research paper for hiv/aids kenya

7/21/2019 Research Paper for HIV/AIDS Kenya

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1Andi Gero

Honors 392B

The Millennium Developmental Goals for HIV/AID in !en"a 2###$2#1%

ABSTRACT: CONTEXT AND INFO

In 19&'( the first !en"an )ase of HIV/AID *as dia+nosed, in)e then( fi+htin+ the

epidemi) has -een one of the nation.s +reatest health and development )hallen+es, In 1999

!en"a de)lared the disease a national disaster( durin+ a time of etremel" hi+h prevalen)e 0over

1# and hi+h proportion of deaths due to AID,1 The +overnment.s multi$se)toral approa)h and

devolution of health )are( *hi)h is +ivin+ )ontrol of health )are infrastru)ture to lo)al and

)ommunit" )ontrol as opposed to a top$do*n federal )ontrol( have attri-uted to most of the *or

and su))esses in )om-atin+ this disease as the "ears +o on,

In the "ear 2###( several )ountries si+ned onto the Millennium Development Goals( a set

of ei+ht international o-4e)tives to rea)h -" the "ear 2#1%, 5f the ei+ht +oals( num-er si )alls to

)om-at HIV/AID( malaria and other diseases, There are several parts of the +oal( outlinin+

plans to halt and -e+in to reverse the spread of HIV/AID -" 2#1%( more spe)ifi)all"( indi)ators

for MDG6 in)lude of )ondom use durin+ last hi+h$ris seual )ondu)t( the proportion of people

-et*een a+es 1% and 2' *ho have )orre)t and )omprehensive no*led+e of HIV/AID and

epandin+ s)hool attendan)e of orphans and non$orphans -et*een the a+es of 1# and 1', 2 MDG6

also plans to +rant universal a))ess to HIV/AID treatment for those in need 0individuals *ith

7D' )ounts of less than 2## -" 2#1#( *orin+ to in)rease the proportion of individuals *ith

a))ess to A8T out of the infe)ted population( as *ell as -e+in to reverse the in)iden)e of malaria

1 MIIT8: 5; D<V5=>TI5 AD ?=AIG MDG TAT> 8 <?58T ;58 ! <:A 2#13 ?G, 21

2 ID, AT ?G, 22 G8A?H



2Andi Gero

Honors 392B

0and other ma4or diseases -" the "ear 2#1%,3 These +oals and tass *ere a+reed upon and

framed in )olla-oration and man" nations( in)ludin+ !en"a( adopted the plans and parti)ipated

in pro+rams in an effort to rea)h the set +oals, More )omprehensive +oals for eradi)atin+

HIV/AID in !en"a in)luded other MDGs su)h as Goal '( 8edu)in+ 7hild Mortalit"( and Goal

%( Improvin+ Maternal Mortalit" have -een lined *ith efforts and pro+rams involvin+ Goal 6

sin)e the HIV/AID epidemi) also has a +reat effe)t on these areas of health,

THE AIDS EPIDEMIC IN KENYA BETWEEN 2000 AND 2015

Data from the ?ro+ress of ations 2###( )on)ernin+ the AID epidemi)( sho*ed that prevalen)e

in the "ears 199'$1999 ran+ed from 1@ in males and 26 in females( -et*een a+es 1%$19, ' In

2##3( 6,@ of all adults in !en"a *ere infe)ted( *ith *omen havin+ mu)h hi+her rates than

men( *ith &,@ )ompared to ',6, omen -et*een a+es 2# and 3# *ere espe)iall" vulnera-le

to the disease( ho*ever( *omen *ho started en+a+in+ in seual -ehavior at earlier a+es *ere

more liel" to -e HIV positive, This is due to mere statisti)al pro-a-ilit"( the more earlier one

starts havin+ se( the more a)ts performed the hi+her lielihood of )ontra)tin+ some form of

seuall" transmitted infe)tion 0TI( in)ludin+ HIV, In males( the prevalen)e of HIV in men *ho

*ere )ir)um)ised *as a-out 3 as opposed to the 12,6 amon+ un)ir)um)ised men 02##3, %

Almost %## !en"ans died ea)h da" from AID, A-out 9# of infe)tions in !en"a are throu+h

seual )onta)tin 2#11 over &# of all unprote)ted seual a)ts involvin+ ?=HA o))urred

3 >D? ! <:A <BIT<

'?85G8< 5; ATI5 ?G, 6

% !DH 2##3 AT ?G, 1@



3Andi Gero

Honors 392B

-et*een married or )oha-itin+ partners6 and a-out 1# result from mother$to$)hild

transmission 0MT7T, 5ften spouses *ere una*are of the serostatus of their seual partners

*hi)h lead to the hi+h rates of unprote)ted seual inter)ourse, ?revalen)e *as hi+her in ur-an

areas( and varied -et*een the different re+ions( ho*ever all re+ions *ere in fa)t affe)ted, @, This

)ould have -een due to the fa)t that in ur-an settin+s more people are )rammed in smaller

spa)es( there is more intera)tion and )onta)t -et*een people and there is more a))ess and

opportunit" to en+a+e in ris" -ehavior, In 2### HIV/AID a))ounted for 22,3' of total :ears

of =ife =ost and 19,6 of the totall" Disa-ilit"$Ad4usted =ife :ears( *hi)h is a measure of the

disease -urden in num-er of "ears lost due to an illness( disa-ilit" or earl" death )ontri-uted -" a

disease,&

The e" populations affe)ted in)lude pre+nant *omen( )ommer)ial se *orers and their

)lients( and "oun+ adults, A-out 1' of people +ettin+ HIV( as stated -" the 2#11 Glo-al

HIV/AID response 8eport 7ard( *ere lined to se *or net*ors( their )lients and -"

)onseCuen)e their )lients. other se partners/spouses,9 These seual relationships demonstrate

and follo* epidemiolo+i)al net*orin+ models )on)ernin+ )on)urren)"( -oth in terms of the

point prevalen)e of )on)urren)" *hi)h is the proportion of adults en+a+in+ in seual -ehaviors

*ith multiple partners at a spe)ifi) point in time( as *ell as the )umulative prevalen)e of

)on)urren)" *hi)h is the ratio of adults that have had multiple seual partners at an" time *ithin

