Byanyima: To win HIV war, provide contraceptives to young people

Kenya is grappling with rising HIV infections among teenagers according to the World Aids Day 2022 report.

It also revealed that the country had recorded an increase in new HIV infections for the first time in a decade with more than 2,000 cases. We spoke to the Joint United Nations Programme on HIV/AIDS (UNAIDS) executive director Winnie Byanyima, who arrived in the country this week for a state visit, for some insights.

Thank you so much for speaking to us, my first question is, why are there more infections among girls and women than boys and men? 

The lack of access by so many girls and women to sexual reproductive health and more so contraceptives is the major reason why there are so many newer infections among girls and women than among boys and men. 

What is increasing access really about?

Increasing access isn’t just about putting up clinics and making available contraceptives, it’s about safe spaces where girls and young women can have the privacy they need and choose the method they want so as to protect themselves from infections, HIV and sexually transmitted infections (STIs).

This is not happening for every girl and every woman. 

There has been debate about the role of sexual education in all of this. What is your take? 

Our girls and boys are growing up without that lifesaving knowledge of how to take care of their own bodies, protect themselves and how to make the right choices as they are growing.

These things must be taught before they reach puberty, they shouldn’t be taken by surprise. It’s unfortunate that many traditionalists are resisting sexual education in schools and so we are seeing lost opportunities and lives lost because of ignorance, and gender inequalities.

Do you think it’s time the Kenyan government allowed teenagers to access contraceptives?

That’s an interesting question. If a girl is going to be exposed to situations where she is having sex, forced sex or consensual sex, then she needs lifesaving protection.

I wouldn’t want to see any child getting pregnant or getting infected just because of a moral argument that is not applicable and if it was really applicable would she be having sex? We know that many young girls are not controlling the environment around them and so it is important to place there what will make her safe. 

What should sexual reproductive health services in Kenya look like? 

They must be friendly to young people and they must give the privacy that even a young woman needs because you know many women who test positive don’t even feel safe to tell their partners.

When it comes to dealing with stigma, is there any experience you have had that stands out?

Recently I was in Jamaica and I visited an amazing centre where communities are delivering services. I have been going to this centre for the last 18 years and people know me well there. I found five HIV-positive women who work there by going out and finding people who need help, and services and connecting them to the facility. But do you know what? Two of them wanted to take a picture with me but did not want me to tweet it and explained that in their village no one knew that they are HIV positive.

Kenya has been dealing with a shortage of condoms that has seen sex workers resort to re-using them as government cites a ‘supply chain issue’. What is your take on this?

A shortage and supply chain issues are basically the same thing. We do see stockouts of commodities in a number of countries and we know what needs to be done.

I find that the dishonesty of public officials is often the reason delays in the procurement of supplies and transportation of life-saving commodities happen. They take months to issue a tender. Often, these delays are self-imposed as they try to find a way to gain from these commodities, though at times there are issues with global supply.

A supply chain of life-saving commodities has to be managed much more carefully, it’s very important that procurement is efficient and transparent so that you get the best value for your money.

We have seen delays in procurement and supply of ARVs by governments. How detrimental is this in the fight against HIV/AIDS? 

We see most of them within national borders and they are usually due to poor planning or downright corruption, which is very unfortunate. It is a sad situation that someone who needs a tablet so as to stay alive is unable to get it. It is a scar on our humanity. It is also fair to recognise that as a result of the Covid-19 pandemic, the production of some key ingredients used in making ARVs stalled.

Is Kenya and Africa capable of making their own HIV drugs? 

Local manufacturing is very important. If countries are going to be able to pay for the people who need to be on treatment for life, this cost must be contained. 

Secondly, we need local manufacturing for health security. For example, we did see that when Covid-19 vaccines came, the monopoly World Trade Organisation rules that allow companies to hike a price artificially and deny a treatment that is life-saving to many people kicked in.

In order for us to never again be in a situation where our lives are in the hands of rich countries, we must produce medicines on our continent and I think our leaders are seeing that as a priority today.

This is one of the issues that I raised with Deputy President Rigathi Gachagua on Monday within the context of your Universal Health Coverage (UHC) because UHC is going to be paid for by domestic resources, Kenyan taxpayer’s money should not be used to procure medicines abroad.

How do you feel about the recent win at the Supreme Court by a Kenyan woman living with HIV who challenged forced sterilisation?

I was very excited. This ruling sent a very strong signal to all Kenyans that someone living with HIV must give consent over her body. It is so important because it is not just about HIV but also about a woman’s right to control her own body, there can be no medical reasons why you should perform anything on a woman’s body without her consent.

It is also very important to observe that people living with HIV have equal rights with everyone else. They should not be discriminated ... when you discriminate you enable the spread of the virus.

Last week saw you at the centre of the Dar-es-Salaam declaration to end AIDS by 2030, please tell us about it.

12 African countries with the highest HIV burden including Kenya have come together and decided to work together towards closing the treatment gap and ending HIV/AIDS in children by 2030. 

Finally, what should we expect from UNAIDS at the upcoming African Union Heads of State Summit in Addis Ababa?

We will be attending the first lady’s summit and our aim is to take there our two initiatives: one of ending HIV in children because we want first ladies to be champions, and secondly, we will be reporting to them on our progress on Education Plus.