Are more Kenyan girls than boys contracting HIV at birth?

Mother and child reading. Photo Via

A story carried by the Standard Newspaper citing a nine-year study carried out by the Ministry of Health, the Kenya Medical Research Institute (Kemri), and the Clinton Health Access Initiative has indicated that more girls are getting infected with HIV at birth than boys.

Despite advances in medical technology and treatment practices to prevent mother-to-child transmission of HIV at birth, an estimated 13,000 new infant HIV infections occur annually in Kenya.

This large number is attributed to widespread poverty and lack of social support, which severely limited the uptake of early infant diagnosis, and despite the growing uptake and support for preventing mother-to-child transmission (PMTCT) services such as the Beyond Zero initiative, many of the infections happening because mothers may be unaware of their HIV status and are delivering at home, away from a medical facility.

HIV-infected women who deliver outside of facilities tend to have lower income and be less educated and less likely to be on treatment, meaning that their infants are especially vulnerable.

The study, which focused on rural Kenya, assessed the HIV status of 365,841 infants aged two years and below from January 2007 to July 2015. The reason for setting the age cap at 2 years is that without antiretroviral therapy (ART), approximately 50% of HIV-infected infants die by the age of two.

So, are girls more likely to contract HIV than boys at birth?

PesaCheck has researched the issue, and finds that the claim made in the Standard article is PARTIALLY TRUE for the following reasons:

The study found that there was a marked difference in prevalence rates for boys and girls. There were more girls who tested positive for HIV at birth than boys. A total of 161,682 male infants and 164,259 female infants were tested, with an overall HIV prevalence rate of 8.4% for boys and 8.9% for girls identified.

The report acknowledges that the exact mechanism of HIV transmission in utero is not known, but one hypothesis is that the Y chromosome in males has a higher affinity to the virus, making them more susceptible to HIV, leading to a higher rate of male intrauterine death among HIV-infected fetuses.

As a result, females are more likely to survive after infection, leading to the higher numbers of girls born infected with HIV.

In this database, females did not appear to be testing later than males, so age at testing did not seem to explain the imbalance. Confirmation in other studies and further investigation is needed to better understand this phenomenon.

The Kenya Demographic and Health Survey 2014 indicated that male children are more likely than female children to die during their first year of life (44 deaths versus 37 deaths per 1,000 live births).

In Kenya, Women are more vulnerable to HIV infections compared to Kenyan men, with the national HIV prevalence at 7.0 per cent for women and 4.7 per cent for men as per the 2015 HIV Estimate report.

In 2015, there were 98,170 children below the age of 14 living with HIV, with 6,613 new infections and 5,004 AIDS-related deaths. This data was not broken down by gender to show how many were either female or male infants.

Child HIV infection from HIV positive mothers has remained largely stable at about 14% in the last three years. This trend needs to be reversed if Kenya is to achieve the global target of eliminating mother to child transmission of HIV

The data from this nine-year study shows an overall reduction in infections, due in part to intervention measures put in place to prevent mother-to-child transmission, and it adds in the element of early infant testing to detect HIV at birth so that infected infants can be put on treatment as soon as possible.

Therefore the claim by The Standard that more Kenyan girls than boys are being infected with HIV by their mothers is PARTIALLY TRUE. While the study shows that more girls are born HIV-positive than boys, this difference could be due to chance. The report states that this data is not nationally representative, and it should not be used to draw conclusions about the trend of mother-to-child transmission in Kenya. What it does show is that mother-to-child transmission still remains a challenge, especially in rural areas, where poverty, lower education levels and lack of access to medical facilities puts infants at risk of HIV infection, particularly those born to mothers who may be HIV-positive.