Disrupted care: The hidden gap in Kenya’s HIV response

For 33-year-old Doreen Moraa Moracha, living with HIV since birth had become a surprisingly manageable routine over the years. This has become possible with one pill daily, two clinic visits yearly, and minimal lifestyle disruptions. But in 2025, she was diagnosed with diabetes. She discovered a harsh reality that millions of people living with HIV face. While HIV care has become streamlined, the health system still treats other chronic conditions as an afterthought.

Now Doreen finds herself running between clinics and repeating tests. She has to coordinate her own care across two systems, the HIV clinic and the diabetes clinic. Her experience underscores the urgent need for integrated healthcare.

“I have been open about my journey of living with HIV for the last 10 years. Adding diabetes might look like just an addition, but it’s not, “ the prominent HIV advocate says. “Managing both at the same time is overwhelming, and it worries me about the quality of my life.”

Beyond medicine, the logistics are exhausting. Separate clinics mean more visits, more paperwork, and more responsibility. “It’s hectic,” she admits. “Even at the HIV clinic, I’m asked to do tests such as kidney and liver function elsewhere and bring back results. I wish doctors could communicate directly instead of relying on me as the go-between.”

A system under pressure

Doreen’s story is not unique. According to Kenya AIDS Strategic Framework (2020-2025) more than 1.5 million people are living with HIV in Kenya. Studies further indicate that around 62%

of them also manage at least one noncommunicable disease (NCD), such as diabetes, hypertension, or cardiovascular conditions, compared to 51% among people without HIV.

Dr. Joshua Kimani, a clinical and research director at Partners for Health and Development in Africa (PHDA), explains that antiretroviral drugs (ARVs) can increase the risk of NCDs.

“At PHDA we manage 10 sex worker outreach programs (SWOP), including one research clinic. We have about 45,000 to 50,000 enrolled patients, of which 31,000 have been active in the last three months. Around 25% of them are living with at least one NCD,” he says. He adds that female sex workers (FSWs) and men who have sex with men (MSM) face compounded challenges, being stigmatized, discriminated against, and marginalized by both community taboos and laws that criminalize them.

But Kenya’s HIV care system was never designed to handle multiple chronic conditions. Funding limitations leave patients struggling. Dr. Kimani recalls a sex worker with a cervical condition who could not afford a biopsy costing KSh 6,800. “She had to stop working, which meant no income even for food,” he says.

Global disruptions, local consequences

This year’s World AIDS Day UNAIDS theme, “Overcoming disruption, transforming the AIDS response,” reflects a reality the world is currently grappling with. Conflicts and war, income and economic shocks, and shifting donor priorities have disrupted life saving HIV services worldwide.

According to UNAIDS, the global HIV response entered crisis mode after the United States halted funding. Under current funding-crisis scenarios, UNAIDS estimates the world could see

3.9 million additional new infections between 2025 and 2030 and up to 1.4 million new infections annually by 2030.

Kenya, once a model for integrated community health, is already showing signs of reversed progress. Such as longer wait times, stockouts of essential medicines and vitamins. Stigma and discrimination are also. Moreover, several antiretroviral therapy (ART) clinics have temporarily closed. Some are without proper referral systems in place. These disruptions have spilled over to patients managing both HIV and NCDs.

“Funding cuts affect people living with HIV who also have NCDs because they now have to cover the cost of both,” Dr. Kimani says. “HIV treatment was previously free, but NCD care is expensive. Some conditions require costly tests, specialist consultations, and regular transport. People know they need this care but can’t afford it, and that brings a lot of mental strain.”

Speaking in a Zoom interview, he adds that the consequences are often devastating. Patients may be counseled early on how to manage their conditions, but the advice is ineffective if they cannot afford the necessary medication. “With chronic diseases, timing is everything,” he emphasizes.

At 60, after decades in healthcare and research, Dr. Kimani worries that prevention programs are collapsing alongside treatment. "The worst bit is — no funds for HIV prevention, and no one has ever treated themselves out of an epidemic,” he says.

This year, Kenya recorded 20,105 new HIV infections, with more women than men affected. Nairobi County reported the highest number of new cases, with more than 3,000 people testing positive.

Hope, innovation, and the road ahead

Doreen believes this gap is fixable. She argues that Kenya urgently needs a more integrated model. One that brings HIV care, NCD management, and general health services under the same roof.

“If we cannot house all the services together, at least let the health system be digitized and synchronized,” she says.

“Doctors should be able to see a patient’s full history. I shouldn’t have to keep repeating that I have HIV at the diabetes clinic. Then explain I have diabetes at the HIV clinic. There has to be a better way in this era of technology.”

Yet despite these challenges, there has still been meaningful progress this year in the global effort to end the HIV epidemic. Kenya, for instance, is among nine countries selected to introduce

Lenacapavir, a groundbreaking long-acting injectable pre-exposure prophylaxis (PrEP), by January 2026. Approved by WHO in July 2025, the injection provides protection for up to six months. This is a major step in strengthening Kenya’s push to eliminate new HIV infections.

As the world marks World AIDS Day, the call to action is clear: we must keep moving forward. It is crucial to get tested, know your status, and encourage others to do the same. Awareness, early diagnosis, and consistent care remain the strongest tools we have. Especially at a time when global disruptions threaten hard-won progress.

As Doreen puts it, “The HIV response is really built on hope and resilience. We have to keep going because the lives of 40 million people globally depend on that hope and resilience, so we can overcome the disruptions we have faced this year.”

HIV in focus

This news story has been published as part of our HIV in focus news network. This is a network of writers and journalists from focus countries, dedicated to delivering news on HIV and sexual health. The network aims to amplify the voices of communities most affected by HIV and share the stories that matter to them.

About the writer

Karuana Mwai is an award‑winning Kenyan journalist with expertise in international cooperation, conflict resolution, climate change, AI safety, sexual and reproductive health, and human rights. Her work has been recognized through awards and residencies, including the AU‑EU D4D African Journalist Competition, the Spear of African Peace Essay Competition, and a journalist‑in‑residence program at the Institute of Tropical Medicine in Antwerp. She holds a Bachelor’s degree in Mass Communication and Journalism from the Technical University of Kenya.