6 G=5BA= HIV/AID 8 <?5< ?85G8< 8 <?58T 2#11 >I7<;( H5( >AID

@ TH< ! <:A ATI5A= HIV/AID T8AT<GI7 ?=A 2###$2##% ?5?>=A8 V<8I5 ?G, '$%

&GBD 75M?A8< <BIT<

9 G=5BA= HIV/AID 8 <?5< <T, A=, ?G, 26



'Andi Gero

Honors 392B

a +iven time frame, hen net*ors -ased on )on)urren)" form( the rates/velo)it" of

transmission -e)ome amplified and lead to a mu)h more inter)onne)ted s"stem of transmission,

in)e HIV follo*s the I model of transmission( the t*o possi-le -oesE one )an fit into are

us)epti-le and Infe)ted 0or epanded as Maternal to us)epti-le to <posed to Infe)ted(

meanin+ that there is no re)over" on)e a person has -een infe)ted, 1# <ven if )lients didn.t

al*a"s have )on)urrent seual partners( the se *orers did( *hi)h epanded and intert*ined

the seual net*ors of ever"one involved( in)reasin+ rates of transmission -" )onne)tin+ their

)lients. net*ors and spreadin+ the disease laterall",

Pregnant !"en an# MTCT 2000$2015

A))ordin+ to the 2##3 !en"a Demo+raphi) and Health urve" !e" ;indin+s( *omen in

!en"a had an avera+e of ',9 )hildren sli+htl" hi+her than the rates re)orded in the 199& DH( in

addition( fertilit" trends varied a)ross provin)es and -ased on edu)ation and e)onomi) status,

omen *ho had some form of se)ondar" seemed to have on avera+e a-out half as man"

)hildren as opposed to *omen *ho didn.t( and the same pattern *as seen -et*een hi+hest and

lo*est *ealth Cuartiles, There is also a sli+ht dis)repan)" in desired famil" siFe -et*een men

and *omen( *ith men *antin+ ',3 )hildren on avera+e and *omen *antin+ 3,9 on avera+e, 11

in)e these so)ial( politi)al( and even familial/marital disparities eist( vulnera-ilit" to Mother to

7hild HIV Transmission 0MT7T is )onne)ted to and influen)ed -" a spe)trum of varia-les,

A-out 9# of *omen in !en"a re)eived antenatal )are 0a sli+ht de)line sin)e the 199& !DH

and a-out 1# did not +et an" )are at all( a-out @# !en"ans had no*led+e that HIV )an -e

1# =<7T>8< '/3#/1% <?ID<MI7 M5D<=IG <T58! <?ID<MI5=5G:

11 !DH 2##3 ! <: ;IDIG ?G, 3$'



%Andi Gero

Honors 392B

transmitted throu+h -reastfeedin+( ho*ever onl" a-out a third of *omen ne* that MT7T )ould

-e redu)ed -" treatment and therap" durin+ pre+nan)",12 This +ap in no*led+e a-out treatment

)onne)ts to the other t*o MDGs( Maternal Health and 7hild Mortalit", If more HIV positive

mothers *ere on treatment for HIV durin+ their pre+nan)ies( not onl" *ould their health

improve( -ut the )han)es of their -a-ies )ontra)tin+ HIV *ould -e redu)ed *hi)h in turn *ould

redu)e the )han)es of these ids d"in+ from HIV/AID or 5pportunisti) Infe)tions earl" on in

life, Ho*ever( -et*een the "ears of 2##2 and 2##%( mortalit" of )hildren under the a+e of five

livin+ *ith AID *as 11& deaths per 1(### live -irths( sli+htl" hi+her than mortalit" *ithout

AID *hi)h *as 9& deaths per 1(### live -irths, 13 This sho*s that even thou+h HIV/AID

)ontri-uted +reatl" to )hild mortalit"( it *as not the sole reason )hildren *ere d"in+ -efore the

a+e of five,

CONTRO% EFFORTS IN 2000 TO COMBAT THE AIDS EPIDEMIC IN KENYA

everal )ontrol efforts( pro+rams and interventions *ere put in pla)e to fi+ht the epidemi)

-et*een the "ears of 2### and 2#1%( some at international levels and some at the

national/)ountr" level, The !en"a ational HIV/AID trate+i) ?lan *as laun)hed in De)em-er

of 2###( si+naled a ne* phase in the *ar a+ainst the epidemi), Due to this plan the !en"an

+overnment has -uilt relationships *ith several G5s( the private se)tor( and donors( hopin+ to

implement interventions on multiple levels, The plan hoped to end the epidemi) and redu)e its

impa)ts on so)ial and e)onomi) aspe)ts of life( -" redu)in+ HIV prevalen)e a-out 2#$3# -"

2#1#( in)rease a))ess to )are and support for infe)ted individuals and stren+then the response

12 ID, AT ?G, 11 AD 1%

13 =<7T>8< '/9/1%$>I7<; 02##% G8A?H



6Andi Gero

Honors 392B

)apa)it" at all levels,1' Additionall" in Ma" of 2### the !en"an 7D7 HIV/AID offi)e -e+an

*orin+ *ith the national +overnment and partners to provide prevention and treatment a+ainst

opportunisti) infe)tions and TB in -oth adults and )hildren( to de)rease MT7T( in)rease

voluntar" male )ir)um)ision( testin+ and )ounselin+( and -ehavioral interventions 0eviden)e$

-ased, This pro+ram also *ored to help )reate stron+er la-s and net*ors to resear)h dru+

resistan)e( advan)e earl" infant dia+nosis as *ell as -lood safet" and infe)tion )ontrol( and to put

in pla)e a pu-li) health s"stem responsi-le for resear)h( plannin+( implementation and evaluation

of the pro4e)t.s pro+ress,1%

5ther measures in)luded the Greater Involvement of ?eople livin+ *ith or affe)ted -"

HIV/AID 0GI?A( an a)tion plan a+reed upon in ;e-ruar" of 2###( *hi)h set out to redu)e

sti+ma and dis)rimination a+ainst ?=HA( to in)rease advo)a)" and information outrea)h( to

stren+then support +roups and to improve the Cualit" and Cuantit" of servi)es provided, There

has -een a push to inte+rate GI?A into the International ?artnership a+ainst AID in Afri)a( and

promotin+ GI?A in >AID,16 The 2##9 GI?A 8eport 7ard for !en"a states that the plans have

indeed -een in)luded into the ational HIV and AID trate+i) ?lan, This in)lusion has led to

the involvement of ?=HA in poli)" and pro+ram interventions at national( provin)ial( distri)t

and )onstituen)" platforms,1@

1' I D. AT ?G, 2

1% 7D7 ! <:A <BIT<

16 >AID ?85G8AMM< 7558DIATIG B5A8D ?G, 1'

