WAD Report - F4 1

W O R L D A I D S D AY R E P O R T 2 0 2 2
IT IS A RACE 2030
AGAINST
TIME
The journey to end AIDS as a

public health threat by 2030 is getting tighter.
In the last decade, Kenya brought treatment to scale, new
infections and AIDS-related deaths have declined, but the
progress is not enough. We must redouble our efforts.
W O R L D A I D S D AY R E P O R T 2 0 2 2
IT IS A RACE
AGAINST TIME
The journey to end AIDS as a public health threat by 2030 is
getting tighter. In the last decade, Kenya brought treatment to
scale, new infections and AIDS-related deaths have declined, but
the progress is not enough. We must redouble our efforts.
WORLD AIDS DAY REPORT 2022
Most of the AIDS-related deaths in 2021 occurred

among men, who are less likely than women to be
diagnosed, start and stay on treatment and reach an
undetectable viral load. We call on communities to
support men’s access to testing and retention to care.
Nelson Otwoma
National Coordinator, Network of People
Living with HIV in Kenya-NEPHAK
4
Ending the epidemics of HIV, Tuberculosis

and Malaria is a key priority under Sustainable
Development Goal three, which aims to ensure
healthy lives and promote well-being for all.
We are presented with a unique opportunity

to catalyse the end of these syndemics whose
synergistic interaction results in excess disease
burden. We shall align the political goodwill of
Kenya Kwanza Government, resources, science
and technical capacities to implement high-
impact interventions to realize this vision.
Susan N. Wafula, Cabinet Secretary, Health
We join the global community to commemorate Kenya remains committed to ending AIDS as a
the World AIDS Day on 1st December 2022 with public health threat by 2030. We are focused on
satisfaction over the progress made in combating advancing a response that is people, rights and
the HIV epidemic. On this day, we celebrate our science centred. The World AIDS Report 2022
heroes - the people living with HIV, health care outlines key achievements in the HIV response.
providers, scientists, donors and policymakers In line with the Kenya AIDS Strategic Framework
who have dedicated all their efforts to address II 2020/21 to 2024/25, the report also examines
the HIV epidemic. We observe the day in memory the gaps while outlining key recommendations to
of the more than 2 million lives lost to AIDS- accelerate progress in the HIV response.
related deaths since the first case was officially
documented in 1984. We highlight and celebrate the milestone reached
in HIV treatment. In one decade we doubled the
number of people living with HIV. The hallmark
v
We highlight and celebrate the In 2021, the estimated number of new HIV
HIV programme for reaching infections increased by more than 2000
more than 1.1 million people cases from 32,027 in 2020 to 34,540 in
with Antiretroviral Therapy 2021. The report identifies key challenges
(ARTs) and 73% achieving viral including the clustering of new HIV infections
suppression by the end of 2021. among children, adolescents and younger
people. We underscore the need to bridge
the programmatic gaps and accelerate
of success for HIV treatment is a suppressed viral progress in our prevention efforts for these
load for an individual and others living with HIV in subpopulations. The interventions include
the same community. We highlight and celebrate addressing syndemic factors such as sexual
the HIV programme for reaching more than 1.1 and gender-based violence and adolescent
million people with Antiretroviral Therapy (ART) pregnancies that significantly contribute
and 73% achieving viral suppression by the end of to vulnerability to new HIV infections.
2021. Treatment success depends on the correct We emphasize on the need for sustained
use of ARVs supplied through a coordinated momentum to re-invigorate primary HIV
supply chain system. The World AIDS Report 2022 prevention. This is as a critical litmus test for
report highlights the key strengths and gaps that successful universal health coverage and
require our attention in commodity security. sustainable development goals.
What Now?
1 Invest in primary prevention

strategies delivered through
a model that is efficient for
2 Increase access to HIV
diagnosis and treatment
among sub-populations left
3 Prioritize programmatic
gaps, select the right
interventions for the disparate
the diagnosis, treatment and behind including children and epidemic typologies across 47
control of epidemics. men counties.
4 Intergrate services and

invest beyond health
facility-based interventions
5 Promote technological
innovations in diagnosis,
treatment and accountability
6 Close the gaps in delivering
essential HIV commodity
security through a predictable
to address the syndemic for efficiency gains. and strong supply chain
factors that reinforce the HIV system.
epidemic.
vi
We have demonstrated resilience in our strive to

swiftly protect the gains made in responding to
other syndemics in the context of the COVID-19
pandemic. We thank our stakeholders who
galvanised their efforts to keep us on track.
Mr. Geoffrey Mbirua Gitu,

Board Chairperson, NSDCC
The National Syndemic Diseases Control Council In the HIV sector, we moved fast to protect the
appreciates all its stakeholders who have gains made in the response over the years from
significantly contributed to the progress made in the COVID-19 related disruptions. We have
the HIV response. We have jointly achieved and witnessed the resilience of our stakeholders,
sustained a positive trajectory whose gains we especially in people living with HIV and
must safeguard. vulnerable communities. We commend the
health providers who quickly developed policies
For the last two years, the global health and guidelines that appreciated the difficulties
community faced an unprecedented challenge of we faced due to movement restrictions.
the COVID-19 pandemic. Lessons learned in the
many years of responding to the HIV epidemic
were instrumental in shaping the interventions for In the World AIDS Day Report 2022, we applaud
the new pandemic. all stakeholders for their resilience in dealing with
the syndemics of HIV, Tuberculosis and Malaria.
vii
COVID 19 related disruptions, instability in global by 2030. We must do everything in our power
economies and other emerging challenges to secure the gains made. We now have the
have resulted in increased vulnerability to HIV science and tools that we can utilise to accelerate
and a decline in resources available for the HIV progress.
response.
It is indeed a race against time to end AIDS.
The World AIDS Day, reminds us of the need
to recommit to ending AIDS as public threat
viii
Letter of Appreciation
Dr Ruth Laibon–Masha (PhD)

Chief Executive Director, National Syndemic
Diseases Control Council
The successful development of the World AIDS for managing strategic information for their
Report 2022 would not have been possible efforts to collate data that was utilised to compile
without the incredible efforts of a multi-sectoral this report.
team of stakeholders. On behalf of the National
Syndemics Diseases Control Council, I appreciate We recognise the significant contributions
all our partners in the HIV response who of other government agencies including the
significantly contributed to the results outlined in National AIDS and STI Control Programme,
this report. the National Council for Population and
Development, and the County Governments
We acknowledge the work of the multi-sectoral who have contributed to the development of
coordination committee members responsible the report. The results outlined in this report
ix
demonstrate the leadership of the County Special thanks to Clinton Health Access Initiative,
Government in the implementation of the the Bill and Melinda Gates Foundation through
Kenya AIDS Strategic Framework II 2020/21- the University of Manitoba, Elizabeth Glaser
2024/25. Pediatric AIDS Foundation for their technical and
financial support in drafting this report.
The role of the National Empowerment Network
of People Living with HIV and AIDS in Kenya We recognise the efforts of staff from the
for shaping the HIV response in Kenya is National Syndemics Diseases Control Council led
appreciated. Indeed in the race against time is a by Joshua Gitonga, who steered the processes of
tribute to many lives lost along the way. developing the report.
x
Executive Summary
The Kenya World AIDS Day Report 2022 outlines report highlights the urgent need to address
key achievements in the HIV response as guided inequalities that reinforce injustice and promote
by the targets set in the Kenya AIDS Strategic negative health outcomes. The report also
Framework II (KASF II 2020/21 -2024/25) and underscores the need to bridge all gaps that
other regional and global commitments. In ten hinder progress for the most vulnerable sub-
(10) years, Kenya has doubled the number of populations, particularly girls, young women,
people diagnosed with HIV and on life saving and children while addressing syndemic factors
antiretroviral treatment from 603,997 in 2012 such as sexual and gender-based violence and
to 1,122,334 million people at the end of 2021, adolescent pregnancies that reinforce their
with 73.3 % of those on treatment attaining viral vulnerability and risk of HIV.
suppression.
The Country continues to explore avenues for
Despite these and other successes in the HIV health services integration, to achieve universal
program, the estimated number of new HIV health coverage. The need for increasing
infections increased by more than 2000 cases domestic resources to bridge the gaps in the
from 32,027 in 2020 to 34,540 in 2021. This procurement of essential HIV commodities
report identifies key challenges contributing is emphasized. The report underscores the
to this reversal in progress, including the urgent need for country ownership towards
clustering of new HIV infections among children, implementing high-impact interventions to end
adolescents and younger people, and the HIV as a public health threat.
impact of commodity insecurity. Further, this
xi
xii
Table of Content
AIDS-related Deaths.................................................................................................................................8
We are off track on ending AIDS among Children, adolescents and young people the 7th year of
the 2030 Agenda for Sustainable Development Goal. ...................................................................11
Elimination of mother-to-child transmission of HIV is feasible ..............................................11
Diagnose, treat and achieve viral suppression among all children, adolescents, and young
people living with HIV..................................................................................................................13
Treatment outcomes for adolescents and young people remain sub-optimal, with
significant gaps in knowledge of HIV status and treatment uptake.......................................15
Reducing Sexual Transmission of HIV among children, adolescents and young people.............16
Expanding access to HIV prevention choices ..........................................................................20
Progress in reducing new HIV infections among key populations.........................................21
Prevention of HIV among people with untreated substance use disorders .........................23
Aging and HIV ..............................................................................................................................26
Other Sexually Transmitted Infections........................................................................................27
What now?...............................................................................................................................................29
1. Invest in primary prevention strategies delivered through a model that is efficient for the
diagnosis, treatment and control of epidemics .......................................................................30
2. Prioritize programmatic gaps, select the right interventions for the disparate epidemic
typologies across 47 counties.....................................................................................................30
3. Intergrate services and invest beyond health facility-based interventions to address the
syndemic factors that reinforce the HIV epidemic ..................................................................34
4. Promote technological innovations in diagnosis, treatment and accountability for
efficiency gains..............................................................................................................................36
5. Close the gaps in delivering essential HIV commodity security through a predictable and
strong supply chain system. ........................................................................................................36
Annexes....................................................................................................................................................38
xiii
HIV testing during community

