By Njeri Murigi
For years, Homabay County, nestled on the shores of Lake Victoria in the western part of Kenya, struggled with one of the highest HIV prevalence rates in the country.
However, the county has recently emerged as a beacon of hope in the fight against HIV, significantly reducing its prevalence from 27.5 percent in 2009 to 15.2 percent in 2023.
What many people don’t know are the strategies the county implemented to achieve this significant progress. According to Stephen Omondi the County AIDS and STIs Coordinator (CASCO), this remarkable achievement is the result of innovative strategies and relentless efforts by the county’s health officials and community leaders.
“One of the key strategies that led to this success was taking healthcare services directly to the community. This is after the health workers recognized that, waiting for people especially the youth and sex workers, to seek out services was ineffective,” said Omondi.
According to him, they have been setting up mobile clinics in remote areas, markets, and hotspots frequented by sex workers. These clinics offer not only HIV testing and counseling services but also provide educational sessions about safe practices and the importance of regular testing.
“By meeting people where they are, the county has significantly increased the number of individuals getting tested and receiving the necessary care,” added Omondi.
Apart from setting up mobile clinics, the county has also been offering protection products and services such as pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), voluntary medical male circumcision, and condoms to those in need, regardless of age. The reason for this initiative is that last year alone, about 49 percent of all new HIV infections among adults were in young people aged 15 to 19.
“Such high numbers indicate a critical need to protect these young individuals, as they represent the future. Their health and well-being are paramount, and it is our collective responsibility to ensure they have the resources and support necessary to thrive,” said Omondi.
According to him, they have also been diligently working to combat gender-based violence and early teenage pregnancy, as these factors markedly increase the risk of HIV transmission among young people. However, they have managed to reduce the number of teenage pregnancies slightly from 33 percent in 2022 to 23 percent in 2023 because of the provision of contraceptives and condoms for sexually active girls. Omondi says that it has not been an easy task.
The reason is, that there are legal complexities in our country. For example, the Ministry of Education prohibits the provision of contraceptive services to school-going children. In contrast, the Department of Health is mandated to provide these services to those in need, because health is a human right and everybody is entitled to the health service that they need.
“The Ministry of Education and Ministry of Health, their policies are different, and we need to harmonize them so that they speak for that child in need. This child is a child of the Department of Health, this child is a child of the community, and is a child of the ministry of education, “ he said.
“If the ministry of education policies prohibit ministry of health from offering certain health services to adolescents in school, but these adolescents are seeking for these services, what are we supposed to do? Refusing to provide the services would be akin to neglecting pregnant adolescents because they became pregnant at a young age, which is not our mandate. Our responsibility is to offer services to all who need them and provide accurate information to everyone seeking it.”
The county has also prioritized the elimination of mother-to-child transmission of HIV. They have achieved this by ensuring that all pregnant mothers undergo HIV testing at least three times before delivery and twice afterward. Moreover, they ensure that all mothers deliver at health facilities. This stringent testing protocol has proven effective in early identification of HIV-positive mothers, enabling prompt intervention and treatment.
Pregnant women who have tested positive for HIV have been receiving antiretroviral therapy, significantly reducing the risk of transmitting the virus to their babies. Health workers have also been providing comprehensive follow-up care, ensuring that both mothers and their newborns receive the necessary support.
“We typically monitor our HIV-positive patients until the baby reaches two years old. Once we confirm the baby is HIV-negative, we transition focus to the mother’s ongoing care and treatment,” said Caroline Atieno, Reproductive Health Coordinator, Kabondo Kasipul Sub-County.
According to her, the county has successfully reduced mother-to-child transmission from 18 percent to 5.3 percent. Furthermore, hospital deliveries have increased from 48 percent to 78 percent. Additionally, 99 percent of all pregnant women receive HIV testing. The remaining one percent includes those who do not attend antenatal clinics or visit facilities that do not offer testing services.
Justus Ochola, Deputy County Research and Innovations Coordinator for Homabay County, says that another critical factor contributing to the county’s success is its collaboration with traditional birth attendants (TBAs) to promote hospital deliveries for all women.
Through this partnership, TBAs are incentivized with tokens of appreciation each time they refer a pregnant woman to a health facility for delivery. This collaborative effort ensures that more women receive essential healthcare services during childbirth, further strengthening the county’s efforts to reduce maternal and child health risks.
“We decided to work with TBAs because we realized that as trusted community members, competing with them directly would be counterproductive. Instead, we sought to establish a collaborative relationship to integrate them into our efforts. This ensures they become integral partners and a reliable channel for referring mothers who seek their services to deliver at health facilities,” says Ochola.
Community education and involvement have also played a crucial role in these efforts. The county has been organizing numerous awareness campaigns, workshops, and seminars to educate the public about HIV prevention and treatment. Due to all these concerted efforts, Ochola says that today 95 percent of the population in Homabay County has been tested in the last year and only five percent of women of reproductive age in the county have not been tested.
Those who have been found positive have been initiated to treatment and the county is hopeful that they will be able to achieve the UNAIDS 95-95-95 targets to end the HIV epidemic by 2025. UNAIDS 2025 targets state that, by 2025 95 percent of people with HIV will know their status, 95 percent of people with HIV who know their status will be on treatment, and 95 percent of people with HIV on treatment will be virally suppressed.
The other 2025 targets are: 95 percent of people most at risk of HIV will have access to combination prevention services, 95 percent of women of reproductive age will have their sexual reproductive health needs met, 95 percent of people will be able to access services to eliminate parent to child transmission of HIV, 90 percent of people with HIV and most at risk of HIV have access to services to support their overall health, such as for sexual and gender-based violence, mental health, tuberculosis and other health conditions.
Additionally, fewer than 10 percent of countries will have punitive laws and policies that deny people access to justice, fewer than 10 percent of people with HIV and most at risk of HIV will experience stigma and discrimination, and fewer than 10 percent of women, girls, people with HIV and people most at risk of HIV will experience gender inequality or violence.
