In its recently released annual report on the global AIDS epidemic, the United Nations lowered its estimates of the numbers of people infected worldwide by 6.5 million. The U.N. says most of the decline reflects changes in the methodology for measuring the extent of the disease. But as Derek Kilner reports for VOA from Nairobi, Kenya stood out as one of the few cases where there has been a genuine easing of the epidemic.
New figures show that the percentage of people in Kenya living with the AIDS virus fell to 5.1 percent in 2006, down from 5.9 percent a year earlier and 9 percent in the mid-1990s.
The sustained progress, experts say, is largely a product of widespread changes in sexual behavior. Ruth Nduati, a professor of pediatrics at the University of Nairobi, says one such change has been the age at which girls become sexually active.
"Among young women there's been a very definite increase in age of sexual debut. It's now at 20 years. It used to be as low as 15 years, several years ago. This takes women out of a pivotal time when they are very, very vulnerable to STDs and HIV," said Nduati.
Other significant behavioral shifts include a decrease in the number of sexual partners, especially for men, and a rise in the use of condoms.
In 1999, Kenya's government declared AIDS a national emergency, and the issue was highly visible in the 2002 election that brought President Mwai Kibaki to office.
The government's efforts are visible in the number of Kenyans receiving antiretroviral treatment, which grew from 3,000 in 2002 to 118,000 in 2006. Similarly, over 400,000 people received voluntary counseling and testing, or VCT, in 2006, up from only 1,000 seven years ago.
The government's focus on HIV/AIDS has been bolstered by large infusions of cash from foreign donors. Kenya, for example, received over $208 million from America's PEPFAR program in 2006, second only to South Africa.
Boaz Cheluget, head of monitoring and evaluation at Kenya's National AIDS Control Council, says one of the main reasons Kenya has been able to translate the attention and money into successful programs is that the country's work force is highly skilled.
"Kenya has an advantage," said said Cheluget. "I think the quality of staff and service provision in any sector is high, and so when we introduce something the implementation is of quality. I have been to many countries, and I can see there are quite a lot of gaps in terms of skilled workforce, in terms of performance, in terms of governance."
Cheluget says the country's high literacy rate also contributes to the success of projects implemented at the local level.
In the run-up to World AIDS Day on December 1, Kenya has been holding a number of events to encourage testing. Patrick Obath, managing director for Shell Oil in Kenya, was one of the many business leaders participating at one such event in Nairobi on November 26.
"We have had HIV/AIDS programs at work since 2002. We have had a policy which was piloted at Kenya Shell and has now been adopted globally by Shell. And in the last three years when we have had VCTs at work, we have had about a 98 percent uptake," said Obath.
Education efforts have also expanded recently, bolstered by the introduction of free primary education in 2003, and the corresponding rise in school attendance. General knowledge of HIV in Kenya is now nearly universal.
But with some 230 people still dying every day from AIDS and antiretroviral therapy going to fewer than half of those who need it, AIDS remains a serious challenge for Kenya.
And the country's success in controlling the epidemic also presents another cause for concern for some experts, including Dr. Nduati.
"The challenge is that every day you have a new cohort of youngsters who haven't had the experience of seeing an AIDS epidemic visibly," said Dr. Nduati. "Young people today have seen AIDS in a visible way, it's a real message. When the epidemic is not so visible because we've done great work in reducing it, then you will find it harder to convince youngsters of behavior change."
Cheluget fears a drop in concern may also extend to the political sphere. Unlike in 2002, AIDS has not been a major issue in the election campaign that is currently gaining public attention.
"In the parties that are competing now, I am not seeing mention of HIV. Maybe there is quite some complacency," said Cheluget. "Many parties, they haven't focused. They are saying they are going to deliver for people. There is no mention of HIV/AIDS"
And there is a concern about the financial sustainability of Kenya's AIDS programs. The scaling up of treatment, testing, equipment, and staff has been expensive. And while the government has made an effort to contribute funds for such activities, over 98 percent of the bill is being paid by foreign donors.
