Kenya lacks a full picture of sexually transmitted infections (STIs), with most studies concentrated in urban areas, leaving rural populations largely unrepresented, warns Sexual and Reproductive Health Specialist Samuel Kimani.
Speaking on Friday, Kimani said education, behaviour change, and access to contraceptives are key to preventing infections and ensuring reproductive health. “Most of the research that we have in STIs in this country are conducted in big cities, urban areas, or when with reference to HIV, it's in areas where HIV was prevalent,” he said.
He explained that this urban focus means the national data may not reflect the situation in rural areas. “So we cannot say that we actually have a very clear idea of the prevalence of STIs in all the parts of the country,” he added.
Data collected through government programmes such as the National AIDS and STI Control Programme (NASCOP) and the National Syndemic Diseases Control Council (NSDCC) show that HIV prevalence in Kenya stands at about 3.3–3.7%, with an estimated 1.4 million people living with the virus. Women are disproportionately affected, with rates of 5.3% compared to 2.6% among men.
The burden of infection is concentrated in a few counties. Around 53–60% of cases are found in ten counties, including Nairobi, Kisumu, Homa Bay, Nakuru, Siaya, Migori, Uasin Gishu, Kakamega, Kajiado, and Narok. Counties bordering Lake Victoria report the highest rates, with Homa Bay at 15.2%, Kisumu 14.5%, Siaya 13.2%, and Migori 9.7%. Urban centres like Nairobi and Mombasa also report high numbers of cases.
Kenya has made progress in reducing new infections, with numbers dropping by about 78% over the last decade—from over 100,000 cases in 2013 to around 22,154 in 2022—thanks to expanded testing, condom distribution, and antiretroviral programmes.
Kimani noted that research tends to follow areas of high population density or previously recorded high disease rates. “Research normally are done where the location is prevalent, and where the problem is,” he said.
However, he warned that rural populations may face similar risks that are not captured due to limited studies. “If sufficient research had been conducted in the rural areas, I'm not certain what it is that we would find,” he added.
The expert also highlighted the role of contraceptives in controlling infection rates, cautioning that shortages could increase risks. “That is true. It is bound to increase,” he said. Still, he stressed that preventing STIs goes beyond a single product. “Sexual and reproductive education is very key, because it's not only the condom that can help you protect,” he explained.
Personal sexual behaviour also plays a major role in infection risk. “Even your own behaviours as a person and your own sexual habit can actually shape whether you're going to get that disease or not,” Kimani said.
In clinical practice, he said, healthcare providers follow a broader framework for STI screening and treatment. “When it comes to STI screening and STI treatment, we talk about the four C's,” he said, highlighting the condom, treatment, and partner follow-up as key elements. Education remains critical during treatment. “Even if you treated someone and you didn't tell him or her how they got the disease, it is likely to recover,” he noted.
Kimani warned that improper completion of medication could lead to drug-resistant infections. “If you don't tell them how to finish the medication, it is accurate to develop some resistance,” he said. “If someone is transmitting the resistant one, it becomes resistant for the whole population.”
Healthcare providers also take detailed patient histories to understand the context of infections and guide treatment. “Most of the conditions may be similar, but in terms of the management they may be very different,” he explained.
Beyond STIs, Kimani discussed maternal and reproductive health services offered by Marie Stopes Kenya, including antenatal care, delivery services, and postnatal support. “We do offer comprehensive maternal and child health in terms of the deliveries,” he said, noting that antenatal, delivery, and post-delivery services form part of wider maternal health programmes.
He addressed public perceptions of abortion, describing it as a medical procedure often misunderstood in public debate. “Abortion is termination of pregnancy before term,” he said. Medical circumstances, such as non-viable pregnancies, may necessitate termination. “If we don't have maybe a fetal heart, there is no reason why you should continue with that pregnancy,” Kimani explained. He added that the Kenyan constitution does not completely prohibit abortion but limits it to cases handled by qualified medical professionals. “It should actually be done within the framework of someone who is a health expert,” he said.
Kimani concluded by emphasising the priority of protecting both mother and child in healthcare delivery. “At the end of the day, we are taking care of the mother in terms of their health,” he said.