1@ GI?A 8 <?58T 7A8D ! <:A$ 75>T8: A<M<T 2##9 ?G, @



@Andi Gero

Honors 392B

hen assessin+ the etent to *hi)h universal a))ess to treatment *as su))essful(

respondents +ave a num-er of reasons that ma" inhi-it a)hievin+ the tar+et -" 2#1#, The main

-arriers des)ri-ed *ere so)io$e)onomi) fa)tors that have to -e dealt *ith -efore even startin+ an

A8V pro+ram, 5thers epressed a )on)ern for la) of re+ulation( *ith people in need a-usin+

the s"stem and a)Cuirin+ A8V from more than one sour)e 0se*in+ data( as *ell as a la) of

staff and funds to handle the *orload and maintain order, ome feared an in)rease in A8V

resistant strains of HIV due to inadeCuate implementation of treatment( some held the -elief that

there *as not enou+h 7D' and viral load testin+( and a +ap -et*een those infe)ted and those

*ho a)tuall" ne* their HIV status supposed from the lo* uptae of A8Vs, 8espondents *ere

also ased *hat )ould -e done to help rea)h these +oals, General ideas )omprised of involvin+

?=HA in the de)ision pro)ess( restru)turin+ the top$do*n implementation of pro+rams and

*orin+ *ith )ommunities( lar+er +overnment fundin+ and suppl" of ne)essar" tools and staff,

Ho*ever the" a+reed that the ?=HA in)lusion and )ommunit" -ased treatment plans have

-een *orin+ *ell,1& This sort of horiFontal devolved s"stem )ould potentiall" -e the e" to hi+h

rates of pro+ram su))ess in !en"a in the "ears to follo*,

In 2##3( The ational <mpo*erment et*or of ?eople livin+ *ith HIV/AID in !en"a

0<?HA! *as )reated and set out to promote a more meanin+ful ?=HA involvement in

national efforts to fi+ht TB and HIV/ AID throu+h post$test )lu-s( support +roups( )ommunit"

-ased or+aniFations( net*ors and G5s, The +roup aims to improve the Cualit" of life for those

affe)ted -" HIV and AID( *hether the".re infe)ted or not, The" *ored to in)rease edu)ation

and no*led+e of ?=HA in order to -rin+ them into poli)"( de)ision main+( and

1& I D. AT ?G, 36$3&



&Andi Gero

Honors 392B

pro+rammin+ dis)ussions and initiatives,19 <?HA! emphasiFed GI?A and the importan)e of

individual eperien)e and )ommunit" involvement leadin+ into national response efforts, In

order to a)hieve these +oals the or+aniFation *ored to eradi)ate sti+ma and dis)rimination( to

en)oura+e infe)ted individuals to redu)e their ris of transmittin+ the virus to others and their

)han)es or re$infe)tion( thus not onl" -rin+in+ do*n infe)tion rates -ut also improvin+ Cualit"

life for ?=HA, ith an AID 7ompetent ?=HA leadership( <?HA! strived to a)hieve

so)ial transformation amon+ infe)ted individuals( partners( families and )ommunities to mo-iliFe

and or+aniFe themselves ris per)eptions( so)ial norms and prevention( )are( treatment and so)ial

prote)tion( and redu)e mar+inaliFation for most at ris populations,2# In a su))essful )ampai+n(

partnered *ith 7hristian Aid and >AID support( the +roups influen)ed the national +overnment

to suppl" free antiretroviral treatment in 2##2, This +ave man" livin+ *ith HIV and AID

opportunit" and a))ess to mu)h needed treatment and improved outloo( ho*ever this effort did

not help *ith other issues su)h as improvin+ diets or a))ess/a-ilit" to pa" for transportation in

order to attain the medi)ation, Gaps *ere slo*l" -ein+ attempted to -e fied -" lo)al +roups

su)h as 7hristian Aid partners 0su)h as !<A( !<<8<=A( and BIDII to ensure as man"

people as possi-le +et the )are and treatment the" need *hile it.s still availa-le to them,21 ot

onl" do these efforts help *ith -iomedi)al )are and intervention( the" also )hallen+e sti+ma and

is helpin+ to -rea so)ial norms and ta-oos around the disease( *hi)h hopefull" leads to more

dis)ussion( involvement and voluntar" testin+ in the future, The do*nside to this pro+ram(

19 <?HA! <BIT< 0;I

2# I D.

21 7H8ITIA AID <BIT<



9Andi Gero

Honors 392B

ho*ever( is the potential harm or reversal of su))ess on)e the time frame of free A8T epires and

people are left to sear)h for other *a"s to a))ess treatment and )are, Ho*ever( in 2##3( !en"a

-e+an implementin+ the Antiretroviral Therap" 0A8T ?ro+ram *hi)h *as dramati)all" s)aled

up in the net de)ade, The pro+ram *as Cuite su))essful -et*een the "ears of 2##3 and 2##9 as

adult uptae rose from 3 to @@,& respe)tivel", In 2#1#( treatment eli+i-ilit" rose from 7D'

levels of 2%# to 3%#( allo*in+ more people to have a))ess to treatment, >ptae of A8T -"

)hildren also sa* su))ess as rates rose from 2 in 2##% to '2 in 2#13( mu)h lo*er than the

rate of improvement amon+ adults,22

E&&!rt' t! e()")nate MTCT an# Materna( Deat* #+e t! HI, 2000$2015

The national ?MT7T ?ro+ramme in !en"a -e+an in the "ear 2###( and *ored to de)rease the

proportion of infants *ith HIV -" 2# -" 2##%( and %# -" 2#1#, in)e then( '(### ?MT7T

sites providin+ servi)es have -een put in pla)e *ith over 9% of *omen in antenatal )are *ith

a))ess to HIV testin+ and )ounselin+, This initiative has -een revie*ed and monitored to address

e" )hallen+es( ho*ever( reports indi)ate that on a national level !en"a has made si+nifi)ant

improvements to servi)es and in )reatin+ demand, Ho*ever( these advan)es have not -een

enou+h to rea)h the vision of eradi)atin+ ne* HIV infe)tions in )hildren( or to )ut maternal death

in half -" 2#1%, In order to help a)hieve these +oals( initiatives *ere and are headed more

to*ards efforts to mo-iliFe !en"ans to demand a))ess to prenatal servi)es )all for individual and

