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

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

Stay With Me

I have never known a pain this sharp,
a hurt that stays in every breath,
as if sorrow has built a home inside my chest.
I sit here drowning in my own silence,
tears spilling like tides I cannot command,
wondering how I strayed,
wondering if I’ve lost the best part of me,
you.

I keep replaying my mistakes,
each one cutting deeper than the last,
and I fear that in their shadow,
your love for me might dim.
The thought alone unmakes me.
It is a heaviness I cannot outrun,
a shame that knots itself into my bones.

If only regret could mend,
if only apologies could erase,
I would gather up every fragment of your hurt
and carry it away until you felt light again.
But healing, I know, is not so quick.
It asks for patience. It asks for trust.

“I’m sorry” feels too small,
too fragile for the weight of what I mean.
Yet it is the truth on my tongue,
and I speak it with trembling hope.
Because we have weathered storms before,
you and I,
and somehow we’ve always come through
stronger, side by side.

Still, I know you deserve better
than the hurt I’ve caused.
I hate myself for placing this burden on you.
But if your heart can find space
for one more chance,
I promise I will spend every day
proving love right again,
proving us right again.

@okelododdychitchats

Man, I am Handsome

Men are not taught to see themselves as wonders.
We are raised to be stoic pillars, to bear weight in silence, to give and rarely pause to admire the giver. Yet here I stand, seeing myself with unashamed eyes, and for once, I speak it.

I am the most handsome man.
Mirrors tell me so,
Life itself sculpted me into this. I walk into a room and the air hesitates; I am presence. Followed by the rest—ah, perhaps one or two who might come close, but even then, I remain singular.

O God, you must have stayed on me.
When you carved the curve of this jaw, the arch of these shoulders, the stretch of these long bones reaching six feet tall. You painted my skin the deep color of rich earth after rain, dark, fertile, alive, and filled it with juice sweeter than the tongues of poets could ever capture.

Look at this frame: built with labor, yet graceful; strength that does not shout but simply exists, unyielding.
And within, a mind—ah, this mind!sharp enough to draw envy, steady enough to draw trust, restless enough to seek and never settle.

What else, man? What else could I ask for?
Potential thrumming in my veins, character like bedrock under my feet.
I am art. Not perfect, no, but what masterpiece ever was?

So here I am.
Appreciating me.
Because if I cannot honor the marvel of my own making, who will?

@okelododdychitchats

If I Die Today

What if I were to die today, beloved, would your heart stir at all, or would the silence between us deepen into an endless grave? Would you pretend, for the eyes of the world, that you had loved me, that in the shadows of our days you carried a flame you never lit? Or would you let truth, raw and cruel, escape your lips and say, “He was never worth knowing”? I wonder how heavy my name would sound upon your tongue when spoken before mourners, how steady or broken your voice would be if asked to read the words of my eulogy. Would my absence cut through your chest like a blade, or would it wash over you like a gentle relief, as though a long burden had at last been lifted?

For often, in your weariness, I hear a sentence unspoken, that my love itself wearies you, that my presence is not balm but weight. And I, foolish in devotion, still stretch myself toward you like a tree bends toward a reluctant sun. You say you are tired, yet it sounds to me as if you are tired not of days but of me: tired of my words, tired of my arms, tired of the tribe from which my blood flows. My heart trembles with the thought, do you despise the very breath with which I call your name?

If death should come to me as swiftly as twilight, would it soothe you? Would the quiet of my absence give you the peace my living presence could not? To love you has been to walk a path of thorns barefoot, yet still I would choose it, still I would kneel before the altar of your indifference and offer the bruised fruit of my heart. For love, when true, does not measure return, nor count the wounds it gathers; it only asks to give, even unto its last breath. And if that breath comes today, then my only prayer is this, that somewhere in the hollow of your silence, you might whisper that I loved you, fiercely and without apology.

@okelododdychitchats

Her Candle

The gift of strawberry and vanilla
is sweet, light as breath upon glass,
a fragrance that stays softly
but drifts like memory in the air.

The gift of peach with apricot
is warm, full, and ripened by desire,
a deeper note that stirs the senses,
yet it fades as twilight fades from day.

But her skin holds a scent beyond the jar,
a living perfume no hand can craft.
Her face is the light the flame seeks to imitate,
her spark the fire no wax can contain.

So I do not long for the candle she makes,
nor the perfumes she blends with care,
but for the burn that lives in her presence,
a flame that is wholly hers.

@okelododdychitchats

A Rose for You, My Love

The red rose sings of wild fire,
The white one breathes like the sea,
One burns with untamed longing,
One rests in serenity.

But I bring you a soft blush petal,
Not white, not crimson bright,
It holds the warmth of sunrise
And the still of falling night.

For love is not just quiet,
Nor only made to burn,
It’s the tender pull of yearning
And the joy when you return.

So here, my love, this rosebud,
It’s not bold, but it is true.
It blooms with gentle longing,
Like the way I bloom for you.

@okelododdychitchats

I Miss You More

I feel it everywhere.
In the quiet moments,
in the places you used to sit,
in the way the air feels a little heavier
without your presence in it.

There’s a space,
not loud or dramatic,
just a soft kind of empty
that follows me around.

I try to fill it with noise,
with work, with words,
but nothing really fits.
Because it’s you that’s missing.

I don’t just miss you in the big ways,
I miss the small things too.
The glance. The laugh. The comfort.
And somehow,
I just keep missing you more.

@okelododdychitchats

IF YOU LOVE ME, HOLD ME

Hold me,
not just my hand,
but all of me.
Wrap your arms around my body
like you know what it’s been through.
Like you’ve heard the storms it carries
and still want to dance in the rain with me.

Take my hand,
don’t ask where we’re going.
Let’s run,
not to escape,
but to feel free
for the first time in a long time.

Hold my heart,
gently,
like it’s the last soft thing in a hard world.
Place it close to yours,
let them beat together
in a rhythm only we understand.

Touch my waist like it’s sacred.
Pull me into your chest
like you’re pulling me into forever.
And when you kiss me,
don’t make it rushed.
Kiss me like you’re trying to teach time
how to slow down.

If one tear falls—just one,
don’t panic.
Wipe it.
Don’t ask if I’m okay,
just look at me like you see everything
and say,
“It’s going to be alright.”
And mean it.

When I say I’m cold,
don’t go looking for a sweater.
Be the warmth.
Be the safe place I curl into
when the night gets too loud.

And when I say “I love you,”
don’t whisper it back.
Say it like a vow.
Say it like your soul recognizes mine.
Say it like you’re not going anywhere.

Because real love
isn’t made of grand gestures.
It’s in how you stay,
how you see me,
how you reach for me in silence.

So if you love me,
hold me,
not just in your arms,
but in your everyday.

@Okelododdychitchats