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Women and HIV: Challenges and Opportunities - Kenya

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Title: Women and HIV: Challenges and Opportunities - Kenya


1
Women and HIV Challenges and Opportunities -
Kenya
  • Dr. Jemima Kamano
  • Associate Program Manager, AMPATH
  • Lecturer and Consultant Physician, Moi University
    School of Medicine and Moi Teaching and Referral
    Hospital
  • www.ampathkenya.org

2
Map of Kenya
  • Kenyan Statistics
  • Country population 44,351,000 people
  • Women population 50.11
  • Life expectancy 61 years
  • GDP per capita is US 1800, i.e. 82 lower than
    the worlds average. Population below poverty
    line 45.9
  • Prevalence of HIV 5.6
  • Prevalence of HIV in women 6.9
  • Prevalence of HIV in men 4.4

3
AMPATH
  • Academia and Government partnership
  • Started in 2001 in response to HIV
  • Restructured in 2009 to address population health
  • Currently taking care of 60,000 HIV positive
    patients, of whom 68 are women

4
Gladys
  • Married to a philandering husband at age of 21
  • Not employed and no special skills
  • Husband, sole breadwinner, denied her permission
    to ever take a HIV test
  • Diagnosed HIV positive at ANC 4th child
  • Disclosed status, beaten and abandoned by
    husband, family and in-laws
  • No income, 4 children, and expected to attend
    clinic, exclusively breastfeed, and eat healthy
  • Worst fear through all of this was what if my
    children are also infected?

Gladys at her workstation at AMPATH.
Gladys giving a talk in one of the motivational
sessions to patients in the psychosocial support
group.
5
Jane
  • Jane, 45 years old.
  • HIV positive on ART for the last 15 years.
  • Widowed at 29 years, and raised her 4 children
    alone.
  • First born daughter got an early pregnancy from
    the sex for fish trade at age 12.
  • Jane recently had a minor stroke and was then
    diagnosed hypertensive treatment unaffordable.
  • Jane has never had a pap smear, yet her two
    sisters have both been diagnosed with cervical
    cancer. She has lived in fear of any kind of
    screening.
  • Recently regained hope after joining a support
    and GISE group and now able to afford
    hypertension care since its integration in CCC.

6
Esther
  • Esther 18 year old orphan.
  • Born with HIV and started ARVs as a child.
  • Grew up with step family, endured lots of abuse
    about having been promiscuous like her mother.
  • Due to the abuse, lost hope early and had very
    poor adherence in early teenage years failed
    first line.
  • Now in college, on second line, biggest
    challenge disclosure to peers, dating with HIV.
  • Her words I do fear what will happen when my
    second line finally fails, so I do all in my
    power to keep it working. But when the time
    comes, I know AMPATH will find a way for me, you
    already kept me for 18 years, and now am full of
    life and have so much to live for.

7
Challenges
  • Women socio-economically and culturally
    disempowered and more stigmatized.
  • Limited access to healthcare Health systems
    underfunded, static and geared to diseases rather
    than populations.
  • Limited access to capital, skills Silo programs
    at national level and in healthcare
  • Little community involvement in funding and in
    planning.
  • Continued risky sexual behavior among
    especially younger
    women with continued
    spread and low access to screening.
  • Without community screening, higher rates of MTCT
    in community despite falling rates in hospitals.
  • HIV mortality rates still high, and resistance
    rates increasing.
  • Aging population with HIV hence increased NCDs
    that are now contributing immensely to the health
    burden but remain unaddressed.

8
Opportunities
  • Population health approach Find, Link, Treat and
    Retain (FLTR) Early case and risk finding and
    intervention control.
  • Integrated care task shifted/shared to the lowest
    primary care level Care package thats community
    centered.
  • LACE (Legal Aid Centre of Eldoret).
  • Population health supported by Zuri Health
    Insurance and AMPATH coordinated microfinance
    groups.

9
Expected outcomes from microfinance groups
  • Group caring for themselves
  • Improved linkage target gt 80
  • Retention in care target gt 95
  • Improved drug compliance/adherence
  • Improved quality of life
  • Cost reductions patients program
  • Economic gains for the group from activities
  • OVERALL Reduction in community VL HIV
    incidence -- HIV pandemic control

10
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13
MembershipFamily Preservation Initiative
  • Total of over 10,000 members ever enrolled in
    GISE
  • 83.33 female members
  • 75.01 attendance rate to group meetings
  • 98.8 retention rate
  • 13.3 average membership growth rate

14
Conclusion
  • Era of HAART may have brought new hope, but
    deeper socio-economic and systems issues still
    need to be solved.
  • Funding ? Access ? Utilization
  • Nothing can put women down forever, they always
    will bounce back and stronger.
  • Investing in women, the only way to ensure
    population health.

15
Acknowledgements
  • PEPFAR and USAID
  • Abbott
  • AbbVie
  • Eli Lilly and Company
  • Grand Challenges Canada
  • AMPATH Consortium
  • Kenya MOH
  • The great people of Western Kenya

16
Thank you
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