Background information on psychosocial factors influencing HIV prevalence
During the past 40 years, since diagnosing HIV for the first time, more than 78 million
people have contracted HIV with about half (35 million), dying from AIDS related
illnesses, thereby leaving approximately 17 million children orphaned having lost one or
both parents (UNAIDS, 2016). Currently, about 3.4 million children aged 15 years and
below are living with the virus, further resulting in a significantly serious dependence
burden especially considering that those disproportionately affected (persons aged
between 24-49 years old), constitute the most active segment of the population
(UNAIDS, 2019). Perhaps, this is why UNAIDS (2013) views HIV and AIDS problem
not merely as a health issue, but also as a developmental issue.
Further, a survey of the disease incidence shows that there is virtually no country in the
whole world that seems to have escaped the impact of the HIV pandemic – implying that the
disease has a global presence. Yet, in terms of distribution and spread, HIV shows a notable
regional variability. For example, in 2018, Sub-Saharan Africa (SSA) was home to 20.1
(53%) out of the 37.9 million people infected with HIV globally; majority of whom lack
access to medication (UNAIDS, 2019). In addition, evidence from country specific studies
reveal that majority of the people have a good knowledge about HIV and AIDS as well as
transmission and prevention methods. Interestingly, education appears to lead to behaviour
change in developed countries, but that seems not to be the case for the less developed
regions including Africa. Research evidence points to psychosocial as well as economic
factors—particularly poverty and gender disparities as key barriers hindering behaviour
change (Ogunmola, Oladosu & Olamoyegu, 2014).
Kenya has the joint 4th largest epidemic in the world, alongside Mozambique and Uganda
with an estimated population of 1.6 million infected with HIV in 2018. During the same year,
an estimated 25,000 deaths occurred out of AIDS related illnesses which saw the number of
children orphaned by the pandemic rise to 105,200 (NACC, 2018). However, since 2010,
HIV prevalence has generally declined by almost one half nationally; from 10.5% to 5.9%.
Despite the declining HIV prevalence rate among Kenyans, the effect on women is more
pronounced compared with men. For example, in 2017, HIV prevalence rates were estimated
at approximately five percent (5.2%) for women compared with about four percent (4.5%)
for men. At the same time, young women aged between 15-24 years were three times more
likely to be living with HIV than young men of the same age.
HIV and AIDS has a catastrophic impact on the population demographics, regional
distribution, and economic potential. For example, in terms of gender, women are more
vulnerable to HIV infection resulting in a shorter life expectancy compared to men; and
in terms of age, HIV and AIDS have the effect of increasing the population of children
and the aged in society since majority of those infected are aged between 24 and 49
years; thus increasing the dependence burden (Kimanga, Ogola & Umuro, 2014). In
terms of regional distribution, HIV and AIDS shows variability—affecting some regions
more than others; while in terms of economic potential, the pandemic shows a
devastating impact on the poor compared with the rich due to increased costs for
medication, treatment and provision of food.
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In addition, it would appear that the successful implementation of the HIV prevention and
treatment programmes have yielded positive results in containing new HIV infections in
most countries of the world including those from SSA, including Kenya. But, infections
in some regions are reportedly still high and increasing instead of declining or stabilizing
resulting in HIV prevalence rates depicting geographical variability. For example, in
2017, Kenya’s estimated HIV prevalence rates ranged from as low as 0.1% in Wajir
County to as high as 21.0% in Siaya County. (NACC, 2018).
In a study, the Kenya Prevention Revolution Road Map (2016), estimated that about
63,715 (8%) of the Kisii Central Sub-county population were living with HIV. This
prevalence rate is higher than the mean national rate that stands at 6%. Also, the HIV
incidence is increasing (NACC, 2018). This increase in HIV infections is suspected to be
driven by various factors—among them, engaging in risky sexual behaviour such as
trading sex (Elmes et al., 2014), Men having sex with men [MSM]; (Friedman et al.,
2014), inter-generational sex, inconsistent use of condoms, forced sex (Allen et al.,
2013), and having sex with multiple partners (Agardh, Tumwine, & Ostergren, 2011).
Other factors include, poverty, (Woldemariame, 2013), level of educational attainment
(Fako, Kangara, & Forcheh, 2010), unemployment (Sarode, 2010), and gender based
violence (Ochako, Ulwodi, Njagi, Kimetu, & Onyango, 2011).
In sum, HIV impacts negatively on every sphere of life—from agriculture and education, to
the economy and the labour force. It’s related mortality of the skilled and experienced
manpower has resulted in low productivity, increased costs of production, medical expenses
at an individual and organizational level. It is against this backdrop that this study
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sought to assess the psychosocial factors influencing increased HIV prevalence in Kisii
Central Sub-county, Kisii County, Kenya.
1.2. Statement of the Problem
Advances in medical science coupled with increased awareness of the HIV and AIDS have
transformed the lives of persons infected with HIV tremendously– from thinking about an
early death to living with a manageable chronic condition. Persons Living with HIV and
AIDS (PLWHA) today, live a near normal life. Although, the HIV situation is generally
stabilizing or declining globally, in some regions, the incidence is still high and increasing
due to psychosocial factors associated with risky behaviors, non-adherence to medication
regimes, leading to shortened survival rates (Farinpour et al., 2013; Cook et al., 2014).
Available evidence has been inconsistent about the existing relationship between
psychosocial factors and the HIV/AIDS prevalence rates. While some studies have
demonstrated a negative relationship between psychosocial factors, HIV prevalence and
risky behaviours (Robins et al., 2014); others have failed to find any such relationship
(Kalichman, 2014). The inconsistency in these studies may be related to the fact that the
specific link between HIV and psychosocial factors is still not clearly distinguishable. As
a result, there need to understand which psychosocial factors operate in HIV-infected
individuals and impact their ability to consistently act rationally. Such knowledge may
proof useful in providing assistance for the full understanding of high-risk sexual
behaviours among PLWHA.
The HIV incidence in Kisii Central Sub-county has been on the increase rather than
stabilizing or declining like in neighbouring counties such as Homabay, Migori and
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Kisumu (NACC, 2014). Although, there may be several unique factors contributing to
increased HIV prevalence in Kisii Central sub-county, no attempt has been made to
determine the extent to which psychosocial factors have contributed to this increase in
prevalence. Therefore, this study is an attempt to establish key psychosocial factors
responsible for increased HIV prevalence in Kisii central Sub-county and their inter-
relationships.
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