Rising HIV cases among older men and Gen Z worry experts

The rise in romantic relationships between Generation X, often referred to as ‘grey heads,’ and young women in Generation Z  (Gen Zs) has sparked intense social debate, challenging traditions and raising concerns about emerging health risks.

While society has long viewed significant age-gap relationships with incredulity, a notable trend has emerged of young women increasingly pursuing sexual partnerships with older men.

However, these inter-generational relationships now face a critical challenge beyond social acceptance.

A troubling trend has emerged among GenZs.

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Known as “Kugongewa”, it glorifies multiple sexual partnerships and casual relationships, while abstractly shaming those involved in these illicit relationships, including cheating spouses.

This sexual sociological shift has raised serious concerns among health professionals and social commentators alike.

“The rate at which HIV and STD infections have grown in Nairobi is not a laughing matter,” notes a concerned citizen on X, as the conversation about HIV prevention has found new life on social media platforms, with many Kenyans calling for improved sex education.

“It’s particularly concerning because of people’s negligence and attitude of dealing with consequences later.”

The power imbalance in these relationships often manifests in reduced ability to negotiate safe sex practices. “Many young women feel unable to insist on condom use or regular HIV testing,” says Eunice Kinywa, a HIV awareness advocate.

“You’ll find someone has multiple sexual partners, sometimes five or six, and none of them are sure of their HIV status.”

Recent health data reveals an alarming rise in HIV transmission rate between these age groups, casting a shadow over what some young women have celebrated as a symbol of personal choice and financial independence. While HIV prevalence is lower among men (2.2 per cent) compared to women (4.5 per cent), approximately 4,205 men aged 45 and older succumbed to Aids-related illnesses in 2023.

Kenya’s fight against HIV/Aids presents a complex picture of both progress and persistent challenges, particularly among its youth population.

 While the country has made significant strides in reducing overall infection rates, alarming trends among young people and the emergence of risky social behaviour threaten to undermine the efforts.

According to the latest data from the National Aids and STI Control Programme (NASCOP), Kenya recorded 22,154 new HIV infections in 2022, marking a significant 83 per cent reduction from 101,560 cases in 2013.

However, beneath these encouraging statistics lies a concerning reality. Women continue to bear a disproportionate burden, accounting for 67 per cent (12,558) of new infections in 2022.

The Kenya Demographic and Health Survey 2023 reveals a stark generational divide in infection patterns. Young adults aged 15-34 years contributed to an overwhelming 75 per cent of all new adult HIV infections in 2022, with the 15-24 age group alone accounting for 41 per cent of new adult cases.

Among adolescents aged 10-19 years, there were 7,307 new infections, highlighting the vulnerability of Kenya’s youth.

The World Health Organization (WHO), indicates that age-disparate relationships significantly increase HIV transmission risk. A 2023 WHO report on sub-Saharan Africa found that women aged 15-24 who have sexual partners over 10 years older, are twice as likely to contract HIV compared to those with partners closer to their ages.

Journalist Ciru Muriuki sparked debate on X, stating, “We really need to bring back the heavy education on STIs and HIV/Aids that was happening in the 90s and 2000s. Sex education based solely on abstinence doesn’t work.”

Her sentiment resonated with many, including social media user Wamutahi, who highlighted institutional challenges. “The greatest block to comprehensive sex education in Kenya is the church. One time someone suggested something of the sort in a seminar I attended, the religious delegation almost lynched her.”

Parents’ struggles with sex education were noted by Ayoma Wechuli, who wrote, “Most parents do not know where to start... the little knowledge young people have on sex education is from school and not home.”

In response to these challenges, Kenya is expanding its HIV prevention toolkit with several new options beyond the traditional daily oral Pre-Exposure Prophylaxis (PrEP).

Millicent Kiruki, a senior research officer at LVCT Health, has highlighted several groundbreaking prevention options now available to Kenyans.

“We’re seeing remarkable advances in HIV prevention technology,” she says.

