The Kenyan government plans to continue to lobby the U.S. government to try to gain additional money for its donor-funded antiretroviral drug distribution program, the Financial Times reports (Degli Innocenti, Financial Times, 4/6). Kenyan Health Minister Charity Ngilu in February said that the government hopes to provide free antiretroviral drugs to 140,000 HIV-positive individuals by 2005. She also said that the government has adopted the World Health Organization's 3 by 5 Initiative to combat HIV/AIDS. The initiative, which aims to treat three million HIV-positive people by 2005, calls for training 100,000 health care workers, refocusing 10,000 clinics in developing countries and using some common antiretroviral drug combinations to treat HIV/AIDS. However, the plan does not provide the drugs or subsidize their cost (Kaiser Daily HIV/AIDS Report, 2/17). The United States has "frozen" funding for the Kenyan program because Kenya plans to distribute generic, fixed-dose combination drugs, according to the Times. The United States requires that countries receiving funding for antiretroviral treatment use brand-name drugs, which are three times as expensive, the Times reports (Financial Times, 4/6). Officials from HHS, WHO, UNAIDS and the Southern African Development Community at a two-day meeting in Gaborone, Botswana, last week discussed an agreement over standards for generic antiretroviral drugs for use in developing countries (Kaiser Daily HIV/AIDS Report, 4/1). "We will keep lobbying [the United States]," Dr. Mary Wangai, antiretroviral program manager for NASCOP, Kenya's national AIDS program, said, adding, "We are making a huge effort to set up the sites, inform patients and train health workers. I am optimistic the rollout will work because the community will cooperate."

"Enormous" Challenges
The Kenyan plan faces "enormous" challenges because the country's health system is "inefficient and chronically underfunded," the Times reports. "Health spending is low, even by regional standards, and it shows," Albertus Voetberg, lead health specialist at the World Bank in Nairobi, said, adding, "The little spending there is not targeted at those who need it most, with the result that poverty and disease in the rural areas have been increasing, compounded by AIDS." The Kenyan government, which spends 1.2% of the country's gross domestic product on health care, has pledged to increase health care spending from 6.5% of its annual budget to 10%, according to the Times. Kenya also is "making progress" on combating HIV/AIDS, the Times reports. The number of HIV-positive individuals in Kenya has decreased from 2.5 million in 2000 to 1.4 million in 2004, and AIDS-related deaths have fallen from 800 per day to 300 per day, according to statistics from NASCOP. HIV testing also has increased 10-fold since 2002, according to the Times. But Voetberg said that although the HIV/AIDS epidemic is "way down" in urban areas, the epidemic has "yet to peak" in rural areas of Kenya.

Political Leadership, Businesses
Political leadership has been "key" to reducing the "secrecy, denial and stigma" surrounding HIV/AIDS in Kenya, according to the Times. Kenyan President Mwai Kibaki has taken a lead role in combating stigma surrounding the disease by appearing in posters with his arms around HIV-positive people. "The new government has made a difference because it has promoted openness," Phyllis Njoki of the Kenyan AIDS nongovernmental organization consortium KANCO said. However, the Kenyan business community is "lagging behind" political efforts, the Times reports (Financial Times, 4/6). Most companies in the East African countries of Kenya, Tanzania, Uganda and Zambia do not know how many of their employees are HIV-positive, according to a survey released in February by accounting firm PricewaterhouseCoopers. PwC between July 2003 and September 2003 asked more than 216 companies in the four countries how they were responding to the epidemic. According to the results, most companies had not tried to determine the number of HIV-positive workers they employ (Kaiser Daily HIV/AIDS Report, 2/12). The survey found that Kenya is "far ahead" of its neighbors Tanzania and Uganda in the percentage of companies that have HIV prevention programs and that provide condoms to their workers (Financial Times, 4/6).

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