Interview with coordinator of CDC's Global AIDS Program

Interview with Barbara Marston, coordinator, HIV Care and Support Activities Global AIDS Program of the US Centers for Disease Control in Kenya Question: What are the prevalence rates of HIV/AIDS in Nyanza Province, Western Kenya? Answer: According to the Kenya demographic and health survey for 2003, prevalence in the province was 15 percent. There is wide geographic variation, with lower rates in Kuria and Gucha districts and higher rates close to Lake Victoria [an estimated 40 percent in Suba and Homa Bay, based on sentinel surveillance]. Q: What demographic group is at higher risk of contracting HIV/AIDS? A: Population-based data clearly shows a higher risk for young women compared to young men. There are very high rates among prostitutes and older men. Q: Is there a difference between prevalence rates in cities/towns and rural areas? A: There are generally higher rates in urban areas than rural areas, although the differences are becoming less pronounced. Q: How does HIV/AIDS affect the people of Nyanza Province? A: The impact varies in different circumstances. It can divide communities and exacerbate poverty. Then again, the needs - for example of the sick or of orphaned children - bring out the best in some people. Q: Is there a good level of knowledge in the community about HIV/AIDS transmission and the virus itself? What steps have been taken to bring this information to the population, particularly in rural areas? A: There is a growing understanding of HIV and its modes of transmission. The government and numerous community organisations and NGOs are working to increase knowledge about HIV. There is still a stigma surrounding HIV/AIDS and its sufferers, but attitudes are changing. Q: Are voluntary counselling and testing (VCT) centres available to the majority of the population? Are they being used? A: There are now several VCT centres in each district in Nyanza Province, but given the high levels of poverty these still may be out of reach for many people. [Government health facilities charge a token fee of 100 Kenyan shillings (US $1.40) for tests and a month's dose of ARVs, but the fee can be waived for those who cannot afford it. Many people who live far away from health facilities are, however, unable to raise the bus fare to travel to medical centres]. Several organisations are providing mobile VCT services, helping to reach areas where VCT centres are not easily available. The numbers of people being tested is rising. Q: Are condoms available to the majority of the population? A: Yes, but they are not used consistently. Q: Is treatment and care available to the majority of the population? A: There are more than 80 clinics providing HIV treatment services - more than 35 providing antiretrovirals (ARVs) - but there are still barriers, especially transport to these centres for people in very rural areas. Q: What is the Kenyan government doing to help deal with the HIV/AIDS situation in Nyanza Province? A: I'm not qualified to comment on the full range of interventions. Prevention activities are supported by various ministries. Both prevention and treatment are supported by the ministry of health. Major activities include the scaling up of testing (both VCT and testing in clinical settings such as hospital wards, outpatient departments and TB clinics); scaling up of prevention interventions such as abstinence promotion, prevention of mother-to-child transmission programmes, condom distribution; and treatment services, including support for basic services and support for treatment programmes providing antiretroviral drugs. There has been very substantial progress, but there is always more that can be done. Q: What, in your opinion, would be the best way of dealing with the HIV/AIDS pandemic in this area? A: There is a need for major behaviour changes (delay in age of first sex, reduction in the numbers of sexual partners) and expansion of the prevention and treatment programmes I mentioned. Q: If things don't change dramatically, what is the future for Nyanza Province? A: The impact will continue to be devastating for some time, even if dramatic changes are made. Nyanza is facing reductions in the sections of the population that are most important to the economy - young adults.