Putting HIV-positive people at the centre of prevention

People living with HIV must take their place at the forefront of HIV prevention efforts in Kenya if they are to be truly successful, senior government officials said at the launch of a set of national guidelines for rolling out "Prevention with Positives" in the capital, Nairobi.



"We have focused so much on empowering HIV-negative people to avoid infection. We now need to focus on people who are already infected and empower them to prevent new infections, re-infection, and maintain their own and their partners' good health," said Dr Nicholas Muraguri, head of the National AIDS and Sexually Transmitted Infections Control Programme.



One of the main aims of the guidelines is to ensure that all HIV-positive Kenyans are aware of their status; government statistics show that 84 percent of HIV-positive people do not know they are infected. "We want to de-stigmatise the HIV test so that HIV testing becomes a 'kawaida' [usual] thing," he said.



"At one point, every adult with sexually transmitted HIV was the HIV-negative partner in a discordant relationship," Muraguri said. "Over 44 percent of married HIV infected partners have an HIV-negative partner - if they are aware of their status, they can take steps to protect their partners from infection."



In a 2008 Ugandan study, knowledge of HIV status was associated with increased condom use.



Prevention with Positives includes encouraging partner disclosure, scaling up prevention of mother-to-child transmission, increased condom use, large-scale male circumcision, and ensuring adherence to antiretroviral (ARV) drugs, which have been shown to significantly reduce the risk of mother-to-child as well as sexual HIV transmission.

At one point, every adult with sexually transmitted HIV was the HIV-negative partner in a discordant relationship

The government's development of the guidelines was supported by the United States President's Emergency Plan for AIDS Relief, the Elizabeth Glaser Paediatric AIDS Foundation, and the US Centres for Disease Control, among others.



Nelson Otuoma, chairperson of the Network Empowerment of People Living with AIDS in Kenya (NEPHAK), noted that "NEPHAK has more than 1,000 member organizations of people living with HIV, each with an average of 18 members; these people have a common message - they must not be generous with the virus, giving it away; they want to be mean with it, keeping it to themselves."



He said the guidelines would be very useful in providing a basis on which health workers could learn to deal with issues facing HIV-positive people.



"If a nurse gives a patient ARVs and then sees the same patient pregnant, they are sometimes shocked and ask, 'You mean after getting HIV you still have sex?'," Otuoma said. "With the guidance, they will know that of course HIV-positive people have sex, and will be able to help them to have healthy children and prevent further infections."



He said that if the government was to ensure that all HIV-positive people were aware of their status, then it also needed to find ways to ensure that all these people would have treatment when they needed it. An estimated 30 percent of HIV-positive Kenyans who need ARVS have no access to them.



The guidelines will now be distributed across the country, starting at provincial level and reaching county level by September, with training courses for health workers in both clinical and community settings.



kr/he