1. EMERGING ISSUES
ON HIV AND AIDS

2. Background Information
Kenya is home to one of the world’s harshest HIV and
AIDS epidemics.
An estimated 1.5 million people are living with HIV;
around 1.2 million children have been orphaned by
AIDS; and in 2009 80,000 people died from AIDS-
related illnesses.
Kenya’s HIV prevalence peaked during 2000 and,
according to the latest figures, has dramatically reduced
to around 6.3 percent.
This decline is thought to be partially due to an increase
in education and awareness, and high death rates.

3. Background contd..
Whilst many people in Kenya are still not being reached with
HIV prevention and treatment services, access to treatment is
increasing.
More than half of adults who need treatment are receiving it,
with around 100,000 additional adults on treatment in 2010
than in 2009.
In comparison, the number of children in need of
antiretroviral treatment that are receiving it is extremely low.
An estimated 170,000 children are eligible to receive
treatment, yet only around 1 in 5 have access to it. This
demonstrates Kenya still has a long way to go in providing
universal access to HIV treatment, prevention and care.

4. Access to ARVs and ART
In 2003 only 5 percent of people needing ART were
receiving antiretroviral therapy.
In 2006 Kenya’s President announced that
antiretroviral drugs would be provided for free in
public hospitals and health centres.
In 2007 treatment coverage was low at 42 percent
with only 172,000 on treatment.
Nevertheless, by 2009 the number of people
receiving antiretroviral therapy had significantly
increased to 336,980.

5. Access to ARVs and ART contd…
However, due to a 2010 change in WHO treatment
guidelines, which recommend starting treatment
earlier, the proportion of people eligible to receive
antiretroviral treatment remained at only 48
percent.
Under the previous guidelines, treatment coverage
would have been 65 percent.
By 2010, access to treatment had increased further
with 432,621 receiving treatment, around 61 percent
of those in need.

6. Access to ARVs and ART contd…
“Despite an increase in children accessing
treatment, the overall coverage for children remains
extremely low.”
Around half of those infected with tuberculosis (TB)
are co-infected with HIV in Kenya, although this
varies widely according to region. Antiretroviral
treatment for co-infected individuals has been found
to improve patient survival if it is administered as
soon as possible after TB treatment.

7. FACTS ABOUT POST EXPOSURE
PROPHYLAXIS (PEP )

8. PEP
Post-exposure prophylaxis (PEP) is a special course of HIV
treatment that aims to prevent people from becoming infected
with HIV.
PEP is prescribed, in some instances, to people who have
potentially been exposed to the virus.
The treatment, which can be accessed from clinics and health
centers in many parts of the world, can prevent the virus from
becoming established in the body of someone who has been
exposed.
PEP is particularly important for people who have been
sexually assaulted or people who have been exposed to blood
through a needle injury or other accident at work

9. How does PEP work?
Post-exposure prophylaxis is an antiretroviral drug
treatment that is started immediately after someone
is exposed to HIV.
The aim is to allow a person’s immune system a
chance to provide protection against the virus and to
prevent HIV from becoming established in
someone’s body.
It usually consists of a month long course of two or
three different types of the antiretroviral drugs that
are also prescribed as treatment for people living
with HIV.

10. Contd…
The World Health Organisation recommends
prescribing zidovudine and lamivudine as the
preferred regimen, stating that countries are
generally advised to use the same regimens as they
would for treating HIV.
The British HIV Association recommend a
combination of drugs called Truvada (tenofovir and
emtricitabine) and Kaletra (lopinavir and ritonavir).

11. Effectiveness of PEP
The conclusions from both human and animal trials
is widely recognized and as a result, a number of
countries have produced guidelines suggesting the
possible use of post-exposure prophylaxis in both
occupational circumstances (for example a health-
care worker who has been exposed in a hospital) and
non-occupational circumstances (for example a
person who has had unprotected sex).
They tend to suggest that, as it is not 100 percent
effective, post-exposure prophylaxis should only be
used as a very last resort.

12. Effectiveness contd…
In cases where PEP is used, there are various factors that can
affect its effectiveness.
 Delayed initiation: In order for post-exposure prophylaxis to have a
chance of working, the medication needs to be taken as soon as
possible, and within 72 hours of exposure to HIV. Left any longer and it
is thought that the effectiveness of the treatment is severely diminished.
 Resistant virus: The person who potentially transmitted HIV (the
‘source’) may have a drug-resistant HIV virus, which could make PEP
ineffective.
 Adherence: It is very important that a person using PEP takes the
treatment exactly as prescribed by their doctor or health worker. The
side effects of the medication are a reason why some people find it
difficult to adhere to the full 28-day course of treatment properly.

13. Who can benefit from post-exposure prophylaxis?
People exposed to blood or bodily fluids at work
Victims of rape or sexual assault
People potentially exposed through needles
People who may have been exposed to HIV through
consensual sexual contact

14. Risks and side-effects
As with most antiretrovirals, post-exposure
prophylaxis can cause side effects such as:
 Diarrhoea Headaches
 Nausea / vomiting Fatigue.
Some of these side effects can be quite severe and it
is estimated that 1 in 5 people give up the treatment
before completion.
There is also the risk that taking PEP may cause a
person to develop drug resistance should the patient
become infected with HIV and need to be treated
with antiretrovirals

15. Other emerging issues
Discussion
What is HIV super-infection?
HIV and Gender vulnerability
HIV and Contraceptives in relation to increasing
vulnerability

