Distribution of HIV; Global, Regional and local i.e.

Kenya; Gender & Age disparities in

HIV distribution

Global HIV STATUS

HIV, the virus that causes AIDS, is one of the world’s most serious public health challenges.
Consequently, it is reversing many of the development gains in the world, leaving populations more
vulnerable to poverty, malnutrition, ill health, and mortality.
In 2023 an estimated 39.6 million people were living with the HIV virus across the globe
(https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics).
Since the start of the epidemic, an estimated 74.9 million people have become infected with HIV
and 32 million people have died of AIDS-related illnesses.
It is estimated that 1.5 million people were infected with HIV in 2021, accounting for 32%
decline in new HIV infections since 2010. Of these, 1.3 million were adults, while 160,000
were children below 15 years of age.
The vast majority of people living with the HIV epidemic reside in low- and middle-income
countries, with an estimated 68% living in sub-Saharan Africa. The severe consequences in
these countries have been an upsurge in the number of orphaned children, high poverty levels,
retarded development.

New infections

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In 2018, there were roughly 1.7 million new HIV infections.
In the past eight years, global new HIV infections have declined by about 16%, from a 2.1
million in 2010.
In 2018, more than half of new HIV infections globally were among key affected populations and
their partners.
Young women are especially at risk, with around 6,200 new infections each week among young
people aged 15-24 occurring among this group.
In sub-Saharan Africa, four in five new infections are among girls aged 15–19 years and young
women aged 15–24 years are twice as likely to be living with HIV as men.
More than one-third (35%) of women around the world have experienced physical and/or sexual
violence at some time in their lives. In some regions, women who experience violence are one
and a half times more likely to become infected with HIV.

Regional Impact—The vast majority of people with HIV are in low- and middle-income
countries. In 2021, there were 20.6 million people with HIV (53%) in eastern and southern
Africa, 5 million (13%) in western and central Africa, 6 million (15%) in Asia and the Pacific,
and 2.3 million (5%) in Western and Central Europe and North America.

Treatment
In 2018, 62% of all people living with HIV were accessing treatment. Of those, 53% were virally
suppressed. This equates to 23.3 million people living with HIV receiving antiretroviral treatment
(ART) in 2018 – up from 7.7 million in 2010.
HIV and AIDS in Kenya
Kenya is a geographically diverse country in East Africa with a population density of 85.1
people per sq. km in 2016 distributed across 47 countries.
In 2017, Kenya was ranked 3rd among eastern and southern African countries with new HIV
infections amongst adult people aged between 15 years and above.
In 2016, 64% of people living with HIV were on treatment, 51% of whom were virally
suppressed.
Kenya’s HIV epidemic is driven by sexual transmission and is generalized, meaning it affects all
sections of the population including children, young people, adults, women, and men.
Overall, Kenya has the joint third-largest HIV epidemic in the world (alongside Tanzania) with
1.6 million people living with HIV in 2018. In the same year, 25,000 people died from AIDS-
related illnesses. While this is still high the death rate has declined steadily from 64,000 in 2010.

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Geospatial variation of HIV prevalence is wide-ranging from 21.0% in Siaya county to the
lowest 0.01% in Garissa County and an approximated 52,000 new infections across all ages.
The country has 47 counties that form the structure for a decentralized system of government.
In 2016, the five highest-HIV burden counties were: Nairobi, Homabay, Kisumu, Siaya, and
Migori.
These numbers have changed with the National AIDS control council indicating that 4.8% of
Kenyans were infected with HIV virus by 2021. This is however a significant drop from
5.6% in 2016 and 4.9% in 2017.
A drop has been attributed to the aggressive campaign centered on education and voluntary
counseling testing (VCT) services.

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Geography seems to be a huge factor in HIV distribution with 65% of all new infections
occurring in 9 out of the country’s 47 counties – mainly on the west coast of Kenya. In particular,
new HIV infections in major cities Nairobi and Mombasa increased by more than 50% (from a
collective total of 4,707 in 2013 to 7,145 in 2017). As a result, HIV prevalence ranges from
0.01% in Wajir to 19.7% in Homa Bay.
Groups most affected by HIV in Kenya
Sex workers
Sex workers have the highest reported HIV prevalence of any group in Kenya. The most recent
data from 2011 estimates 29.3% of female sex workers are living with HIV.
In 2017, the overall percentage of female sex workers who were positive for HIV decreased
from 29% in 2011 to 12% in 2017. This is due to interventions targeted toward HIV
infections among female sex workers (FSWs)
How sex workers contribute to the spread of HIV
1. They have sex with multiple partners
2. Many of the abuse drugs, this makes them vulnerable to sharing needles and predisposing
conditions such as unprotected sex, or rape.
3. They have limited access to drugs such as PrEP or PEP
4. They may engage in unprotected sex for more money
5. They experience stigma and discrimination, making them shy from seeking treatment.
6. They experience mistreatment from some clients.
Homosexuals - Men who have sex with men (MSM)
HIV prevalence among men who have sex with men (sometimes referred to as MSM) in Kenya is
almost three times that among the general population. Data from 2010 estimates HIV prevalence
among men who have sex with men at 18.2%.
In 2012, HIV incidence among men who have sex with men (MSM) in Kenya is was high as
35%
People who inject drugs (PWID)
In 2011, an estimated 18.3% of people who inject drugs (sometimes referred to as PWID) in
Kenya were living with HIV. The majority of people who inject drugs are concentrated in
specific geographical areas such as Nairobi and Mombasa.
Young people
More than half (51%) of all new HIV infections in Kenya in 2015 occurred among adolescents
and young people (aged 15-24 years), a rapid rise from 29% in 2013. Many of these infections
will have occurred among young key populations.

