Transcript Document

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
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 world’s 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%
Map of Kenya
• 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
AMPATH
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
Gladys at her workstation at AMPATH.
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:
Gladys giving a talk in one of the motivational sessions
“what if my children are also infected?”
to patients in the psychosocial support group.
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.
Esther
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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.”
Challenges
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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.
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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.
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 that’s community
centered.
• LACE (Legal Aid Centre of Eldoret).
• Population health supported by Zuri Health
Insurance and AMPATH coordinated microfinance
groups.
Expected outcomes from
microfinance groups
• Group caring for themselves
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Improved linkage; target > 80%
Retention in care; target > 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
Membership
Family Preservation Initiative
Total number of members ever enrolled in GISE groups
12,000
10,889
10,000
8,584
8,000
9,366
7,091
5,371
6,000
6,071
4,198
4,000
2,475
2,000 1,280
462
Jun-14
Mar-14
Dec-13
Sep-13
Jun-13
Mar-13
Dec-12
Sep-12
Jun-12
Mar-12
Dec-11
Sep-11
Jun-11
Mar-11
0
Dec-10
• 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
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.
Acknowledgements
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PEPFAR and USAID
Abbott
AbbVie
Eli Lilly and Company
Grand Challenges Canada
AMPATH Consortium
Kenya MOH
The great people of Western Kenya
Thank you