The Opportunity Cost of a Lost Girl: Why Adolescent Health Is an Economic Issue

To address the structural challenges of adolescent health in Kenya, experts are increasingly viewing the Triple Threat, the intersection of teenage pregnancy, HIV, and gender-based violence, as a singular public health emergency that requires a unified institutional response. The gradual erosion of national pregnancy rates, which dropped from 18% to 15%, is seen by policy analysts as a sign of progress, yet one that masks deep-seated regional inequalities. In areas like Samburu, where the rate remains at 50%, the crisis is viewed not merely as a health issue, but as a systemic breakdown of the protective social infrastructure intended to support the girl child. This crisis is compounded by the Triple Threat synergy, a lack of agency to negotiate safe sex often results in a simultaneous surge in new HIV infections and unplanned pregnancies, frequently rooted in gender-based violence.

Education remains the most significant predictor of reproductive outcomes in the country. Data from the Kenya National Bureau of Statistics (KNBS, 2022) indicates that only 5% of girls who complete secondary school become pregnant, a stark contrast to the 40% observed among those with no formal education. Institutional experts emphasize that education is thebest contraceptive, serving as the most effective long-term shield for a girl’s future. The current Education Re-entry Policy is designed to treat pregnancy as a temporary pause in a girl’s development rather than a permanent exit from society. By mandating that schools readmit young mothers without conditions, the government is prioritizing the long-term economic viability of these young women. We must support her return and protect her potential to mitigate the massive opportunity cost to the national GDP.

With the rollout of the Social Health Authority (SHA), there is a strategic move to eliminate the financial barriers that often drive transactional sex. This phenomenon occurs when girls, particularly from the poorest households, exchange sexual favours for basic necessities like sanitary pads or school fees. Health administrators argue that removing the cost of maternal care is a pivotal step in normalizing adolescent health services. When girls can access youth-friendly clinics without the fear of financial strain or the stigma of judgment, the likelihood of safe deliveries and the adoption of postpartum family planning increases. This approach frames reproductive care as an essential public service, similar to the management of other chronic health conditions.

Sociological research highlights that the social death of a pregnant teenager is frequently a by-product of community-level shaming. While childbearing rates are significantly higher in the lowest income bracket, they drop drastically for the wealthiest, suggesting that pregnancy is often a symptom of economic desperation. The community’s role must shift from isolation to integration, especially as new threats like digital grooming emerge. Experts suggest that a girl’s destiny should be shaped by her dreams, not her zip code, and that ending thesocial death of teenage pregnancy is Kenya’s path to a stronger nation. Breaking the cycle of poverty requires community leaders to stop negotiating defilement cases through traditional settlements and instead move toward formal legal accountability.

For Kenya to reach its development goals, the focus must remain on the enforcement of the Sexual Offences Act at the grassroots level. Legal advocates insist that justice cannot be settled with livestock or secret payments. Every instance of legal accountability sends a clear signal that the safety and education of the girl child are non-negotiable national priorities. By aligning government policy, community action, and economic support, the goal is to ensure that every girl has the power to decide her own future on her own terms.

@doddyokelo

What Next for Kenya’s HIV Response?

Otieno, a resident of Kamwango in East Kamagambo, Rongo Sub-county, sits on the edge of his bed, the weight of the world pressing heavily upon his shoulders. He looks at his wife, Achieng, who is meticulously organizing their remaining ARV tablets, and their seven-year-old daughter playing by the window. For years, those pills have been their lifeline, a daily ritual of survival. But the news on the radio is cold. Following the transition in Washington on January 20th, 2025, and the looming impact of March 2026, the whispers in the clinic queues have turned into a dull roar of panic. He hears that the containers might stop coming, and the thought of the virus waking up in his daughter’s blood because of a political shift thousands of miles away is a terror no father should carry.

For 23 years, Kenya has been receiving roughly 69% of its HIV funding from the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR). This massive investment, totaling over 8 billion dollars (approximately 1.1 trillion Kenyan shillings) was the backbone of the national response, paying for the very ARVs Otieno’s family is counting on, the laboratory reagents for viral load testing, and the salaries of over 40,000 health workers, nearly 18% of the country’s total health workforce, who now face an uncertain future.

The crisis has ceased to be a storm on the horizon, it has become the drying of the well, a sudden, natural silence where the ever-flowing vein of supply once lived long. Since the executive freeze in early 2025, approximately 34 million dollars (4.5 billion Kenyan shillings) worth of life-saving commodities have been caught in a logistical gridlock. This disruption was triggered by a stop-work order that deactivated the payment and distribution systems managed by U.S.-funded agencies. By March 2026, the buffer stocks that once protected patients like Otieno from supply shocks will have run dry. In many facilities, doctors have been forced to ration medicine, moving from three-month prescriptions to one-week emergency packs, a desperate measure to ensure that at least everyone gets something, even if it isn’t enough.

To bridge this gap and heal the mess of daily adherence, there is a growing call to develop and deploy long-acting treatments for reactive individuals. While currently available injections like Cabenuva require a visit every two months, the dream is to innovate even further, creating a once or twice yearly injection specifically for treatment. Such a breakthrough would be the ultimate sustainability tool by replacing 365 daily reminders with just one or two clinical visits, the government could drastically reduce the logistical nightmare of monthly pill distribution. It would solve the adherence crisis for families like Otieno’s, ensuring that even if a shipment is delayed or a clinic is crowded, their protection remains locked in their blood for months. This transition to long-acting treatment is the missing piece that could turn the tide, making the 2030 goal of zero transmission a reality by removing human error and pill fatigue from the equation.