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Young women are almost twice as likely to acquire HIV as their male counterparts and accounted
for 33% of the total number of new infections (23,312) in 2015. In comparison, young men
accounted for 16% of all new HIV infections (12,464).

People in prisons
The prevalence among inmates in Kenya is however higher than the national average at 8.2%.
Among female inmates, it is 19% and among male inmates, it is 5.5%.
Women
In 2016, women accounted for 910,000 of the 1.6 million people living with HIV in Kenya.
Men often dominate sexual relationships, with women not always able to practice safer sex
even when they know the risks. For example, in 2014, 35% of adult women (aged 15-49)
who
were or had been married had experienced spousal violence and 14% had experienced sexual
violence.

Orphaned and vulnerable children (OVC)

More than four-fifths of all children orphaned by HIV/AIDS worldwide live in sub-Saharan Africa,
where every eighth child is an orphan—that is, has lost one or both parents.
In countries like Botswana, Zimbabwe, and Lesotho that are hardest hit by HIV/AIDS, up to one in
every four children are orphaned. The orphan crisis is projected to worsen in the coming years,
reflecting the AIDS crisis.
HIV/AIDS not only orphans children but also makes children more vulnerable in a number of ways.
For example, in many countries, HIV/AIDS has reversed improvements in child morbidity and
mortality rates achieved during the last several decades.
Furthermore, the epidemic influences child survival both directly through mother-to-child
transmission and indirectly through diverting resources and attention away from children to the care
and treatment of a sick parent.
Children of HIV-positive parents suffer from the trauma of sickness and eventual death of a parent
and associated hardships.
The death of even one parent could force changes in living arrangements, displacement, and lack of
resources for schooling, health care, and food for children.
Socio-economic factors influencing the global spread of HIV
1. Poverty: In low-income countries, poverty increases vulnerability to HIV infections. Lack of
access to healthcare, poor nutrition, and limited education make it difficult for individuals to
seek testing, prevention, and treatment services.

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 2. Education: Education about HIV transmission and prevention plays a crucial role in curbing
the spread. In regions where there is limited access to education, especially sexual health
education, people are more vulnerable to contracting the virus.
3. Healthcare Access: Inadequate healthcare infrastructure in low-income countries limits
access to antiretroviral therapy (ART) and other preventive measures
4. Cultural Practices: For example as polygamy, early marriage, wife inheritance and
reluctance to use condoms, contribute to the spread of HIV. In many regions, stigma
surrounding HIV/AIDS also discourages people from seeking testing and treatment.
5. Gender Inequality: Women in Sub-Saharan Africa, are more vulnerable to HIV due to
economic dependence, gender-based violence, and cultural norms that reduce their ability to
negotiate safe sex practices.

Promising signs. Despite these challenges, there have been successes and promising
signs. New global efforts have been mounted to address the epidemic, particularly in the
last decade. The number of people who have newly acquired HIV has declined over the
years. In addition, the number of people with HIV receiving treatment in resource-poor
countries has dramatically increased in the past decade, and dramatic progress has been
made in preventing perinatal transmission of HIV and keeping pregnant people alive.

Unequal progress. However, despite the availability of a widening array of effective

HIV prevention tools and methods and a massive scale-up of HIV treatment in recent
years, UNAIDS cautions there has been unequal progress in reducing new HIV infections,
increasing access to treatment, and ending AIDS-related deaths, with many vulnerable
people and populations left behind. In addition, HIV-related stigma and discrimination.

References
Waruru A, Wamicwe J, Mwangi J, Achia TNO, Zielinski-Gutierrez E, Ng'ang'a L, Miruka F, Yegon P,
Kimanga D, Tobias JL, Young PW, De Cock KM and Tylleskär T (2021) Where Are the Newly Diagnosed
HIV Positives in Kenya? Time to Consider Geo-Spatially Guided Targeting at a Finer Scale to Reach
the “First 90”. Front. Public Health 9:503555. doi: 10.3389/fpubh.2021.503555.

https://www.afro.who.int/health-topics/hivaids
https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics