The silent struggles of Kenya’s HIV-positive children left behind

By Daisy Okiring

It’s barely 6 a.m. in Shivakala, a quiet village tucked into the green hills of western Kenya’s Kakamega County.

A sharp wind cuts through the banana trees as 9-year-old Nabiru pulls on his oversized sweater—threadbare and riddled with holes. He slips into worn-out sandals and begins his walk to school, carrying nothing but a tattered book and a dream.

He hasn’t eaten since yesterday afternoon. There’s no breakfast waiting for him. No lunchbox. Only the promise of a classroom and the hope that, someday, he’ll become a neurosurgeon.

“My mum used to say I would be a doctor,” he says, voice small but steady. “When I am in school, I feel close to her.”

His mother died from AIDS-related complications when Nabiru was just two years old. His father passed before he was born. Now, he lives with his grandmother—Mama Nanjala, 89—who relies on a walking stick and occasional help from neighbors. Together, they navigate life on the margins: no steady food, no reliable income, and increasingly, no access to the life-saving HIV medication that keeps Nabiru alive.

A quiet emergency in rural Kenya

The year 2021 marked a turning point in Kenya’s decades-long fight against HIV. After the US Agency for International Development (USAID) cut ties with the Kenyan Medical Supplies Authority (KEMSA) over alleged mismanagement, a standoff emerged that left shipments of HIV antiretroviral drugs stuck at the port of Mombasa for months.

For the over 1.5 million people living with HIV in Kenya, the ripple effects were devastating. Clinics ran dry. Community health workers scrambled to ration supplies. And for children like Nabiru, the shortage meant days—sometimes weeks—without medication.

Empty shelves at a rural dispensary in western Kenya during the 2021 ARV shortage. Children were the hardest hit. Photo/Reuters

“I missed my drugs three times last month,” Nabiru says softly. “Sometimes they tell us to share tablets, or to come back later when they have more.”

For pediatric patients, such interruptions can be fatal. Children are especially vulnerable to viral rebound and drug resistance when their treatment is inconsistent. And yet, in villages like Shivakala, families had little choice.

“We had no pediatric drugs for months,” says a nurse from a rural health dispensary near Nabiru’s village. “Some parents started crushing adult tablets to give to children. It’s dangerous—but when you’re desperate, you do what you must.”

Invisible wounds: The stigma children carry

Even when medication is available, children with HIV face another battle—one much harder to treat.

“Sometimes the other children don’t sit with him,” says Mr. Khisa, Nabiru’s teacher. “There are rumors. They say he’s cursed. That he’s dirty.”

He watches his student with growing concern. Once lively and curious, Nabiru now often stares out the window in class, withdrawn and distracted.

“He struggles to concentrate,” the teacher says. “His moods change fast. He isolates himself. It’s not just the illness—it’s everything that comes with it.”

At school, Nabiru struggles with concentration and isolation. ‘His moods change quickly,’ his teacher says. Photo/Courtesy.

In Kenya, stigma around HIV remains entrenched, particularly in rural areas. A 2008 Human Rights Watch report found that children living with HIV are often excluded by their peers and even mistreated by caregivers. Health workers confirm that some families avoid local clinics for fear of being seen—opting instead to travel hours away to seek treatment in secret.

For Nabiru, silence has become survival.

“I don’t tell anyone,” he says. “Even my best friend doesn’t know. If they knew, they might not play with me.”

Left behind by a system that promised more

In many ways, Kenya has made progress. Since the early 2000s, international donor support helped scale up HIV treatment nationwide. But as Kenya’s economy grew and it graduated to lower-middle-income status in 2015, donor support began to shrink. Programs once heavily funded by PEPFAR and USAID are now being handed off to the government.

But the transition hasn’t been smooth.

In 2021 alone, at least 18 counties—including parts of Kakamega—reported stockouts of essential HIV drugs. Pediatric formulations were hit hardest. Caregivers reported having to collect drugs weekly instead of monthly. Some missed appointments entirely due to lack of transport or food.

Mama Nanjala sighs as she recounts one such day.

“The clinic said to come back next week,” she says. “We walked there, far, and they said no medicine. He cried that night. He thought he was going to die.”

With only her little farm and support from neighbors, she can barely afford food. Most nights, she shares a plate of maize meal with Nabiru—if they’re lucky. On bad days, they go without.

The dream that refuses to die

Still, each morning, Nabiru wakes up and walks to school. He sharpens his pencil, opens his books, and tries to focus—even as hunger gnaws at his belly.

“I want to help children like me,” he says. “When I become a doctor, I will give medicine to everyone.”

He is among over 100,000 children in Kenya living with HIV, according to the Ministry of Health. Many of them are orphans. Many are raised by aging grandparents. And many, like Nabiru, continue to dream in the face of overwhelming odds.

“This boy is special,” says Mr. Khisa. “He’s bright. He’s kind. He just needs a fair chance.”

Can Kenya protect its most vulnerable?

Advocates argue that children like Nabiru should never have been put at risk.

“This crisis was avoidable,” says Rachel Mbugua, a member of the Kenyan HIV Advocacy Network. “The government failed to act quickly. Donor politics should not cost lives—especially not children’s lives.”

Dr. Amos Abimbola, who studies drug access in sub-Saharan Africa, agrees. “Kenya must build resilient supply chains and invest in its own health systems. Relying entirely on foreign aid leaves us vulnerable.”

While USAID has since resumed some support, and supply chains have begun to recover, the damage lingers. Families are still rebuilding trust. Children are still catching up on lost treatment. And for many rural communities, the scars run deep.

A future worth fighting for

As the sun dips behind the hills of Shivakala, Nabiru returns from school and lights a kerosene lamp. He flips through his science book slowly, mouthing each word. His grandmother watches from her stool, knitting together frayed pieces of fabric.

“He will be someone,” she says. “He has a purpose.”

And perhaps he does. In a country still grappling with inequity, silence, and stigma, the story of one boy walking to school without food—but never without hope—is a reminder of what’s at stake.