ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
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December 1 - 15, 2011
ISSUE 052
A bimonthly newspaper by the Media Diversity Centre, a project of African Woman and Child Feature Service
Trust Fund to bridge donor gap Shrinking support creates need for alternative sources
By ARTHUR OKWEMBA As we celebrate World Aids Day, we have to confront the fact that funding channelled towards HIV/Aids treatment and care is shrinking. This means there is need to find alternative ways of funding these important initiatives in an effort to save lives and prevent new infections if we are to achieve the target of getting to zero as captured in this year’s theme. The United States President’s Emergency Plan for AIDS Relief (PEPFAR), which supports half of the patients on treatment, for instance, has indicated that it is not going to increase the current HIV/Aids funding for the next four years. There are concerns that even if PEPFAR agrees to continue funding HIV/Aids programmes after 2014, when the current funding comes to an end, the amount is likely to remain the same or be less. The Clinton Health Access Initiative, the main funder for HIV treatment programmes for children, had indicated that it will stop any further procurement of paediatric Antiretroviral (ARVs) drugs by end of September 2011, according to NASCOP’s Kenya Anti-Retroviral Drugs Stock Situation-December 2010. Official communication on the final closure of the funding is yet to be made public. With this funding coming to an end, the Government is expected to provide budgetary allocation to take over 35,000 children currently receiving treatment and care services or scout for a donor to assist with regards to funding. Continued on page 4
Thirty years since the first case of HIV/Aids was reported, stigma remains a major issue while challenges face funding for antiretroviral therapy. Efforts to get a vaccine remain a dream, though researchers at Kenya Aids Vaccine Initiative are now testing on human beings. Pictures: Reject Correspondent
“Using external funding to run HIV/Aids programmes may not be sustainable in the long-run. We need to start thinking more of how to use resources generated locally to finance these programmes.” — Dr Ibrahim Mohamed, the Head of National Aids and STD Control Programme
Read more Reject stories online at www.mediadiversityafrica.org
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
New Constitution defends widows’ rights As we mark this year’s World Aids Day, women who were harassed, intimidated and frustrated after the death of their husbands may soon no longer be sad. Millions of widBy ODHIAMBO ORLALE ows now have a special reason to smile. Unlike in the past when they were left at the mercy of their inlaws to inherit them whether they liked it or not, under the new Constitution and specifically through ried to their husbands beyond the grave. That the Marriage Bill, widows have a retrogressive argument was also used by inright to consent to or reject such a proposal. laws to disinherit their daughters-in-law who The Bill, which is still being reviewed by the failed to comply with the unwritten traditional public at forums organised by the Constitutional laws. Implementation Commission (CIC) chaired by The Government and other stakeholders Charles Nyachae, states in Article 11 that: “No took a deliberate stand to fight the practice, marriage shall be contracted except of the free blamed for increasing HIV/Aids among marwill of each of the partners.” ried couples and the youth. This was done While the issue of women’s rights has always through public awareness campaigns in media, generated a lot of debate, this particular one was workshops, seminars, funerals, weddings and at not left out either during a recent forum in Naichief ’s barazas. robi presided over by commissioners Catherine Mumma and Philomen Mwaisaka. Members of the Luo Council of Elders were Since then, various studies have revealed a at pains to educate participants on the controhigh HIV prevalence among a number of key afversial tradition saying the media has focused fected groups, including commercial sex workonly on the negative aspects. Their counterers, injecting drug users, men who have sex with parts from the Nchuri Ncheke and officials men, truck drivers and cross-border mobile from the civil society were adamant that the populations. practice was inhuman and outdated in this day Women were disproportionally affected and age. by HIV. In 2008-2009 HIV prevalence among women was twice as high as that for men at eight percent and 4.3 percent respectively. In recent times, cases of widows being forceThis disparity is even greater in young women fully inherited by in-laws, especially in western aged 15-24 who are four times more likely to Kenya, whether they had tested for HIV or not become infected with HIV than men of the was the order of the day. same age. The real life stories have not only been shockKenyan women experience high rates of ing but also very horrifying. In some instances violent sexual contact which is thought to conwidows and even orphans have been battered, tribute to the higher prevalence of HIV. raped and/or defiled exposing them to sexually In 2003, a nationwide survey indicated that altransmitted diseases including HIV. most half of women reported having experienced The argument then was that under customviolence and a quarter of women aged between ary law, widows had no rights and were mar-
Women affected
Wife inheritance
12 and 24 had lost their virginity by force. The adult HIV prevalence is greater in urban areas (8.4 percent) than rural areas (6.7 percent) of Kenya. However, as around 75 per cent of people in Kenya, with a population of 40 million, live in rural areas, the total number of people living with HIV is higher in rural settings (one million adults) than urban settings (0.4 million adults).