16. FACTS ABOUT VOLUNTARY MEDICAL
MALE CIRCUMCISION (VMMC)

17. What is VMMC?
VMMC (Voluntary medical adult male circumcision)
A medical intervention that reduces (does not
eliminate) risk of HIV infection among sexually
active, HIV uninfected men.
Three high-quality scientific studies showing that
male circumcision reduces the risk of getting HIV by
60%

18. Advantages of MC as an addition to existing
prevention interventions
Very good safety profile
One time intervention
Most importantly, it works (and saves lives)
Other potential advantages:
Can be delivered through existing health care system (after
enhancing capacity)
Likely to be benefits for partners of circumcised men
Other health benefits (reduce other STI and complications of
STI)

19. 2007 KAIS: Male circumcision and HIV
Province with the highest HIV prevalence (Nyanza) has the lowest MC level
Province with the second highest HIV prevalence (Nairobi) has second
lowest MC level

20. HIV 3 times more prevalent among uncircumcised
men than circumcised
Source: 2007 Kenya AIDS Indicator Survey

21. Rate of new HIV infection 3 times higher among men
not circumcised
0
1
1
2
2
3
3
4
4
5
5
Not circumcised Circumcised
Percentincidentinfections(%)
Source: 2007 Kenya AIDS Indicator Survey

22. For the avoidance of doubt!
Medical Adult Male Circumcision
is and shall remain
VOLUNTARY

23. FACTS ABOUT BREASTFEEDING

24. Exclusive breastfeeding
WHO strongly recommends exclusive breastfeeding for
the first six months of life.
At six months, other foods should complement
breastfeeding for up to two years or more.
In addition:
 Breastfeeding should begin within an hour of birth;
 Breastfeeding should be "on demand", as often as
the child wants day and night; and
 Bottles or pacifiers should be avoided.

25. Health benefits for infants
 Breast milk is the ideal food for newborns and
infants. It gives infants all the nutrients they need
for healthy development.
 It is safe and contains antibodies that help protect
infants from common childhood illnesses - such
as diarrhoea and pneumonia, the two primary
causes of child mortality worldwide.
 Breast milk is readily available and affordable,
which helps to ensure that infants get adequate
sustenance.

26. Benefits for mothers
Breastfeeding also benefits mothers. The practice
when done exclusively is associated with a natural
(though not fail-safe) method of birth control (98%
of protection in the first 6 months after birth).
It reduces risks of breast and ovarian cancer later in
life, helps women return to their pre-pregnancy
weight faster, and lowers rates of obesity.

27. Long-term benefits for children
Beyond the immediate benefits for children,
breastfeeding contributes to a lifetime of good health.
Adults who were breastfed as babies often have lower
blood pressure and lower cholesterol, as well as lower
rates of overweight, obesity and type-2 diabetes.
There is evidence that people who were breastfed
perform better in intelligence tests.

28. Why not infant formula?
Infant formula does not contain the antibodies found
in breast milk. When infant formula is not properly
prepared, there are some risks arising from the use of
unsafe water and unsterilized equipment or the
potential presence of bacteria in powdered formula.
Malnutrition can result from over-diluting formula
to "stretch" supplies.
Further, frequent feedings maintain the breast milk
supply. If formula is used but becomes unavailable, a
return to breastfeeding may not be an option due to
diminished breast milk production.

29. HIV and breastfeeding
An HIV-infected mother can pass the infection to her infant
during pregnancy, delivery and through breastfeeding.
Antiretroviral (ARV) drug interventions to either the mother
or HIV-exposed infant reduces the risk of transmission of HIV
through breastfeeding.
Together, breastfeeding and ARV interventions have the
potential to significantly improve infants' chances of surviving
while remaining HIV uninfected.
WHO recommends that when HIV-infected mothers
breastfeed, they should receive ARVs and follow WHO
guidance for breastfeeding and complementary feeding.

30. Regulating breast-milk substitutes
An international code to regulate the marketing of
breast-milk substitutes was adopted in 1981. It calls
for:
All formula labels and information to state the
benefits of breastfeeding and the health risks of
substitutes;
No promotion of breast-milk substitutes;
No free samples of substitutes to be given to
pregnant women, mothers or their families; and
No distribution of free or subsidized substitutes to
health workers or facilities.

31. Support for mothers is essential
Breastfeeding has to be learned and many women
encounter difficulties at the beginning. Nipple pain,
and fear that there is not enough milk to sustain the
baby are common.
Health facilities that support breastfeeding - by
making trained breastfeeding counselors available to
new mothers - encourage higher rates of the practice.
To provide this support and improve care for
mothers and newborns, there are now more than 20
000 "baby-friendly" facilities in 152 countries thanks
to a WHO-UNICEF initiative.

32. Work and breastfeeding
Many mothers who return to work abandon
breastfeeding partially or completely because they do
not have sufficient time, or a place to breastfeed,
express and store their milk.
Mothers need a safe, clean and private place in or
near their work to continue breastfeeding.
Enabling conditions at work can help, such as paid
maternity leave, part-time work arrangements,
facilities for expressing and storing breast milk, and
breastfeeding breaks.

33. The next step: phasing in new foods
To meet the growing needs of babies at six months of age,
complementary foods should be introduced as they continue to
breastfeed. Foods for the baby can be specially prepared or
modified from family meals. WHO notes that:
Breastfeeding should not be decreased when starting
complementary feeding;
Complementary foods should be given with a spoon or cup,
not in a bottle;
Foods should be clean, safe and locally available; and
Ample time is needed for young children to learn to eat solid
foods.

34. ASANTE!!!