)olle)tive a)tion,23

22 MIIT8: 5; D<V5=>TI5 <T, A=, ?G, 2'

23 ATI5A= <MT7T 75MM>I7ATI5 T8AT<G: ! <:A MIIT8: 5; H<A=TH 2#12$2#1%

?G, 9$ 12



1#Andi Gero

Honors 392B

In une 2#11( *orld leaders )ame to+ether at the > Hi+h =evel meetin+ to start a )ampai+n

that *ould eliminate MT7T of HIV as *ell as redu)e maternal death due to AID, The" planned

to laun)h a pro+ram tar+etin+ 22 )ountries( in)ludin+ !en"a( *hi)h all to+ether a))ounted for

9# of all pre+nant *omen livin+ *ith HIV, The" hoped to redu)e the ne* num-er of infe)tions

amon+ )hildren -" 9#( redu)e the num-er of AID related maternal deaths -" %#( redu)e

HIV in)iden)e in *omen if reprodu)tive a+e 08A -" %#( and redu)e unmet need for famil"

plannin+ to Fero amon+ *omen 2#1%, ational efforts have no* fallen in line *ith the Global

Plan towards the Elimination of New HIV infections in children and Keeping their Mother Alie

!"##$!"#% frame*or( headed -" the Ministr" of Health to a)hieve this vision,2'

THE C-RRENT AIDS EPIDEMIC IN KENYA .2015/

The )urrent data of the AID epidemi) in !en"a( a))ordin+ to the 7D7( estimates that

the prevalen)e of HIV amon+ a+es 1%$'9 is at 6,# 02#13 more spe)ifi)all" %,6 amon+ men

and @,6 amon+ *omen( *ith &1 A8T )overa+e per H5 2#1# standards 02#12 and

1(6##(### livin+ *ith the disease and a-out %&(### deaths due to HIV/AID 02#13, 2% hile

prevalen)e seems to have dropped sin)e 2###( it has not )han+ed mu)h throu+hout the past five

"ears *hen )ompared to 6,@ in the 2##3 and @,' in 2##@( and these national rates still raise

)on)ern despite si+nifi)ant efforts and pro+ress in fi+htin+ HIV/AID, The !en"a AID

Indi)ator urve" 0!AI reported that in)iden)e is hi+h *ith a-out 12%(###$133(### ne* adult

)ases and 32(### pediatri) )ases a "ear, >D? also noted that most )ases *ere amon+ married

)ouples( *hi)h )alls for a ne* fo)us in intervention *hi)h previousl" tar+eted )ommer)ial se

2' ID, AT, 12

2% >AID <BIT< ! <:A



11Andi Gero

Honors 392B

*orers and sin+les, The" also state that efforts to*ards a)hievin+ universal a))ess to A8T have

-een slo*er than anti)ipated( and !en"a *as not liel" to rea)h the tar+et of havin+ &# of

people in need of A8T on treatment until 2#13 instead of the set +oal of 2#1# as estimated -" the

!en"a ational AID trate+i) ?lan,26 This dela" in lar+e part is due to the fa)t that even thou+h

the num-er of people on A8T is in)reasin+( the num-er *ho are in need of treatment is +ro*in+

even faster, <stimates su++est that -" the end of une 2#1#( a-out 6& of people in need 0ne*

7D' level +uidelines of 3%# *ere on A8T, 5f the ne* infe)tions ever" "ear( 21 are amon+

*omen a+es 1%$2'( '',1 are amon+ heteroseual se in union and 2#,3 are amon+ )asual

heteroseual se, 5ver half 06% of all ne* infe)tions o))ur *ithin nine out of the '@ )ounties

in the )ountr",2@ These )ounties lie on the *estern side of the )ountr" and are )lose and

)ompa)ted +eo+raphi)all"( providin+ eviden)e for the need to transfer from a national top$do*n

intervention to )ommunit" -ased efforts( *hi)h !en"a has -een *orin+ to*ards for several

"ears throu+h multi$se)toral and devolution approa)hes,

Pregnant W!"en an# MTCT )n Kena )n 2015

In 2#1'( !en"a adopted 5ption BJ( under *hi)h all HIV positive *omen are put on

triple )om-ination A8T treatment *hen dia+nosed( and treatment is )ontinued for life re+ardless

of 7D' )ounts( and all HIV positive pre+nant *omen are )urrentl" eli+i-le for antiretroviral

treatment, In 2#13( an estimated @9(### pre+nant *omen *ith HIV delivered -a-ies( and the

num-er of infe)tions in )hildren de)lined -" 3& from 2##9 to 2#13, 5n a positive note( && of

pre+nant *omen in !en"a are tested for HIV( over half 063 of pre+nant *omen *ere re)eivin+

26 >D? ! <:A <BIT<

2@ ! <:A HIV ?8<V<TI5 8 5AD MA? AT ?G, %



12Andi Gero

Honors 392B

A8T for ?MT7T in 2#13( and over a third 031 of HIV positive )hildren *ere in )are in 2#1'

as opposed to 12 in 2#1# and 2@ in 2#12, In addition( there a-out 2% of *omen are

re)eivin+ A8T for their o*n health,2& In 2#13 there *ere 19#(### )hildren -et*een a+es # and 1'

out of a total of 1( 6###(### people livin+ *ith HIV,29

A))ordin+ to the 2#1' Annual 8eport -" the 7D7 in !en"a( nearl" 1,3 million *omen

attendin+ antenatal )are( la-or and deliver( and postnatal )lini)s *ere +ettin+ tested for HIV(

*hi)h a))ounts for rou+hl" 96 of all *omen re)eivin+ those servi)es, >ptae of A8T in)reased

form 69 in 2#13 to &9 in 2#1' and in those same "ears the use of hi+hl" a)tive antiretroviral

therap" 0HAA8T in)reased from 36 to 6',3#

C-RRENT CONTRO% EFFORTS TO COMBAT AIDS IN KENYA

In une of 2#1'( the !en"a HIV ?revention 8evolution 8oad Map 07ountdo*n to 2#3#

*as *ritten( *hi)h no* aims to stren+then HIV prevention and *or to*ards the ultimate +oal

of redu)in+ in)iden)e to Fero -" 2#3#, The overall +oals of the plan are to redu)e %# of ne*

infe)tions in !en"a %# -" 2#1%( @% -" 2#2# and 1## -" 2#3#, 31 The +eneral plan to

a)hieve these )han+es is throu+h the restru)turin+ and shiftin+ of )urrent intervention and

treatment pro+rams, The 8oad Map sets out ' steps to help eradi)ate HIV/AID, These )han+es

)all to move 1 from a primaril" intervention$driven to a population$driven approa)h( 2 from