outreach at Loyangalani,
Marsabit County
xiv
New HIV infections continue to outpace

those newly placed on treatment
The Kenya AIDS Strategic Framework II Laikipia County led the country with a 20%
(2020/2021 -2024/2025) outlines the need to reduction of new HIV infections between 2020
reduce new HIV infections by 75% (less than and 2021. Other counties including Nairobi,
8,838) by 2025 towards ending AIDS as a public Uasin Gishu, Nakuru, Nyeri, Kilifi, Bomet, Kericho,
health threat by 2030. Kiambu, Makueni and Elgeyo-Marakwet, made
progress in the reduction of new HIV infections.
For the first time in more than a decade, the
number of new HIV infections increased in 2021 During the same period, there was an increase
by 7.8%, from 32,027 in 2020 to 34,540 in 2021. in new HIV cases by more than 30% in other
Ten (10) counties, Nairobi, Kisumu, Homabay, low-burden counties of Samburu, Isiolo, Wajir,
Siaya, Migori, Nakuru, Mombasa Kakamega, Kisii Mandera, Marsabit, Turkana, Lamu and Tana River
and Uasin Gishu accounted for 57% of all new with the highest increase occurring in Samburu
HIV infections that occurred in 2021. County.
Trends in the reduction of new HIV infections against Kenya AIDS Strategic framework II targets
90,000
80,000 We must redouble our efforts to
70,000 meet the 2025 targets of reducing
60,000
new HIV infections by 75%
50,000
40,000
30,000
20,000
10,000
0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025
New infections KASF II targets
1
There was one new infection (34,540)

for every three people (109,557) newly
put on ART programme in 2021, which
undermined the efforts to end the
epidemic Total new HIV infections
34,540
Women and girls continue to bear the brunt
of the epidemic. In 2021, an estimated 66.7%
(23,051) of all new HIV infections occurred 66.7% 33.3%
among women and girls. Women and girls
tended to become infected at a much earlier age
23,051 11,489
than men and boys of the same age with 8 out
of every 10 new HIV infections occurring among
adolescent girls and young women aged 15-24.
An estimated 52% of all new
Among adult men and boys, those aged 20-39
infections occurred among
contributed to 76% (6,700) of the 8,874 new HIV
adolescents and young adults
infections that occurred among those aged 15 aged 15-29
and above.
The size of key populations groups is estimated

7%
at 61,650 men who have sex with men, 197,096 15%
female sex workers, 26,673 people who inject New HIV
and use drugs, and 4,370 transgender people. infections by age
26%
Key populations have higher HIV prevalence 0-14
compared to the general population. They 15-29
30-44
experience stigma, discrimination, criminalisation
45+
and violence, which further increase their risk
52%
and vulnerability to HIV and sexually transmitted
infections. About 9-11% of those who were found
in physical hotspots are below the age of 18. Source: Kenya HIV Estimates 2022; NSDCC
2
Access to HIV Treatment
Kenya has committed to diagnose, treat and therapy (ARV) medicines for opportunistic
achieve viral suppression for at least 95% of infections, nutrition products, laboratory supplies
the 1,437,267 people living with HIV by 2025. for diagnosis and treatment, condoms for the
Women and girls comprise 64% of the people prevention of HIV and Sexually Transmitted
living with HIV. Infections (STIs), and unplanned pregnancies,
and medically assisted therapy for people who
In 2004, Kenya established the HIV prevention inject drugs. By the end of 2021, Kenya had
and treatment programme underpinned by the 1,122,334 million people living with HIV on
principles of universal health coverage. The treatment with 73.3% of them virally suppressed.
programme provides free-to-use antiretroviral
All ages 95-95-95 Cascade Children 95-95-95 Cascade
People living with HIV 100% Children living with HIV 100%
Diagnosed 92% Diagnosed 69%
Treatment 78% Treatment 59%
Virally Suppressed 73.3% Virally Suppressed 55.5%
26.7% 44.5%
22% 41%
18% 31%
Achieved Gap
Sources: Kenya HIV Estimates 2022, National Syndemic Diseases Control

Council
3
Over the last five years, while the number The burden of the HIV epidemic is
of people living with HIV on treatment disproportionate across counties
increased, there is disproportionate
decrease of both external and domestic
resources for procurement of commodities
Turkana Mandera
Marsabit
30 1,200,000 West Pokot

Wajir
Samburu
Elgeyo
Trans Marakwet
Nzoia
Isiolo
Bungoma Uasin Baringo
Gishu
25 1,000,000
Busia
Laikipia
Kakamega Meru
Nandi
Vihiga
Siaya
Nyandarua
Kisumu
Tharaka-Nithi
1 Kericho Nakuru
3
Homa Bay Nyeri Garissa
7
Embu
2
Kisii Bomet Murang'a
20 800,000
Migori Kiambu
Narok
2
Nairobi
Machakos
Kitui
Tana River
2 Makueni Lamu
Kajiado
15 8 600,000
7
7 Kilifi
Taita Taveta
58% (835,803)
10 400,000
Mombasa
of people living
Kwale
with HIV are from

5
12 11 200,000
10 counties
9
Nairobi 153,818 Nakuru 58,678

0 0 Kisumu 130,036 Mombasa 54,303
2015/16 2016/17 2020/21 Homa Bay 122,954 Kakamega 50,991
Siaya 97,922 Kiambu 46,571
PEPFAR Global Fund GOK Gap PLHIV Migori 77,690 Kisii 42,842
4
Kenya has an overarching challenge where new Access and adherence to life saving
HIV infections are dominant among younger
HIV Treatment remains a priority
adults below the age of 29, while the larger
cohort of the people living with HIV are older
adults, many of whom might have been infected Access and adherence to available HIV treatment
at a younger age. are inhibited by other factors including the
perception of good health; denial of HIV
The country must invest in both primary and diagnosis; poor family support following positive
secondary prevention strategies through diagnosis; and anonymity and stigma concerns
effective interventions to control the epidemic. in HIV care services.
Aging with HIV is associated with an increased
risk of co-morbidities, which requires an Most adults (85%) aged 35 and above living with
integrated care model. Adults living with HIV HIV were on treatment by the end of 2021 as
are more likely to suffer (36%) forms of non- compared to 66% of those below the age of 34,
communicable diseases as compared to 28% of including children. Gender dynamics are also
people without HIV diagnosis likely to suffer one observed among adolescents and adults aged
or two NCDs of the same age group respectively. 15 and above with 73% of men and boys living
These NCDs include cancer, diabetes and high with HIV accessing treatment as compared to
blood pressure. 81% of women and girls of the same age.
In 2021, the majority 62.1% (892,508) People Living with HIV on treatment
of the estimated people living with HIV
were adults aged 35 and above
People Living with HIV by age and sex