Constitutional provisions
However, the new Constitution gives widows and women in general the right under the Bill of Rights to associate with and/or marry whoever they so chose. In Section 45 of the Constitution on family, it states: “(1) The family is the natural and fundamental unit of society and the necessary basis of social order, and shall enjoy the recognition and protection of the State.” And in (2) “Every adult has the right to marry a person of the opposite sex, based on free consent of the parties.” So as Kenyans commemorate the World Aids Day, there is light at the end of the tunnel for widows to control their sexuality and chose either to remain single or to be remarried by a man of their choice as a first step of preventing the spread of the disease which has taken its toll on the country’s population. The campaign got a recent boost following the launch of an Equity HIV Tribunal, the first of its kind on the continent. During a visit to the country recently, the UNAIDS Executive Director Michel Sidibe, singled out Kenya for being among the 56 countries of the world that had made steady progress in availing HIV treatment to its citizens. He alluded that Kenya also scored well in HIV prevention programmes such as reducing the vertical prevention of HIV transmission. “This Equity Tribunal links human rights, not only with the HIV epidemic but also with the much needed social equity,” noted Sidibe.
Tribunal set up to handle cases on HIV By DUNCAN MBOYAH The Government has put in place a tribunal that is expected to arbitrate on behalf of people living with HIV who are denied employment opportunities, insurance covers or thrown out of their homes due to their status. The tribunal fills a vacuum that has existed in the protection of the rights of persons infected and or affected by HIV. “Instances when the fundamental rights and freedoms of both the infected and the affected have been contravened without being remedied is now long gone,” noted Prof Alloys Orago, Director of National Aids Control Council (NACC). Orago said stigma against people living with HIV has been on the increase and this has affected efforts in HIV management and programming within communities.
Framework
The tribunal is part of the institutional framework established under the HIV and Aids Prevention and Control Act 2006 that provides an enforcement mechanism for the Act. The tribunal is part of a legal framework for the management of HIV and Aids. “Already several cases have been handled and most of them resolved by the tribunal,” noted Orago. The Constitution has established a strong framework for the observation and enforcement of fundamental human rights and freedoms. The tribunal’s role in the enforcement of human rights as mandated in the Act is expected to supplement the broad objective of fundamental human rights and freedoms under the Constitution. The Aids pandemic has presented huge chal-
From left to right, Prof Alloys Orago Executive Director National Aids Control Council (NACC), Esther Murugi, Minister for Special Programmes, Maureen Murenga of National Empowerment Network of People Living with HIV/Aids in Kenya (NEPHAK) and Prof Mary Getui NACC Chairperson during the launch of the national Aids Tribunal recently. Picture: Duncan Mboyah lenges to the economy given that the number of infected people continues to rise. Some of these challenges border on violation of human rights of persons living with HIV/Aids and those affected by the pandemic who are equally violated. The tribunal is chaired by lawyer Ambrose Rachier. Other members are Joy Asiema, Mohammed Kullow, Prof Julius Kyambi, Dr Ephantus Chomba, Angelino Siparo and Joe Muriuki. The tribunal, which will work under the office of the Attorney General will handle legal
issues relating to HIV, including discrimination against people living with HIV and protecting the confidentiality of medical records. It has the status of a subordinate court with the right to summon witnesses and take evidence. Some of the cases lined up for the tribunal include discrimination against people living with HIV at work places, in schools, colleges, at foreign embassies and even at home. According to the Act, it is an offence to conduct an HIV test on a person with disability or a minor without the written consent of a guardian.
Misconception on TB fuelling discrimination By HENRY KAHARA In as much as progress is being recorded in Tuberculosis treatment and awareness, it has emerged that there is a lot of stigma with the public and medical practitioners. There are many people who assume that once somebody has been diagnosed with Tuberculosis, they are HIV positive. However, according to Dr Videli Duba from Kisumu, this should not be the case and more awareness needs to be created to reduce the stigma and misconceptions. “Some people think that if you have TB you are HIV- positive yet this is not true, you may have HIV but you don’t have HIV and vice versa,” noted Duba. While stigma remains a challenge, Kenya is on the way to winning the battle against tuberculosis. However, the success will only be viable if funds to battle the disease continue being channelled through the right channel. It is anticipated that increase of funds to address TB will help in achieving Millennium Development Goal number six which seeks to combat HIV/Aids, malaria and other diseases. Among the targets is to see TB reduced. Speaking during the Second Kenya International Scientific Lung Health conference at Kenyatta International Conference Centre (KICC), Dr Benard Lang’at noted: “Kenya is way above international pattern for last year we were able to treat successfully 47 per cent out of the target 50 per cent.”
