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

Let Me In

Your mind is a cathedral of locked doors,
where I walk the perimeter, tracing the cold stone,
listening for the silver resonance of a breath that sounds like my name.
I am an expert in the art of the unspoken,
gathering the crumbs of your glances like a hungry bird,
content to wait in the shadow of your mystery
until the daylight finally learns how to break through.

Expose the map of your pulse, the hidden place
where your armor thins and the genuine heart beats.
I do not ask for a tour, I ask for the keys to the foundation,
to be the protagonist in the story you tell yourself at midnight.
Let me inhabit the space of your firsts,
as the very oxygen that fills your lungs
before the world taught you how to hesitate.

I can feel your love like a subterranean river,
heavy and gold, moving where the marrow dreams of light.
But I am drowning in the shallows of your caution,
wondering if you will ever let that river break the banks.
I love you with the violence of a sun that never sets,
I am waiting to see if you will finally surrender to the same
beautiful, terrifying gravity that holds me to you.

@doddyokelo

Happy Birthday, Dear One.

You were the weight that kept me grounded
when the world felt made of iron and salt.
Not just a witness to my seasons,
but a companion through the thickest briars,
staying close with a quiet, stubborn loyalty
that still feels like a minor miracle.

A heart such as yours
cannot be measured in common coin.
I wish for you a life that mirrors your own depth,
a vitality that throbs like the solstice sun,
the ease of a long-shadowed afternoon,
and a heart that never knows a drought.

On this day of your beginning,
and through all the chapters you’re yet to write,
may you see yourself through the eyes of those you’ve helped.
You are rooted in our stories now,
the name we say when we talk about home,
a presence that stays long after the lights go out.

Happy Birthday, Dear One.

@doddyokelo

Final Gear

I’ve marked no map with ink or public pride,
To show the woods where I intend to go.
The things I seek have nowhere left to hide,
And what I reap is what I choose to sow.
I take the path where fewer shadows bide,
And leave the crowds to talk of what they know.

The fence I mend is built of quiet stone,
To keep the peace and part the draining guest.
A man can walk a standard mile alone,
And find in silence all he needs of rest.
For every seed of will that I have grown,
I ask no leave to put it to the test.

So let the wheels engage their hollow, wind-swept song,
Across the hills and through the turning lane.
I owe no word to prove where I belong,
Or why I chose the sun above the rain.
The drive is short, the inner light is strong,
I go my way, and need not explain.

Bye 2025.

@doddyokelo

Monday, But Why ?

I am tired,
shrunken, chilled, and worn at the cuffs of my soul.
The night itself, a careless laundress,
folded me wrong and ironed in the creases of a bad mood.

My thoughts are heavy, they are a parade of strangers
wearing wet wool coats, stomping through the hallways of my mind.
And my intellect is bald, yes, but worse,
a barren, frozen tundra where not a single rebellious idea
has the audacity to sprout.

It is Monday.
the same old cracked vinyl of a gloomy chorus,
stuck, skipping, repeating the universal dullness.
My strength is a barometer at zero,
my motivation a phone on airplane mode.

This is the taste of it,
Monday, served on a cold porcelain plate.
Bitter at the edges, bland and beige in the middle,
a main course of immediate responsibilities.

But really,
why must Monday always show up like a guest who never takes the hint to leave?

@doddyokelo

How It Feels To Be Home

I am afraid,of the dark that breathes and shifts,
It bends and folds around the corners of my mind,
Where unseen eyes wait in shadowed silence,
And whispers crawl like wind through broken glass.
The night becomes a mouth, open and waiting,
And I am its trembling sound, half-alive, half-lost,
Reaching out for the sound of your name,
To anchor me where the light once stayed.

I see them, those figures born of fear’s design,
They lean against the walls like memories uninvited,
Their outlines blur in the dim, uncertain air,
And I cannot tell if they move or merely breathe.
They haunt the corners of my sight like regret,
Soft, cruel, and patient in their waiting,
Till your voice, gentle as dawn, loosens the dark,
And the room remembers how to breathe again.