0-34 years 35 years and above
32% 68%
0-14 41,622 | 41,257
15-34 149,222 | 312,659
35+ 320,028 | 572,477
5
HIV treatment coverage is uneven across counties. Children living with HIV aged 0-14 have
Treatment coverage among adults is lower than disproportionate access to HIV treatment. Only
70% in 19 counties with Mandera and West Pokot nine counties (Busia, Embu, Homabay, Isiolo, Kitui,
having the lowest treatment coverage of 48% and Machakos, Makueni, Marsabit and Vihiga) achieved
50%. Nairobi, Murang’a and Kirinyaga counties more than 70% treatment coverage for children.
achieved more than 90% treatment coverage
among adults.
Antiretroviral treatment coverage across counties (all ages)
Turkana Mandera
Marsabit
Wajir
West Pokot
Samburu
Elgeyo
Trans Marakwet
Nzoia
Isiolo
Gishu
Busia
Laikipia
Kakamega Meru
Nandi
Vihiga
Siaya
Nyandarua
Kisumu
Tharaka-Nithi
Kericho Nakuru
Embu
Migori Kiambu
Narok Nairobi
Machakos
Kitui
Tana River
Makueni Lamu
Kajiado
Antiretroviral
treatment coverage
More than 95% Kilifi
Taita Taveta
80% - 94%
50% - 79% Kwale
Mombasa
Less than 49%
6
7
AIDS-related Deaths
Preventable deaths AIDS-Related Deaths by Age and Sex

continue to occur
Age Male Female Total
Kenya loses an estimated 65,000 people annually 0-4 1,182 1,156 2,338
to HIV, Tuberculosis and Malaria related illnesses.
5-9 135 134 269
The HIV epidemic has had far-reaching social,
10-14 266 265 532
economic, health, and population effects. Since
the first case was officially recorded in 1984, 15-19 506 453 959
there have been more than 2 million AIDS-related 20-24 626 679 1,304
deaths in the country. By 2011, an estimated one 25-29 833 926 1,759
million children in Kenya had lost both parents to 30-34 1,071 1,225 2,296
AIDS-related deaths. Chronic illness and death 35-39 1,519 1,304 2,823
are the most common reasons why households 40-44 1,597 1,331 2,928
slide into poverty across the globe.
45-49 1,514 1,197 2,711
50-54 1,149 823 1,971
In 2021, the country lost an estimated 4,098
55-59 700 486 1,186
children and adolescents below 19 to AIDS-
related deaths. These deaths were attributed to 60-64 387 272 659
low diagnosis and treatment coverage for this 65-69 201 151 352
sub-population. Among the estimated 82,917 70-74 93 77 169
children living with HIV aged 0-14, about 31% 75-79 39 35 74
were not diagnosed, 41 % of those diagnosed 80+ 21 22 43
were not on treatment while 45% of those on
treatment had not achieved viral suppression.
The lower treatment coverage for men and boys is evident by the
number of AIDS-related deaths. In 2021, an estimated 8,291 men
aged 30 and above died of AIDS-related deaths as compared to
6,923 women of the same age group
8
AIDS-Related deaths increased in counties - Nairobi, Kisumu, Homabay, Siaya,

2021 for the first time in a decade Migori, Nakuru, Mombasa, Kakamega, Uasin
Gishu and Kajiado.
Kenya has made significant progress towards
ending AIDS through a large-scale treatment In six counties (Samburu, Isiolo, Turkana, Lamu,
programme. In the last decade, the estimated Wajir, and Vihiga) the estimated number of AIDS-
AIDS-related deaths reduced by 57.7%, from related deaths increased by more than 50% in
52,964 in 2010 to 19,486 in 2020. However, 2020 as compared to 2021. In Samburu County,
the number of AIDS-related deaths increased the number of AIDS- related deaths increased
by 15%, from about 19,486 in 2020 to 22,373 3-fold.
in 2021. Half of these deaths occurred in 10
AIDS-Related
52,964 58,446 35,821 28,214 20,997 19,486 22,373
deaths
10% 38.7% 21.2% 25.6% 7.2% 14.9%

Reduction Reduction Reduction Reduction Reduction Increase
Year 2010 2013 2015 2017 2019 2020 2021
9
HIV-related deaths by county, 2021/2022
Turkana Mandera
Marsabit
Wajir
West Pokot
Samburu
Elgeyo
Trans Marakwet
Nzoia
Isiolo
Gishu
Busia
Laikipia
Kakamega Meru
Nandi
Vihiga
Siaya
Nyandarua
Kisumu
Tharaka-Nithi
Kericho Nakuru
Embu
Migori Kiambu
Narok Nairobi
Machakos
Kitui
Tana River
Makueni Lamu
Kajiado
HIV related deaths

50% increase
Kilifi
0% - 49% Taita Taveta
0% - 13% Decrease
Mombasa
Kwale
AIDS-related deaths increased across 35 counties. In six counties

(Samburu, Isiolo, Turkana, Lamu, Wajir, and Vihiga) the estimated
number of AIDS-related deaths increased by more than 50% in
2021 as compared to 2022. In Samburu County, the number of
AIDS- related deaths increased nearly 3-fold
10
We are off track on ending AIDS among children,

adolescents and young people, at the 7th year of the
2030 Agenda for Sustainable Development Goal
Elimination of mother-to-child outcomes for both mothers and children through

transmission of HIV is feasible large-scale and high quality interventions
that include: Prevention of mother-to-child
Kenya is committed to the triple elimination of transmission of HIV programmes, HIV testing
mother-to-child transmission of HIV, hepatitis, during pregnancy, ensuring access to
and syphilis as a public health priority. The antiretroviral treatment, safe childbirth and
programme is focused on improving health breastfeeding, infant testing and treatment.
Coverage of prevention of HIV from mother to

child services
Year Number receiving Coverage %

2009 67,061 76.82
2010 61,563 73.04
2011 58,127 71.2
2012 51,028 64.06
2013 50,101 64.65
2014 52,049 69.8
2015 59,214 86.64
2016 59,444 88.46
2017 53,236 80.89
2018 54,708 85.38
2019 52,494 84.89
2020 50,612 85.29
2021 52,578 90.89
11
The country had envisioned a fast track approach achieved less than 5% HIV transmission rates
that would reduce mother-to-child transmission from mother to child, with a country average
of HIV to less than 5% by 2021. While significant of 8.9%. Some counties, including Mandera,
progress has been made, the targets remain Wajir, Marsabit, West Pokot, Isiolo, Garissa
elusive. Across the country, the gains in ending and Samburu, have high HIV mother-to-child
new HIV infections among children have transmission rates of 20%.
plateaued. In 2021, none of the counties had
16% 14%
Mother to child transmission of HIV rate
14%
11.5%
12% 10.8%
9.7% 8.9%
10% 8.3%
8%
6%
4%
2%
0
2013 2015 2017 2019 2021 2022
MTCT rate Target
Despite the gains in HIV response, Kenya is yet

to meet the target required for the elimination of
mother to child transmission of HIV
12
Diagnose, treat and achieve viral Sources of Mother-to-Child

suppression among all children, Transmission of HIV
adolescents, and young people
living with HIV Started ART before the pregnancy: 1.78%
child infected during pregnancy
The use of antiretrovirals for pregnant women, Started ART during the pregnancy: 3.02%
their partners and infants effectively interrupts
the transmission of HIV during pregnancy and Dropped off ART during pregnancy: 16.18%
the breastfeeding period. Most (64.13%) of the
cases of mother-to-child transmission of HIV Started ART late in the pregnancy: 3.72%
occur when an HIV-positive mother drops off
ART during this period. Did not receive ART during pregnancy 25.12%
Mother infected during pregnancy 6.47%
Started ART before pregnancy: child 1.84%

infected during breastfeeding
Most (64.13%) of the cases of mother-to
Started ART during pregnancy: child
-child transmission of HIV occur when
2.71%
a HIV positive mother drops off ART or
Dropped off ART: child infected
does not receive ART during pregnancy
15.85%
during breastfeeding
or breastfeeding period
Started ART late in pregnancy: child 0.95%
Did not receive ART during breast- 6.98%

feeding
Mother infected during breastfeeding 15.37%
5,160
new HIV infections among
children in 2021
13
In the last decade, Kenya has progressed in the ARV treatment coverage for children aged 0-14
living with HIV. In 2021, this progress faltered with the ART coverage for children dropping from
76.5% in 2020 to 59.0%. There is evidence to show that 3 out of every 10 children living with
HIV who do not receive antiretroviral therapy for HIV die after one year of life. The mortality rate
increases to 52.5% by the second year of life.
The viral load suppression in children under one year is also sub-optimal compromising their
health, and well-being and may increase mortality.
Early HIV diagnosis and treatment for children significantly reduces morbidity and mortality rates.
Kenya can leverage the Global Alliance to end AIDS among children and adolescents platform
to end inequalities faced by children living with HIV by ensuring early identification with timely
linkage to care, and strengthening social protection mechanisms while supporting guardians and
caregivers.
82,917
children Living
with HIV
Access to HIV treatment

for children remains a
challenge. In 2021, about
3,138 children aged 0-14
14,412 68,505 died from AIDS-related
deaths. Majority (60%) of
Children living with HIV Children living with
not on antiretroviral HIV on antiretroviral these children are below
treatment treatment 5 years
14
Treatment outcomes for adolescents and young people remain sub-optimal,

with significant gaps in knowledge of HIV status and treatment uptake
AIDS-related deaths among adolescents and

young people aged 15-24 years
2021
2,257 2016
3,853
2020
2,196
2018
2019 2,830
2,621
Uptake of HIV diagnostic services among

adolescents and young people15-24
894,556
2018
1,454,394
1,021,778
2019 1,779,697
578,468
2020
1,113,620
456,306
Kenya loses about 6 adolescents 2021
949,664
and young people aged 15-24
daily to AIDS-related illnesses Boys and young men Girls and young women
Source: National Syndemic Diseases Control Council 2022 HIV Estimates Source: Ministry of Health, Kenya Health Information System
15
Ending Sexual Transmission of HIV among