Technology
Currently, Kenya has the latest tool, gene expert which is used to detect the TB virus. The machine is able to detect very low amount of germs and can give the results in a period of less than two hours, making it easy to embark on treatment. “The machine is helping us to diagnose the problem easily and, therefore, making it easier for us to treat the patient on the problem direct,” explained Duba. He noted that there is need for new TB vaccine as BCG which was developed 90 years ago has not been improved since then and, therefore, has a lot of challenges. “BCG is not recommended for use in infants infected with HIV. It is clear that a new TB vaccine along with other new tools are is needed to meet global goals that target to eliminate it,” said Duba. Giving her real life experience on the Multi Drug Resistance MDR-TB Luceta Nkatha,24, said that she has been diagnosed with the disease four times now. Nkatha, a tutor from Meru says the disease has cost her much for she has been in and out of hospital many times. “I was first diagnosed with TB in 2007. I was treated and was well but when I went back to the hospital after two months, similar symptoms were discovered,” says Nkatha. She adds: “The doctor broke the bad news that I was suffering from TB again.” The situation kept on recurring until she was transferred to Kenyatta National Hospital for further treatment. “At this time it was my fourth treatment. I was weak and weighed 36kg. My health had deteriorated so much I was forced to bend when walking,” explains Nkatha adding that it was hard for her. Up to date Nkatha says that she is yet to recover completely.
ISSUE 052, December 1 - 15, 2011
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Unfiltered, uninhibited…just the gruesome truth
Struggle to find sustainable financing of HIV By DUNCAN MBOYAH Since the first Aids case was reported in Kenya in early 1980s, the country has relied on donor funding in its fights against the scourge. Currently, the bulk of financing of HIV/ Aids comes from development partners that contribute over 70 percent of finances for management of programmes that include availing of antiretroviral (ARVs) to those infected. Currently, Kenya faces significant challenges in funding its programmes to provide expanded HIV/Aids services to people living with HIV. “We do not have money yet the number of newly infected people continues to increase forcing us to think otherwise,” said Prof Alloys Orago, Director of National Control Council (NACC) during an interview. Following a partnership agreement signed between the Kenya Government and United States of America, the Government is expected to increase support for the sector to enable American government avail support worth KSh510 million in the period between 2010–2014.
Sustainability
Over the years, donor supported for HIV/ Aids has stagnated as some donors express their intention to offload persons on ARVs to the Government. Considering that 2014 is not far away, the Government has come up with a self-sustaining way of serving the people living with Aids better given that 11,000 people get infected every year and require ARVs. “We currently have 400,000 people living with HIV who are on ARVs whereas over 750,000 HIV positive persons are in need of the ARVs,” noted Orago. Significantly, much of the resources used to finance the current strategy are derived from the donors and now the Government has to progressively start increasing domestic and sustainable resources. “These are our people and we must look for sustainability for those on treatment by asking Kenyans to start owning HIV programmes and other health care programmes,” observed Re-
gina Obam, NACC head of strategy. Besides sustainable financing, Obam noted that NACC has plans of starting a HIV trust fund that will be funded from the lottery, air levy, airtime levy, unclaimed assets in the banks and philanthropists. She noted that the trust fund has been proposed as a sustainable mechanism for scaling-up care and support for HIV/Aids in Kenya. Since all government institutions Aids activists protesting over threats by the United States government to withdraw funding including ministries, state corporafor ARVs. Currently many Aids programmes are faced with challenges of funding and the tions and parastatals are involved in the fight against HIV/Aids, more regovernment of Kenya is struggling to find alternative sources. Picture: Reject Correspondent sources will be managed at a central place. ue their support. tegic and programmatic goals. It would also “For accountability and prudent manageCHAI will be exiting Kenya as a funder for identify and assess potential strategies for rement of the fund, this has to be devolved from paediatric ARVs after the present fiscal year, ducing any expected resource gaps. the government control while at the same time 2010-2011. This will open a gap in the resourcThis is important given a social responsibila delivery mechanism has to be determined by es for paediatric anti-retroviral therapy across ity to improve health outcomes for the People consulting the stakeholders,” noted Obam. both drugs and diagnostics. Living with HIV (PLHIV) requiring care and From 15 public service delivery points in Therefore, there can be no expectation that treatment, many of whom are not currently 2003, antiretroviral therapy services were prothe overall funding from PEPFAR will increase, reached by the services. vided at 700 sites by December 2008, and the or that funds will be repurposed to address the Kenya has a financing gap of $959 million numbers continue to grow. gaps in one functional area over the other. over 2010-2013 in HIV treatment and care “We are also planning to manufacture our Overall, the resources in this function area alone yet the year 2010-2011 represents the last own ARVs and condoms to help reduce costs will diminish, while due to scale-up the targets year with fairly predictable sources of funding on imports besides asking research institutes to and hence the need will continue to increase. for HIV/Aids treatment and care. become innovative towards helping the counAdditionally, the application of new treatment The active external funders including the try come up with home grown solutions,” exguidelines for prevention of mother to child US government’s funding through the Presiplained Obam. transmission will require additional resources dent’s Emergency Programme for Aids Relief The sustainability analysis is to assess rethan were initially estimated. (PEPFAR), the Clinton HIV Aids Initiative source needs and gaps for meeting established (CHAI) and the Global Fund for Aids, TB, and targets, improving quality as well as other straMalaria (Global Fund) are unlikely to continThe cost of drugs for first-line ART treatment used to be prohibitive, but have recently reduced. However, the average annual cost of first-line ART per person is still close to $200 (not inclusive of laboratory costs at initiation or related to clinical monitoring), which makes it difficult to finance through out-of-pocket mechanisms for middle-class patients. Kenya, just as other countries, has decided to switch from a previous mainstay of the — Prof Alloys Orago fixed-drug combination, stavudine, towards a more effective, less toxic, but more expensive drug tenofovir.
