Last month, UNAIDS announced that the sixth Millennium Development Goal – to halt and reverse the spread of HIV – has been reached nine months ahead of schedule. However, while this seems to show there is light at the end of the tunnel, the announcement has prompted Kenyan HIV activists to ask questions about issues around adherence and the misuse of life-saving HIV medication.
UNAIDS’ announcement was made during the Third International Conference on Financing for Development in Addis Ababa, Ethiopia (13 -16 July). In a report titled ‘How AIDS changed Everything’, UNAIDS also stated that the world was on track to end the AIDS epidemic by 2030.
But previous media reports have highlighted how antiretroviral medicine is being sold in backstreets in Kenya. This calls into question whether current adherence counselling is adequate to enable beneficiaries to understand the effects and the dangers of using the drugs incorrectly.
Adherence counselling vital
Nairobi resident Gideon (not his real name), 52, recalls that when he was put on antiretrovirals in 2005 patients were required to take a course in adherence where they would take notes. “The counselling was done in a group and every patient would be accompanied by a relative who would sign as a witness that the patient would adhere to the medication and diet to the letter,” he said.
Gideon, who is an HIV advocate, blames the misuse of antiretrovirals on inadequate adherence counselling. He believes the UNAIDS success story may not be sustained unless more investment is made in this area.
“Unless antiretroviral beneficiaries are well-educated not to sell or misuse the medication, they will continue falling into wrong hands, and that is no achievement!” he said.
Though the Kenya AIDS Response Progress Report 2014* indicated that the number of people living with HIV reached with antiretroviral treatment had increased from 6,000 to 656,000 over ten years, the question many are asking is whether all the medication has ended up in the right hands.
Between 2011 and 2013, the Kenyan media was flooded with stories of antiretroviral misuse which ranged from lacing illicit local brew to selling the medicine in backstreets. Media reports claimed that some people who sold the drugs in the slum areas were doing it out of poverty, to feed themselves.
Moreover, in a recent interview, a Nairobi-based sex worker (who requested anonymity) revealed that there is no record of the people who receive antiretrovirals as post-exposure prophylaxis and they can go back for more as often as they need. Post-exposure prophylaxis is a short course of antiretroviral drugs that stops exposure to HIV from becoming a life-long infection (Avert).
“I go for them in pretence I was raped and sell them to clients who are shy of queuing in hospitals waiting for a refill,” she said, adding that she sells antiretrovirals to clients who have never been tested but suspect that they could have HIV.
Undermining Kenya’s HIV response
Kenya has the fourth largest HIV epidemic in the world (Avert). To change this there needs to be sufficient adherence counselling and support to ensure the 690,000 people receiving antiretrovirals are using them properly. Because if they are, according to experts, it is almost impossible for a person with an undetectable viral load (the amount of HIV virus in the bloodstream) to infect another person.
Lucy Kainyu, secretary general of the Network of Journalists Living with HIV, says that if adherence counselling was given in all health facilities, every beneficiary would understand the value of the medication.
“Though Kenyans receive antiretrovirals at no cost from their local health facilities, they should be enlightened that ‘someone’ pays for them dearly in order for them to be offered free of charge,” she says. She adds that if there was adequate adherence counselling, beneficiaries would think twice before selling them in back streets.
*Kenya AIDS Progress Report 2014, section 6.1: Reaching people living with HIV with life-saving antiretroviral treatment.