Funding cuts, rising infections: Kenya's fragile HIV gains under threat
Acting CEO of the National Syndemic Diseases Control Council Douglas Bosire during an interview on November 19, 2025.
What you need to know:
- In 2005, we lost about 110,000 Kenyans due to Aids-related illnesses. In 2024, we lost 21,000. We had about 94,000 new HIV infections in 2005.
- In 2024, we recorded about 19,991 new infections.
The HIV epidemic in the country has faced a long, uneven journey. Just as progress seemed to stabilise, Kenya was struck by funding cuts from the United States government this year. For the first time in three years, the number of new infections has increased, mostly among young people.
As the World marks Aids Day under the theme, ‘Overcoming disruption, transforming the AIDS response’, Douglas Bosire, the acting Chief Executive Officer at the National Syndemic Disease Control Council (NSDCC), shared with Healthy Nation the country's progress, challenges, and interventions in place after donor funding was withdrawn.
How has the HIV epidemic changed over the years in Kenya?
The first case of HIV in Kenya was detected in 1984. Over the period, a lot of progress has been made. In the 90s, there was a lot of fear, anxiety, and the government at the time did not have a solution to offer people infected with the virus. Extensive advocacy, awareness creation, and research went into finding solutions to mitigate the epidemic's impact. This led to the birth of antiretroviral treatment (ART). However, this discovery was not available or of benefit to low- and middle-income countries until the early 2000s when the manufacturers' patent rights had expired.
Was there any tangible impact when the interventions were made available to Kenyans?
In 2005, we lost about 110,000 Kenyans due to Aids-related illnesses. In 2024, we lost 21,000. We had about 94,000 new HIV infections in 2005.
In 2024, we recorded about 19,991 new infections. Regarding mother-to-child transmission, in 2005—at the advent of free mass HIV treatment programmes—about 35 per cent of mothers transmitted the virus to their children. Last year, that number dipped to nine per cent.
How are protecting these gains?
Amidst this progress, our response remains delicate; the gains are fragile and must be protected. We do this by granulating and studying the data, breaking it down to identify which population cohorts are still lagging. Kenya has committed to ending Aids as a public health threat by 2030, and we are doing well towards those targets.
Are there specific groups are not doing very well?
Yes. We are particularly concerned about young children aged 0-14 years. In the HIV response, we classify populations into two main groups: children (0-14) and adults (15+). We have noticed we are leaving the children behind.
We measure success using the 95-95-95 cascade: 95 per cent of people living with HIV should know their status; of those, 95 per cent should be on treatment; and of those, 95 per cent should be virally suppressed. In 2024, the average viral suppression rate among adults was about 83 per cent. Among children, it was significantly lower at about 66 per cent.
How are these new infections among children occurring?
We know that almost two-thirds (67 per cent) of mother-to-child transmissions occur because the mother either comes late to Antenatal Care and is tested late, drops off treatment during pregnancy, or gets infected with HIV while breastfeeding. So, interruption or non-initiation of ART accounts for most new infections in children.
Isn’t this concerning?
Of course. If we keep adding children to the 1.326 million Kenyans already living with HIV, it burdens the country with treatment and care costs. We currently spend an average of about Sh25 billion per year to keep people on treatment and care.
The latest data from NSDCC show a surge in infections among young people categorised as adolescents. What’s driving this?
Kenya is a young nation; 59 per cent of the population is below 24, and 75 per cent is below 34. The country stands to harness a significant demographic dividend if these young people grow up healthy and productive. Key syndemic factors are driving infections: the median age for sexual debut is about 16 years, and these encounters are mostly unprotected, leading to mistimed pregnancies.
Speaking of mistimed pregnancies. We have issues with the triple threat. What is the situation like?
In 2024 alone, about 240,000 pregnant girls aged 10-19 presented at health facilities nationwide. That’s an average of 660 per day;a startling and shocking number that demands action. Early pregnancy predisposes young mothers to vulnerability, stigma, and lack of support, often leading to repeat pregnancies.
Also read: Why teen pregnancy rises during holidays
We also see disproportionate levels of sexual and gender-based violence (SGBV). In 2024, the country recorded about 43,000 SGBV cases. Tragically, 17,000 involved children aged 10-17. This means one in three SGBV cases in Kenya was a child.
Are we doing anything about this especially in a bid to reduce HIV cases?
We are campaigning to increase the reporting rate for SGBV, working with the Ministry of Interior and community health promoters to ensure timely reporting. From a medical and HIV programming perspective, if a person is defiled and potentially exposed to HIV, they need to seek care within 72 hours for post-exposure prophylaxis (PEP) to prevent seroconversion. We still see survivors of defilement seroconverting.
So, when we look at all these three factors that are affecting our young people, the issue of new HIV infections, adolescent pregnancies and sexual and gender-based violence, we find that there is a nexus among them.
As a government, we decided to break our silos because these syndemics are related. We combine our efforts, stretch our coin so that we can have more impact to end the triple threat.
What practical strategies have you put in place to end this triple threat?
First, mothers need to know their status. We encourage at least four Antenatal care attendants before delivery. We are also leveraging national government administrative structures, like chiefs and assistant chiefs, to disseminate these messages daily.
How are young people taking part in this conversation?
We are ensuring young people are not only included but lead the conversations. We’ve noticed a knowledge gap. In the 90s, robust, well-funded advocacy and awareness programmes existed. Unfortunately, with dwindling donor funding, some of these programmes are no longer supported.
We now have a programme in all counties called Maisha Youth. These are youth champions who go to schools, social places, and religious institutions to advance this conversation.
How is Kenya planning to sustain itself beyond the donor funding?
We have been on a journey towards self-reliance. Last World AIDS Day, we launched the Kenya Operational Plan towards a sustainable HIV response three months before the recent funding cuts. The cuts mainly affected prevention programmes. For commodities and treatment, the disruption was brief as we use a co-funding model and don’t entirely rely on donors.
Kenya is implementing an integrated system for HIV care. There will no longer be isolated comprehensive care clinics for HIV, which will help reduce stigma. Under the Primary Healthcare Fund and the Social Health Insurance Fund, we are working to include HIV services to ensure sustainability.
Lenacapavir, the long-acting pre-exposure prophylaxis, was recently recommended by the World Health Organization. When will Kenya receive it?
Kenya is an early adorter selected by the Global Fund and will receive Lenacapavir starting in January 2025. Initially, it will be for key populations who are at highest risk. People need at least two injections per year. We are receiving 96,000 doses, and we have about 40,000 people in the key populations category. By 2027, the commodity is expected to be available locally and commercially at a reduced rate of about USD 40 (Sh5,184). Young people must remember that PrEP does not prevent other infections, and it is not a morning-after pill.
Why do Western Kenya counties have the highest burden of people living with HIV?
This pattern has existed since the advent of HIV. Certain cultural factors, like historically low uptake of voluntary male medical circumcision (VMMC), drove infections.
Science shows VMMC reduces infection risk. Most people in those counties have now adopted it, and new infections are coming down. The high prevalence persists because people are on treatment, virally suppressed, and living normal lives, which is a success. We don’t want prevalence to drop rapidly as that would mean people are dying. In fact, Western Kenya has lower new infection rates compared to some other counties. Stigma has also reduced significantly there, enabling more open conversation about HIV.
