HIV patients now at the mercy of fate after 41,000 health staff fired

The dismissal of more than 41,000 health workers, previously funded by the US Government, has left thousands of people living with HIV without adequate care.

Most of the dismissed employees were front line workers dedicated to serving HIV and TB patients, providing essential treatment and support.

But with stop-work order signed by US President Donald Trump in January, HIV services have been moved to outpatient units in hospitals under an integration program.

Prior to the freeze on foreign aid, people living with HIV were attended to at Comprehensive Care Clinics (CCC), which provided HIV testing, anti-retroviral drugs (ARV) distribution, viral load testing and counselling services.

These clinics have since closed as Kenya’s Ministry of Health and county governments integrate services into outpatient departments.

The National Empowerment Network of People Living with HIV/AIDS in Kenya (NEPHAK) has welcomed the integration of HIV services into the broader health programme but warns that it may lead to increased stigma.

Jerop Limo, a youth representative at NEPHAK, expressed concerns and fears that they might experience treatment errors, incorrect ARV prescriptions if served by staff who are unfamiliar with HIV treatment, and stigma, which may discourage people from seeking care.

Increased stigma

Additionally, new clinicians may also fear injecting and testing patients as they fear being infected by the virus, being their first time to handle people living with HIV.

Sadly, she fears some workers are likely to use stigmatising language, referring to people living with HIV as “HIV people”, labelling that is not only discriminatory, but may discourage individuals from seeking care.

The transition has, therefore, left many people vulnerable.

“Those who were let go were the very professionals who had been extensively trained in HIV care. For example, the clinicians understood service delivery, how to support young people living with HIV, and how to reduce stigma. For them, HIV was manageable, and they provided care with confidence and expertise,” said the youth.

At least 41,547 Kenyans had been employed under the President’s Emergency Plan for AIDS Relief (Pepfar) programme.The employees collectively earned an annual salary of Sh17.4 billion through Pepfar’s HIV programme. Among their roles was to provide clinical services, community support and programme management across the 47 counties, from health facilities at Level 3, 4, 5 and 6.

A brief on the impact of the US government’s re-evaluation and realignment of foreign aid was prepared by the National Syndemic Disease Control Council (NSDCC), the National Aids and STI Programme (Nascop), and the Kenya Medical Supplies Authority (Kemsa).

For smooth service delivery amid shaky funding move, the government is expected to allocate an emergency kitty of Sh4 billion to maintain health workers handling HIV services across the country.

“During the Financial Year 2024/25, Pepfar’s support for the HIV programme is allocated to the following areas—human resources for health at a total annual cost of Sh17,376,505,147 (October 1, 2024, to September 30, 2025),” reads a section of the document.

Consultation fee

Limo noted that while integration was meant to be gradual, it should consider the needs of young people and vulnerable groups.

“Integration of HIV into other health programs should be handled with care to ensure that HIV related stigma does not lead to treatment interruption,” says NEPHAK executive director Nelson Otwoma.

Apart from confusion caused by integration, Otwoma regretted that people living with HIV are now being forced to pay consultation fee at the outpatient unit, a charge that majority cannot afford.

“In general healthcare settings, you start from outpatient, where you pay consultation fee, either Sh50 or Sh100 depending on the hospital. If you cannot afford transport, how can you afford consultation fee?” he posed.

The official urged the government to form one coordinating body for HIV response at the national level-only responsible for policy and standards.

“Counties should work with people living with HIV to develop guidelines on HIV integration and pay attention to adolescents and young people, including young mothers.

Previously, HIV services were provided free of charge.
Without urgent intervention, Kenya risks reversing the progress made in the fight against HIV/AIDS.
The funding gap comes at a time HIV infections in Kenya have declined by 78 per cent. The country is currently reporting 16,752 new HIV infections and 20,489 AIDS related deaths, that is at least 78 per cent change in HIV infections since 2010.