Kenya's efforts to stop new HIV infections are facing fresh pressure after the number of people starting the country's free HIV prevention pill dropped by nearly 80 per cent in three years, exposing the impact of shrinking donor support on one of the country's biggest prevention programmes.
Data from the National Syndemic Diseases Control Council (NSDCC) shows 170,551 people enrolled on oral Pre-Exposure Prophylaxis (PrEP) in 2022, the highest annual figure ever recorded. By 2025, new enrolment had dropped to 35,704, leaving uptake at just 39 per cent despite the medicine remaining available at no cost.
The decline comes as Kenya continues to record about 13,936 new HIV infections every year, according to the 2026 Kenya HIV Estimates Report. Women remain the most affected, with HIV prevalence standing at 4.3 per cent compared to 2.1 per cent among men, while adolescents and young people aged between 15 and 24 account for 41 per cent of new adult infections.
PrEP is a preventive medicine that lowers the risk of acquiring HIV by up to 99 per cent when taken consistently. Kenya introduced oral PrEP in 2015 before making it part of the national HIV combination prevention strategy in 2016, placing greater focus on preventing infections alongside treatment.
Since then, the country has expanded its prevention options to include oral TDF, the dapivirine vaginal ring, injectable Cabotegravir and injectable Lenacapavir, making Kenya one of the few countries in East Africa with multiple HIV prevention choices.
Even with those options, the programme took time to gain momentum. There were no recorded oral PrEP initiations in 2016 and 2017 before cumulative enrolment reached 45,600 by the end of 2018.
The programme gathered pace over the following years as donor-backed HIV prevention projects expanded, community health workers were deployed and peer educators reached populations that rarely accessed health facilities.
By the close of 2021, cumulative oral PrEP enrolment had climbed to 127,904 before more than doubling to 298,455 by the end of 2022 after the record annual enrolment of 170,551 people.
Figures from the Global PrEP Tracker maintained by the Aids Vaccine Advocacy Coalition (Avac) show cumulative oral PrEP initiations in Kenya now stand at 580,228.
However, annual enrolment has continued to fall, dropping to 139,548 in 2023, then 106,521 in 2024 before reaching just 35,704 last year.
The drop coincides with changes to USAid-funded HIV prevention programmes following the US government's America First policy review, which saw major HIV prevention grants and contracts suspended or terminated.
In Kenya, USAid contracts and grants worth Sh108.34 billion were terminated, disrupting community outreach, peer support programmes and follow-up services that encourage eligible people to begin PrEP and help users remain on the medication.
Health experts warn that when those support systems disappear, fewer people are enrolled while others stop taking the medicine because they no longer receive routine follow-up.
The decline has raised concern that people who should have started PrEP but did not may remain exposed to HIV infection, highlighting the risks of relying heavily on donor-funded prevention programmes.
Research conducted between December 2021 and March 2023 among 384 people eligible for PrEP in Homa Bay and Kericho also points to low awareness and continued use of the medicine.
The study found that only 68 per cent had heard of PrEP. Just 17 per cent had ever used it, while only five per cent were taking it at the time of the survey.
Among those who knew about PrEP but had never used it, 51 per cent cited concerns about side effects associated with taking a daily pill, while 36 per cent worried about cost. Another 33 per cent said they did not believe they were at risk of HIV infection.
A separate study conducted in western Kenya painted a similar picture. Of the 275 participants who had heard of PrEP, nearly 75 per cent had never used it.
Among the 69 participants who had previously started the medicine, 72.5 per cent had stopped taking it.
Researchers also found that almost one in three people living in high-risk communities had never heard of PrEP, while adolescents aged between 15 and 19 were the least likely to have used the medicine despite facing a high risk of HIV infection.
To improve HIV prevention, Kenya has introduced long-acting alternatives that remove the need to take a daily pill.
Injectable Cabotegravir, which provides protection every two months, was approved in 2024, while injectable Lenacapavir, administered twice a year, was approved in 2026 and started rolling out in February.
About 7,900 people drawn from 15 counties have already received Lenacapavir during the first phase of implementation.
Preliminary figures from the National Aids and STI Control Programme (Nascop) and LVCT Health show Kenya has recorded the highest uptake of Lenacapavir globally.
Even so, the injection is currently available in only 15 of Kenya's 47 counties, with wider rollout plans coming at a time when HIV prevention funding has tightened.