Hiv/aids Interventions and Their Implications on Sub-national Population Projections in Kenya

Abstract

Kenya has experienced rapid population growth since the first count in 1897. Regional varia-tions in the population growth have been witnessed over the years and population projections done to predict what the future would be. Although these population projections exist, varia-tions in the tempo of population growth continue to persist across the regions of kenya. Hiv prevalence also persists. However, county specific population projections are lacking even as more and more interventions to address hiv/aids scourge are initiated. Population projections are crucial for development planning at the county level since kenya has devolved system of governance. This study focused on generating county specific population projections taking into account the effect of hiv and aids interventions. The study had three objectives. The first objective focussed on generating population projections without taking into account the effect of hiv and aids and associated interventions. The second objective emphasised on generating county specific population projections while incorporating county hiv prevalence rates. The third objective focused on generating county population projections while incorpo-rating both county level hiv prevalence rates and the levels of uptake of hiv/aids interven-tions. Three data sets were used in this study, namely: the 2009 kenya population and housing cen-sus (kphc) data, the 2012kenya aids indicator survey (kais) and the 2014 kenya demo-graphic and health survey data. Three methods of analysis were used namely: ratio share method, the standard cohort component approach to population projections and the hiv ena-bled cohort component method of projecting populations. The initial analysis showed that for all counties, population will continue to grow over the projection period (2009-2030). The findings of the study also revealed that both hiv/aids epidemic and the interventions initiated to mitigate the effects of the hiv/aids in kenyan population will continue to affect population growth at the county level in kenya. In absence of hiv/aids, population size and life expectancy at birth in all counties are higher than they are when hiv prevalence’s are included. When hiv/aids interventions are included in pop-ulation projections, both population size and life expectancy at birth are consistently higher than they are when only hiv/aids is included but they are lower than it is the case in the absence of hiv/aids scenario.

As far as fertility projections are concerned, the results indicated that hiv/aids will lead to fertility reduction across all the counties. Counties with relatively high hiv prevalence are projected to experience relatively high percentage reduction in tfr while counties with rela-tively low hiv prevalence on average showed modest percent reduction in tfr. When hiv/aids and programs were introduced in population projections at the county level, the results indicated that these programs are indeed influencing population change at county level although the effectiveness of these programs varied across the counties. Counties cur-rently experiencing low uptake of hiv/aids interventions are expected to record the highest percent reduction in tfr by 2030. On the other hand, counties currently saturated with hiv/aids interventions are expected to record relatively low percent reduction in tfr by 2030 The key limitation of the study is that the model used could not produce projections of net migrants at sub national level. At the sub national level, migration plays a key role in population growth since different regions may experience different in flows and out flows of migrants. Consequently, the effect of hiv and aids on migration flows at sub national level could not be ascertained. The study therefore focused on mortality and fertility projections at sub national level. The study recommends that population projections for future planning should take into account the role of hiv and aids related programs. The study also recommends that further research should focus on how to take into account migration as a major cause of population growth especially in urban areas where population growth will occur not only by natural increase but also by migration. The assa2008 model used in this study needs to be structured to capture more determinants of fertility and mortality such as contraceptive prevalence rates and poverty levels. The model also needs to be tested in countries with low hiv prevalence to test its uni-versality.