A geographical study on the HIV/AIDS pandemic in Kenya

The global HIV / AIDS epidemic has displayed heterogeneous geographical pattems at the various scales of analysis and perspective. Using the case of Kenyaぅ thespatial pattems of the HIV / AIDS epidemic were examined at three levelsラ theregionalう thelocalう andthe individual level. HIV prevalence data on pregnant women合om1990 to 2004合omsentinel 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四 temporalmaps 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う when the HIV surveillance startedラ andin 2000, when the prevalence reached its highest levelラshowed that ethnic groups distribution as the strongest factor influencing the spatial patterns at the provinciallevel. Poverty and income inequality showed positive relationship with the provincial HIV prevalence ratesラ withthe 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 (PL WHA) in Nairobi showed that the epidemic is also spatially heterogeneous at a lower level of perspective. There is higher concentration of PL WHA 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 PL WHA企omoutside the city as well as intemal residential shift, are contributing to the spatial pattems 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 deprived residential areasラ whichis 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 PL WHA are other major factors that are inf1uencing 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ラ asmigrants maintain continued link with their home origins through合equentvisits through out the year. An insight into the life course of the PL WHA revealed a complex scenario that places one on the HIV / AIDS risk pathway. Early entry into sexual relationships reveals a society strongly inf1uenced by contemporary cultureラ especiallyamong the urban dwellers. Parent's ethnic and socio-economic status detennines the locality of upbringing; low socio-econ01nic 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ラ poverty (income levels) and culture (both ethnic and contemporary) at both the societal and individual level is inf1uencing 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ラ andthe proper use of antiretroviral treatment will also contribute immensely in controlling the spread of the epidemic as well as its effects on the soclety.