Alarming: Nairobi Now Leads With Highest Number of New HIV Infections Nationwide

Nairobi County has overtaken traditional hotspots to record the highest number of new HIV infections in Kenya, raising fresh concerns about the epidemic’s evolving dynamics in urban centres.

The capital city registered 3,045 new infections in 2024, surpassing counties in the Lake Victoria region that have historically borne the heaviest burden of the disease.

The revelation comes as Kenya grapples with a 19 per cent increase in new HIV infections nationally, with cases rising from 16,752 in 2023 to 19,991 in 2024, according to the latest Kenya HIV Estimates report released by the National Syndemic Disease Control Council on Sunday.

Health Principal Secretary Ouma Oluga described the situation as a wake-up call for the country’s HIV response strategy.

“Nairobi’s position as the leading source of new infections underscores the need for urgent, differentiated interventions that address the unique risks present in urban settings,” Dr Oluga said during the report’s launch.

The data reveals a troubling concentration of new infections, with ten counties accounting for 60 per cent of all new HIV cases nationally.

Behind Nairobi, Migori County recorded 1,572 new infections while Kisumu registered 1,341.

The traditional hotspots of Homa Bay, Busia, Siaya, Kakamega, Nakuru, Mombasa, and Bungoma complete the list of high-burden counties.

Health experts attribute Nairobi’s leading position to a confluence of factors unique to the capital’s dense urban environment.

The city’s large mobile population, active commercial sex trade, numerous entertainment venues, and influx of economic migrants create conditions that fuel HIV transmission.

Research has shown that urban centres with high population density and economic migration often experience increased sexual network turnover and higher transmission risks.

Young people aged 15 to 34 continue to bear the brunt of new infections, forming the majority of cases.

Women remain disproportionately affected, with the national HIV prevalence standing at 4.0 per cent among females compared to 2.0 per cent among males. Overall, Kenya’s HIV prevalence stands at 3.0 per cent.

The report further reveals that 1,326,336 Kenyans were living with HIV as of 2024, including 62,798 children. Alarmingly, AIDS-related deaths increased to 21,007 in 2024 from 18,473 the previous year, representing a rise that health officials say reflects gaps in early diagnosis, treatment adherence, and retention in care.

“AIDS-related deaths, recorded at 21,007 in 2024, remind us of the need for renewed focus on early diagnosis, treatment adherence, and retention in care,” Dr Oluga emphasised.

The concentration of infections in Nairobi presents unique challenges for prevention efforts.

Informal settlements, which house a significant proportion of the city’s population, are particularly vulnerable.

Studies have shown that poverty, limited access to healthcare, high rates of transactional sex, and barriers to education combine to create heightened HIV risk in these areas.

Among adolescent girls and young women living in urban informal settlements, factors such as early pregnancy, inability to complete secondary education, and engagement in transactional sex to meet basic needs significantly increase vulnerability to HIV infection.

Young women in cities are nearly twice as likely to acquire HIV as their male counterparts.

Key populations including female sex workers, men who have sex with men, and people who inject drugs face additional layers of risk compounded by stigma, discrimination, and criminalization that limit their access to prevention and treatment services.

Despite the troubling increase in new infections in the high-burden counties, the report noted encouraging progress in other regions.

Twelve counties, including Elgeyo-Marakwet, Wajir, Mandera, Kisii, Machakos, Kericho, Uasin Gishu, Nakuru, Bomet, Baringo, Trans-Nzoia and Laikipia, recorded a 75 per cent drop in new infections.

Nationally, Kenya has achieved a 52 per cent decrease in new HIV infections since 2013, demonstrating the impact of sustained prevention efforts including voluntary medical male circumcision, pre-exposure prophylaxis programmes, and expanded access to antiretroviral therapy.

The NSDCC emphasised that the persistent regional disparities highlighted by the data call for differentiated, county-led interventions tailored to local epidemic dynamics.

For Nairobi, this means addressing the specific drivers of urban transmission including improving access to HIV testing and prevention services in informal settlements, scaling up targeted interventions for key populations, and strengthening sexual and reproductive health services for young people.

Health officials stress that achieving equitable epidemic control will require sustained commitment, increased investment in prevention programmes, and innovative approaches that reach the most vulnerable populations where they live and work.

The findings come as Kenya works toward meeting global targets to end AIDS as a public health threat by 2030, a goal that will require dramatically reducing new infections while ensuring universal access to treatment for those already living with the virus.