Reduced cost
“We do not have money yet the number of newly infected people continues to increase forcing us to think otherwise.”
Counterfeit ARVs pose challenge to consumer safety By PAM INOTI In September, the Kenya government was faced with a daunting task of ensuring that all counterfeit antiretroviral drugs were recalled from the market and those already issued be returned to Government pharmacies. The ARVs were found to be falsified versions of a World Health Organisation (WHO) certified generic drug purchased through a distributor endorsed by the Kenya Pharmacy and Poisons Board (KPPB), the country’s drug regulatory authority. Minister for Medical Services, Prof Anyang Nyong’o assured stakeholders and survivors that investigations were being carried out by relevant authorities to seal the loopholes. “As a government we take very seriously issues of treatment of HIV/Aids. Loopholes at times do exist but when we learn our lessons, we work to seal them,” observed Nyong’o as he emphasized on the Government’s HIV stand. According to WHO specifications, a coun-
terfeit drug is one that is deliberately and fraudulently mis-labelled with respect to identity source. WHO further notes that counterfeit drugs can apply to both branded and generic products.
High rates
Noting on the importance that should be attached to consumer safety, Kenya Association of Manufacturers (KAM) lamented that the level of drug counterfeiting in Kenya is unacceptably high and drastic measures must be taken to thwart the trend. Nelson Otuoma, coordinator of the Network of People Living with HIV and Aids in Kenya (NEPHAK) was appalled about the falsified versions of ARVs, saying, “it is very scary, especially with a disease whose treatment calls for strict adherence to a regimen”. He termed the careless slip as a measure that outrightly jeopardised treatment of those living with HIV in Kenya. “The Government’s drug procurement
system is riddled with corruption and unless counterfeit drug issues were stringently addressed, the risk of fake drugs penetrating the market will continue to pose a threat to consumers,” noted Otuoma. Health experts say it is crucial for the government to urgently address the situation in order to allay fears and retain the confidence of people living with HIV in the Government’s ability to provide them with effective medical care. While the Government was able to retrieve the counterfeit medication from various pharmacies, it has not been able to get the batch that had already been consumed or is in the hands of consumers who were not aware of the unfolding situation. This is especially in rural areas where access to the right information is limited. Despite being frequent end users, some consumers may also not be aware of any changes to the appearance of the drugs, to raise concern with the drug suppliers. Other pharmacies are operated by quacks
who knowingly obtain their stock from suppliers who thrive on counterfeit drugs. A consulting physician familiar with ARVs at Kenyatta National Hospital is of the view that once drugs are recalled, it is illegal for any medical personnel to prescribe such medication or for any pharmacy to distribute them.
Anti-counterfeit agency
Kenya published the Anti-Counterfeit Act of 2008, and in early 2009 created an AntiCounterfeit Agency to combat counterfeiting and trade in counterfeit goods. The law also extends to counterfeit medications, which are among the most counterfeited items in the country. The Act proposes stiff fines and prison terms extending up to 15 years for those caught trading in counterfeit goods. As a subsequent to the Anti-Counterfeit Act of 2008, the Anti Counterfeit Regulations 2010 were published under legal notice no. 126/2010 on August 27, 2010 and entered into force with immediate effect.
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Better management of HIV make women safer By ARTHUR OKWEMBA One morning, seven years ago after an animated discussion with her husband about conceiving their second child, Mary Alividza left to see a doctor about her recurring cough. The doctor, among other things, requested for a HIV test to help him determine what was causing this cough. That is when she learnt about her HIV positive status. Immediately, her life and plans changed. She decided she was not going to have more children for fear of transmitting the virus to her unborn baby. This decision invited violent reaction from husband and relatives. Since then her life became a nightmare. The relatives demanded that she either gives birth to more children or allow him marry another woman who was going to do so.
