Walking Down the 90.90.90 HIV Treatment Targets Lane with Phenny Adhiambo Awiti.

This piece serves the purpose of celebrating one of the NEPHAK celebrity members. To celebrate Phenny Adhiambo Awiti, we take a walk through the 90.90.90 HIV HIV treatment targets lane because she has emerged as one of the strong members and advocate under the network.

Phenny, talks to the media in the sidelines of the 2018 HIV Treatment and Care Conference in Nairobi.

First is to remind our readership what we mean by the 90.90.90 HIV treatment targets. The 90.90.90 HIV treatment targets refer to the commitment to ensure 90% of the population are aware of their HIV status; 90% of people living with HIV are enrolled and retained on HIV treatment and care and; 90% of people living with HIV who are on treatment and care achieve viral suppression. The targets were set by the Joint United Nations Program on AIDS (UNAIDS) to be delivered by 2020. Kenya has embraced the 90.90.90 targets and have included them as national targets in the Kenya AIDS Strategic Framework (KASF). If delivered by the set date of 2019, the targets are able to place the world in the path to end AIDS by 2030 or even earlier. The 90.90.90 targets are therefore part of the foundation for the 2030 Sustainable Development Agenda.

In NEPHAK we subscribe to the national goals and targets as set by the Ministry of Health. As such, NEPHAK has embraced the 90.90.90 HIV treatment targets as documented in the KASF and other national policy and guidelines aimed at improving the health and well-being of communities. In fact, the current NEPHAK strategic plan (NEPHAK Strategic Plan IV: 2017 – 2021:  http://nephak.or.ke/wp-content/uploads/2018/11/NEPHAK-SP-2017-2021-Synopsis.pdf) is a call to action to deliver on the 90.0.90 targets and sustain the health and wellbeing of children, adolescents, women and men living with HIV. The plan is a roadmap to rally PLHIV and affected communities behind the fast track plan to end AIDS and deliver on the 2030 Sustainable Development Agenda.

It is the 90.90.90 targets journey that NEPHAK walks and in which Pheeny Awit has excelled. Phenny Awiti who is mother of two girls, is only 26 years but the experience and expertise she has gathered in the field of HIV is marvellous. She is therefore celebrity and champion in matter of HIV prevention, care, treatment and support.  Phenny first learnt of her HIV status when she was a student on a girls boarding school in Homa Bay county. It was tragic to say the least. Before that, Phenny like any other girl who has HIV felt nothing and expected nothing. An organization went to the school where Phenny was learning and girls were asked to volunteer to donate blood. This was a noble venture for the young girls. Many stepped forward, including Phenny. As part of the step to donate blood, one had to be tested for HIV. According to Phenny, she stepped forward for the love of soda and bread. That is when things turned tragic. She was told she cannot donate blood because she is HIV positive. There was no discussion and no counselling.

That is how Phenny started the 90.90.90 targets journey even before the global community set the targets. Phenny was 16 years. Although she was devastated, she managed to maintain her calm, only struggling in her heart and her mind what the future would bring. The calm was disturbed when she confided in her best friend. The friend was scared and in the state of panic, shared with everyone who cared listen about Phenny’s HIV status. This is what Phenny remembers as her worst period in living with HIV. She faced real stigma. She was isolated, ridiculed and avoided. The young girls could not reconcile how one of them had AIDS and was still mixing up with them. Others blamed her for going for the HIV test while others blamed her for telling her friend. According to Phenny, sharing her status with a close friend made it look like she was the only person in the world who had HIV. However, she did not loose hope and continued to believe that she will still live on. You can also see: https://www.standardmedia.co.ke/health/article/2001290273/how-a-loaf-of-bread-made-me-discover-i-was-hiv-positive

Since she survived through the school challenges, Phenny believed she will always survive. After school, she met people who were willing to talk to her about HIV and about health issues. She was assured that people with HIV can live normal lives if they did certain things right. One important thing was getting into HIV treatment. Phenny then enrolled on HIV treatment and that was her walk into the 2nd 90. In treatment, Phenny became of one the 90% of people living with HIV who are on lifelong treatment. According to Phenny, even HIV treatment comes with challenges: “You have to accept that you will be on treatment forever, you have to do as the clinician says and you have to ignore people who don’t believe on ARVs, including religious leaders who profess faith healing”.  

And therefore, and despite challenges, Phenny has been attending her clinics as told by the health care workers and taking her ARVs as prescribed by the clinician. With such religious level of adherence to HIV treatment, Phenny has now joined a group of people living with HIV who have achieved undetectable viral load. Being undetectable viral load should not confuse anyone though. A person living with HIV is considered to have an ‘undetectable’ viral load when antiretroviral treatment has brought the level of virus in their body to such low levels that blood tests cannot detect it. In other words, As the name suggests, an undetectable viral load occurs in people living with HIV when the virus exists in such small quantities that it can’t be detected by standard blood tests.

