On 15 January 1985, the front page of The Standard newspaper carried the headline: ‘Killer sex disease in Kenya.’ That headline referenced the story of the first HIV-related death in Kenya. Cited in the East African Medical Journal, the story went that the deceased was a 34-year-old Ugandan journalist who had been hospitalised at the Kenyatta National Hospital in Nairobi, who had died on 8 May 1984. Two years later, Joe Muriuki (the future Dr. Joe Muriuki) went public with his HIV status, becoming the first Kenyan to openly share that he was living with the virus. It was also around that time that the National AIDS Control Council that had been formed in 1986, became fully operational and was renamed the National AIDS/STD Control Programme (NASCOP).
This marked the first decade of the HIV/AIDS epidemic.
13 years after that gory 1985 headline and just a year before President Daniel arap Moi declared HIV/AIDS a national disaster and established the National Aids Control Council, Francis Obonyo was diagnosed with HIV. This was at the tail-end of the second decade of the global HIV/AIDS crisis, teetering into the third. The early 2000s had President Mwai Kibaki declaring total war on HIV/AIDS, becoming the first African head of state to feature in a TV commercial on HIV/AIDS for the Pamoja Campaign as well as some of the most audacious campaigns such as “Nakufeel”, “Nimechill” and the controversial “Mpango wa Kando”.
Much has changed since then.
I met Francis Obonyo in August 2021 at the Crowne Plaza hotel in the heart of Nairobi’s Upper Hill during the launch of the National Undetectable=Untransmittable (U=U) campaign organised by the Ministry of Health. The U=U campaign, a global roll out of the myriad efforts focused on achieving “triple zero outcomes” – zero missed appointments, zero missed doses, and zero viral load – was chiefly a message of hope in the fight against HIV/AIDS. Francis was there to lend his voice and labour to the cause. Since his diagnosis in 1998, Francis, who works as a peer educator at a sub-county health facility, has been part of numerous HIV/AIDS related campaigns, both at national and grassroot levels.
Francis’ voice was particularly central in the campaign for two reasons.
First, as a champion for viral suppression (viral load of <200 copies/mL), having been on ARVs religiously since day-one, and having been virally suppressed for years. This is the gospel he preaches in his line of duty as a peer educator. Secondly, as one in a polygamous marriage, Francis is a testimony to the science of healthy HIV-concordant couples (both partners are HIV infected). After his diagnosis with HIV, his first wife left him only to return years later when he had taken up a second one. Both his wives live with HIV as well but his five children – two from his first wife and three from his second wife – are all HIV negative.
When one is diagnosed with HIV, they are often put on antiretroviral drugs immediately, to stop the virus from replicating in the body. The drugs stop HIV from damaging the immune system and reduce the amount of virus in the bloodstream – known as the viral load. When HIV can no longer be detected (this is normally immediately after testing positive for the virus and being on ARVs consistently for six months), the patient is said to have undetectable viral load– they cannot transmit the virus through sex. Couples may also conceive and have children without passing on the virus. This is the premise on which the U=U campaign is solidly built on.
The week before the campaign, Francis had been at a local vernacular radio station, in what has become his everyday work life, creating awareness to the realities of HIV and promoting adherence to antiretroviral therapy. But for a man constantly laying himself bare for the world, the lines between his personal life and his work are probably blurred, if not non-existent. His life is his work.
“Vernacular ndio watu wengi wanaelewa,’’ he told me. ‘‘Tunawaeleza watu wajikinge na wale ambao wamepata ni ugonjwa, wajikubali na watumie dawa.”
The science behind the U=U campaign is from the decade-long HIV Prevention Trials Network 052 (HPTN 052) clinical trial that studied 1,763 HIV sero-discordant couples – one partner is HIV-infected and the other is not – at 13 sites across nine countries in Asia, Africa, and the Americas. The study found that starting HIV treatment early, when the immune system is relatively healthy, reduced the risk of sexually transmitting the virus to an uninfected partner by 96 percent.
A decade back, this was not possible.
But, as we marvel at the scientific and medical advances, we are reminded that the fight is far from over. If anything, we might need to bring out our entire arsenal.
A worrying trend is building up.
From the 2022 World Aids Day Report from the National Syndemic Diseases Control Council (formerly the National Aids Control Council) an increase in new HIV infections was recorded for the first time in a decade. The number of cases between 2020 and 2021 rose by 2,000 cases, with 52 percent of the new infections occurring among adolescents and young adults aged between 15 and 29 years.
Much of the new infections are pinned to the COVID-19 pandemic that not only overwhelmed the healthcare system but had attendant consequences such as increased sexual activity especially among adolescents and youths, no ready access to preventive measures and treatment and sexual and gender based violence. When sex is violent or forced, women are put at high risk of HIV infection. Violence diminishes their ability to negotiate condom use with perpetrators or ask about their status. Harmful traditions such as virgin cleansing — men marrying virgins in the hope of being ‘cured’ of HIV — and practices such as female genital mutilation can also lead to an increased risk of HIV infection for women and girls.
Moreover, for the better parts of 2021 and 2022, Kenya experienced a shortage of condoms, largely blamed on high taxes levied on suppliers. In the last decades, HIV/AIDS has been held at bay by antiviral drugs, aggressive testing and public education campaigns. But the COVID-19 pandemic caused profound disruptions in almost every aspect of that battle.
This did set back efforts made in curbing new infections.
The Kenya Demographic and Health Survey 2022 revealed that knowledge of HIV prevention was lowest among adolescents aged 15-17. This group that falls within the at-risk population that is 15 to 24 years as per the United Nations Programme on HIV/AIDS (UNAIDS), struggles with knowledge on testing, adherence to treatment and prevention, sexual behaviour, SGBV and pubescent pregnancy. UNAIDS estimates — if no action is taken — 1.2 million people will be newly infected with HIV by 2025—three times more than the 2025 target of 370 000 new infections.
On 15 February 2022, Joe Kariuki died. Not from HIV/AIDS but from cancer.
If you are too young to have experienced the awful intensity of the first decades of the HIV/AIDS crisis, or if you were old enough but distant from the unfolding of the epidemic, the 35 years between the time Dr. Joe Kariuki went public and when he died will educate you on the milestones made in curbing HIV and AIDs.
If you do remember, the 35 years will refresh your memory on the shockwaves of dread and resultant deaths; the infamous Kemron ‘cure’ developed by Dr. Davy Koech of Kenya Medical Research Institute (KEMRI) and to which Dr. Kariuki was among the first to test run; Prof. Arthur Obel’s Pearl Omega for which he was later sued for by patients; and the time President Moi declined advocating the use of condoms because they promoted promiscuity. Not forgetting the Silent Epidemic mini-documentary voiced by former Cabinet Secretary Raphael Tuju that formed part of school lessons when HIV/AIDS was introduced into the curriculum.
Now, we have U=U, self-testing kits, PrEP (pre-exposure prophylaxis) and are possibly living in the decade that could birth a cure, given the advancement in science. But until then, we must not lose focus. We need to recommit ourselves, financially and scientifically, to address the spiking numbers especially among young people.