Wednesday, 30 July 2008 18:00

Is someone lying about the HIV prevalence ?

Written by Arthur Okwemba

As they exchanged pleasantries and sat next to each other during the launch of the 2007 Kenya AIDS Indicator Survey (KAIS) yesterday, very few people knew all was not well.

The release of the findings of this study had started on a very acrimonious ground, with some government officials not willing to be part of a gathering that would release them.

The point of contention was how to release to the public the 7.8 per cent HIV prevalence captured in the KAIS study that was higher than 5.1 percent announced last year and the 6.7 per cent captured by 2003 Kenya Demographic and Health Survey (KDHS).

And this was for a reason. For the past five years, the government has consistently presented statistics showing that the HIV prevalence rates on a downward trend.

In the 2003 KDHS, the prevalence was 6.7 per cent, the following year, the government said it had plummeted to 6.1 per cent, and further to 5.9 per cent in 2005. By 2006, the country prevalence rate had gone down to 5.1 per cent.

Government and UN officials praised the trend, and never warned the public if a bigger study with a bigger sample size is done, then the figures would be different. 

They instead clapped and praised Kenya for a job well done with its interventions. Kenya was now cited among the few African countries with success stories. 

While this declining trend was on figures from the antenatal surveillance -which were then extrapolated to the entire population - the government seems now to be running away from them, choosing to use the 2003 Kenya Demographic and Health Survey as a benchmark of its analysis of the KAIS findings. 

Although in terms of the sample size and design, the KAIS and KDHS studies can be well compared, the question is, were the statistics coming from the antenatal surveillance centres wrong? 

Now faced with the KAIS findings, the government has been close to a month, discussing and agonizing on the authenticity of the results and how to make them public. 

The Board of the National AIDS Control Council had expressed reservation about the study, which was funded by the United States government to a tune of US$ 6 million. 

When the results were first released by the team of researchers, the board is understood to have tasked one of its senior scientists with expertise in epidemiology –scientists who studies causes, spread, and control of diseases in populations-, to scrutinize the study to see if it was scientifically sound or if some things were not done right. 

The scientist returned a clean bill of health about the findings. The US scientists who participated in the study on the other hand applied pressure on the government to release them. 

At this point, this matter was referred to the cabinet and other senior government official for direction. After several meetings and discussions, it was agreed that National Aids Control Council and National Aids and STD Control Programme, come up with an explanation to give to the public why the 7.8 per cent prevalence rate. 

One of the explanation the government officials are to put forward is as more people access antiretroviral drugs, lives are prolonged, with the number of deaths decreasing. 

And since prevalence measures the number of people living with HIV and AIDS at a particular point in time, then the high prevalence is justified. 

The other reason is those taking ARVs have regained their health and are having more sexual partners than before. 

Indeed, experiences from elsewhere are showing that some of those on these drugs and good nutrition have very low viral loads, which make them think they have low chances of HIV transmission, hence engaging in unprotected sex. 

Even with these explanations, the government is not done yet. It is understood the United States through USAID, which funds the production of the Kenya Demographic and Health Survey, has said it will not finance the HIV component of the survey after spending over Sh 400 million on KAIS. 

From the donor’s point of view, the KAIS findings should be sufficient for the 2008 KDHS. 

But the government insists they have to undertake another similar study to, among many other things, confirm if indeed the KAIS study findings are correct.

Senior government officials and Ministries of Health, Special Programme and Finance have been tasked to find funds from donors and other sources to finance this study expected to commence in October. 

For now, the KAIS findings raise some pertinent questions about what is really going in the HIV and AIDS field. 

Are African countries, Kenya included, telling the whole truth about the HIV prevalence of their countries? Should Kenya abandon using the HIV prevalence rate in the antenatal clinics to extrapolate to the entire country? 

As sub-Saharan Africa been turned into a huge project where researchers are playing around with statistics as a way of perpetuating their sources of income? 

Is someone lying to us or we using the wrong methodologies or different methodologies and samples sizes to come up statistics that re expected to guide our policies and strategies?.

This confusion can also be blamed on some UN agencies that are known to change formulas used to calculate the HIV prevalence that end up showing lower rates than is the case in reality. Government officials then use these figures to brag of how their preventive strategies are working. 

An AWC-Feature

 

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