Bridge to Breakthrough: Preventing HIV infections in Kenya, one conversation at a time
Through the lens of National Geographic photographer Rena Effendi, meet the network of organizations and people turning HIV prevention into a community act of care—and learn how prevention tools, including long-acting options, are making that possible.
HIV prevention in Kenya
Growing up in Kenya, Brenda Odera heard people talk about HIV (human immunodeficiency virus), but she did not hear as much about its impact specifically on women and girls. The country has made enormous strides in its response to HIV, and the incidence rate has dropped more than 80% in one decade. Still, a gender divide persists: Of all new HIV cases in 2024, more than half were women aged 15 and older.
Odera began advocating for HIV prevention out of a desire to help close this gap. She talks to women and girls along the shores of Dunga Beach in her community of Kisumu about pre-exposure prophylaxis (PrEP). PrEP is the routine use of prescription medicine, such as daily pills or long-acting options, to help prevent HIV before being exposed to it.
But an array of barriers can prevent women from seeking PrEP, including stigma associated with going to a clinic and keeping pills at home where they might be discovered. Long-acting prevention options provide a way for medication to be given discreetly in a clinic, which may help with privacy concerns.
Odera told her story to Rena Effendi, an award-winning social documentary photographer for National Geographic. "I'm drawn to stories about resilience—especially stories about women who work in their communities to advocate for a better path forward," Effendi says. "[Brenda] is building a bridge between her community at risk and modern medicine."
The kind of work that Brenda does can be not only lifesaving, but it can also provide freedom and comfort to these women who are at risk in this community.Rena Effendi, National Geographic photographer
How community advocates are increasing PrEP access
Brenda currently spends 40 hours a week in her community as a volunteer "PrEP champion," offering information to women who may benefit from HIV prevention. When women decide to start PrEP, Odera often walks them to Lumumba Sub-County Hospital herself.
Dr. Jared Olwal, a clinician who runs the PrEP clinic at Lumumba, has come to rely on this partnership. He recalls noticing that almost no women under 25 were coming in for PrEP, until Odera started bridging the gap. He has also seen firsthand a shift with new long-acting options: women can access prevention services discreetly. “They walk away without anybody knowing what they have,” or which medications they may be using, Olwal says.
Odera is part of a larger group of activists, educators, and providers who emphasize the importance of community advocacy and promote interventions that meet people where they are. Co-Executive Director at the Global Network of People Living with HIV, Florence Riako Anam, brings her own lived understanding to that aspiration. Her experience living with HIV shapes how she thinks about access. She notes that in the past, HIV was thought of as "a disease for bad women" who had done something wrong, while systemic reasons for HIV incidence were often ignored. Prevention was positioned as a societal tool—not something for self-care and agency. "Listening to communities makes the whole system that brings prevention and treatment to people move faster," Anam says.
Why long-acting HIV prevention options matter for women
Women in Kenya often have unique factors that pose hurdles to HIV prevention and treatment, notes Elizabeth Bukusi, Chief Research Officer at the Kenya Medical Research Institute. Biologically, women are more prone to get HIV. And many women are often financially dependent on partners, unable to negotiate condom use, and have fewer employment opportunities, making them more vulnerable. If a woman lives in a one-room space with others, taking medicine in private is not always possible.
Prevention is not just the key. It may be the door itself to ending the HIV pandemic. My sincere hope is that my granddaughters will not have to face the same things that my generation faced.Professor Elizabeth Bukusi, Chief Research Officer at the Kenya Medical Research Institute
For many in Kisumu, a fishing and trade hub, days are long and busy, and finding time to learn about HIV prevention or visit a clinic can be a challenge. Odera describes her work as starting a conversation. She gauges a woman's level of interest in knowing what PrEP is, how to get it, and what the options are.
Driving access through partnerships
“Transformative scientific innovation can only reach its full potential through strong partnerships,” said Daniel O'Day, Chairman and Chief Executive Officer of Gilead Sciences. “Progress against HIV has always depended on collaboration among governments, global health organizations, healthcare providers and local communities. By listening to and working alongside those closest to the epidemic, we can help ensure that scientific breakthroughs reach the people who need them most and move us closer to ending HIV as a public health threat.”
When Odera looks ahead, she sees a community where PrEP is not stigmatized and more women are taking charge of their health: "I really hope to continue doing what I'm doing and enlightening more and more girls, so that we have more champions like me in the future."
