Dr Masha KASH Presentation Triple Threat.pptx

HIV in Kenya in 2023

1. End The TRIPLE THREAT NEW HIV INFECTIONS, PREGNANCIES, SEXUAL AND GENDER-BASED VIOLENCE AMONG ADOLESCENTS Dr. Ruth Laibon -Masha Chief Executive Officer National Syndemic Diseases Control Council

2. A Multi-sectoral, evidence-based initiative that adopts a Whole Government and Society Approach to enhance commitment and accountability towards ending new HIV infections, pregnancies and sexual and gender-based violence among adolescent in Kenya ENDING ADOLESCENT TRIPLE THREAT INITIATIVE IN KENYA

3. No. Country No. of PLHIV 1. South Africa 7.8M 2. India 2.3M 3. Mozambique 2.1M 4. Tanzania 1.7M 5. Nigeria 1.7M 6. Zambia 1.5M 7. Kenya 1.4M 8 Uganda 1.4M Kenya ranks seventh globally in the HIV epidemic, with an estimated 1.4 million people living with HIV Source: UNAIDS

4. To end AIDS as a public health threat, we geo-specific risks and vulnerabilities among women and girls must be examined and addressed. Distribution of people living with HIV by gender and age cohort in 2022 Source; HIV Estimates, 2022

5. 1,377,784 Kenyans living with HIV in 2023 67,869 Children (0-14 years) living with HIV in 2023 2.6% 5.3% National HIV prevalence is 3.7% 18,473 AIDS-related deaths 2022 Country No. of PLHIV Kisumu 128,091 Nairobi (County) 124,609 Homa Bay 120,600 Siaya 96,297 Migori 76,053 Nakuru 57,635 Mombasa 50,656 Kakamega 48,733 Kiambu 45,917 Kisii 42, 210 In 2022 57% of people living with HIV were in 10 Counties 18.3% HIV PREVALENCE AMONG KEY POPULATIONS Source: Kenya HIV Estimates 2023 HIV burden in 2023

6. 22,154 New HIV Infections 4,474 12,558 5,122 Children aged 0-14 Women Men Source: Kenya HIV Estimates 2023 New HIV infections 2023

7. Reduction of new HIV infections is not fast enough to achieve the goal of ending AIDS as a public health threat by 2030. Source: Kenya HIV Estimates

8. Why end the Triple Threat? Source: HIV Estimates, KHIS

9. Adolescents and young adults aged 15-34 years contributed to 75% of all new adult HIV infections in 2022 Data Source: 2022 HIV Estimates

10. Treatment coverage lowest among adolescents and young people aged 20-24 years in 2023 Source; KHIS

11. Higher proportion of AIDS-related mortality rates among adolescents and young people aged 10-24 in 2023 Source; KHIS

12. Lower proportion of young people aged 15-24 accessing HIV diagnosis Source; KDHS 2022 Most of HIV infections at an early age are likely to be diagnosed from the age of 25 .

13. 11.6 million adolescents (24.4%) of the total population in Kenya Adolescence; Marks the transition from childhood to adulthood Important physical body and mental growth Prepares the body for reproduction Provides an opportunity for affirming important values and beliefs Important stage for human capital development. Without proper holistic investments and guidance, many adolescents make decisions which impacts negatively on them through to adulthood Triple Threat draws at initiatives draws attention to syndemic interactions between HIV and other harmful social and structural conditions that drive to excess morbidity and mortality Source: KNBS Population Census 2019

14. Important Definitions Endemics: Endemics are a constant presence of disease or infection in a specific location. For example, Malaria is endemic to parts of Africa. Epidemic: An epidemic is actively spreading; new cases of the disease substantially exceed what is expected. More broadly, it’s used to describe any problem that’s out of control. Pandemic: A pandemic is described as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people A syndemic : is a cluster of one or more epidemics driven by interactions between the constitutive epidemics and harmful social and structural conditions that drive excess morbidity and mortality related to the diseases .

