In Kenya, men are increasingly becoming the leading demographic among new cases of people living with HIV who present with Advanced HIV Disease (AHD).
Experts attribute this worrying trend to late engagement in care, which places them at higher risk of disease progression, opportunistic infections, and AIDS-related deaths, despite the availability of free HIV testing and treatment services.
Technical experts and PLHIV communities stress that focusing on men is essential to reversing the current trend. With Many men delaying HIV testing due to stigma, fear of diagnosis, or misconceptions about the disease. Even after testing positive, some are reluctant to start or continue treatment, leading to a critical drop in their immune function.
According to Dr Lazarus Momanyi, a Technical Assistant at the National AIDS & STI Control Program (NASCOP), men are more likely to seek care when their disease has significantly progressed. “People living with HIV (PLHIV) with Advanced HIV Disease (AHD) often present themselves to care when they have very low CD4 cell counts and are at higher risk for disease progression, development of opportunistic infections, and death,” Dr. Momanyi said.
Advanced HIV Disease is characterized by a CD4 cell count of less than 200 cells/mm³ or the presence of severe clinical symptoms categorized as WHO stage 3 or 4 events. This includes individuals who are new to antiretroviral therapy (ART), those who have interrupted their treatment and returned to care, and those experiencing treatment failure. “All children under the age of five living with HIV are considered to have Advanced HIV Disease unless they have been on treatment for over a year and are clinically stable,” Dr. Momanyi explained.
He was speaking at a media and technical engagement event in Nairobi organized by Nephak in collaboration with Nascop to sensitize on the plight of people living with HIV (PLHIVs) with Advanced HIV disease (AHD).
He was speaking at a media and technical experts engagement event in Machakos County organized by Nephak in collaboration with Nascop to sensitize on the plight of people living with HIV (PLHIVs) with Advanced HIV disease (AHD).
He stressed that Kenya needs to work towards the UNAIDS 95:95:95 targets and the focus must shift to engaging men and children in HIV care early and consistently. Addressing the unique barriers faced by these groups is essential to preventing the progression to Advanced HIV Disease and reducing AIDS-related deaths.
Dr. Momanyi explained that many people especially male adults die from AHD because of delayed HIV diagnosis, delayed enrolment in care and ART initiation, treatment interruptions and treatment failure due to non-adherence and drug resistance.
Momanyi further explained that among the newest client’s, 40 percent present themselves with AHD therefore there an urgent need to optimize early detection and diagnosis of AHD by implementing effective screening programs.
“Going forward HCW will use CD4 tests to identify AHD while screening all newly diagnosed PLHIV, those returning to care after treatment interruptions and those with suspected treatment failure.”
He further revealed that Kenya is working on Advanced HIV Disease (AHD) implementation plan which is still in its draft stage that aims to guide healthcare workers in ensuring access to common opportunistic infections screening, treatment and prophylaxis and linkages to other healthcare services for all AHD cases and will also guide in monitoring and evaluation and reporting HIV cascades including outcomes and mortality.
He also said that government is working to build capacity of healthcare workers to manage AHD and critically ill patients and adoption of new more effective, less toxic molecule Flucytosine and Liposomal Amphotericin and sensitization of healthcare workers for its roll out in this month.
While National Empowerment Network of People Living with HIV In Kenya (NEPHAK) Chairperson Nelson Otwoma said that it is sad that the gains made over-time is being reversed with the country now recording more HIV deaths because of delayed or late engagement with care despite the availability of free testing and treatment.
“We are witnessing trends that we used to see a long time ago coming back, HIV related deaths are coming back because we are still seeing people not taking up testing of HIV, delaying testing or doing it when it is too late, particularly men,” Otwoma said adding that “men are coming to care too late. By the time they are diagnosed with Advanced HIV Disease, their immune systems are severely compromised. We need to address the barriers that prevent men from accessing care early.”
According to NASCOP data 1,377,784 Kenyans were living with HIV and 67,869 children in 2022. Of the total number 2.6 percent are male and 5.3 percent being females. In 2022 Kenya recorded 18,473 AIDs related deaths with 22,154 new infections.
Out of the 22,154 new infections recorded in 2022 12,558 were females while 5,122 were male while 4474 were children. 41 percent adult new infections occur among adolescents and young people aged 15 to 24 years.
Karen Wamboi Omanga urged the care implementers to embrace patient centered integrated approach of care urging that it can address both stigma and reduce cost of care since one can be attended to in different clinics on the same day.
She observed that the stand-alone HIV clinics may prevent people from seeking care from them because of stigma.
“If health workers are trained well to integrate services, care seeking behavior will not be associated with stigma and discrimination since someone will not deduce what a client is ailing from since everybody will be seeking care from the same clinics.”
Nephak called for innovative approaches to not only amplify the plight of PLHIV on AHD but also working with communities to understand the needs and priorities of PLHIVs and raise awareness of the emerging issue of Advanced HIV disease and improving access to care.
