Kenya’s HIV epidemic is often referred to as generalised – affecting all sections of the population including children, young people, adults, women and men.
30% of new HIV infections in Kenya are among people from key populations
However, in recent years a number of studies have identified concentrated epidemics among certain groups who are particularly vulnerable to HIV transmission. The government’s current HIV/AIDS strategy, the Kenya AIDS Strategic Framework 2014/2015 – 2018/2019 (KASF) acknowledges this, describing the epidemic as “deeply rooted among the general population” alongside “concentration of very high prevalence among key populations.”
It is estimated that 30% of new annual HIV infections in Kenya are among people from key populations. This is disproportionate to how many people from these groups exist within the population.
Geographic location is also a factor, with 65% of all new infections occurring in nine out of the country’s 47 counties – mainly on the west coast of Kenya.
Men who have sex with men (MSM) and HIV in Kenya
HIV prevalence among men who have sex with men (sometimes referred to as MSM) in Kenya is almost three times that among the general population. The most recent statistics, from 2010, estimate HIV prevalence among men who have sex with men at 18.2%.
Condom use among men who have sex with men is fairly low but has been rising. In 2013, an estimated 69% of men who have sex with men reported using a condom the last time they had anal sex, up from 55% in 2011.
Homosexuality is “largely considered to be taboo and repugnant to [the] cultural values and morality” of Kenya.
The act of sodomy is illegal in Kenya and can carry a prison sentence of up to 14 years.
These legal and social attitudes lead to high levels of stigma and discrimination towards men who have sex with men as well as other members of the lesbian, gay, bisexual and transgender (LGBT) community, deterring many people from seeking the HIV services they need.
In 2013, a group of Kenyan civil society organisations presented a report to the Committee Against Torture stating that people who are LGBT in Kenya face constant harassment, violence and death threats by police officials, who also blackmail them with threats of arrest if they refuse to pay bribes.11
People who inject drugs (PWID) and HIV in Kenya
In 2011, an estimated 18.3% of people who inject drugs (sometimes referred to as PWID) in Kenya were living with HIV.
The majority of people who inject drugs are concentrated in specific geographical areas such as Nairobi and Mombasa.Low condom use and unsafe injecting practices exacerbate transmission.
In 2012, Kenya introduced needle and syringe programmes and opioid substitution therapy to help reduce HIV transmission among people who inject drugs.15. In 2015, results from a survey of people who were accessing these services found nearly 90% had used a clean syringe last time they injected, compared to 51.6% in 2012.
Sex workers and HIV in Kenya
Sex workers have the highest reported HIV prevalence of any group in Kenya. In 2011, an estimated 29.3% of female sex workers were living with HIV.17 By comparison, 2011 findings from the Sex Workers Outreach Project showed an HIV prevalence of 30% among female sex workers and 40% among male sex workers.
This is echoed in a 2015 study of female sex workers in Nairobi, which found around one-third to be living with HIV.
However, female sex workers are reportedly better at protecting themselves from HIV transmission compared to other groups who are vulnerable to HIV such as men who have sex with men. For example, the 2015 Nairobi study (mentioned above) found 86.9% reported using a condom with their last client and almost two-thirds (62.6%) always using a condom with clients. Testing rates were also high with 86.6% having ever tested for HIV and 63.1% having tested for HIV in the past 12 months.
Women and HIV in Kenya
Although HIV prevalence among the general population has fallen in Kenya, women continue to be disproportionately affected by the epidemic. In 2014, 7.6% of women were living with HIV compared with 5.6% of men.
Young women (aged 15-24) account for up to 21% of all new HIV infections with a prevalence of between 4 and 6 times higher than males of the same age. This is found across all groups and across all geographic areas, from young female sex workers and young women who inject drugs to young women in discordant couples and young women in and out of school.
As in many parts of sub-Saharan Africa, women and girls in Kenya face discrimination in terms of access to education, employment and healthcare. As a result, men often dominate sexual relationships, with women not always able to practice safer sex even when they know the risks.
In addition, young Kenyan women are more than three times more likely to be exposed to sexual violence than young Kenyan men.23 About 33% of girls in Kenya have been raped by the time they reach the age of 18, with 22% of girls aged 15-19 reporting their first sexual intercourse to have been forced.
Young Kenyan women also have a lower level of HIV knowledge than their male peers. The 2014 Kenyan Demographic Health Survey (KDHS) found that only 54% of young women could correctly identify ways of preventing sexual transmission of HIV and rejecting misconceptions about HIV transmission, compared to 64% of young men.