15. Examples of Syndemic Situations The word  syndemic  is a blend of syn, meaning “ together ,” and – demic , as in epidemic or pandemic .  Medical anthropologist Merrill Singer created the term  syndemic in the early 1990s. He argued that the AIDS health crisis was more than an epidemic and that many interrelated factors were working together to worsen the intensity and damage of the AIDS crisis.  A commonly cited example of a  syndemic   is the interaction between HIV and tuberculosis; having one of these diseases makes a person much more susceptible to the other.  Another such example is sexually transmitted infections (STI) . While HIV is also an STI, the presence of certain STIs, such as syphilis and herpes, cause breaks in the lining of the genital tract that can then become entry points for HIV. Evidence shows that underlying factors like poverty, criminalization, specific behaviours , violence, gender inequality impact multiple diseases and epidemics, including HIV, TB, STI and malaria 

16. Most adolescents who reported having sex would have preferred if they had delayed their sexual debut “Looking back to the first time you had sexual intercourse, do you think you would have preferred to: have” Waited longer before having sex with anyone, Right time? Not have waited so long,

17. Education is a key factor to delaying sexual debut Source: KDHS 2022

18. KDHS

19. Source: KHIS About 17% of antenatal clinic clients in 2023 was an adolescent aged in Kenya.   KENYA Year 10-14 years 15-19 years Total adolescent pregnancies (10-19 years) Antenatal clinic clients Proportion of adolescents attending antenatal clinic 2016 23,356 252,277 275,633 1,296,168 21% 2017 23,516 316,160 339,676 1,223,317 28% 2018 22,451 404,684 427,135 1,435,246 30% 2019 20,121 376,719 396,840 1,429,951 28% 2020 16,956 314,593 331,549 1,465,589 23% 2021 21,823 294,364 316,187 1,547,656 20% 2022 15,279 245,455 260,734 1,479,899 18% 2023 12.996 241,757 254,753 1,500,800 17%

20. We have to guard against economic dividends being eroded Source: KNBS, 2019 Census

21. Counties of Meru, Narok and West Pokot reported high rates of adolescent pregnancies attending ANC clinics in 2023 with at least 1 in every 4 pregnancies reported being an adolescent aged 10-19 Source: KHIS 2023

22. There is increased reporting of SGBV across the years Source: HIV Estimates, KHIS There is slow reduction in adolescent pregnancies which don’t match the scale of the challenge at hand

23. Source: KHIS Reporting rates of s exual and gender-based violence cases among children and adolescents has increased Year SGBV 0-9 years SGBV 10-17 years All ages % children and adolescent SGBV 2016 1,113 2,466 5,810 62% 2017 886 2,613 6,340 55% 2018 1,793 5,587 11,456 64% 2019 1,931 7,293 13,516 68% 2020 2,348 11,465 19,839 70% 2021 2,912 16,476 38,842 50% 2022 3,846 21,457 59,636 42% 2023 3,403 20,143 53,960 44%

24. Only Forty 40% of sexual and gender-based violence cases reported were presented within 72 hours in 2023 Source: KHIS 2023

25.   All SGBV cases (10-17) Reported within 72 hours SGBV Eligible Survivors Initiated on PEP 10-17 years SGBV Eligible Survivors Completed PEP 10-17 years SGBV Rape survivors seroconverting 3 months after exposure 10-17 years Rape/defilement survivors pregnant 4 weeks after exposure 10-17 years 2017 2,613 - 2,001 804 59 136 2018 5,587 - 3,707 1,562 40 310 2019 7,293 - 4,195 1,535 46 445 2020 11,465 9,052 6,609 2,523 119 848 2021 16,476 7,876 5,890 2,626 235 1,665 2022 21,457 8,737 6,400 2,578 236 1,945 2023 20,143 7,978 5,870 2,499 183 1,934 Uptake of Post Exposure Prophylaxis is sub-optimal for children and adolescent survivors of sexual violence

26. Perpetrators of SGBV

27. Source: KHIS 2023 10 counties reported more t han 50% of Sexual and Gender Based violence cases occurring among adolescents 10-17 years in 2023

28. Data Source: KHIS In 2021 we observed a geographical overlap in distribution of new HIV infections, pregnancy and sexual and gender based violence cases among adolescents

29. Approximately 4.3% of adolescents who reported engaging in sexual activity were subjected to non-consensual encounters. 31.6% of those having sex desired to avoid pregnancy, yet only 7.7% employed contraceptive methods.