children, adolescents and young people
Sexual and gender-based violence and adolescent pregnancies are predictors of vulnerability to HIV
among children, adolescents, and young people. A national survey conducted among adolescents in
2019 showed that the average age of sexual debut in Kenya is 171. In 2021, the number of new HIV
infections among those aged 15-24 increased by 7.7% as compared to the previous year.
New HIV infections among adolescents and young people aged 15-24
40,000
35,776
35,000
30,000
25,000
Number
20,000 17,667
14,410
15,000 11,638
11,229
10,000
5,000
0
2014 2015 2016 2017 2018 2019 2020 2021 2022
New HIV infections
Source: HIV Estimate 2021, National Syndemic Diseases Control Council
1 Violence against Children Survey ,UNICEF 2019
16
Kenya has made significant investments to ensure adolescents and young people are educated, enjoy
a healthy life and attain their aspirations. The overlapping challenge of new HIV infections, unintended
pregnancies, and sexual and gender-based violence among children, adolescents and young women,
dubbed the Triple Threat, undermines the impact of investments made. Increasing new HIV infections among
adolescents and young people makes it challenging to end AIDS as a public health threat in Kenya.
In 2021, pregnancies
Adolescent pregnancies
among children aged
• Adolescent mothers diagnosed with HIV must cope with the 10-14 increased by 28.7%
mistimed pregnancy and initiation onto lifetime treatment during from 16,956 to 21,823.
antenatal care.
• Adolescent mothers diagnosed with HIV have poor ART adherence rates compared to adults, and
are hence likely to transmit HIV to their babies during pregnancy and breastfeeding. They have poor
outcomes in the programme for prevention of mother-to-child transmission of HIV.
• Girls who do not complete secondary school education have higher vulnerabilities to HIV and other
sexually transmitted infections. An additional year of schooling decreases the probability of an adult
woman testing positive for HIV by 6%2.
• Adolescent pregnancies are associated with increased risks of HIV, premature birth, low birth weight,
perinatal death, and disability, school dropout, child labor and early marriages. They perpetuate the
vicious cycle of increasing social services burden, such as healthcare.
• Poverty is one of the key reasons that lead to sex exploitation and sex work among women and girls3.
Sex workers and their clients contribute about 14% of new HIV infections in the country.
Adolescent pregnancy infringes on young people’s fundamental rights to complete education, leading to
the loss of economic opportunities.
2 Behrman, J. A. (2015). The effect of increased primary schooling on adult women’s HIV status: Universal Primary Education as a natural experiment. Social science &
medicine, 127, 108-115.)
3 HIV and AIDS situational analysis on sex workers and their clients in Kenya
17
Trends in adolescent pregnancies from 2016-2021
Proportion
of adolescents
Total adolescent Antenatal attending antenatal
Year 10-14 years 15-19 years pregnancies clinic clients clinic
2016 23,356 252,277 275,633 1,296,168 21%
2017 23,516 316,160 339,676 1,223,317 28%
2018 22,451 404,684 427,135 1,435,246 30%
2019 20,121 376,719 396,840 1,429,951 28%
2020 16,956 314,593 331,549 1,465,589 23%
2021 21,823 294,364 316,187 1,547,656 20%
Source: Ministry of Health Kenya Health Information System
We must provide all girls with menstrual and other hygiene

commodities to reduce their vulnerabilities to sexual exploitation
18
Sexual violence, including rape, defilement and incest, infringes on a child’s and human rights
while narrowing opportunities for women and girls to meaningfully participate in socio-economic
development. It can lead to HIV infection, sexually transmitted infections, mis-timed pregnancies
and increased risk of chronic physical and mental ill health. A survey conducted in 2019 established
that 46% of women and 52% of men aged 18-24 had faced at least one type of violence during their
childhood in Kenya. Orphans and other vulnerable children face an increased risk of violence with
delayed access to healthcare.4 The number of reported cases of sexual and gender-based violence
against children and adolescents increased by more than three-fold between 2016 and 2021, with
majority of the perpetrators being relatives.
38,842
40000
50,000
40,000
Number of SGBV cases reported
30,000 19,839
16,476
20,000 13,516
11,456 11,465
10,000 6,340
7,293
5,810 5,587
2,912
2,466 2,613 1,931 2,348
1,793
0
1,113 886
2016 2017 2018 2019 2020 2021
sGBV 0-9 Yrs sGBV 10-17 Yrs Total SGBV cases reported- (all ages)
4 The Plight of Orphans in Kenya
19
Expanding access to HIV prevention choices
Kenya was among the first African countries to roll out a national programme to provides pre-exposure
prophylaxis (PrEP) for preventing HIV acquisition in 2016. While the programme is successful, coverage
among sub-populations such as discordant couples and young girls and women is still sub-optimal.
Uptake of pre-exposure prophylaxis among discordant couples
54%
35,000
31,401
47%
30,000
25549
25,000
44%
Number on PrEP
20,000 16,810
15821
15,000 11963
10,000 82% 61%

7003
1394 4618
5,000
1146
0 2833
2017 2018 2019 2020 2021
Eligible PrEP Discordant Couple Initiated (New) PrEP Discordant Couple
Source: Kenya Health Information System
20
Progress in reducing new HIV infections among key populations
The estimated number of key populations, including female sex workers, men who have sex with men,
people who inject drugs and transgender people has increased over time. These populations are at
higher risk for HIV, irrespective of the epidemic type or local context. They face additional social and
legal challenges that increase their vulnerability to HIV. HIV prevalence among these sub-populations
is 4-times higher than that of general population. The HIV programme targeting key populations has
yielded impressive results. The contribution of new HIV infections from key populations reduced from
33% in 2009 to 13% in 2020.
HIV AMONG KEY POPULATIONS
Contribution to New HIV Infections
2009 2020
33% 13%
HIV prevalence
Female Sex Men who have People Who General

Workers sex with men Inject Drugs Population
29.3% 18.2% 18.7% 4%
Population size estimates
Female Sex Men who have People Who Transgender

Workers Sex with Men Inject Drugs
197,096 61,650 26,673 4,370
Sources: NASCOP IBBS 2011, NASCOP KP Size estimates, 2020, NASCOP KP Size estimates, 2012 (Source: KPSE II report, NASCOP 2020)
21
Distribution of Key populations across counties
Men who have sex with men Female sex workers

distribution 2020 distribution 2020
Turkana Mandera Turkana Mandera
Marsabit Marsabit
Wajir Wajir
West Pokot West Pokot
Samburu Samburu
Elgeyo Elgeyo
Trans Marakwet Trans Marakwet
Nzoia Nzoia
Isiolo Isiolo
Bungoma Uasin Baringo Bungoma Uasin Baringo
Gishu Gishu
Busia Busia
Laikipia Laikipia
Kakamega Meru Kakamega Meru
Nandi Nandi
Vihiga Vihiga
Siaya Siaya
Nyandarua Nyandarua
Kisumu Kisumu
Tharaka-Nithi Tharaka-Nithi
Kericho Nakuru Kericho Nakuru
Homa Bay Nyeri Garissa Homa Bay Nyeri Garissa
Embu Embu
Kisii Bomet Murang'a Kisii Bomet Murang'a
Migori Kiambu Migori Kiambu
Narok Nairobi Narok Nairobi

Machakos Machakos
Kitui Kitui
Tana River Tana River
Makueni Lamu Makueni Lamu

Kajiado Kajiado
150 - 500 688 - 5,000

501 - 3,500 Taita Taveta
Kilifi
5,001 - 15,000 Taita Taveta
Kilifi
3,501 - 15,271 15,001 - 39,227

Mombasa Mombasa
Kwale Kwale
Transgender People who inject drugs

distribution 2020 distribution 2020
Turkana Mandera Turkana Mandera
Marsabit Marsabit
Wajir Wajir
West Pokot West Pokot
Samburu Samburu
Elgeyo Elgeyo
Trans Marakwet Trans Marakwet
Nzoia Nzoia
Isiolo Isiolo
Bungoma Uasin Baringo Bungoma Uasin Baringo
Gishu Gishu
Busia Busia
Laikipia Laikipia
Kakamega Meru Kakamega Meru
Nandi Nandi
Vihiga Vihiga
Siaya Siaya
Nyandarua Nyandarua
Kisumu Kisumu
Tharaka-Nithi Tharaka-Nithi
Kericho Nakuru Kericho Nakuru
Homa Bay Nyeri Garissa Homa Bay Nyeri Garissa
Embu Embu
Kisii Bomet Murang'a Kisii Bomet Murang'a
Migori Kiambu Migori Kiambu
Narok Nairobi Narok Nairobi

Machakos Machakos
Kitui Kitui
Tana River Tana River
Makueni Lamu Makueni Lamu

Kajiado Kajiado
0 - 100 0 - 500
101 - 500 Taita Taveta
Kilifi
501 - 1,000 Taita Taveta
Kilifi
501 - 1,064 1,001 - 4,198

