Hungry, Kenya Fights AIDS

Kenya 2012

By Juliana Resende

June 20, 2012

Also published at BR Press

“HIV is a national disaster.” These are the words of Dr. Bashir M. Issak, director of the Reproductive Health Division of the Ministry of Public Health and Sanitation in Kenya. He is referring to the deadliest periods of AIDS in the country and in the world, such as in 1999. As a microcosm of Africa, a panoramic of the illness in this sub-Saharan African nation speaks volumes about the impact of the HIV treatments on the continent, the theme of this third report that the BR Press has produced in Kenya, at the invitation of the International Reporting Project (IRP).

Rose Cangua

Photo: Juliana Resende/BR Press

Currently, HIV kills fewer people than does malaria, a long-established disease and one with whom the AIDS virus encompasses 50 percent of the annual health budget in Kenya. This corresponds to less that 5 percent (US$3.2 billion) of the Gross Domestic Product (around US$65 billion), divided between general services (35 percent) and reproductive health (15 percent). Kenya has one of the highest rates of population growth in the world, with nearly one million babies born per year, despite the HIV epidemic. There are close to two million HIV-positive individuals within a population of 38 million Kenyans. Fifty percent of the population lives on less than US$1 per day.

Tomato and corn vendor Rose Cangua, age 40, is one of those people living with HIV in subhuman conditions—without electricity, running water, or sewage—in Kibera, the largest slum of Nairobi and of sub-Saharan Africa. She learned of her status three years ago when her husband died of AIDS, leaving her with five children, the youngest of whom, age 4, was infected. Both mother anc child take free antiretroviral drugs, provided by the NGO Doctors Without Borders (and paid for by the government, according to Dr. Isaak), but they don’t have access to a meal every day. In Kenya, it is estimated that between 25 and 40 percent of those who are HIV positive are women between 20 and 30 years of age.

Collateral Damage

“Malnutrition is a huge challenge to the treatment of HIV, and it drives the need for more effective public policies,” says Dr. Kayla Laserson, director of the Kenyan Medical Research Institute of the Centers for Disease Control and Prevention (KEMRI/CDC), one of the world’s largest centers for the research and treatment of illnesses. KEMRI/CDC works with the Global Health Initiative and is funded by the U.S. government, which invests US$12 million annually into the HIV program. The virus has nearly twice the prevalence among 15- to 49-year-olds in the province of Nyanza (14.9 percent) than in the rest of Kenya (7.4 percent). Thirty years ago, KEMRI/CDC settled in Nyanza to research malaria, the other strength of the institution.

KEMRI/CDC serves and follows nearly 30,000 patients and has already tested almost 200,000 in Nyanza. It is not surprising, then, that it was in this predominantly rural region, served by the third-largest city in Kenya, Kisumu, where this reporter accompanied the counseling and HIV testing by KEMRI/CDC agents of a couple living below the poverty line. The process is completed in the patient’s home, where they experience more privacy.  Although testing is a sine qua non condition in the treatment and control of the illness, the reporter sensed a little anxiety and resistance on the part of the couple. According to Laserson, “Here [in Nyanza] there is much less stigma. People live with and talk about HIV. It’s better to have a larger number of HIV-positive individuals aware of their status and in treatment,” she finishes.

Breaking the Cycle

In the case of Eston Wambedha, 34, and his wife, Florence Achieng, 20, testing was consensual, after much discussion and the promise of confidentiality. Both authorized the test done on-site, plus an additional confirmation in a laboratory. However, the husband already knew that he was positive and appeared to want to know the status of his partner. He assured the health agents that since he had tested positive he began to use condoms during sexual relations, a dubious assertion given the relationship of dominance that men have over their wives in Kenya, the cultural acceptance of polygamy, the precarious lifestyle of extreme poverty, and, especially, the demonstration on the use of condoms that the agents insist on performing on the visit.

Still, the fact that in 2011 actions by KEMRI/CDC had reduced the infection rate between couples of discordant HIV status by 96% by administering antiretroviral drugs as a prophylaxis to the negative partner shows that they have made excellent progress in breaking the cycle of HIV transmission. But once again, without adequate nutrition, hygiene, and basic infrastructure, it will be difficult to achieve healthy lifestyles, even though treatment is generally sustained and exhibits both adherence and efficiency. “There has been immense progress in the treatment of HIV/AIDS, but there is still much to do,” admits Laserson. In this context, it’s clear that HIV is a problem and has a high cost in order to be fought, if not prevented. But absolute poverty is still the most terrifying face of underdevelopment in Kenya and the fight for survival.

Juliana Resende, writer/editor for BR Press, is blogging from the International Reporting Project's reproductive health-themed trip to Kenya. This article was translated from Portuguese by Dominique Mack.