Kenya's HIV prevalence fell from 7.2 percent to 5.6 percent between 2007 and 2012, according to the preliminary results of the latest Kenya AIDS Indicator Survey (KAIS), but officials fear that unless the country reduces its reliance on donor funding for its HIV programmes, these gains will not be sustainable.
"Prevalence is falling despite the fact that more HIV-positive people are living longer [as a result of being on HIV treatment], so we are clearly moving in the right direction," said Peter Cherutich, head of prevention at the National AIDS and Sexually Transmitted Infections Control Programme (NASCOP).
"We attribute the fall in prevalence mainly to fewer new infections, which are a result of putting more people on treatment," he added.
Studies have shown that earlier antiretroviral (ARV) treatment can reduce the risk of heterosexual HIV transmission by as much as 96 percent.
More than 70 percent of eligible HIV-positive Kenyans - those with a CD4 count (a measure of immune strength) of 350 or lower - are on ARVs. Eighty percent of them have "viral suppression", meaning the virus is at undetectable levels, and have a low risk of infecting others with the virus.
The country also has a number of HIV-prevention interventions - from prevention of mother-to-child transmission programmes to medical male circumcision and counselling and testing campaigns - that have contributed to lower infections and higher rates of treatment.
Close to 1.2 million Kenyans are living with HIV, according to the report; women had an overall prevalence of 6.9 percent, compared to men’s prevalence of 4.4 percent and children’s 0.9 percent prevalence. HIV prevalence among adults varied by region, with substantial drops found in the Coast, Nairobi and Rift Valley regions. Nyanza, the region worst hit by HIV, saw a mild increase, from 14.9 percent in 2007 - when the last KAIS was released - to 15.1 percent in 2012.
According to Allan Ragi, executive director of the umbrella organization Kenya AIDS NGO Consortium (KANCO), progress seen in the fight against HIV is a result of the various stakeholders - the government, donors, civil society and people living with HIV - pulling together at all levels to ensure that the right policies, messages and interventions are put in place.
"The government has created a conducive environment for us to work, even when it is sometimes in conflict with the law, such as targeting and involving men who have sex with men and drug users in HIV programmes," he added.
Domestic investment needed
But NASCOP’s Cherutich warned that, with over 80 percent of Kenya's HIV programmes externally funded - the largest donors are the US President's Emergency Plan for AIDS Relief and the Global Fund to fight AIDS, Tuberculosis and Malaria - the progress was unsustainable.
"In the event that they stop funding such programmes, these interventions could stall and thus draw back the gains that have so far been realized," he said.
He added that another key priority for the government was to get more people to know their HIV status in order to get still more people on treatment, reducing the number of new infections further still.
KANCO's Ragi said there was also a need to focus the energy and investment more narrowly on the sources of new infections, both geographically and in terms of populations facing greater risk of HIV, such as married couples, men who have sex with men, drug users and sex workers.