Mombasa Mombasa
Kwale Kwale
22
Prevention of HIV among people with untreated substance use

disorders
Kenya has intensified efforts to provide harm reduction services to people who inject
drugs. The number of people who inject drugs on medically assisted therapy increased
from 45 in 2015 to 8,557 in 2022. Harm reduction for people injecting drugs is one of
the key interventions for reducing HIV transmission.
2015 2022
People who inject drugs People who inject drugs
enrolled on Medically enrolled on Medically
Assisted Therapy Assisted Therapy
45 8,557
23
We are making progress in harm reduction, them to end their addiction if they have already
including reducing exposure to risk and HIV started. Supporting people who inject drugs and
transmission among people who inject drugs. are living with HIV to adhere to their treatment
More than 20,000 people who inject drugs are is essential to ensure success. Most of the
reached with the needle and syringe program. young people are driven to change due to peer
Over 8,000 people who inject or use drugs are pressure. There should be enhanced legal and
on opiate substitution therapy program as part of policy environment to address substance use
Medically Assisted Therapy (MAT) in Kenya, with disorder through public education, establishing
9 clinics established within public health facilities. preventive programs, community-based services,
and incorporating psycho-social rehabilitation
The burden of substance use disorders in sub– into SUD treatment.
Saharan Africa is very high. In Kenya, there are
an estimated 26,673 people who inject drugs.
More than 10% of people aged between 15
and 65 also have an alcohol use disorder. The
median age of onset of any substance use is 11
years and considerably lower than that (16– 19
years) reported elsewhere in the world. One
in five adolescents reported having used at
least one substance in their lifetime. Substance
abuse is linked to unprotected sexual acts which
is a significant driver of HIV and viral hepatitis
transmission5.
Young people are also likely to show more high-

risk behaviour, such as sharing injecting needles
and other drugs paraphernalia. The global rate
of Hepatitis C (HCV) among people who inject
drugs is 52%. People who inject drugs also
have higher rates of tuberculosis as compared
to the general population. HIV prevention
programs should reach out to vulnerable youth
to prevent them from starting to inject or help
5 National Authority for The National Authority for the Campaign Against Alcohol
and Drug Abuse 2019 Report
24
I have lived with HIV for the last 37 years. Aging with HIV also presents
a higher risk of other non-communicable diseases, including cancers,
diabetes and hypertension. Along the way, I have lost many friends,
including Joe Muriuki who was a social pillar in combating HIV stigma.
Last year, I battled COVID-19 to the verge of death at the intensive care
unit. I was privileged to access quality health services to celebrate another
birthday. We must strengthen an integrated health systems model that is
responsive to both the prevention and management of diseases
Reverend Anisia Karanja
25
Aging and HIV burden in the absence of interventions. The cost

of managing NCDs is also projected to increase
Older people are less likely than younger people by 58% from Ksh 230 billion in 2016 (3.4% of
to get tested for HIV. Older adults might be GDP) to Ksh 607 billion by 2030.
coping with other diseases associated with aging,
which can mask the signs of HIV. Lack of access Projection of the proportion of people living
to high-quality health facilities and services could with HIV with one or two non-communicable
also lead to late HIV diagnosis, allowing the virus diseases
to progress to AIDS.
Kenya has a growing number of older people
37%
living with HIV due to improved access to
treatment. An estimated 883,694 of the 1.4
30%
million people living with HIV are aged between
35 and 74 years. Many of them were diagnosed
with HIV in their younger years. Between 2010
and 2021, about 622,724 deaths have been
averted, attributed to ART uptake. With the
survival trends, more aged people will live with
HIV over time. This means that there is a need to
13%
place emphasis on the provision of services to
11%
10%
protect the elderly from age-related conditions
9%
that may worsen their quality of life. 4%
4%
4%
3%
Aging with HIV has several challenges, including
2%
1%
1%
1%
the onset of other chronic illnesses that increase
morbidity and mortality rates. People living
Hypertension
Type 2 diabetes
High total cholesterol
Chronic kidney disease
Depression
Cardiovascular disease
Cancer
with HIV are at a heightened risk of acquiring
non-communicable diseases due to increased
inflammatory markers and associated adverse
effects of antiretroviral medicines for HIV
treatment. The cohort of aging people living with
HIV is likely to significantly contribute to NCDs’
2018 prevalence 2035 prevalence
26
Other Sexually Transmitted fetus if the maternal infection is not detected

Infections and treated sufficiently early in the pregnancy.
Most untreated primary and secondary syphilis
Kenya relies on syndromic management of other infections in pregnancy result in severe adverse
sexually transmitted infections. Laboratory-based pregnancy outcomes. In early maternal syphilis,
testing is costly and requires trained personnel. the risk of mother-to-child transmission of syphilis
The risk of loss-to-follow-up, given the delay in can be up to 80%. Early diagnosis and adequate
reporting results for laboratory-based testing treatment of the mother, ideally before the
hinders implementation. The most commonly second trimester, can quickly cure the fetus and
reported sexually transmitted infections of public minimize adverse outcomes.
health significance include chlamydia, gonorrhea,
mixed fungal infections and syphilis. There is an The number of women and infants affected
unabated trend on the reported cases of sexually by syphilis remains unacceptably high. In five
transmitted diseases for the last four years. The counties, Homabay, Kericho, Narok, Nandi, Busia,
number of pregnant mothers diagnosed with Baringo and Migori, the positivity rates among
syphilis increased by 35% from 10,403 in 2018 to women attending the antenatal clinic are higher
14,073 in 2021. than 2%.
Sexually Transmitted Infections

2018 310,572
2019 331,187
2020 324,626
2021 316,824
It is crucial that all women are

Source: Kenya Health Information System
provided with early syphilis screening
and treatment as part of high-quality
Syphilis is one of the most common
antenatal care, to enable a healthy
sexually transmitted infections globally, with
pregnancy experience. In addition, all
approximately 6 million new cases occurring
women diagnosed with syphilis and
annually. Kenya has intensified efforts to eliminate their infants require treatment. Sexual
mother-to-child transmission of syphilis. partners of ANC clients need to be
reached for testing and treatment too
Mother-to-child transmission of syphilis, or
congenital syphilis, is usually devastating to the
27
Syphilis positivity rate among mothers attending antenatal clinic by county
Syphilis positivity
Syphilis Positive
ANC clients
Homa Bay 1,453 4.9%

Kericho 759 3.7%
Narok 753 2.4%
Nandi 452 2.2%
Busia 461 2.1%
Baringo 314 2.1%
Migori 750 2.0%
Turkana 525 1.9%
Laikipia 288 1.8%
Isiolo 106 1.5% Turkana Mandera
Meru 488 1.4% Marsabit
Kajiado 542 1.4%

Mandera 281 1.2%
Nakuru 794 1.2%
Wajir
West Pokot
Tharaka Nithi 122 1.1%

Samburu
Elgeyo
Trans
Nairobi 1,789 1.1%

Marakwet
Nzoia
Isiolo
Gishu
Tana River 89 1.0%

Busia
Laikipia
Kakamega Meru
Nandi
Vihiga 144 0.9%

Vihiga
Siaya
Nyandarua
Kisumu
Tharaka-Nithi
Garissa 233 0.9%

Kericho Nakuru
Embu
Kisumu 317 0.8%

Migori Kiambu
Nyandarua 124 0.8%

Narok Nairobi
Machakos
Kitui
Tana River
Nyamira 145 0.8%

Kakamega 386 0.8%
Makueni Lamu
Kajiado
Machakos 209 0.7%

Kwale 197 0.7% Kilifi
Siaya 215 0.7%

Taita Taveta
Kitui 176 0.7% Kwale

Mombasa
Elgeyo Marakwet 82 0.6%

Nyeri 93 0.6%
Uasin Gishu 215 0.6%
Bomet 145 0.6% Homa Bay, Kericho, Narok,
Muranga 132 0.6% Nandi, Busia, Baringo and
Kiambu 343 0.5%
Bungoma 283 0.5% Migori have Syphillis positivity
Kisii 162 0.5%
Trans Nzoia 79 0.4%
of 2% and above among
Makueni 72 0.3% pregnant mothers attending
Taita Taveta 26 0.3%
Samburu 24 0.3% the antenatal clinic
Kilifi 133 0.3%
Embu 35 0.2%
Mombasa 79 0.2%
Lamu 8 0.2%
West Pokot 21 0.1%
Wajir 12 0.1%
Kirinyaga 9 0.1%
Marsabit 8 0.1%
28
What now?
We need to scale
up effective interventions
for prevention and
treatment that are accessible
for people in need
Dr. Rose Wafula, Head

NASCOP
29
1. Invest in primary prevention with HIV in that same population. Globally, a

strategies delivered through a benchmark value of 0.3 and below is indicative
model that is efficient for the of optimal trajectories. The 2021 data shows that
34 counties were on the right path with Muranga
diagnosis, treatment and control of County leading the efforts to control new HIV
epidemics infections, indicating effective prevention efforts.
It is feasible for Kenya to achieve a 75% reduction
As per the 2019 KNBS census, adolescents in new HIV infections by 2025 if all counties
and young people aged 15- 24 years account reduce their IPR by 20%.
for 20% of the population. New HIV infections
among this age group 15-24 accounted for 40%
of the 29,380 new adult infections in 2022. This HIV Incidence Prevalence Ratio per county
sub-population is projected to increase from
9,733,174 to 12,612,171 by 2030 (KNBS 2019),
requiring additional investments to prevent new
HIV infections and avert deaths.
Investing more in HIV prevention among