Phenny has adjusted her schedule and tasks to accommodate medication. She never misses a pill regardless of what she is doing. She recently surprised participants at a public forum in Kisumu when she stopped her speech to take her medicine. She was addressed the public forum when the time reached for taking medication. She simply pulled her tin of the drugs, swallowed one and followed with water. According to her, this reduces stigma and encourages other PLHIV who may still be fearing taking ARVs because of where they are.

Even with this, PLHIV like Phenny know that being undetectable isn’t a constant state and if you stop taking your medication then your viral load will go back up again. By achieving undetectable viral load, Phenny is one of the 90% of PLHIV in Kenya who have done so. This is a real achievement for PLHIV and those who provide care to them.

In the context of HIV treatment, it has now been confirmed that Undetectable Equals Untransmittable (U=U) states that people living with HIV who are on antiretroviral therapy and have been undetectable (less than 40 copies in a milliliter of blood) for at least six months cannot infect others through sexual transmission. The consensus statement on U=U is really exciting to both scientists and communities because it offers the prospect of ending AIDS.  See: https://www.positivelyaware.com/articles/undetectable-equals-untransmittable. Phenny too is happy to be part of the U=U movement. The movement is motivated by the fact that science is working for people living with HIV.

Phenny the PMTCT Champion

Importantly, Phenny is not just living her life alone but she is happy to share with other PLHIV and that is part of the reason we share her story and walk with her down the 90.90.90 lane. Within NEPHAK, Phenny is an inspiration because she makes the NEPHAK call for leveraging the lived experience real. This is what makes NEPHAK relevant. We leverage the lived experience by people like Phenny and channel it into the fast-track plan to deliver on the 90.90.90. And while we appreciate the science that has transformed HIV from a killer disease to a chronic health condition, we also celebrate people like Phenny Awiti who have embraced the science and are now testimonies to the fact that HIV treatment works.

The hope of ending AIDS as a public health problem lies in the courage and the voluntary outreach by people like Phenny. She does not only reach out to PLHIV with NEPHAK but also to HIV negative people. She is an HIV prevention champion and a promoter of condom use. She reaches out to people online and also through face-to-face meetings as demonstrated in the photos below.

One area where Phenny has played a significant role is in the prevention of mother to child transmission of HIV. Herself being a young mother with HIV free children, Phenny has a lot to tell young women living with HIV who desire future births. The country can also benefit from her experience. Phenny is a PMTCT Champion. As the country focuses on reduction of mother-to-child transmission of HIV and Syphilis in line with the global super-fast-track framework that aim to end new HIV infections among children (Start Free) and keeping their mothers alive, adolescents (Stay Free) and end paediatric and adolescents AIDS, one person who cannot be ignored is Phenny Awiti. Phenny will surely be needed to campaign for the pre-elimination and elimination of both paediatric HIV infections and congenital Syphilis.

Phenny Awiti uses her photo to educate adolescent girls and young women and WLHIV on exclusive breastfeeding. 

Aware of the many sexual health risks and challenges women go through, Phenny is not limiting herself to HIV only. She advocates for the health, well-being of girls and women. She has even taken a campaign and awareness creation of breast cancer in women. Alongside breast cancer, Phenny also talks about cervical cancer and encourages women and especially those living with HIV to demand for cervical cancer screening. Within NEPHAK, Phenny has become dependable in the advocacy to ensure that sexual and reproductive health and rights needs of all people are fully met to prevent HIV transmission. This resonates well with the NEPHAK call for PLHIV to access integrated services, including for HIV, TB, sexual and reproductive health, maternal, newborn and child health, food and nutrition and non-communicable diseases especially at the community levels.

Phenny Awiti during HIV Treatment Education session

In the last six months, Phenny has taken up the role of reaching out to adolescents and young people infected and affected with HIV with the NEPHAK’s goal of ensuring that young people access information, get awareness to enable them create demand for services through social and other media. See: For young people living with HIV, she runs HIV Treatment Education sessions to educate young people on the available ARVs in Kenya and how they work to enable people ward off opportunistic infections and sustain viral suppression.

So as to help prevent sexual health risks such as unwanted pregnancies and new HIV infections, Phenny recently released in the social media a post that left many talking. The photo post was to promote condom use. In her words, Phenny explained to young girls that: “If it has to happen, then make sure condom is part of it”. The photo is still doing rounds on Facebook with varied comments. The good thing is that the message reached the intended target.

Phenny uses her voice, her videos and her photos to promote HIV prevention.

For more about Phenny see: https://mpasho.co.ke/3-years-together-father-two-children-left-another-woman-phenny-awiti-narrates-journey-living-hivaids/ and https://kisumuinsyder.co.ke/2017/06/17/phenny-awiti-my-hiv-status-does-not-make-me-any-different-from-the-rest/ and you can also watch: https://www.youtube.com/watch?v=Wji6Si0QDD4 and https://www.youtube.com/watch?v=nyMczJK3BFs