I hear them too, the voices that hiss and murmur,
They tell me of endings that never began,
Of love that rusts beneath the weight of time.
They are not real, I tell myself, they are smoke,
Yet they know the cracks in my courage by name,
They slip through the seams of my silence,
Till your presence returns, steady and golden,
And their cruel chorus falls to dust.

Without you, fear builds its kingdom in my chest,
A fortress of shadows and unanswered prayers,
But when you come, the darkness loses its teeth.
You are the dawn that rinses the night of its grief,
The calm after thunder, the stillness after rain.
You make the corners smooth again,
And I, once a ghost in my own house,
Find my pulse, steady and sure, in your light.

So come, my calm, my gentle resurrection,
Wrap your warmth around this frightened skin,
Hold me like a promise you mean to keep,
Till the dark forgets my name,
Till every whisper learns to fade,
Till the moon watches us without envy,
And the stars sing softly of peace.

Walk with me, down these hollow streets of thought,
Where my footsteps answer old fears,
Let your hand fit mine like sunlight fits morning,
Let our shadows melt into one.
For with you, the night forgets its hunger,
And even silence dares to dream again.

Come, fill this hollow where my heart once broke,
Plant your laughter in the cracks of my chest,
Let love grow where fear once built walls,
Let your light spill over my broken fields.
With you, every barren thing learns to bloom again,
The air tastes of spring, and I remember,
How it feels to be unafraid,
How it feels to be home.

So come, be my light, my refuge, my calm,
Walk with me until the dark forgets its way,
Hold me till the world grows quiet and kind.
For when you are here, the night stands still,
And even my ghosts bow in surrender,
For they, too, know your name means dawn.

@doddyokelo

A Place Only We Know

Meet me,
in the quiet tremor between your heartbeat and your breath,
where silence breathes itself into longing,
and the shadows of your heart whisper soft songs
only the two of us can hear.
There, love hides barefoot,
waiting for us to arrive without words,
without fear, only pulse and promise.

Meet me among the stars,
where ambition burns like incense,
and the galaxies whisper of us in light-years.
See how my eyes hold constellations
that spell your name in patient fire,
how even the dark bends slightly
to make room for our glow.

Meet me where the ocean exhales,
where the horizon trembles like a secret,
and salt baptizes every forgotten pain.
Let the tide pull us clean of yesterday,
let the water write forgiveness
across our skin until we gleam
with something close to forever.

Meet me in the forest’s open breath,
where trees lean close as witnesses,
and sunlight spills like honey between their fingers.
Here, the earth sings beneath our feet,
a lullaby older than sorrow.
We’ll rest where roots remember love
more deeply than words ever could.

Meet me upon the drifting clouds,
that tender border where heaven blushes
against the skin of the world.
Let’s waltz on vapor,
our laughter scattering like rain over cities asleep,
each drop a note of joy
falling back to where we began.

Meet me atop the mountain’s breath,
where air is thin but truth is thick.
Breathe me in until your lungs forget
where you end and I begin.
Let the wind carry our names into eternity,
two syllables of devotion
resonating through stone and sky alike.

Meet me, my love,
not in time, but beyond it.
Not in place, but in presence.
Anywhere the soul dares to open,
any moment brave enough to bloom.
Meet me there,
where everything is still,
and we are infinite.

@doddyokelo

Love, Receipted

You call me lazy,
as if rest were rebellion,
as if the absence of a paycheck meant
I’d married idleness and sworn fidelity to failure.
You think I wake each morning to romance poverty,
to sip on the bitter tea of rejection
and call it breakfast.

You think I don’t hunt for work,
darling, I’ve applied so hard the internet knows my name.
I’ve learned new skills until my mind wheezes from exhaustion,
repackaged my dreams in “professional tone,”
and written cover letters that could melt granite.
Still, the silence from employers breathes louder
than any sermon on hard work.

But go on, roll your eyes like coins in a rich man’s pocket.
You love the performance of pity, don’t you?
The way you sigh,
You wear my struggle like a badge
that says “look what I tolerate.”
You hold my empty wallet against my neck
like a priest offering salvation through mockery.