Turkana Mandera
children, adolescents and young people is

Marsabit
critical to preventing new HIV infections and

ending AIDS-related deaths. The projected cost West Pokot
Wajir
saving of averting HIV infections from birth to Elgeyo

Samburu
current life expectancy (67 years) is about KES

Trans Marakwet
Nzoia
Isiolo
Gishu
17,642,047.74. Busia
Kakamega
Nandi
Laikipia
Meru
Vihiga
Siaya
Nyandarua
Kisumu
Tharaka-Nithi
2. Prioritize programmatic gaps,

Kericho Nakuru
Embu
select the right interventions for

Migori Kiambu
Narok Nairobi
Machakos
Kitui
the disparate epidemic typologies

Tana River
Makueni Lamu
across 47 counties.
Kajiado
HIV Incidence
In line with KASF II, the Incidence to Prevalence Prevalence Ratio
Kilifi
Taita Taveta
Ratio (IPR) is a critical indicator to measure > 0.03

Mombasa
progress. IPR refers to the number of new

Kwale
<= 0.03
infections occurring per year in a population

divided by the number of persons living
30
The Kenya HIV epidemic is disparate by

population and geography, with the HIV
prevalence ranging from as high as 16.2% in
Homabay to as low as 0.2% in Garissa and
Turkana Mandera
Marsabit
Wajir counties. An epidemic appraisal for

Kenya defined the epidemic typologies as
Concentrated, Generalising, and Mixed. The
Wajir
West Pokot
Samburu
classification reflects the specific behaviours

Elgeyo
Trans Marakwet
Nzoia
Isiolo
present for each infection to lead, on average, to

Gishu
Busia
Laikipia
Kakamega
more than one new infection. The epidemic in 22

Nandi Meru
Vihiga
Siaya
Nyandarua
Kisumu
Tharaka-Nithi
counties was classified as Concentrated, Mixed

Kericho Nakuru
Embu
epidemic in 21 counties and Generalized in 4

Migori Kiambu
Narok Nairobi
Machakos
Counties.
Kitui
Tana River
Makueni Lamu
Kajiado
Generalising epidemics;
4 Counties
Mixed epidemics; 21 Counties
Kilifi
Taita Taveta
Concentrated epidemics;
22 Counties
Mombasa
Kwale
31
Epidemic Typologies: Definitions

Concentrated epidemics are those where ongoing transmission is within
sub-populations at higher risk due to sexual practices or needle-sharing
networks. In all concentrated epidemics, the appropriate intervention is
to scale up effective and focused HIV prevention programmes to reduce
transmission in the high-risk networks. In addition, the intervention
should maintain high coverage of pregnant women for HIV testing and
treatment for those living with HIV.
Generalising epidemics is where HIV transmission is mainly sustained

by high-risk sexual behaviour in the general population, without any
substantial contribution by the defined subpopulation at risk. In all
generalising epidemics, appropriate intervention should focus on
changing sexual behaviour patterns in the general population. In
particular, the focus should be on reducing multiple and concurrent
partnerships and using other prevention measures, such as increasing
the proportion of men who are circumcised, where relevant.
Additionally, there should be a high coverage of pregnant women for
HIV testing and treatment for those living with HIV.
Mixed epidemics occur when there is a substantial contribution from

the general population’s sexual behaviour patterns and defined
subpopulations at risk due to shared networks of higher risk practices. In
a mixed epidemic, the programming focus should be on a dual strategy
of changing sexual behaviour patterns in the general population and
reducing transmission in the key and priority populations. In addition,
interventions should maintain high coverage of pregnant women for HIV
testing and treatment for those living with HIV.
Black coloured lines indicate high risk sexual or needle sharing contact between individuals
Contributors: B.M. Ramesh, Parinita Bhattacharjee, Franklyn Songkok, Joshua Gitonga, Shem Kaosa, Japheth
Kioko, Faran Emmanuel, Souradet Shaw, Helgar Musyoki, Mary Mugambi, Stephen Moses, Catherine Ngugi,
Ruth Laibon Masha, James Blanchard
32
33
3. Intergrate services and invest HIV is also a sexually transmitted infection

beyond health facility-based and shares transmission dynamics with other
interventions to address the STIs. People who have STIs are more prone to
acquiring HIV. People living with HIV who are not
syndemic factors that reinforce the on treatment are also prone to suffer from active
HIV epidemic tuberculosis.
The word syndemic is a blend of syn, meaning Factors such as sexual and gender-based
“together,” and –demic, as in epidemic violence, poverty, food insecurity, incarceration,
or pandemic introduced to label the synergistic substance abuse disorders make people
interaction of two or more coexistent diseases vulnerable to HIV, STIs, and TB. People living with
and the resultant excess burden of disease. HIV and those infected with STIs and TB are often
It describes a situation in which two or more stigmatized, which often constitutes an obstacle
interrelated factors work together to make a to the effective implementation of interventions.7
disease or health crisis worse6.
In Kenya, due to geographical burden,

the presence of HIV, Tuberculosis, sexually
transmitted infections (STI) and malaria has
resulted in syndemic situations. The diseases
cause sickness and death, reducing the size
and productivity of the country’s workforce
while imposing an indirect economic burden.
For example, the interaction between HIV and
tuberculosis in Kenya is syndemic. While one
is caused by bacteria and the other a virus,
infection with HIV makes a person much more
susceptible to TB and complicates the clinical
progression, management, and control of both
conditions. These two diseases are interrelated
in that the presence of one indirectly helps the
success of the other.
7 Bromberg, D. J., Mayer, K. H., & Altice, F. L. (2020). Identifying and Managing
Infectious Disease Syndemics in Patients with HIV. Current opinion in HIV and
6 Medical Anthropologist Merrill Singer in the early 1990s AIDS, 15(4), 232. https://doi.org/10.1097/COH.0000000000000631
34
The association between food insecurity and HIV creates a syndemic situation; a complex cycle
that increases the vulnerability to one and complicates the severity of the other. Although food
insecurity affects entire communities primarily through decreased household economic capacity,
women and children are disproportionately affected.
Food insecurity also leads to an increase in transactional sex for money or food, migration in
search of food, and additional vulnerabilities such as condom-less sex, sexual and gender-based
violence, poor mental health, and substance abuse. Inadequate nutrition negatively impacts
the HIV continuum of care, specifically through disrupting ART adherence and engagement
with care. In addition, malnutrition, and unsafe infant feeding practices, such as mixed feeding,
increase the risk of mother-to-child transmission of HIV8”.
The success of the HIV response depends on the design of policies and programs that address
facilitating factors such as ensuring food security, particularly among those most vulnerable,
eliminating gender-based violence and homelessness, among others.
8 Lieber, Mark, et al. “The synergistic relationship between climate change and the HIV/AIDS epidemic: a conceptual framework.” AIDS and Behavior
25.7 (2021): 2266-2277
35
4. Promote technological of antiretroviral drugs (ARVs) for life within a

innovations in diagnosis, treatment stable supply chain. To achieve an uninterrupted
and accountability for efficiency supply of preventions commodities, diagnostics
tools and HIV treatment countries are required
gains to consolidate their demand and maintain a
minimum stock of 9 months (6 months of supply
Closing financial gaps in the HIV response will at the central store level and 3 months at the
require an examination of the efficiencies and facility level).
effectiveness of the vertical models of service
delivery, formulation of policies, resource The Kenya HIV Programme is designed on
mobilization, monitoring, and evaluation, a universal health coverage model where
coordinating stakeholders and setting of treatment and prevention commodities are
standards and norms for quality assurance. provided free to the user. Since it was brought to
Technological innovations such as point-of-care scale in 1994, the procurement of essential HIV
diagnostics and integration of services will result commodities including long-life treatment has
in technical and allocative efficiencies that are largely, (80%) depended on external resources.
central to ensuring value addition to the clients, Urgent and proactive steps are required to
communities and health system. secure domestic resources that will maintain
both HIV primary prevention and treatment
programmes amidst other competing priorities
5. Close the gaps in delivering
such as climate change. Any level of disruption
essential HIV commodity security in the HIV programme can result to the
through a predictable and strong unforgiving resurgence of AIDS.
supply chain system
Over the last 10 years, while external resources
The hallmark of success for HIV treatment is have significantly declined, there has been no
suppressed viral load for an individual and others proportionate increase in domestic resources. In
living with HIV in the same community. Kenya the FY 2022/2023, the country has a funding gap
has committed to accelerating progress towards of KES 10 billion required to maintain a stable
the achievement of the global targets of 95-95- supply of essential commodities.
95 targets by 2025. Increasing the number of
people living with HIV who are aware of their
status, access to treatment and viral suppression
across all sub-populations and geographies is
dependent on the consistent and sustained use
36
Funding Landscape for Essential HIV Commodities for FY 2022/23 in USD