The most widely available option, oral PrEP, can now be accessed at over 2,200 facilities nationwide. Offering 99 per cent protection when taken as prescribed, it represents an affordable option at approximately $40 per year.

A newer addition to the prevention arsenal is the Dapivirine Vaginal Ring, approved in 2021. This monthly option provides 35 per cent effectiveness and costs about $156 (around Sh20,000 ) annually.

“A three-month version showing improved drug concentration levels is currently under development,” Kiruki notes.

The most recent breakthrough comes in the form of Injectable Cabotegravir (CAB-LA), recently approved by the Pharmacy and Poisons Board. This bi-monthly injection boasts over 90 per cent efficacy at $180 (Just above Sh23,000) per year and is scheduled for market introduction next year. Notably, it has been proven safe for pregnant and breastfeeding women.

Looking ahead, researchers are developing Lenacapavir, a six-monthly subcutaneous injection currently in clinical trial stage. Early results are promising, showing 100 per cent efficacy in women and 96 percent in men, as it awaits approval for HIV prevention.

“Each PrEP option offers unique advantages, but also comes with its own challenges. There is no ‘perfect’ solution, just the best choice for each individual’s needs,” says Kiruki.

Dr Francis Angira, a Research Officer at KEMRI-Center for Global Health Research, points to another breakthrough. “In January 2021, the FDA approved Cabenuva, the first long-acting injectable treatment for adults with HIV, combining Cabotegravir and Rilpivirine in a single monthly or bi-monthly injection.”

According to a KEMRI research officer, HIV is constantly evolving into new strains, and this makes it hard to develop a vaccine, however scientists are making progress.

The KEMRI researcher notes that while HIV’s constant evolution makes vaccine development challenging, the scientific community remains committed to this goal. Meanwhile, current prevention methods, including condoms and oral PrEP, continue to play a crucial role in slowing HIV transmission.

“There is no cure for HIV, but medicine (oral antiretroviral therapy) helps manage/ suppresses the HIV virus, prevent opportunistic illnesses and accord makers continue to develop new treatments for people living with HIV, turning their focus to long acting therapies,” said Dr Angira.  

Researchers are also studying a pill that could protect you from HIV for 30 days. Two other HIV prevention pills, Truvada and Descovy, have been around for years, but you take them daily.

“Although these drugs lower your chance of getting HIV by anywhere from 74 per cent to 99 per cent, many people are not aware of them or are afraid they would be ashamed for taking them,” said Dr Angira. Researchers are also working on HIV prevention methods that last for months or even years, and could offer new choices for protection against the virus or improvements that are already in use.

“Although HIV continues to prove uniquely challenging for development of a vaccine, the HIV research community remains fully committed to doing just that, and each study brings us a step closer to this realization,” he said.  

According to KEMRI researchers, HIV prevention involves stopping the spread of HIV, which is an important step toward ending the outbreak of the disease around the world.

“Today, there are several methods such as condoms and oral PrEP to slow HIV, and scientists are working on new tools.”

Speaking during the launch of World AIDS Day 2024 Half Marathon on Wednesday 30, 2024 October in Nairobi, Cabinet Secretary Dr Deborah Barasa emphasizes the government’s commitment through reformed healthcare models and strengthened national systems.

“The global objective remains clear: ending AIDS by 2030, guaranteeing treatment for all people living with HIV, and preventing new infections. With only six years left, it’s a race against time.”

Achieving viral suppression remains crucial for those on antiretroviral therapy; today, the health CS says, 97 per cent of people living with HIV on treatment in Kenya have reached this milestone.

Health experts emphasize the need for expanded access to prevention methods, enhanced youth-focused interventions, increased community engagement, sustained funding for prevention programs, comprehensive sex education and reduced stigma around HIV testing and treatment.

The CS notes, “Challenges remain, particularly in addressing Aids among children, adolescents, and young people. Adolescents, especially girls, face a triple threat: HIV infections, early pregnancies, and exposure to sexual and gender-based violence.”

To end AIDS, she says, we must come together, harness our collective power, and see this mission through to the finish line.