Violence
“I was subjected to verbal violence by relatives. Some even roughed me up but I stood my ground,” recalls Aids activists demonstrate in the streets of Nairobi calling for an end Alividza. “What they did not know to discrimination on those who are living infected or affected with HIV. were the reasons why I had refused Picture: Reject Correspondent to conceive. My husband never defended me and hence the continuous violence.” Globally, one in to the baby, more women, and couples are willAlividza is just one of the many HIV positive three women endures ing, to have babies. women who have experienced gender based vidomestic violence, is “We are seeing more HIV positive women olence at the hands of their husbands, partners, coerced into sex, or is willing to get pregnant and getting the support and relatives for refusing to get pregnant. Howabused psychologically of their husbands since they are convinced all is ever, in the past couple of years, things have during her lifetime. well with their baby,” explains Patel. changed with the advent of new technology. Other surveys from Such trend is reducing violence against Statistics from various hospitals where an efaround the world show women as they are to meet their biological fective prevention of mother to child transmisthat between 10 and needs without much stress and fear of violence. sion is being run indicate that over 70 percent of 50 per cent of women Agnes*, says with the aid of antiretroviral children born by HIV positive women are HIV are victims of physical drugs, she has managed to give birth to two negative. abuse by their intimate HIV negative babies. “With the current technology and knowlpartners at some point “I feel normal like any other woman and edge as well as good facilities, there is no need in time during their my husband, relatives and friends treat me the to deny a woman who wants to have a baby the lifetime. Experts say HIV positive women are same. The most reassuring thing is giving birth opportunity to do so,” says Surendra Patel, an included in this category. to a negative child when you are HIV positive.” adjunct Professor at the University of Nairobi However, HIV pundits agree that with betRecent studies indicate that gender based College of Biological and Physical Sciences. ter HIV management leading to better quality violence perpetrated against persons who are “Times that doctors never gave women this opof life, people are going to treat the disease like HIV positive, especially women, is taking away tion are long-gone.” any other chronic illness. Consequently, all oththe beauty of motherhood. HIV positive women He adds: “Chances of an HIV positive womer forms of violence against women, and even who cannot give birth receive double share of the an who has been following the doctors’ instrucmen who are HIV positive, is going to reduce violence: discrimination and abuse (especially tions well in giving birth to a HIV negative baby or be eliminated completely. verbal and emotional) for not giving birth. are extremely high.” What is worrying, however, is access to This type of violence is said to be the most
Assurance
However, while these outcomes are highly celebrated, another positive dimension of the improved access to anti-retroviral therapy (ARVs) and other technologies that has not received much attention is the reduction of violence against women. With the assurance that the use of antiretroviral drugs in combination with caesarean section significantly reduces the chances of viral transmission
pervasive form of human-rights abuse worldwide.
ARVs and other technologies that contribute to reduction of this gender-based violence, is not
“Chances of an HIV positive woman who has been following the doctors’ instructions well in giving birth to a HIV negative baby are extremely high.” — Prof Surendra Patel
assured. Major funders of Prevention of Mother to child Transmission initiatives, treatment and other HIV care programmes are either reducing or stopping funding.
Vaccine research
Apart from the financing problems, the future is promising. This year witnessed massive advances in vaccine research. Kenya AIDS Vaccine Initiative is now conducting human trials on three vaccines: two in adults and one in babies. Better ARVs drugs have been developed, which is likely to increase the adherence rates and reduce death rates. The Government has launched a policy and guidelines that specifically focus on Women and HIV/Aids, with the aim of protecting them from HIV infections and HIV related gender based violence. Indeed, this is the true spirit of this year’s theme.
Shrinking support creates need for alternative sources
Continued from page 1 Global Fund on the other hand has been unable to realise its desired funding which might have adverse future implications on the funding extended to Kenya. In October 2010 at the Fund’s Third Voluntary Replenishment meeting in New York, donor governments pledged $11.7 billion for 2011-2013, but this was less than the $13 billion ‘lowest funding level’ identified by the Fund as necessary to continue to expand its work and far less than the ‘ideal’ $20 billion objective. “As a result, expanding access to prevention, care and treatment programmes will be more difficult and efficiency savings (such as provid-
ing money only to those countries that are seen as ‘the worst affected’) may have to be considered,” says AVERT, an HIV/Aids charity organisation based in the UK in its recent newsletter.
Over reliance
In the 2010-2011 national budget, KSh900 million was allocated for the HIV treatment and care programmes. People living with HIV/Aids have said the amount should be increased and confirmed as a budgetary support line given every year. The problem with heavy reliance on external funding is that it is not assured. “Using external funding to run HIV/Aids programmes may not be sustainable in the long-run. We need to start
thinking more of how to use resources generated locally to finance these programmes,” Dr Ibrahim Mohamed, the Head of National Aids and STD Control Programme (NASCOP) has argued on several occasions. Several proposals have been made to government to ensure sustainable HIV financing. One of the proposals by NACC’s Technical Working Group that seems to be gaining popularity in the HIV and Aids circles is the establishment of an HIV and Aids Trust Fund to which the Government, donors, the private sector, and individuals will make contributions. There are proposals that money to go into this Fund can be raised from sources such as levy on air travel, mobile calls, Internet usage,
and remittances from the Diaspora. Studies have shown that if done well, levies such as these can raise huge sums of money. Last year, Technical Working Group on Sustainability for HIV/AIDS estimated that a modest levy of $2.5 (KSh200) for each air passenger ticket (international and domestic) along with $0.05 levy on each tonne of air freight would yield $160 million (KSh12.8 billion) without affecting the demand for such airline services. The Fund is, however, seen as short-term measure in response to ensuring the HIV and Aids treatment, care and prevention programmes are sustainable. A long-term measure is to enrol many households on the National Health Insurance Fund (NHIF).
ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Discovery of Aids vaccine best way to manage pandemic By HENRY KAHARA As we celebrate World Aids Day, the big question that is lingering in almost everybody’s minds is whether a cure for Aids will ever be found. Experts have been and are still in the field with researchers keenly being on the lookout for the first person to come up with a solution for the killer disease. According to Professor Walter Jaoko, Deputy Programme Director of Kenya Aids Vaccine Initiative (KAVI, it is not late for the HIV vaccine to be developed. “Experts have not given up. We are still trying to see whether we can come up with an Aids vaccine,” observed Jaoko. He said that there are for some vaccines took more than 40 years to be discovered, a longer time than the Aids vaccine has taken. “It took experts 47 years for them to discover the polio vaccine while whooping cough vaccine took 20 years, going on with this there is still hope,” Jaoko said adding that it is only 28 years since experts started searching for the Aids vaccine.
Vaccine types
Professor Omu Anzala (right) Director of Kenya Aids Vaccine Initiative (KAVI) and his deputy Prof Walter Jaoko (left) in the laboratory at Kenyatta National Hospital where they have been working towards development of an Aids Vaccine. Picture: Arthur Okwemba
Jaoko stressed that there are different types of vaccines all of which have one purpose. “We have different types of vaccines — live, killed, vector and synthetic — but all of them are meant to protect individuals from being infected by the said disease.” He explained that for a vaccine to be approved, it has to be tested in a period of six months to one year as their reaction is studied. The test starts in small animals like mice and monkeys, if it succeeds in monkey then they move to human beings where it is has to go three phases.
“The first step starts with a small number of 15 to 30 people where doctors get to study it before succeeding to the next phase where the number is increased to 100-200 before proceeding to the third and final phase (three) where it is tested in a range of 5,000 to 10,000 people,” explained Jaoko. He noted that it is only possible to go to the next phase if one has succeeded in the one they were in. Although the test is done in human beings, Jaoko said that it can only done if experts are 100 per cent sure that it is safe to do so. For the five HIV vaccine trials which have been conducted world since 2001, scientists
have only succeeded up to the second phase and failed to go to the third phase after the results were not progressive. “The one which was most successful was done in Thailand but currently there some other three on- going tests where two adults are involved,” he observed. According to Jaoko vaccines are the among the most cost effective and efficient tools to fight infectious diseases. “Aids vaccine, integrated with existing prevention and treatment strategies is the best hope for controlling and eventually mending the pandemic,” he reiterated.
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Government hospitals best for managing HIV By BONIFACE MULU Diseases that affect the blood diseases such as anaemia and leukaemia (blood cancer) can be life threatening and dealing with them demands great care. This also includes diseases such as HIV and Aids infection. According to the Kitui District Hospital medical officer of Health Dr Celestine Matei, the diseases that are life threatening must managed at a hospital. “Blood diseases should be treated at the general hospital while other diseases such as malaria can be treated at a private clinic,” said Matei. She noted that it is only Government hospitals that have the technological expertise for screening blood for blood transfusions in the country. She was lecturing participants during a oneday HIV/Aids training seminar organised by the Kitui Rural Girl Development Project at the Maendeleo ya Wanawake offices in Kitui town. The meeting was supported by the Kitui Central Constituency Aids Control Committee. Matei noted that government hospitals offer quality services because they have technical and trained people. She advised on the importance of knowing one’s HIV status and recommended that people visit Voluntary Counselling and Testing (VCTs). As she created awareness on HIV/Aids, Matei reiterated the fact that there were different strains of the virus. She said those who were living with the infected must try and feed them on carbohydrates, proteins and protective rich foods. “We have HIV patients in our community and in other parts of the country. So we are all affected and must try to prevent infections,” she said. Matei observed that the Government had a policy on prevention with positives. This includes prevention from mother to child transmission (PMTCT. She, therefore, advised pregnant mothers to go to hospital early and start clinic at 12 weeks. “If found to be HIV positive, they should be given the AZT/3TC medication at 14 weeks,” said Matei.
Children remain biggest victims as poverty fuels sex exploitation By JOY MONDAY It is 1.30 pm and a group of children are rushing back to school from lunch. Screams are heard from a nearby bush. Shortly, a man emerges from the direction of the screams and walks past the pupils before dashing into a maize plantation. The suspicious children go to the bush to check what was going on and to their disbelief it is their classmate Regina* wailing in pain on the ground. Regina has been defiled. The children report the matter to the school management and she is taken to hospital for treatment. It does not take long before police apprehend and arrest the culprit as investigations commence to facilitate the prosecution of the suspect.