Program Area Annual Funding Global Fund Government of Kenya Annual Funding
required (KSh) gap (including
(including 6 6 months buffer
months buffer stock)
stock)
Counterpart Ministry of US Government
Financing Health
ARV medicines (for ART, 121,477,703.04 38702534.64 18,221,655.46 44,203,910.00 20,349,602.95
PMTCT, PrEP, PEP)
Medicines for opportunistic 16,299,874.03 0.00 5,564,571.69 827,183.00 9,908,119.34
infections
Nutrition Products 18,985,734.93 0.00 2,807,922.64 16,177,812.29
Laboratory 65,050,676.23 2,434,336.27 6,853,572.64 22,561,500.00 33,201,267.32
Condoms (male and 7,001,144.64 2,621,794.09 4,379,350.55
female), condom lubricants
and dispensers
Other commodities for 9,485,431.57 488,444.58 8,996,986.99
Key populations Opioid
Substitution Therapy and
STI medicines
Voluntary Medical Male 901,791.83 901,791.83 0.00
circumcision (VMMC)
Total Commodity Costs 239,202,356.28 44,247,109.58 25,075,228.10 9,274,286.16 67,592,593.00 93,013,139.45
Procurement and Supply 19,136,188.50 3,539,768.77 3,385,155.79 1,252,028.63 5,407,407.44 7,441,051.16
Management (PSM)
related cost
Total Costs (Commodity 258,338,544.79 47,786,878.34 28,460,383.89 10,526,314.79 73,000,000.44 100,454,190.61
Costs+8 % PSM Cost)
Source: National STI and AID Control Programme 2022
The country will need to explore and secure fiscal space to bridge the rising financing gaps due
to the global dwindling resource envelope. The transition of resource streams for procurement of
commodities and human resources that are externally funded will require realistic domestic plans.
37
Annexes
38
County People Living with HIV County New HIV Infections County AIDS Deaths
(2021) (2021) (2021)
Nairobi 153,818 Nairobi 3,828 Kisumu 1,703
Kisumu 130,036 Kisumu 3,118 Homa Bay 1,589
Homa Bay 122,954 Homa Bay 2,696 Nakuru 1,332
Siaya 97,922 Siaya 2,180 Nairobi 1,300
Migori 77,690 Migori 1,943 Siaya 1,276
Nakuru 58,678 Nakuru 1,496 Mombasa 1,031
Mombasa 54,303 Mombasa 1,241 Migori 998
Kakamega 50,991 Kakamega 1,198 Uasin Gishu 826
Kiambu 46,571 Kisii 1,065 Kakamega 712
Kisii 42,842 Uasin Gishu 1,048 Kajiado 685
Busia 36,813 Kajiado 966 Kiambu 663
Uasin Gishu 36,310 Busia 828 Machakos 587
Machakos 34,889 Machakos 821 Kisii 561
Meru 31,186 Bungoma 796 Kilifi 558
Bungoma 30,594 Meru 782 Trans-Nzoia 551
Kajiado 30,255 Kiambu 729 Meru 522
Kilifi 29,962 Narok 725 Busia 513
Kitui 27,919 Kilifi 713 Kericho 502
Trans-Nzoia 24,459 Trans-Nzoia 709 Narok 483
Kericho 22,182 Kericho 666 Kitui 462
Narok 21,848 Turkana 665 Turkana 448
Makueni 21,644 Kitui 614 Bungoma 424
Murang’a 21,550 Nandi 555 Nandi 423
Vihiga 20,825 Makueni 464 Makueni 363
Turkana 20,092 Bomet 457 Kwale 355
Kwale 19,140 Kwale 453 Bomet 346
Nandi 18,681 Vihiga 434 Murang’a 307
Nyamira 16,691 Nyamira 391 Vihiga 293
Nyeri 16,522 Samburu 307 Nyeri 237
Bomet 15,372 Baringo 262 Nyamira 219
Kirinyaga 13,502 Laikipia 243 Laikipia 208
Embu 11,017 Murang’a 239 Samburu 205
Nyandarua 10,570 Embu 230 Kirinyaga 194
Taita-Taveta 9,952 Elgeyo-Marakwet 218 Taita-Taveta 189
Samburu 9,307 Taita-Taveta 209 Embu 186
Laikipia 9,130 Nyeri 193 Baringo 174
Tharaka-Nithi 7,937 Tharaka-Nithi 175 Elgeyo-Marakwet 151
Baringo 7,777 Kirinyaga 157 Nyandarua 149
Elgeyo-Marakwet 6,722 Nyandarua 137 Tharaka-Nithi 133
Isiolo 3,347 West Pokot 126 Mandera 121
West Pokot 3,311 Isiolo 98 Garissa 83
Marsabit 2,717 Marsabit 89 West Pokot 73
Lamu 2,568 Mandera 88 Isiolo 54
Tana River 2,259 Tana River 65 Lamu 48
Mandera 2,190 Lamu 58 Wajir 48
Garissa 1,391 Garissa 38 Marsabit 44
Wajir 835 Wajir 27 Tana River 42
Kenya 1,437,267 Kenya 34,540 Kenya 22,373
39
Adolescent Pregnancies, Sexual and Gender Based Violence and New HIV Infections Among Adoscents (10-19 Years)
ADOLESCENT PREGNANCY (10-19 years)
County 2016 2017 2018 2019 2020 2021 Score
Kisumu 12,853 13,837 8,371 7,552 6,514 6,763
Busia 10,590 9,924 11,425 6,700 5,707 6,003
Migori 15,071 12,882 13,000 10,733 9,342 10,107
Siaya 10,557 11,055 13,696 10,858 7,758 7,161
Mombasa 4,757 7,532 6,922 3,684 2,365 3,358
Kilifi 10,335 11,142 15,590 9,478 7,058 7,440
Kwale 9,186 9,888 12,480 11,251 8,279 6,640
Lamu 1,113 1,771 1,465 1,307 1,062 871
Uasin Gishu 6,611 8,704 9,948 9,455 4,750 5,258
Kiambu 9,641 10,947 14,859 13,526 10,382 8,330
Homa Bay 11,324 14,646 14,733 13,644 11,867 10,116
Kisii 11,301 10,923 13,542 10,980 9,601 10,149
Nyamira 4,781 4,965 5,919 8,255 5,403 4,446
Murang’a 4,396 4,591 6,681 6,660 5,519 4,195
Makueni 4,829 6,552 8,157 7,234 5,396 4,724
Taita-Taveta 1,438 2,413 3,594 1,590 1,428 1,421
Nairobi 18,178 25,814 27,239 26,545 22,128 17,990
Kirinyaga 2,331 3,127 4,298 3,311 2,422 2,347
Machakos 5,796 7,534 9,955 10,898 5,432 5,857
Nakuru 10,712 13,875 18,040 16,496 12,450 11,469
Kitui 6,826 9,015 11,486 8,471 6,468 7,666
Embu 2,105 3,077 2,108 2,151 2,310 2,416
Nyeri 1,623 2,723 2,611 3,022 2,380 1,898
Nyandarua 2,087 2,462 3,836 3,924 2,306 2,497
Kericho 5,514 5,397 9,020 10,523 8,427 7,150
Nandi 4,422 5,911 8,237 8,071 7,089 5,781
Baringo 3,978 4,194 6,223 4,917 4,376 5,214
Wajir 2,342 2,642 3,153 2,954 3,457 3,252
Tana River 3,366 3,532 5,569 5,467 4,584 4,712
Kajiado 7,721 7,510 10,342 12,856 10,872 11,084
Bomet 6,984 9,552 10,075 11,153 9,154 10,147
Tharaka-Nithi 1,904 2,714 4,016 4,015 3,563 2,767
Elgeyo-Marakwet 2,545 3,002 4,137 4,019 4,004 3,757
Laikipia 2,684 3,798 4,999 5,506 5,489 4,030
Meru 9,414 13,346 16,057 15,826 14,669 14,417
Isiolo 1,457 1,679 2,772 2,865 2,092 2,256
Bungoma 8,845 17,636 19,186 14,512 13,376 14,054
West Pokot 5,664 5,704 8,756 8,560 9,808 9,111
Narok 8,359 10,861 15,287 14,962 15,225 13,593
Turkana 4,272 6,463 7,882 8,390 8,450 6,973
Samburu 2,406 2,093 3,938 4,648 4,905 4,201
Vihiga 2,621 3,900 6,620 7,355 6,322 4,674
Trans-Nzoia 3,985 5,532 11,979 11,997 11,601 7,413
Garissa 2,524 3,395 4,460 4,890 3,168 6,033
Marsabit 1,547 1,751 2,933 3,684 3,873 3,799
Kakamega 4,206 8,465 16,969 17,489 14,768 15,166
Mandera 432 1,200 4,570 4,456 3,950 7,481
KENYA 275,633 339,676 427,135 396,840 331,549 316,187
Source: 2021 Estimates and Kenya Health Information System KEY: Teenage pregnancies and SGBV (2016-2021) More than 50% increase Less than 50% increase Decline
40
Adolescent Pregnancies, Sexual and Gender Based Violence and New HIV Infections Among Adoscents (10-19 Years)
SGBV (10-17 Years) NEW HIV INFECTIONS (10-19)
2016 2017 2018 2019 2020 2021 Score 2015 2017 2019 2020 2021 Score
170 246 707 1,903 1,198 976 2688 884 852 579 495
66 100 144 94 259 607 154 136 120 109 111
61 79 177 204 394 485 1557 620 426 353 290
12 20 126 153 496 1,598 2355 890 760 447 371
15 39 228 306 413 522 681 289 190 166 211
396 419 770 707 805 900 397 229 96 107 114
1 5 9 9 21 213 300 134 48 55 72
0 2 1 1 19 29 29 18 9 6 10
81 145 237 508 520 248 158 120 173 195 184
18 26 24 21 155 211 353 222 171 96 86
28 38 92 161 261 697 2945 1004 582 566 462
68 46 135 136 461 832 634 274 275 182 163
95 61 72 115 403 872 454 137 66 68 64
26 7 14 18 94 236 135 114 24 37 40
36 35 53 144 274 308 441 81 63 73 65
15 1 1 2 13 60 148 71 23 26 39
223 221 522 538 803 1,341 1035 1222 386 433 338
36 24 42 33 132 189 61 54 18 24 25
32 15 13 90 148 197 490 99 118 105 106
439 388 503 409 712 1,099 243 185 239 287 297
43 9 99 63 180 238 435 95 84 80 83
58 65 82 74 128 82 167 35 26 32 33
52 78 138 69 294 227 93 81 35 38 31
51 39 35 34 82 240 63 60 20 19 19
3 5 14 15 117 64 97 65 119 106 112
1 2 12 24 45 69 66 48 83 76 94
4 0 2 5 5 30 33 22 41 35 39
0 3 3 6 13 0 9 0 1 1 2
0 0 4 5 4 37 35 16 6 6 8
12 112 199 237 329 336 119 93 140 120 153
10 5 53 56 92 46 66 40 83 74 77
2 3 30 88 112 102 137 28 20 19 24
1 5 1 0 17 30 26 18 26 34 34
40 26 40 44 94 96 46 35 40 49 46
41 70 80 73 118 163 391 79 80 91 94
0 0 3 1 9 54 10 14 6 10
32 55 174 333 684 1,127 120 106 29 98 92
4 0 3 0 14 24 28 22 20 16 16
16 11 67 43 127 86 94 68 138 75 108
79 37 65 31 202 172 133 87 120 59 100
0 4 5 8 16 25 17 11 15 12 46
39 48 94 61 74 279 77 70 49 56 63
99 47 329 286 574 483 154 108 125 102 123
0 1 0 0 19 62 17 0 2 1 4
0 1 0 18 20 3 43 8 21 6 8
61 69 183 168 523 824 203 187 189 166 154
0 1 2 0 0 2 23 0 1 2 5
2,466 2,613 5,587 7,293 11,465 16,476 18,004 8,177 6,166 5,294 5,123
KEY: NEW HIV INFECTIONS (2016-2021) 75% decline in new HIV infections Increase in new HIV infections Less than 75% decline in new HIV infections
41
Distribution of People Living with HIV by age cohort (2021) New infections by age cohort (2021)
Total Male Female Total Male Female
0-4 19,869 10,017 9,853 0-4 5,160 2,614 2,546
5-9 27,713 13,926 13,787 5-9 0 0 0
10-14 35,296 17,679 17,617 10-14 0 0 0
15-19 64,563 26,455 38,108 15-19 5,332 641 4,692
20-24 99,250 33,346 65,903 20-24 6,765 1,978 4,786
25-29 135,186 42,248 92,937 25-29 5,719 2,040 3,679
30-34 162,883 47,173 115,711 30-34 4,371 1,593 2,778
35-39 187,235 55,737 131,498 35-39 2,949 1,089 1,860
40-44 198,165 63,977 134,188 40-44 1,734 665 1,069
45-49 186,340 66,922 119,417 45-49 987 381 607
50-54 137,426 55,460 81,966 50-54 596 210 385
55-59 86,824 37,280 49,543 55-59 389 125 264
60-64 49,105 21,474 27,631 60-64 251 76 175
65-69 26,066 11,037 15,029 65-69 158 44 113
70-74 12,533 4,983 7,550 70-74 87 22 65
75-79 5,514 2,057 3,456 75-79 42 10 32
80+ 3,300 1,101 2,199 80+ 0 0 0
Total 1,437,267 510,874 926,393 Total 34,540 11,489 23,051
42
List of contributors for the World AIDS Day Report
Name INSTITUTION
Dr. Ruth Laibon Masha NSDCC
Joshua Gitonga NSDCC
Parinita Bhattacharjee TSU
Dr. Murugi Micheni NSDCC
Tabitha Areba NSDCC
Dr. Peter Arimi TSU
Dr. Hermes Wanjiku TSU
Charity Mureithi EGPAF
Evallyne Sikuku EGPAF
John Kuria CHAI
Brandwell Mwangi CHAI
Henry Damisoni UNAIDS
Edwin Opwora UNAIDS
Margaret Mwaila NCPD
Jack Ogony NSDCC
Japheth Kioko NSDCC
Morris Ogero NSDCC
Mercy Khasiani NSDCC
Moses Gitonga NSDCC
Jenny Gakii NSDCC
Wendy Chege NSDCC
Violet Otindo NSDCC
Paul Simat NSDCC
Irene Gomba NSDCC
Rebecca Nyambeki NSDCC
Dr. Steve Mutuku NSDCC
Peter Kinuthia NSDCC
Janet Musimbi NASCOP
Jafred Mwangi NASCOP
Rose Ayugi NASCOP
Faith Ngari NASCOP
Frankline Songok NASCOP
Tereza Anwar UNICEF
Dr. Wesley Ohaga MoH
Nelson Otuoma NEPHAK
44
National Syndemic Diseases Control Council
Landmark Plaza, 9th Floor
Argwings Kodhek Road
P. O. Box 61307 – 00200, NAIROBI (KENYA)
TEL: +254-020-2715109/2711261/2715144, 2896000
Website: www.nacc.or.ke/www.nsdcc.go.ke

