World AIDS Day, commemorated each year on December 1st, offers an opportunity to reflect on the progress made in the global battle against HIV/AIDS. Today, in Kenya as in the rest of the world, HIV is a treatable disease. With the advent and availability of antiretroviral therapy, the human immunodeficiency virus (HIV) that leads onto acquired immunodeficiency syndrome (AIDS) can be treated as a chronic but non-threatening disease.

A brief history of HIV/AIDS

There is conclusive evidence that HIV originated in Africa. A viral ancestor to HIV-1, called the Simian immunodeficiency virus or SIV, was found in chimpanzee colonies in south-east Cameroon. Computer models suggest that the first transfer of SIV to humans occurred around 1930.

By the 1960s, an estimated 2,000 people had been infected and certain scientists began to take note. In the 1970s, the world witnessed the first AIDS epidemic in Kinshasa. Though, of course, the disease’s entry into the DRC cannot be directly mapped, the virus likely entered through an infected individual traveling from Cameroon.

In the 1980s, HIV spread on the heels of labour migration, entering East Africa. Uganda, especially, was hit hard. Confusion, stigma, and despondency characterized this period; misconceptions about HIV prevailed, leading to fear, discrimination and an easily exported sense of panic.

The virus spread West, with truck drivers and migrants and their interactions with sex workers posited as a major driver of infection. Then it went South, and, from there, out of Africa.

With all its stigma, with the harrowing way in which it brought it’s sufferers low and toward an early demise, AIDS’ profile grew in the United States of America. Buyers clubs – one of which would be the inspiration for the critically acclaimed Hollywood film Dallas Buyers Club – sprang up around the US. These associations of buyers banded together to circumvent FDA rulings in order to gain access to certain drugs considered as experimental. At the time, AIDS had a 100% mortality rate and, understandably, those suffering with it were desperate and willing to test drugs that the FDA considered experimental, not ready for public purchase or even unsafe.

Various antiretroviral therapy drugs were developed in the later 1980s and early ‘90s and a few showed limited signs of suppressing the virus. However, it wasn’t until 1996, that a new antiretroviral therapy drug – named highly active antiretroviral therapy or HAART in order to distinguish it from its predecessors – was developed.

This was one of the first major turning points in the globe’s battle against HIV/AIDS. HAART suppresses HIV to the point of allowing sufferers to live a fairly normal life. It can even suppress the virus to the point of it’s being impossible to transmit, allowing HIV sufferers access to a life free of the fear of infecting others.

However, antiretrovirals were expensive and it wasn’t until the early 2000s that these life-saving drugs were made readily available.

In 2001 and 2003 respectively, the Global Fund to Fight AIDS, Tuberculosis and Malaria and George Bush Jnr’s President’s Emergency Plan for AIDS Relief (PEPFAR) were established, bankrolling a global antiretroviral roll-out.

Today, many countries still benefit from these funds and the research they conduct. For many in Africa, free antiretroviral treatment – a treatment sufferers must commit to for life – is only made available because of the work done and funding provided through these organisations.

How prevalent is HIV/AIDS in Kenya today?

In Kenya, HIV/AIDS disease prevention and treatment is monitored by the National Syndemic Diseases Control Council (NSDCC). According to their data for this year, the number of people living with HIV has dropped from 1.436 million people in 2022 to 1,377,784 people this year.

Split along gender lines that reflects HIV prevalence numbers that are as follows: 5.3% of women are HIV positive and 2.6% of men are.

Though the numbers are trending downward, there were also 7,307 new HIV infections recorded in Kenya. Worryingly, The Nation reports, many of these new infections were accounted for from young people, Kenyans aged between 15 and 24.

According to an NSDCC spokesperson, in 2023 there are “348,408 Kenyan men and 807,576 women are on ARVs”.

UNAIDS, which works closely with PEPFAR as well as a variety of national organisations across the world, has set a 2030 target for HIV treatment. It’s called the 95-95-95 target and it reflects targets which, if met, will foster an environment in which disease prevalence is better understood and can therefore be better combatted.

Broken down, those targets mean this: UNAIDS wants to see 95% of HIV sufferers knowing that they have the virus, 95% of sufferers accessing antiretroviral treatment and 95% of sufferers with a provably suppressed virus.

With 1,155,984 of Kenya’s known 1,377,784 HIV sufferers on antiretrovirals, Kenya’s 83.87% of sufferers accessing treatment falls short of UNAIDS’ 2030 target but, more worryingly, that is also below the 2020 target which was 90-90-90 for all the above metrics.

Of those targets, the ‘access of sufferers to antiretrovirals’ one is the easiest to measure. For obvious reasons, it is difficult to ascertain exactly how many sufferers know they have the virus without them coming forward to seek treatment. Though consistent treatment does result in a measurably suppressed virus, it is also proving difficult, in Africa, to ensure that those who get treatment see that treatment result in measurable suppression.

If a HIV sufferer discontinues their antiretroviral therapy, the disease comes back, resulting in it’s being both a danger to the sufferer and transmissible once more.

In a recent South Africa-based study of antiretroviral health services, poor retention of treatment is contributing to their low numbers of those receiving treatment (75% of known sufferers) and that treatment’s failure to result in measurable virus suppression.

In South Africa, a variety of reasons have been found as explainers for this phenomenon. Side effects, time limitations and moving around are some of the most frequently given reasons for why a HIV sufferer discontinued treatment.