The US President’s Emergency Plan for Aids Relief (PEPFAR), the biggest funder of HIV programmes in Kenya, is set to significantly scale down its funding, a move activists and government officials believe could negatively affect the country’s fight against the disease.
PEPFAR funds 70 percent of Kenya’s HIV programmes.
“The scale-down of funding to HIV programmes will [negatively] impact [HIV treatment] if the government does not put additional resources,” Joseph Sitienei, head of TB, leprosy and lung diseases at the National AIDS and Sexually Transmitted Infections Control Programme (NASCOP), told IRIN.
“It is no doubt that the scale-down is coming at a time when the government needs to add additional resources to ensure the downward trend in prevalence [is sustained],” he said.
In 2013, the government estimated that its funding gap for HIV was US$1.67 billion.
Peter Cherutich, chairman of the Public Health Society, a lobby group, said: “Any reduction in funding for life-saving antiretrovirals (ARVs) would not only be a violation of human rights but a public health disaster.”
Started by former US President George Bush in 2003, PEPFAR is reducing its area of operations to just 10 counties (out of 47) and aims to end all funding in 2015. The remaining areas receiving PEPFAR funding are in western Kenya which has a higher burden of HIV. Kenya has received about US$2.9 billion from PEPFAR in the last 10 years compared to just US$357.7 million from the Global Fund to Fight HIV and TB over a similar period.
Gains could be lost
With external support, Kenya has made significant gains in the fight against HIV. Today, there are an estimated 640,000 Kenyans on antiretroviral drugs - up from just 36,000 in 2005, while the HIV prevalence has reduced from 7.2 percent in 2007 to 5.6 in 2012.
As the cash crunch begins to bite, experts are calling for HIV prevention to be targeted on high risk groups such as men who have sex with men (MSM), female sex workers, migrants and, increasingly, intravenous drug users (IDUs).
Because they receive the least help from HIV programmes, these groups threaten the progress so far made in fighting HIV, the UN World Health Organization (WHO) warned in mid-July.
According to WHO, female sex workers are 14 times more likely than other women to have HIV and almost 50 times more likely than other adults to have HIV. MSM are 19 times more likely to have HIV than the general population.
The risks of HIV infection among IDUs can be 50 times higher than the general population.
"Globally we are failing certain populations that have the greatest risk yet we know have universally poorer access to health services. These are MSM, sex workers, transgender persons, specifically transgender women, persons who inject drugs and persons who are in prisons or other closed settings," Gottfried Hirnschall, director of the WHO department for HIV, told reporters at a briefing.
Health sector reforms
Kenya is set to release an HIV Response National Strategic Plan sometime before the end of the year which is expected to drive the country’s HIV response for the next three years. Activists expect it to usher in some reforms in the health sector.
“Kenya is on the right track in the fight against HIV. All we need are reforms in the health sector. We expect the adoption of the strategic plan to help bridge the financial gap by looking at more ways to generate revenue and a shift in the way we respond to HIV,” James Kamau, the coordinator of the Treatment Access Network, a local lobby, told IRIN.
The government has been urged to do more to plug the funding gaps. “The government needs to consider how much PEPFAR will be scaling down and compensate appropriately. This will go a long way in ensuring that commodities needed don’t run out of stock and capacity-building needed is sustained,” said NASCOP’s Sitienei.
In 2013, the government allocated US$1.1 million to county governments for HIV.
The government plans, among other things, to set up an HIV endowment fund and national insurance scheme for people living with HIV.