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W O R L D A I D S D AY R E P O R T 2 0 2 2

The journey to end AIDS as a

Most of the AIDS-related deaths in 2021 occurred

Ending the epidemics of HIV, Tuberculosis

We are presented with a unique opportunity

Susan N. Wafula, Cabinet Secretary, Health

1 Invest in primary prevention

4 Intergrate services and

We have demonstrated resilience in our strive to

Mr. Geoffrey Mbirua Gitu,

Dr Ruth Laibon–Masha (PhD)

HIV testing during community

New HIV infections continue to outpace

New infections KASF II targets

There was one new infection (34,540)

The size of key populations groups is estimated

Access to HIV Treatment

All ages 95-95-95 Cascade Children 95-95-95 Cascade

Sources: Kenya HIV Estimates 2022, National Syndemic Diseases Control

30 1,200,000 West Pokot

with HIV are from

Nairobi 153,818 Nakuru 58,678

People Living with HIV by age and sex

Antiretroviral treatment coverage across counties (all ages)

Less than 49%

Preventable deaths AIDS-Related Deaths by Age and Sex

AIDS-Related deaths increased in counties - Nairobi, Kisumu, Homabay, Siaya,

10% 38.7% 21.2% 25.6% 7.2% 14.9%

Year 2010 2013 2015 2017 2019 2020 2021

HIV-related deaths by county, 2021/2022

HIV related deaths

0% - 49% Taita Taveta

AIDS-related deaths increased across 35 counties. In six counties

We are off track on ending AIDS among children,

Elimination of mother-to-child outcomes for both mothers and children through

Coverage of prevention of HIV from mother to

Year Number receiving Coverage %

MTCT rate Target

Despite the gains in HIV response, Kenya is yet

Diagnose, treat and achieve viral Sources of Mother-to-Child

Mother infected during pregnancy 6.47%

Started ART before pregnancy: child 1.84%

Did not receive ART during breast- 6.98%

Mother infected during breastfeeding 15.37%

Access to HIV treatment

Treatment outcomes for adolescents and young people remain sub-optimal,

AIDS-related deaths among adolescents and

Uptake of HIV diagnostic services among

Ending Sexual Transmission of HIV among

New HIV infections

Source: HIV Estimate 2021, National Syndemic Diseases Control Council

1 Violence against Children Survey ,UNICEF 2019

Trends in adolescent pregnancies from 2016-2021

We must provide all girls with menstrual and other hygiene

4 The Plight of Orphans in Kenya

Expanding access to HIV prevention choices

Uptake of pre-exposure prophylaxis among discordant couples