Jury
The suspect is arraigned in court charged with the offence and the magistrate sets the date for the hearing of the case. Come the date of the hearing, Regina and her relatives are missing in court and the magistrate sets another date hopeful that the complainant will appear to provide evidence against the accused person. For the second time, the case fails to proceed and after inquiries, it emerges that Regina’s family is unable to raise fare to attend court. Records at the Kitale Law Court indicate that many defilement and rape cases are pending because the victims are unable to raise the
cost of pursuing justice. Kitale Principal Magistrate Terry Odera acknowledges that the pursuit of justice for children from poor families collapses due to lack of funding to cater for their welfare. “The other day I was forced to raise money for lunch and transport for a child who had turned up for the hearing of her defilement case. She had walked for over 20 kilometres,” Odera said at a workshop organised by the United Nations High Commissioner for Refugees (UNHCR) at Kitale Members Club for court users. Odera said many children abandon cases before hearings due to lack of money to cater for transport from their homes. It was also noted that most lawyers decline to be engaged by the law court to provide probono services and urged the Government to set aside a children’s fund to be given out as stipend to lawyers representing children.
“Many lawyers refuse be engaged in pro-bono service because there is no motivation fee. This denies children justice.” — Justice Martha Koome
“Many lawyers refuse be engaged in probono service because there is no motivation fee. This denies children justice,” noted Justice Martha Koome. The workshop urged for the establishment of a rescue centre in Kitale to accommodate children turning up for court. According to Kitale Catholic Church Justice and Peace Commission (CJPC), at least five cases of sexual abuse are reported daily in Trans-Nzoia County. Many of such cases are not reported to the authority due to poverty and ignorance among the people in the area. This then limits chances of reducing HIV infections as the children, especially, are not protected as they do not get the prophylaxis. The drug when given within 72 hours helps protect against the virus. A report prepared by the CJPC reveals that 1,500 sex abuse cases were reported since last year with a number remaining undisclosed. Rose Obonyo, the Children’s Protection Officer at the UNHCR cites economic, social and cultural related problems to the rising cases of sex abuses in the region. According to the report, there were 784 defilement, 376 rape and 187 sexual assault cases detected and reported to the police. She notes that financial constraints in most families induce the menace with women being exploited sexually by men due to poverty. Brewing dens are the worst hit areas where children under the age of ten are subjected to sex abuses hindering their development.
Children engage in play at school. Picture: Reject Correspondent Pursuance of justice by the victims is hampered by the high cost of legal representation and poverty. “There are many sexual abuse cases going unreported because of bottlenecks such as poverty and ignorance,” notes Obonyo. Statistics at the four Kitale Prisons indicates that majority of the inmates are sex abuse offenders.
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Efforts to have infection among young people reduced By Dorcas Akello An advocacy project has come up with a programme of encouraging youth to use contraceptives. The Tupange Youth project held its first beauty pageant which brought together youths from all walks of life to see who will be the next ambassador for championing the use of contraceptives among the youth. Themed as ‘Miss Fabulous Tupange’, the fashion saw contestants compete for the coveted crown. The contestants who were mainly from the informal settlements were expected to promote awareness in contraceptive use among youth. “Promoting contraceptive and condom use among the youth can lead to decrease in morbidity and mortality due to unsafe pregnancy, abortion and sexually transmitted diseases (STDs) including HIV and Aids,” noted Joab Akuno, Programme Manager for Tupange project. According to Akuno, the programme aims at increasing and sustaining contraceptive use among the urban poor and is expected to contribute to the well-being of the woman, child and entire family.
Information
The Tupange programme has the youth as its primary target population in provision sexual and reproductive health and information. “With the advent of HIV and Aids every effort was put on containing the epidemic and we forgot that there is need to sustain the gains that we had made through the years in ensuring that family planning became part of our culture,” noted Akuno. Reiterating that the rate of unplanned pregnancies in the country is alarming, Akuno noted that a huge number of youth are having unprotected sex. “We must begin to think about the number
“With the risk of teenage pregnancies on the rise, sexually active youth in Kenya need safe, effective and reliable contraception now more than they ever did before.” — Joab Akuno of children we want, we must begin to think about the sizes of our families and think about our population,” explained Akuno. He added: “With the risk of teenage pregnancies on the rise, sexually active youth in Kenya need safe, effective and reliable contraception now more than they ever did before.” He observed: “All people, particularly the adolescents/young people and the underserved are able to exercise their rights to make free and informed choices about their sexual and reproductive health and access to information, sexuality education and high quality services including family planning.” Many governments in sub-Saharan Africa
Contestants for the Miss Fabulous Tupange fashion show on stage during the event. The event sought to find a young person who will be representing the youth in advocating for responsible sexual and reproductive health. Picture: Dorcas Akello view with concern the region’s continued rapid population growth, high birth rates, and escalating rates of HIV infection. Unprotected adolescent sexual activity significantly contributes to these numbers with approximately 41 per cent of the 208 million pregnancies which occur each year being unintended. According to Population Services International (PSI) country director Daun Fest, it is not about promoting specific products but creating awareness in Kenya where it is illegal to have an abortion. Regardless of marital status, preventing unintended pregnancies can prevent unsafe abortions and protect a woman’s from sexually transmitted illnesses including HIV/Aids. Fest noted that the use of contraceptives decreases high incidences of unsafe and botched abortions. “The reality is that as we are presenting choices, the risks related to sexual activity and unwanted pregnancy are among the most serious health risks that young people face,” observed Fest. She added: “This can jeopardise not only their physical health but also have long-term emotional, economic and social well-being.”
