A Geographical Study on the HIV/AIDS Pandemic in Kenya

Abstract

The global HIV/AIDS epidemic has displayed heterogeneous geographical patterns at the various scales of analysis and perspective. Using the case of Kenya, the spatial patterns of the HIV/AIDS epidemic were examined at three levels, the regional, the local, and the individual level. HIV prevalence data on pregnant women from 1990 to 2004 from sentinel sites with continuous surveillance data since the early 1990s were aggregated at the provincial administrative level. Trend curves for each of Kenya’s eight provinces were derived, from which spatial-temporal maps using geographical information systems indicated an epidemic that had diffused in Kenya from provinces located in the west to the rest of the country. The prevalence trends over the surveillance period showed an epidemic that was spatially heterogeneous as the provinces exhibited different infection rates which reached the optimum levels at different times starting from as early as the early 1990s until 2000. Bivariate analysis of the provincial prevalence against socioeconomic and demographic characteristics of the country in 1990, when the HIV surveillance started, and in 2000, when the prevalence reached its highest level, showed that ethnic groups distribution as the strongest factor influencing the spatial patterns at the provincial level. Poverty and income inequality showed positive relationship with the provincial HIV prevalence rates, with the relationship more pronounced in provinces characterised by high income inequality. Migration and urbanization on the other hand showed only moderately low correlation with the HIV prevalence. Mapping the distribution of people living with HIV/AIDS (PLWHA) in Nairobi showed that the epidemic is also spatially heterogeneous at a lower level of perspective. There is higher concentration of PLWHA in areas that are characterised by high population density and high concentration of poor population. Higher infection rates in these regions, coupled with relocation diffusion by PLWHA from outside the city as well as internal residential shift, are contributing to the spatial patterns of the epidemic within the city of Nairobi. Lower cost of basic living conditions is the main contributing factor in the concentration of vulnerable population in the ii deprived residential areas, which is in turn impacting on the spatial pattern of the HIV/AIDS epidemic at the local level. The availability of support organizations, easy access to treatment, and low level of stigma and discrimination against PLWHA are other major factors that are influencing the spatial pattern of the epidemic in Kenya. High rate of circular migration between the rural home and the urban areas is a very probable contributing factor in constant diffusion of HIV between the home provinces and the city of Nairobi, as migrants maintain continued link with their home origins through frequent visits through out the year. An insight into the life course of the PLWHA revealed a complex scenario that places one on the HIV/AIDS risk pathway. Early entry into sexual relationships reveals a society strongly influenced by contemporary culture, especially among the urban dwellers. Parent’s ethnic and socio-economic status determines the locality of upbringing; low socio-economic levels increase migration to environs that place individuals at increased risk of contracting HIV. The life course qualitative exploration found that interplay among urbanization, migration, poverty (income levels) and culture (both ethnic and contemporary) at both the societal and individual level is influencing the diffusion dynamics of the epidemic in Kenya. In mitigation, there is need to address the factors that have contributed to regional disparities in the levels of HIV prevalence, such as cultural practices that have contributed to higher spread in some areas while others are quite low. There is also need to have regional balance in economic strengths in order to reduce migration, especially to the urban areas, which raises infection risk. Addressing income inequality, education and continued awareness campaigns on consistent use of protective means during sexual intercourse, and the proper use of antiretroviral treatment will also contribute immensely in controlling the spread of the epidemic as well as its effects on the society.