Your friends, the walking bank accounts,
toast to success with imported laughter.
They look at me the way one studies
a museum exhibit labeled Before Success.
And you,
you shrink beside them,
embarrassed to be seen loving someone
who doesn’t come with receipts.

I know I can’t afford dinner dates,
but baby, I can give you poetry,
written with hunger’s ink,
where every word costs a piece of my pride.
You want steak, I offer metaphors,
you want champagne, I bring conversation.
But apparently, love without a tip is just noise.

You say I make excuses,
as if failure were a choice I make before breakfast.
Man, I’ve tried,
tried until my hope broke its spine
from bending too long under your expectations.
But effort doesn’t trend, does it?
It’s not sexy on Instagram.

You used to look at me like promise,
now you look at me like pity dressed for dinner.
Your eyes audit my worth
like a cashier scanning expired dreams.
You don’t even say it out loud,
but your silence spells liability.
Love, it seems, needs a payslip now.

So go ahead, call me disgusting,
a broke ass night certified by circumstance.
Laugh with your friends,
they’ve earned their arrogance.
I’ll be here, broke but breathing,
scribbling poems on the back of rejection letters,
because even in poverty, darling,
I write better than they ever will live.

@doddyokelo

The First Flower, The Vagina

The world has sung of sunrises,
of rivers keeping their promise to the sea,
of roses opening after rain.

But rarely has the world spoken
of the first flower it ever knew,
the blossom that does not grow in gardens,
yet feeds every root of humanity.

It cannot be withered by winter,
cannot be starved by famine,
cannot be broken by storm.
It is the beauty at the center of woman,
the place of birth,
of power,
of beauty,
of poetry.

It is no accident that her body
carries both beauty and beginning.
She is a garden,
her petals folding and unfolding with grace.
No sculptor has carved it,
no hand could fashion it better.
This is the seat of power,
waiting in patience,
waiting in reverence.

Do not call it small.
It is wide as oceans,
deep as memory.
Within its folds
nations are conceived,
histories take breath.
Its lines are strong
as the roots of the baobab,
steady as mountains
that do not move.

Yes, it is a flower,
but not a fragile bloom
that dies in the sun.
It is a rose of fire,
a blossom of strength,
pulsing with flow,
beating with song.
Tender for creation,
not decoration.
Its beauty is not for passing eyes,
but for the truth that life itself
begins here.

When it opens,
It blooms in trust,
in the warmth of love,
in the honest catch
of reverent hands.
Like dawn, it spills light.
Like rivers, it flows free.
And in its unfolding
is both poetry and prophecy.

Many have tried to name it,
to paint it,
to own it.
But it belongs to no brush,
no word,
no claim.
It is the garden every woman carries,
the fire every woman guards,
the throne every woman sits upon,
with dignity,
with laughter,
with strength.

Touch it,
and you touch mystery.
Look upon it with reverence,
and you see the handwriting of God
upon flesh.
Here hunger softens,
longing becomes creation,
desire meets its answer.
It is gift,
not possession.
Blessing,
not burden.

So speak of it with respect.
Speak of it as you would
the sun,
the river,
the ground beneath your feet.
It is flower,
it is fire,
it is freedom.
It is woman.

And in its beauty
lives a truth unshakable:
that life,
in all its splendor and sorrow,
begins here,
and nowhere else.

@doddyokelo

In the Dust, A Pulse

I like to seek the treasure hidden in the dust.
To lift what is broken, what others have thrown aside,
and hold it until it speaks.

There is a life in things the eye does not see,
a cup that has forgotten the lips it once touched,
a blade that once sang in the air,
a flower that still dreams of sun though it is ash.

I do not take them as they are.
I search for what they wanted to be.
I listen for the pulse beneath their silence,
for the promise that time could not keep.

And in that quiet,
I find something greater than beauty,
the truth that nothing is ever truly lost,
only waiting to be seen again.

@okelododdychitchats