Kenya’s Ministry of Health and donors want rights for and more resources to reach an estimated 6,000 transgender persons with HIV interventions.
In a July special report in the Journal of the International AIDS Society on key populations and future of HIV in Africa, the ministry has advocated for more resources and the removal of legal barriers.
“There is need for committed funding sources to scale up interventions to address human rights- and gender-related barriers to services for these key populations.”
The ministry says of the about 284,000 people in key HIV populations, transgender have highest infection rates but with the least access to health care.
Among key populations including male and female sex workers, lesbians, gays, and drug injectors, the ministry says transgender are the least reached despite having the highest HIV prevalence.
The key populations targeted by the national programme include 207,000 female sex workers, 51,000 men who have sex with men, 20,000 drug injectors and about 6,000 transgender. Others not quantified include persons in prisons.
The ministry estimates HIV prevalence among female sex workers at 29 per cent, male sex workers at 26.3 per cent, men who have sex with men at 18 per cent, drug injectors at 19 per cent and 39.9 per cent among transgender.
Of the estimated 5,783 transgender in the country the ministry says only 263, or about five per cent are being reached by HIV health care services. This compared to 82 per cent of men who have sex with men reached and 73 per cent of female sex workers.
In a joint commentary, the ministry alongside several western collaborators says Kenya has made much progress in reaching the key populations but still falls below global HIV control targets.
The authors led by Helgar Musyoki of the Ministry of Health, Kenya, included others from the University of Manitoba, Canada, UNAIDS, Global Fund, USaid, the Bill and Melinda Gates Foundation and the hard to profile Nairobi based NGO – Partners for Health and Development in Africa.
Pleading the Kenya case they suggest that while small in numbers, key populations are responsible for significant spread of HIV to the general public.
In the commentary UNAIDS estimates indicate that 62 per cent of new HIV infections every year are among these key populations.
It estimates injecting drug users, sex workers, men who have sex with men, prisoners and transgender people account for almost a third of new infections – 28 per cent in 2019.
Failure to adequately address the needs of these highly vulnerable, yet underserved populations, the authors argue, will increasingly drive the course of the HIV pandemic in sub-Saharan Africa over the coming years.
They say the health ministry, US President’s Emergency Fund for AIDS Relief (PEPFAR), Global Fund and more than 100 partners are doing their part.
But blame national and county laws that continue to criminalize selling sex, same-sex relationships, drug use and drug possession for the poor access to these populations.
Also to blame, the report says is increasing police violence against these groups with almost half of female sex workers reporting police violence, 20 per cent of gays and 44 per cent of drug injectors.
Despite the challenges, the authors say the key population programme in Kenya will be increased in scale and coverage in the next one to two years to achieve the 2025 global targets.
By Gatonye Gathura