30. A Whole-Government and society Approach towards ending new HIV infections, pregnancies and sexual and gender-based violence cases among adolescent GIRLS in Kenya Adolescent pregnancy is a proxy-indicator of heightened risk to HIV infection Sexual and Gender based violence increases the risk of HIV Pregnancy among adolescent girls is often associated with negative health and social outcomes to both the mother and baby and may lead to intergenerational cycles of poverty, poor education and unemployment When compared with older women, adolescent and young mothers have worse HIV related outcomes, including higher new infections of HIV during pregnancy and breastfeeding, and lower rates of retention in HIV care and treatment

31. Why is it Important More than Kes.25 billion spent annually on commodities to prevent and manage HIV Kes.46 billion required to respond and manage sexual and gender based violence cases 17 percent of GDP lost due to lifetime cost of adolescent pregnancy Yet, “ If all girls in Kenya had completed primary school alone, their additional output over their lifetimes would be equivalent to 20% of annual GDP” (World Bank) At Household level, triple threat perpetuates a cycle of poverty

32. Defined the PROBLEM … CHILD MARRIAGE SCHOOL DROP-OUT EARLY PREGNANCY HIV and AIDS A GIRL IS BORN IMMUNISATION EDUCATION NUTRITION SHE TURNS 10 ECONOMIC GAINS MULTIPLYING ACROSS ECONOMIES SHE ENTERS THE LABOR MARKET Unfilled gaps for adolescent girls living in poverty, who have higher vulnerability to sexual and gender-based violence POOR MENTAL HEALTH SEXUAL AND GENDER BASED VIOLENCE We are relying on too many small, fragmented projects that often rely on outdated solutions to make a large-scale impact

33. Leadership and commitment to account for every child in Kenya Bold leadership, accountability, and defined responsibilities; partnership across sectors and leveraging domestic resources and infrastructure to ensure no one is left behind.

34. ……..the book of lamentations?? We must eliminate the siloed approach to adolescent health

35. What is the end the Triple Threat Campaign A multi-sectoral approach, an evidence-based initiative that adopts a Whole Government and Society Approach to enhance commitment and accountability toward ending new HIV infections, Pregnancies and sexual and Gender-Based Violence among adolescents aged 10-19

36. Increase school re-entry among adolescent mothers (Ministry of Education) Sanitary towels distribution in schools (Ministry of Education/ Social protection) Reduce Drug and substance abuse among adolescents and young people (Ministry of Education/ Interior (NACADA), Kenya Police, Prisons department) Increase the mean age of sexual debut (Ministry of Health/ Ministry of Education) Proportion of adolescents accessing HPV vaccine (Ministry of Health/ Ministry of Education) Reduce HIV incidence among adolescents 10-19 years (Ministry of Health) Commitments:

37. Increase in HIV prevention knowledge (Ministry of Health) Increase in awareness of HIV status (Ministry of Health) Reduce cases and experience of sexual and Gender based violence (SGBV) (Ministry of Interior/ Gender/ MOH) Reduce pregnancies among adolescent girls (Ministry of Interior/ Gender/ MOH) Increase the proportion of young people transitioning to work (Ministry of planning) Awareness creation on triple threat (NSDCC/ Ministry of Interior) Commitments:

38. We have to identify sustainable platforms to bridge the knowledge gaps among the young people Source: Kenya Demographic Health Survey

39. A focus on systematic transition from schooling to work is key to reduce the risk and vulnerabilities (20-29)

40. Guiding Principles of the Triple Threat Initiative

41. Data, science, research must be followed by measurable and tangible actions ……. Invested in public education with more than 250,000 Community Gatekeepers- including national government officials, and community health promoters reached through physical meetings

42. Managing the triple threat requires a layered and multi-pronged approach that involves the entire community and promotes investment in education, empowerment and gender equality