not negotiate for condom use. They also resort to selling sex for money as a means of survival (Buve et al, 2002). The females engage in sex earlier and may not use condoms (Madise et al, 2007).
The living conditions in low socioeconomic zones are over crowded predisposing to opportunistic infections for instance in the slums of Nairobi, Kisumu, Mombasa and other urban centres. The better housing, accessibility to healthcare in the higher socioeconomic group reduces their HIV risk and progression to AIDS if infected. The KAIS report shows some disparity between wealth and HIV prevalence. The percentages are 7.52% for the poor and 6.45% for the wealthy (NASCOP, 2009).
Education status has much more effect on the females than males. The prevalence of HIV in non-educated women is 7% and 6.2% for those with tertiary level. In men the prevalence is 4.1% among the non-educated and 5.0%among the educated.(NASCOP, 2009).
Cultural practices
Some traditional practices increase spread the HIV in Kenya. Widow inheritance is still rampant in Nyanza Province. Widows have a high prevalence of HIV at 20.1% (NASCOP, 2009). This ritual involves unprotected sex with the widows by the inheritors. This practice has persisted because it is deeply rooted in the culture. The ritual is to cleanse the widow in order be incorporated back into the society. The widows are considered impure after the death of the spouse. Ayikukwei (2008) observes that: … "the practice of traditional rite is intrinsic to the Luo community as it is in many other African communities despite the devastating effects of HIV/AIDS"… (.Ayikukwei, et al, 2008). Traditionally it was the male relatives to perform the ritual. There are now inheritors who perform the ritual and move from one widow to another. The inheritors have commercialized the ritual due to the large number of widows and the educated men shunning the practice (Ambasa, 2007). The widowers also re-marry when their wives die. This further spreads HIV in the community
Some communities still practice female genital mutilation. The traditional circumcisers do not follow the infection prevention practices. This initiation ritual is done on many girls at the same occasion. There is risk of HIV transmission in addition to the physiological impairment of sexual pleasure and desire .The severe forms of circumcision predispose to genital injuries during intercourse and higher risk of transmission of HIV ((Yount and Abraham, 2007).
Early marriages after the initiation rites enhance the spread of HIV. The young girls marry older men with many years of sexual exposure. The genital tract is not fully mature leading to bruising during sexual intercourse. Shelley Clark cites that early marriage increases the sexual frequency, lowers protective measures .The only benefit is to reduce the girl's sexual partners. (Clark, 2004)
Male circumcision is practiced widely in Kenya. Circumcised males constitute 84% of all males. Nyanza province with the highest level of HIV prevalence at 14.9% has the lowest circumcision rates at 48.2 %( NASCOP, 2009). It has been extrapolated to offer 60% protection against HIV. It is now a policy to encourage male circumcision as preventive measure in addition to other measures (NASCOP, 2008).
Gender
Women are more affected by HIV/AIDS in Kenya. The latest data shows prevalence rates between 15-64 year of 8.4% for women and 5.4% for men. "Women are more susceptible to HIV infection,have less access to care and treatment and are more likely to suffer stigma once affected".(UNAIDS,2004).
Gender violence, female genital mutilation, economic discrimination, low levels of education, and traditional roles like taking care of the sick expose women to greater risk of HIV infection.(Amuyunzu, et al, 2007). Biologically females have a higher chance of acquiring HIV compared to males.
Lifestyle
The individual behavior determines the risk of HIV transmission. Drug use and alcohol abuse is associated with high risk sexual behavior. The injecting drug users share needles, engage in unprotected sex and prostitution to get resources for their addiction.
Men having sex with men (MSM) is a high risk group. The transmission rates are estimated at 4.5%. They also engage in heterosexual sex and have multiple partners which spreads the risk further.(Gouws, et al, 2006). These practices are common in the youth who are showing increasing infection rates (NASCOP, 2009).
Health care services
The health care is overwhelmed by the demand for care of the AIDS patients. There is shortage of staff and brain drain due to low pay. There were 4506 doctors and 40, 000 nurses for the over 35 million people in 2006 (WHO, 2006)
The demand for ARTs (Antiretroviral Treatment) is 488,000. Only 138,000 are on ARTs ( NASCOP,2009).
The health services have been largely supplemented by the global organizations like the Global Fund, UNAIDS, PEPFAR( Presidents Emergency Fund For AIDS Relief).
The government expenditure on health is only 4.6% of the Gross Domestic Product .(WHO, 2006).The Alma-Ata declaration requires a minimum of 15% of GDP to be spent on health care. There is therefore gross under funding coupled with staff shortage. This has led to inadequate preventive, curative and rehabilitative health services.
Employment and working conditions
There are occupations that predispose to HIV infection. These are; long distance truck drivers, fishermen, and female bar attendants.
Long distance truck drivers often stay for prolonged duration away from their families. They abuse drugs and alcohol hence engage in risky sexual behavior (Morris and Ferguson, 2006)
Kissling et al observes that fishermen are migratory, socially alienated, abuse alcohol and are young people (15 to 35 years) .They engage in new partnership at the camps or ports. (Kissling, et al, 2005).
Bar attendants usually also engage in commercial sex to supplement income. They find ready clients from the alcohol consumers.
Globalization
The increase in movement of people into and out of the country enhances the spread of HIV. Sex tourism is a risky behavior that is being compounded by poverty. Commercial sex, homosexuality and drug abuse in the coastal strip is a clear example.
The global treaties have assisted in preventive campaigns, support for treatment, and affordable drugs due to the negotiation of intellectual property rights. The research by institutions and companies in collaboration has come up with better drugs for management of opportunistic infections.
Formation of UNAIDS to coordinate the implementation of HIV control programs has enhanced the political commitment to fight the disease and resource mobilization to assist the poor countries which are the most affected.
CONCLUSION
HIV in Kenya remains a serious challenge to the economic development. The various determinants of the disease are closely interlinked. The socioeconomic status has both cause and effect mechanism. HIV infection is higher in the lower socioeconomic groups. It leads to poverty and therefore creates a vicious cycle.
The cultural factors are still very influential especially in the rural areas. The poor with low education are the most affected. This shows how the socioeconomics determine the practice of the retrogressive cultural practices.
Gender and the norms make women more vulnerable. Social norms economic disadvantages and biological vulnerability exacerbates the risk.
Healthcare strengthening in collaboration with the global partners has lead to mitigation of the impact and created greater awareness about prevention. .The inadequate resources have led to poor preventive strategies and poor care for the affected. Globalization has positive contribution of increasing the resources for HIV/AIDS.
The determinants are interdependent and therefore have overlapping effects on HIV/AIDS in Kenya.