The physical landscape of care is also shrinking. Community Drop-In Centers, which provided a refuge for vulnerable groups to receive medication away from the prying eyes of the general public, have begun to shut their doors as their rent and staff costs were tied directly to the now-paused U.S. grants. This has pushed thousands of patients back into overcrowded outpatient clinics where stigma remains a biting reality. The shift is driven by a fundamental pivot in U.S. foreign policy toward domestic rescissions, clawing back billions in global health aid and leaving a Sh30 billion hole in Kenya’s 2026 health budget.

The Kenyan government has responded with urgency and strategic redesign. Health officials, led by the Ministry of Health, are frantically working to integrate HIV services into the new Social Health Authority (SHA). The goal is to move HIV care from a donor-funded silo into the national insurance framework, essentially treating it like any other chronic condition. To prevent a total stockout, the government is also fast-tracking licenses for local pharmaceutical companies to manufacture ARVs within Kenya, aiming to break the cycle of dependency on foreign shipments that can be halted by a single signature in a foreign capital.

Sustainability is the ultimate goal, but it is a bridge built under fire. The National Treasury is being asked to ring-fence emergency funds to unlock meds held in private warehouses, while civil society groups under the National Empowerment Network of People living with HIV in Kenya (NEPHAK) have taken to the streets to demand that laboratory tests, like viral loads and CD4 counts, remain free under the new insurance scheme. While the move toward a Kenyan-led, self-reliant system is the only long-term solution, for Otieno’s family, the immediate reality is a month-by-month struggle to stay undetectable while the country waits for the first gears of its own factories to turn with purpose.

@doddyokelo

Lenacapavir, The Twice-Yearly Miracle: Is This the End of the Beginning for HIV?

People hesitate most at clinics closest to where they live. That hesitation is rarely about distance or time, it is about being seen. In my journey through community development and health advocacy, I have watched people walk past facilities meant to save their lives because they fear the look that seems to measure you. Fear the silent calculations neighbours make when someone enters a clinic known in the community as an HIV point, whether clearly branded or simply recognized locally. For years, HIV drug points marked with PEPFAR, USAID, or familiar donor logos have told a story before a word is spoken. Separated from other services, they invite judgement and connect dots.

To cope, patients travel. Someone living in Homa Bay town collects ARVs in Oyugis, Ndhiwa, or wherever anonymity feels safer. It helps, yes, but it does not heal the fear. It only relocates it. Treatment becomes a journey of avoidance rather than access. And it raises the question, “should life-saving care require disappearance?” Until HIV services are fully integrated, until seeking treatment looks no different from visiting any other clinic, stigma will continue to do its damage through the systems meant to defeat it.

HIV survives in systems that expose, in routines that punish the ordinary act of seeking care, in the invisible calculations people make every day to remain unseen. And it is within this reality, where access still demands courage, that breakthroughs like Lenacapavir become not just medicine, but possibility.

For decades, the United Nations’ goal of zero new HIV infections by 2030 has felt distant. Roughly 1.3 million people are diagnosed with HIV each year, and the 2025 target, fewer than half a million new infections annually, was missed. As the finish line drifted, global funding tightened. Cuts to PEPFAR and USAID transformed what once felt inevitable into a whisper of hope. Then came Lenacapavir.

Lenacapavir is neither a vaccine nor a cure. It is a long-acting capsid inhibitor, a drug that targets HIV-1’s protective shell and disrupts the virus’s replication at multiple stages. For decades, prevention relied on daily discipline. One missed pill could open a window for infection. Lenacapavir changes that equation. Administered just twice a year, it works like pre-exposure prophylaxis (PrEP) without the daily burden. It offers a six-month shield protection that slips seamlessly into life as it is actually lived.

The trial results were extraordinary. In sub-Saharan Africa, the PURPOSE trials reported zero new infections among women using Lenacapavir. Among gay and bisexual men and transgender women, protection reached 96%. In a field long accustomed to incremental gains, these numbers feel historic.

Breakthrough, though, means little without access. Gilead Sciences, which manufactures Lenacapavir under the brand name Yeztugo, could have confined it to wealthy markets. Instead, it signed royalty-free licensing agreements with six generic manufacturers, opening the door for affordable versions in 120 or thereabout low- and middle-income countries.

In Kenya, the National AIDS and STI Control Programme (NASCOP) is preparing for a nationwide rollout beginning January 2026. Lenacapavir will not replace condoms, daily PrEP, or other prevention tools. It will expand choice. And in high-burden settings, choice is power. Protection without disclosure. Prevention without permission. Safety without explanation.

Can a twice-yearly injection help the world reach the UN’s 2030 target? Possibly. Lenacapavir directly confronts three long-standing gaps in the HIV response:

1. Adherence: No daily pill. No constant reminders. No fear of discovery.

2. Biology: Clinical trials leave the virus with almost no room to replicate.

3. Access: Generic production makes scale realistic, not rhetorical.

Lenacapavir will not end HIV on its own. But it may mark a turning point.

@doddyokelo