2& IATT <BIT<$! <:A

29 >AID DATA 2#13

3# 2#1' A >A= 8 <?58T 7D7 ! <:A

31 8 5AD MA? <T A=( AT ?G, 1#



13Andi Gero

Honors 392B

heavil" -iomedi)al$dependent to )om-ination$prevention plans 0)om-inin+ -iomedi)al(

-ehavioral and stru)tural aspe)ts of intervention( 3 from a health se)tor$driven approa)h to

somethin+ that maes HIV prevention a +eneral pu-li) interest/-usiness( and ' from a national

to a +eo+raphi)al 0)ountr" )luster approa)h, In a -roader sense( the 8oad Map advo)ates

detailed anal"sis and evaluation of pro+rams and populations *ith re+ards to +eo+raphi)al

disparities( and also emphasiFes the need for ne* and improved surveillan)e te)hniCues for HIV

in)iden)e *ith effe)tive ties to servi)es su)h as earl" A8T( stru)tural interventions and in)reasin+

edu)ation and personal no*led+e of individual HIV status,32

7urrent on+oin+ interventions at the -iomedi)al front have -een met *ith some su))ess(

ho*ever there are still ma4or implementation +aps that need to -e addressed, ;or eample(

)ondom use amon+ men a+ed 1%$2' *ith a partner of dis)ordant or unno*n HIV status in the

past 12 months *as '3( and 1' for a+es 2%$6', In )ontrast the use of )ondoms for females

a+es 1%$2' *as 11( and % for a+es 2%$6', This +ap is due to fa)tors su)h as

inadeCuate/infreCuent distri-ution of )ondoms for female use( and freCuent sto)$outs for -oth

female and male a))ess to )ondoms, Another -iomedi)al eample lies in pro+rams )on)ernin+

Voluntar" Medi)al Male 7ir)um)ision( *here onl" %3#(### )ir)um)isions *ere performed out of

the tar+et +oal of &6#(### *ith espe)iall" lo* )overa+e in non$)ir)um)isin+ )ommunities, In

terms of efforts to eliminate MT7T( there are 1,6 million pre+nan)ies ever" "ear( out of *hi)h

&@(### are in HIV positive *omen( *ith onl" @# of positive *omen on A8T, There is a visi-le

disparit" in terms of onl" a lo* num-er of *omen in antenatal )are 0A7( and a-out 1# of

positive *omen in A7 are not re)eivin+ ?revention of Mother to 7hild Transmission

32 I D. AT 2,



1'Andi Gero

Honors 392B

0?MT7T, 5ut of all ne*-orns to infe)ted *omen( a-out 1@ are not tested for HIV upon

-irth,33 In the field of A8T )overa+e efforts( there is a @& national )overa+e amon+ adults *ith

7D' levels -elo* 3%#)ells/m= and '2 national )overa+e amon+ )hildren *ith an overall 3'

of the population livin+ *ith suppressed viral loads, Do*nfalls in this area are )onne)ted to *ea

HIV testin+ and treatment( hi+h 0and +ro*in+ num-ers of people in need of A8T( and a

strainin+ +ap -et*een availa-le )are for )hildren )ompared to )are adults( the former havin+

mu)h lo*er a))ess, 3'

hen anal"Fin+ -ehavioral and stru)tural intervention pro+rams( the same pattern of

+aps and su))esses is re)orded, ithin the -ehavioral realm( there has -een a la) of an" formal

tar+eted intervention( and espe)iall" an inadeCuate addressin+ of stru)tural -arriers affe)tin+

spe)ifi) -ehavioral )han+es, tru)tural interventions fo)usin+ on )hildren en)ompass 7ash

Transfer for 5rphans and Vulnera-le 7hildren 05V7 *hi)h has -een sho*n to de)rease the ris

of HIV -" de)reasin+ the lielihood of seual onset -" 23( -rin+ do*n en+a+ement in ris"

seual -ehavior and dela" first pre+nan)"( as *ell epand enrollment in s)hool, ome small s)ale

pro4e)ts )om-inin+ -ehavioral and stru)tural intervention pro+rams a)ross the )ountr" to -uild

resilien)e of *omen and +irls and redu)e so)ial ineCualities( livelihood inse)urit" and hen)e

*or to eliminate Intimate ?artner Violen)e, 8eports also sho* a +ap -et*een enrollment in

se)ondar" edu)ation -ased on +ender( *ith a-out '& if +irls attendin+ se)ondar" s)hool in

)omparison to %1 of -o"s 02##9,3%

33 8 5AD MA? <T A=, ?G, @$&

3' I D. AT &

3% 8 5AD MA? <T A=, ?G, &$9



1%Andi Gero

Honors 392B

DID KENYA ACHIE,E THE MDS

!en"a has met a fe*( -ut not all( of the MDG tar+ets the" set out to a)hieve( in)ludin+

redu)tion of )hild mortalit"( almost universal enrollment in primar" edu)ation and narro*in+ the

+ender +ap in edu)ation, The" have in)reased interventions and spendin+ on health and

edu)ation *hi)h has thus far resulted in redu)ed HIV/AID prevalen)e( alon+ *ith devolved

health )are and free maternal health )are( there is national potential to improve health and

health)are, Despite a de)line in povert" from '@ in 2##% to 3'$'2 re)entl" 02#1%

ineCualities are still hi+h,36 5verall uptae if A8T is still relativel" lo*( and universal a))ess to

)are has not -een a)hieved,

As mentioned earlier in this tet( !en"a proposed that the" *ould meet their +oal of

havin+ &# of people in need of A8T on treatment until 2#13 instead of the set +oal of 2#1#, In

2#12( !en"a had a little over %# )overa+e of A8T for preventin+ mother to )hild transmission

)ompared to the 2#1% +oal of 9#( and had transmission rates throu+h -reastfeedin+ -et*een

1# and 1% in 2#13( mu)h hi+her than the -elo* % +oal for 2#1%, It is hi+hl" unliel" that

either of these +oals *ill -e )ompletel" met -" the end of 2#1%, Ho*ever( !en"a has made

impressive advan)es in the per)enta+e of )hildren re)eivin+ A8T( *hi)h has a-out dou-led sin)e

2##9( ho*ever in 2#12 the per)enta+e *as a ver" lo* 3&( onl" a fra)tion of the 2#1% +oal of

