How mothers fuel new HIV infections in babies
Adherence to antiretroviral therapy is essential to prevent mother-to-child transmission.
What you need to know:
- According to the 2024 estimates, the country recorded 16,752 new HIV infections, of which 8,937 were recorded in women and 4,072 in men, with approximately 3,743 children newly infected with the virus.
Six out of 10 new HIV infections in babies are due to mothers skipping antiretroviral therapy, according to HIV estimates.
According to the status of the country's HIV epidemic, 2024 estimates by the National Syndemic Diseases Control Council (NSDCC) revealed that 63 percent of new HIV infections among infants were due to mother-to-child transmission related to non-use or discontinuation of medication.
Despite a 1.3 percent decrease in mother-to-child transmission rate from 8.6 percent in 2022 to 7.3 percent in 2023, no county achieved the five percent mother-to-child transmission rate validation target.
From the data, only five counties had a mother-to-child transmission rate higher than 20 percent: Wajir (34 percent), Mandera (27 percent), Samburu (27 percent), West Pokot (21 percent) and Isiolo (21 percent).
It is estimated that there were about 71,433 children (0-14 years) living with HIV in 2023. According to the 2024 estimates, the country recorded 16,752 new HIV infections, of which 8,937 were recorded in women and 4,072 in men, with approximately 3,743 children newly infected with the virus.
The report estimates that about 41,028 Kenyans on antiretroviral (ARV) therapy discontinued their treatment in 2023. Of these, a larger number of male adults, 25,884 in total, experienced treatment interruptions, while about 13,731 female adults also faced similar interruptions. In addition, about 1,360 children interrupted their treatment.
Non-adherence to antiretroviral therapy among pregnant women may be due to stigma and logistical challenges that prevent mothers from accessing essential care, including antiretroviral (ARV) therapy. This crisis is exacerbated by a severe shortage of ARVs.
Adherence to antiretroviral therapy (ART) is essential to prevent mother-to-child transmission of human immunodeficiency virus (HIV) and to ensure the long-term efficacy of ART.
Of the 2024 estimates, seven counties had lower mother-to-child transmission rates than the national average, with Migori, Kisumu, Murang'a, Kirinyaga, Nyeri, Siaya and Nairobi having the lowest mother-to-child transmission rates of less than seven percent.
According to the Kenya Health Information System data source, accessed in July 2024, antenatal care attendance dropped from 96 percent in 2021 to 88 percent in 2023.
Hospitals reported a 100 percent projection of expected pregnancies, but only 88 percent of women attended their first antenatal visit.
There was also a significant decline in the percentage of women tested for HIV at their first antenatal visit, which fell to 72 percent.
Only 73 percent of women gave birth in a hospital.
Only 10 counties – Isiolo, Turkana, Kajiado, Tana River, Lamu, West Pokot, Kirinyaga, Nairobi, Siaya and Kiambu – achieved more than 95 percent ANC coverage in 2023.
Elgeyo Marakwet, Nandi, Garissa, Nyamira, Kwale, Nyeri, Nyandarua, Vihiga, Wajir, Kilifi and Kisii counties recorded less than 80 percent ANC coverage in 2023.
Overall, the country has met the identification and treatment targets (97 percent) in 2023, with viral suppression at 94 percent, but children are lagging behind with viral suppression at 68 percent, and in terms of access to treatment, only 73 percent of children who tested positive are receiving treatment.
Only eight out of ten children living with HIV know their HIV status.
Several reasons could lead to several children not knowing their status including poor testing programmes where conventional testing methods are missing large numbers of people living with HIV, and their mothers not receiving antiretroviral therapy.
The continuing failure to diagnose and provide effective treatment for all children with HIV has claimed the lives of some 2,607 children. This is an increase of more than 300 children from last year, when the country recorded 2,304 HIV-related deaths among children aged 0-14 years.
Exposure of an infant or child to HIV during pregnancy can occur during childbirth and breastfeeding. Mothers living with HIV can give birth to HIV-negative babies.
The World Health Organization (WHO) recommends effective HIV treatment during pregnancy, an informed and careful choice between vaginal delivery and caesarean section, not breastfeeding, and introducing the baby to anti-HIV drugs (infant PEP) for a few weeks.
An infant's or child's exposure to HIV can occur in the womb, during labour and birth, and through breast milk. Although HIV can be transmitted from an HIV-positive mother to her baby during pregnancy, delivery and breastfeeding, being on ART and having an undetectable viral load during pregnancy and breastfeeding significantly reduces the risk of HIV transmission.
Dr Florence Njenga, a medical doctor and Nation columnist, said that a woman living with HIV can give birth to an HIV-negative baby and continue to care for the baby and breastfeed without the baby becoming infected.
She pointed out that prevention of mother-to-child transmission of HIV can be achieved through early detection of infection in the mother. “This is why HIV testing is part of the tests that are done at the first ante-natal visits, and for those who test negative, the test is repeated throughout the pregnancy, delivery and breastfeeding,” she said.
Mothers who test HIV-positive are started on antiretroviral treatment the same day.
“For women already living with HIV and those starting HIV treatment during pregnancy or breastfeeding, it is necessary to take anti-retroviral medication daily, as prescribed. The goal of taking the medication is for the level of the virus to be very low, to the level of not being detected by a viral load test,” she advised.
She adds: “It is important for the mother to notify the health care providers during pregnancy and delivery of their HIV status so that the necessary monitoring can be done, and special care can be taken during the delivery process.”
“It is important to also let the team that is taking care of the baby know that the baby is HIV exposed so that the baby can receive timely prevention medication and necessary tests. The vaccination schedule is also slightly different.”
She advised that the baby should be started on preventive anti-retroviral medication as soon as possible after birth and continue on the medication until six weeks after the baby stops breastfeeding. The baby should be exclusively breastfed for the first six months.
At six months, when complementary feeding starts, breastfeeding can continue as long as the HIV prevention medication is also being taken.
“The baby gets tested for HIV at regular intervals until the time when breastfeeding stops. With timely care and support, mothers can give birth to HIV-negative babies.”
