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NACC explains rising HIV prevalence rates

NAIROBI, August 4 – The government last week announced a new report on HIV/AIDS prevalence in the country.

The 2007 Kenya AIDS Indicator Survey (KAIS) showed that the prevalence rate was at 7.8 percent up from 6.7 percent in 2003.

But by 2006, reports from the National Aids Control Council (NACC) showed that the prevalence had dropped significantly to 5.1 percent.

The two figures were confusing to many, and a higher prevalence rate made the situation no better.

So, why the gap?

NACC Director Professor Alloys Orago responds to the questions.

Q: How would you explain the latest statistics showing a rise in prevalence rates?
A:  I want everyone to look at the rates based on different methodologies. The figures we have been giving between 2004-2006 have been based on data coming from ante-natal clinic attendance and what we find as a result of testing them is what we project to reflect the situation in the general population.

That is different from the methodology that was used in 2003 during the Kenya Demographic Health Survey (KDHS) which was a population based survey and the Kenya Aids Indicator Survey (KAIS) of 2007.  So those are the ones we can compare because if we look at the NACC data and compare it with the population based survey, it will be like somebody comparing a pawpaw and a mango.

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Secondly, the rates that were announced did not come as a shock to me because our programme is pretty successful, and I want to give two pieces of evidence to support this.

In the year 2003 when we had the first KDHS, the national prevalence for a population of ages between 15 and 49 was 6.7 percent. Last year during the KAIS the equivalent figure for that age group was 7.8 percent which means we have a difference of 1.1 percent. That is the basic difference we are talking about.

Now in 2003 the number of Kenyans on anti retroviral treatment was merely 11,000 while in 2007 we had 138,000 Kenyans on treatment.

A cross sectional study like the one done in 2007 will actually pick everybody who is infected irrespective of whether they are on treatment or not. And because we have witnessed a very big number of people on treatment they were captured in the survey.

As you get more successful by putting very many people on treatment you are also going to find those people living longer and any survey will find them.

We have also been successful in keeping new infections or what we refer to as incidence rates on a level ground and that is success in itself.

Q: And what’s that level ground?
A: It’s not something big, it’s just between 1.9 percent and 2 percent based on the figures we have. But now we want to focus on new infections because prevalence is no longer going to be a very good rate to consider given that it’s going to capture people who are on treatment and living longer.

So our concentration now is to reduce new infections to a very low level and that means a lot of advocacy in prevention.

Q: It’s been argued that the presence of ARV’s is also contributing to new infections with some people on treatment continuing to spread the virus.
A: That’s true. We now want to concentrate on what we call positive prevention, working with those who are HIV positive to ensure that they also guard against spreading the virus in their normal, routine interaction, with the general population.

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And that, again, is through advocacy and making sure that when they are on treatment and they engage in sexual practices they protect themselves.

Q: How comes KAIS didn’t focus on children who are below 15 years so that they can also be catered for?
A: When we look at the proportions as reflected in the report, we can actually work backwards and look at the children. From the report you can see the estimated number of children who require treatment and the total numbers of women we think are pregnant and require prevention of mother-to-child transmission services.

So the whole package is in the report.

Q: So as it is, about how many children require treatment?      
A: I think, without going back to the report, I would estimate the number of children requiring treatment will just be about 39,000

Q: Why are women at a higher risk of contracting the virus than men?
A: Well, there are two basic reasons, one of them is biological but the other one has to do with social calls that the African woman is largely exposed to.

Q: And could KAIS  pose a challenge to NACC getting donor funding considering you are also behind schedule in implementing some programmes from round 2 of the Global Fund(on HIV/AIDS, TB and Malaria)?
A: I don’t think we will have any problem. In fact it now gives us a better platform to advocate for more resources coming into the country because we are talking about evidence based programming.

Now we know which groups to target and with what type of interventions so I would like to believe that this is the beginning of a lot of money flowing into programmes in Kenya rather than the other way round.   

Q: Anything else you would like to add?
A: My parting shot to you, please tell Kenyans one critical thing, there is no cause for panic with the figures that were released on Tuesday.

It was something we expected in any successful programme particularly where you are putting people on treatment. My advocacy to all is that everybody needs to know their status because that is the beginning of informed living.

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