1## )overa+e,3@

36 58=D BA! <BIT<$! <:A$75T<T 5V<8VI<

3@ >AID 2#13 ?85G8< 8 <?58T 5 TH< G=5BA= ?=A ?G, 1#$11



16Andi Gero

Honors 392B

ome of the pro-lems that have )ontri-uted to the )hallen+es in a)hievin+ the MDGs

in)lude the fa)t that mu)h of the servi)es and pro+rams are still )ondu)ted in a top$do*n manner

and don.t address the disparities in the epidemi) a)ross the different re+ions and )ounties, 5n)e

implementation moves more and more to the lo)al and )ommunit" level( it *ill -e easier and

more )ost effe)tive to run prevention and edu)ation pro+rams, This *ould also help redu)e

dependen)" on donor and forei+n funds,

PO%ICY AND PRORAM RECOMMENDATIONS FOR KENYA

In !en"a( the poli)ies and pro+rams that )ould lead to the most su))ess in eradi)atin+ HIV and

AID in)lude male )ir)um)ision( antenatal HIV treatment alon+ *ith earl" infant dia+nosis and

maternal )are( +reater distri-ution of )ondoms and addressin+ of so)ial stru)tures and -eliefs that

influen)e sti+ma and health seein+ -ehaviors, These solutions and implementations rel" on a

)om-ination of -iomedi)al and -ehavioral interventions more on lo)al and )ommunit" levels

rather than -i+ national )ampai+ns, As mentioned in an earlier se)tion of the paper( the

HIV/AID epidemi) is most prevalent in a fe* )ounties on the north and *estern sides of

!en"a( so allo*in+ these more affe)ted re+ions to tae )ontrol and initiative over their o*n

pro+rams and )ampai+ns )ould help lo)aliFe and personaliFe treatment and intervention options

to provide the +reatest -enefit to spe)ifi) )ommunities,

More spe)ifi)all"( one pro+ram or poli)" that )ould help redu)e infe)tion rates is

Voluntar" Medi)al Male 7ir)um)ision, In a randomiFed )ontrolled trial in !isumu( !en"a(

results sho*ed that male )ir)um)ision si+nifi)antl" redu)es )han)es of the man a)Cuirin+ HIV



1@Andi Gero

Honors 392B

espe)iall" *hen )om-ined *ith other HIV preventative interventions, This trial *as )ondu)ted in

2##6( -e+innin+ on De)em-er 12( and parti)ipants *ere follo*ed up for 2' months, The men in

the stud" ran+ed from a+es 1&$2' and *ere randoml" assi+ned to either the intervention or the

)ontrol +roup 0*hi)h still re)eived )ir)um)ision 4ust at a dela"ed time( -oth +roups *ere

assessed -" HIV testin+( medi)al eams and -ehavioral intervie*s durin+ their follo* ups at 1(

3( 6( 12( 1& and 2' months, Durin+ this time frame re)orded in)iden)e of HIV *as 2,1 in the

)ir)um)ised +roup and ',2 in the )ontrol +roup,3& As seen in this stud"( infe)tions in

)ir)um)ised men is a-out half that of un)ir)um)ised men( so if all 0or ma4orit" of men *ere to

under+o this simple pro)edure( prevalen)e in men *ould soon -e redu)ed, Therefore( -" default

due to the -iolo+" of se( the in)iden)e rate in *omen *ould also drop, If less men are infe)ted(

then less *omen *ill -e infe)ted as *ell *hi)h *ould also lead to a drop in MT7T, Male

)ir)um)ision( hen)e( is a simple solution *ith a *ide spe)trum if positive out)omes,

In terms of maternal( antenatal and infant )are( ne* infe)tions amon+ )hildren have de)reased as

reported in 2#12( and a ne* initiative *as laun)hed to provide free maternal servi)es at pu-li)

health servi)es( alon+ *ith *aived user fees and pu-li) dispensaries, This )om-ined *ith s)alin+

up the national Mentor Mother pro+ramme *hi)h provides support and -reastfeedin+ edu)ation

and alternatives for HIV positive *omen are ena-lin+ the )ountr" to improve national pro+ress

to*ards a)hievin+ their health +oals,39 <du)ational intervention pro+rams that tar+et -ehavior

and -elief )oupled *ith hei+htened a))ess to and +reater servi)es provided -" -iomedi)al fronts

)reate a positive feed-a) loop of more and -etter )are availa-le for the in)reasin+ num-er of

3& TH< =A7<T V5=>M< 369( 5 9%62( ?G, 6'3$6%6 ;<B 2'( 2##@ 05=I<

39 >AID 2#13 ?85G8< 8 <?58T <T, A= ?G, 3&



1&Andi Gero

Honors 392B

people 0espe)iall" *omen in this )ase *ho are -ein+ edu)ated a-out the disease( their -odies

and *a"s in *hi)h the" )an prote)t themselves and their families, This t"pe of )om-ined

pro+ram also helps )han+e attitudes to*ards eistin+ medi)al and )lini)al servi)es and therefore

)ould lead to in)reased num-ers of *omen/people seein+ out su)h )are,

imilarl" pro+rams and poli)ies that help redu)e sti+ma and related avoidan)e of )are are e" to

)orrallin+ the epidemi) in !en"a, ;or eample( in a stud" -" resear)hers from >7;( 5r+ani)

Health 8esponse and Mi)ro)lini) International( set up mi)ro)lini)s in rural )ommunities served

-" the ena Health 7enter on Mfan+ano Island( !en"a( and invited individuals on A8T to 4oin

*ith a desi+nated )ommunit" health *orer to fa)ilitate, <a)h parti)ipant re)eived )onfidential

HIV testin+ and )ounselin+ as *ell, There +roups are a little different than traditional support

+roups in that the" use or+ani) and often alread" eistin+ so)ial net*ors to drive positive

-ehavior, The pro+ram spanned over % months *ith 1# +roup dis)ussion in)ludin+ HIV

edu)ation( treatment( promotion of status dis)losure and the po*er of support from famil"(

friends and people in similar situations, ;a)ilitators en)oura+ed +roup mem-ers to en)oura+e

their )ommunities to +et tested re+ularl" and enroll in )lini)s, At the end of the stud" parti)ipants

*ere in)ited to tae part in voluntar" +roup testin+, The mi)ro)lini)s helped redu)e some level of

sti+matiFation of the disease -e)ause the" opened up dis)ussion and dis)losure( alon+ *ith

proper edu)ation of the disease that -e+an a desti+matiFin+ pro)ess in the )ommunities, ?atients

*ho felt the" had etensive support from famil" and friends *ere more liel" to eep up *ith

medi)ation and )lini) visits,'# The results( pu-lished in the ournal of A)Cuired Immune

'# > IV<8IT: 5; 7A=I;58IA A ;8A7I75 <BIT<K MI7857=II7 H<=? ! <<? ! <:A

HIV ?ATI<T I 7A8<$ MA: 1&( 2#1%



19Andi Gero

Honors 392B

Defi)ien)" "ndromes 0AID )ommuni)ated that @' of intervention )ommunit" mem-ers

4oined mi)ro)lini)s( and a-out &6 of those tain+ part in the +roup parti)ipated in +roup HIV

dis)losure, 5ver the 22 months of follo* up( those in the mi)ro)lini) pro+ram had half the rate

of a-sen)e from )lini) as the people *ho did not parti)ipate in the pro+ram, '1 An intervention

su)h as this *ould *or ver" *ell in !en"a sin)e the" do not ultimatel" repla)e eistin+

pro+rams -ut rather rel" on eistin+ net*ors to stren+then support and adheren)e *hile

*orin+ to de)rease sti+ma, 7are seein+ -ehavior is still lar+el" influen)ed -" sti+ma sin)e

people still fear dis)rimination and )ertain levels of perse)ution if the" *ere to -e dia+nosed as

HIV positive, This form of support +roup offers a ver" personal individual$to$individual )are and

lets )ommunities operate their mi)ro)lini)s a))ordin+ to lo)al demand and desire, This -rea

from a verti)al national +overnment run and fa)ilitated pro+ram allo*s for +reater trust of the

s"stem 0sin)e fa)ilitators are health)are *orers form the )ommunities and therefore more

potential for involvement in the a)tivities/dis)ussions leadin+ to hi+her rates of treatment uptae,

This pro+ram( a))ordin+ to the >7; arti)le( is also ver" )ost effe)tive for national +overnments

to implement and )ould help !en"a rea)h the >AID +oal of havin+ 9# of people livin+ *ith

AID in treatment and retained )are -" 2#2#, If implemented effi)ientl"( this sort of so)ial(

medi)al and -ehavioral intervention plan )ould help the most affe)ted re+ions and )ounties

)om-at HIV/AID in !en"a and help -rin+ a-out stead" )han+e in )are seein+ -ehavior(

adheren)e and transmission rates in the net fe* "ears to )ome,

KENYA AND THE 30$30$30 P%AN

'1 AID ?>==IG TH< <T58! T5G<TH<8 DATA



2#Andi Gero

Honors 392B

The >AID ?ro+ramme 7oordinatin+ Board set 3 +oals for +lo-al efforts in the fi+ht a+ainst

HIV/AID in 2#13 and laun)hed the initiative on eptem-er 2%th( 2#1', The three main

)omponents of the plan are that -" the "ear 2#2# 9# of all people *ho have HIV *ill -e a*are

of their status( 9# of all people dia+nosed *ith HIV *ill -e on A8T( and to have 9# of all

people re)eivin+ A8T *ill have suppressed viral loads,'2 In a press release on the orld AID

7ampai+n *e-site( the authors outline the )all for !en"a to adopt the >AID 9#$9#$9# plan

full" and immediatel", The )ountr" has pi)ed up H5 +uidelines *hi)h in turn in)reased the

num-er of ?=HA *ho are eli+i-le for treatment( earl" initiation of )are and lifelon+ treatment

availa-le to all pre+nant and -reastfeedin+ *omen( HIV positive individuals *ith a)tive TB and

all )hildren under the a+e of 1#, The" have also -een *orin+ in a 4oint HIV/TB Glo-al ;und

appli)ation, Ho*ever( despite some domesti) finan)in+ of pro+rams( !en"a is still hi+hl"

dependent on donors to fund a ma4orit" of their HIV response, '3 If the +overnment *ere to instill

the 9#$9#$9# initiative( the pro+ram *ould prove to -e ver" )ost effe)tive and drive the national

+overnment to tae on more in$)ountr" fundin+ of the fi+ht a+ainst HIV and even start a HIV

trust fund, 7ivil so)iet" or+aniFations are no* )allin+ on ?resident !en"atta to step up and adopt

this )ourse of a)tion, This alon+ *ith a stren+thenin+ of Ministr" of Health response to address

lo* rates of HIV testin+( viral load monitorin+ and retention in )are )ould help ensure that efforts

to help desti+matiFe the disease and -rin+ a-out an HIV$free so)iet",''

'2 >AID 9#$9#$9# A AMBITI5> T8<ATM<T TA8G<T T5 H<=? <D TH< AID <?ID<MI7 ?G,

1

'3 58=D AID 7AM?AIG <BIT<$?8< 8 <=<A< 26 <?T<MB<8 2#1'

'' 58=D AID 7AM?AIG <BIT< <T, A=,



21Andi Gero

Honors 392B

;or !en"a to a)hieve the 9#$9#$9# +oals -" 2#2#( the" need to reall" *or to*ards rea)hin+

lo)al )ommunities and +ettin+ people to +et tested for HIV, 8i+ht no* mu)h of the fo)us for

testin+ is on pre+nant *omen and infants( and as seen in the data earlier in this paper( those

testin+ rates have improved Cuite dramati)all" over the past 1% "ears, If more )om-ination

pro+rams are put in pla)e alon+ *ith improvin+ eistin+ ones( a*areness of and openness to the

HIV epidemi) )ould help institute -etter support and therefore in)rease voluntar" testin+(

dis)losure( adheren)e and retention of )are, The same t"pes of pro+rams and poli)ies that )ould

help the )ountr" rea)h the Millennium Development Goals )ould help them rea)h the 9#$9#$9#

+oals( if not -" 2#2# then possi-l" -" 2#3# in )om-ination *ith the 8oad Map plan,

ors 7ited

MIIT8: 5; D<V5=>TI5 AD ?=AIG MDG TAT> 8 <?58T ;58 ! <:A 2#13K

HTT?K//,>D?,58G/75T<T/DAM/>D?/=IB8A8:/MDG/<G=IH/MDG2#75>T8:

2#8 <?58T/! <:A/! <:A2#MDG2#2#1',?D;

>D? ! <:AKHTT?K//,!<,>D?,58G/75T<T/!<:A/</H5M</MDG5V<8VI</5V<8VI</MDG6/

?85G8< 5; ATI5K HTT?K//,>I7<;,58G/AB5>T/HIT58:/;I=</?>B L ?52###L <,?D;

G=5BA= HIV/AID 8 <?5< ?85G8< 8 <?58T 2#11 >I7<;( H5( >AIDK

HTT?K//,DATA,>I7<;,58G/758<75D</>?=5AD/D57>M<T6/>?=5AD<D L ?D;/758<75D</>

ALG=5BA=HIVAIDL8 <?58T L < L%2,?D;

TH< ! <:A ATI5A= HIV/AID T8AT<GI7 ?=A 2###$2##% ?5?>=A8 V<8I5K

HTT?K//,:5>TH$

?5=I7:,75M/?5=I7I</! <:A LATI5A= LHIVLAIDLT8AT<GI7 L?=A,?D;

GBD 75M?A8< <BIT<K HTT?K//VIH>B,H<A=THDATA,58G/GBD$75M?A8</

!DH 2##3 ! <: ;IDIGK HTT?K//DH?85G8AM,75M/?>B/?D;/8 1#'/8 1#'!<#3,?D;

7D7 ! <:A <BIT<K HTT?K//,7D7,G5V/G=5BA=AID/G=5BA=$HIV$AID$AT$

7D7/75>T8I</!<:A/D<;A>=T,HTM=

http://www.undp.org/content/dam/undp/library/MDG/english/MDG%20Country%20Reports/Kenya/Kenya%20MDG%202014.pdf





























http://www.ke.undp.org/content/kenya/en/home/mdgoverview/overview/mdg6/
























http://www.unicef.org/about/history/files/pub_pon2000_en.pdf






















http://www.data.unicef.org/corecode/uploads/document6/uploaded_pdfs/corecode/UA_GlobalHIVAIDS_Report_en_52.pdf































http://www.youth-policy.com/Policies/Kenya_National_HIV_AIDS_Strategic_Plan.pdf






















http://vizhub.healthdata.org/gbd-compare/













http://dhsprogram.com/pubs/pdf/sr104/sr104ke03.pdf


















http://www.cdc.gov/globalaids/global-hiv-aids-at-cdc/countries/kenya/default.html










































22Andi Gero

Honors 392B

>AID ?85G8AMM< 7558DIATIG B5A8DK

HTT?K//,>AID,58G/IT</D<;A>=T/;I=</</M<DIA/>AID/75T<TA<T/DATAIM?58T/

G5V<8A7</?7B#3/?7B L11L#1L#2L <,?D;

GI?A 8 <?58T 7A8D ! <:A$ 75>T8: A<M<T 2##9K

HTT?K//,G??=>, <T/A<T/BB L ;I=< L >?D5/2#1%/2#1##92#LGI?AL8 <?58T L! <:A L5=I<,?D;

<?HA! <BIT<K HTT?K// <?HA! ,58 ,!</H5$<$A8</

7H8ITIA AID <BIT< K HTT?K//,7H8ITIAAID,58G,>! /HAT<D5/I$;57>/HIV$

MA=A8IA$H<A=TH/58=D$AID$DA:/;<AT>8<D$?A8T<8/!<:A,A?

ATI5A= <MT7T 75MM>I7ATI5 T8AT<G: ! <:A MIIT8: 5; H<A=TH 2#12$2#1%>AID <BIT< ! <:AK HTT?K//<MT7T$IATT,58G/?$

75T<T/>?=5AD/2#12/11/! <:A LATI5A=$<MT7T$75MM>I7ATI5$T8AT<G: L2#121,?D;

! <:A HIV ?8<V<TI5 8 5AD MA?K HTT?K//, A77,58 ,!</IMAG</D57>M<T/;IA=,?D;

ATT <BIT<$! <:AK HTT?K//,<MT7T$IATT,58G/75>T8I</!<:A/

>AID DATA 2#13K HTT?K//,>AID,58G/</8<GI575>T8I</75>T8I</!<:AN

2#1' A >A= 8 <?58T 7D7 ! <:AKHTT?K//,7D7,G5V/G=5BA=H<A=TH/75>T8I</!<:A/?D;/7D7$!<:A L2#1'8<?58T,?D;

58=D BA! <BIT<$! <:A$75T<T 5V<8VI<K

HTT?K//,58=DBA! ,58G/</75>T8:/!<:A/5V<8VI<

>AID 2#13 ?85G8< 8 <?58T 5 TH< G=5BA= ?=AK

HTT?K//,>AID,58G/IT</D<;A>=T/;I=</M<DIA L A<T/2#13#62%L ?85G8< L G=5BA= L ?=

A L < L#,?D;

TH< =A7<T V5=>M< 369( 5 9%62( ?G, 6'3$6%6 ;<B 2'( 2##@ 05=I<K

HTT?K//,TH<=A7<T,75M/5>8A=/=A7<T/A8TI7=</?II#1'#$6@362&#@296#312$2/ABT8A7T

> IV<8IT: 5; 7A=I;58IA A ;8A7I75 <BIT<K MI7857=II7 H<=? ! <<? ! <:A HIV?ATI<T I 7A8<$ MA: 1&( 2#1%K

HTT?K//,>7;,<D>/ </2#1%/#%/129'61/MI7857=II7$H<=?$!<<?$!<:A$HIV$

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http://www.unaids.org/sites/default/files/en/media/unaids/contentassets/dataimport/governance/pcb03/pcb_11_01_02_en.pdf


































http://www.gnpplus.net/assets/wbb_file_updown/2015/20100920_GIPA_Report_Kenya_ONLINE.pdf























http://nephak.or.ke/who-we-are/














http://www.christianaid.org.uk/whatwedo/in-focus/hiv-malaria-health/world-aids-day/featured-partners/kenya.aspx




































http://emtct-iatt.org/wp-content/uploads/2012/11/Kenya_National-EMTCT-Communication-Strategy_20121.pdf


























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http://www.emtct-iatt.org/countries/kenya/














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http://www.worldbank.org/en/country/kenya/overview
















http://www.unaids.org/sites/default/files/media_asset/20130625_progress_global_plan_en_0.pdf






























http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60312-2/abstract

















https://www.ucsf.edu/news/2015/05/129461/microclinics-help-keep-kenyan-hiv-patients-care















































23Andi Gero

Honors 392B

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http://journals.lww.com/jaids/Abstract/publishahead/Pulling_the_network_together___quasi_experimental.97566.aspx






























http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf






















http://www.worldaidscampaign.org/2014/10/press-release-kenyan-civil-society-applauds-historic-hiv-commitments-by-world-leaders-call-on-president-kenyatta-to-adopt-90-90-90-initiative/














































http://www.health.go.ke/Resources.html














http://www.emtct-iatt.org/wp-content/uploads/2012/10/PMTCT-Factsheet-Kenya.pdf






















https://www.census.gov/population/international/files/hiv/kenya08.pdf




















http://www.unaids.org/sites/default/files/country/documents/KEN_narrative_report_2014.pdf







































2'Andi Gero

Honors 392B

research paper for hiv/aids kenya

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