According to Fest, young people start sexual activity at about 17 years but without correct information and not knowing the options that are available.
Kibera slums, poverty is the root of all evil,” says Virginia Nduta, 27, a member of the Lang’ata Youth Network. According to Zuhura Abubakar, an Arabic language teacher in one of the Islamic Institutions in Kibera, issues of HIV/Aids are far from being a reality especially within the Nubian Community. Many of the people from the Nubian community hold the existence of HIV from a cultural perspective and this contributes significantly to the spread of the virus especially when it comes to issues of marriage. “In my community, gender violence is rampant as many young women continue to be infected since according to Islamic law, the men are allowed to marry as many as four wives,” says Abubakar, 31. With the above scenario, this raises the question of whether the UNAIDS goals which include the reduction of sexual transmissions by half by the year 2015 especially including among young people will be achieved within the stipulated time considering the challenges at hand. According to an assessment on Youth Reproductive Health and HIV/Aids Programmes conducted by Family health International, young people are at the centre of the HIV/Aids crisis in Kenya and in particular, young women aged 15-24, young men aged 20-30 and out-of-school youth are at greater risk of HIV. The survey continues to mention that the
HIV/Aids epidemic, among other diseases, has continued to negatively impact the health of Kenya’s youth. The survey found that six percent of women aged 15-24 were HIV positive, compared with slightly over one percent among men of the same age. HIV is more prevalent in urban areas at 10 percent than in rural areas at 5.6 per cent.
Critics
She disagrees with critics who argue that contraceptive use increases the risk of contracting HIV by encouraging unprotected sex. “No research has ever proved that any reproductive health product has increased promiscuity,” noted Fest. She added: “In fact much of the research shows that the younger you start education, the more likely you are going to have lower teenage pregnancy.” According to the report by ‘Advocates for youth’, youths encounter significant obstacles to receiving sexual and reproductive health services and to obtaining effective, modern contraception and condoms to protect against sexually transmitted infections. According to the report youth face barriers in the form of laws and policies that prohibit or limit confidentiality in serving young people. Such laws and policies fail to recognise both the youth’s needs and ability to make responsible sexual health decisions.
Poverty influencing risky decisions among youth By RUTH OMUKHANGO
As the world celebrates the World Aids Day 2011 under the theme Zero New HIV Infections, Zero Discrimination and Zero AIDS Related Deaths, for the young people in Kenya these words remain a pipe dream. The youth form about 60 percent of Kenya’s population aged 15 to 35 years, and they comprise 61 percent of the country’s unemployed. For young women like 18 year old Fridah Boke, living in Gatwekera Village in Kibera, the impossibility of achieving this dream is further compounded by the recent hard hitting inflation and economic times that have pushed many young women like her towards challenging lifestyles such as sex work all in the name of putting food on the table. Worse still, with the increase of young female sex workers within the slum, early and unplanned pregnancies and premature marriages that have consequently led to an increase in HIV infections. For Boke, a mother of one living with HIV, life in the slums is not easy. Even though she lives with her mother who cooks and sells mandazi, the meagre earnings are not sufficient to take care of the family which also includes Boke’s other three siblings. Due to the difficult circumstances at home, Boke has eloped twice in an attempt to ease her mother’s burden. However, she has always had to go back home due to her irresponsible boyfriend mostly ending in domestic violence.
Although much blame on the failure by youth in Kibera has been placed on parenting, Boke is quick to comment that most parents do not spend time with their children as they are out chasing a livelihood. Most of them are small scale traders and spend a lot of their time out as they look for ways to fend for basic needs.
Lack of fees
Boke who completed her Kenya Certificate of Primary Education (KCPE) about four years ago was unable to proceed to secondary school due to lack of fees. She says that besides peer pressure, the living conditions in the slums such as the proximity of the neighbours who are usually single or married men whose wives reside upcountry has had an impact on the lives of young women who are either raped or lured into sex for money. This has contributed significantly to the spread of HIV among young people in the sprawling Kibera slum. According to Janet Menya, 24, despite the massive campaign and awareness created on the impact of HIV/Aids in Kibera, the biggest challenge is that young women have fallen prey to “sugar daddies” with multiple sexual partners. These are mainly the landlords within the slums who readily have available resources at their disposal and, therefore, a catalyst to the increase in new infections on a daily basis. “Even though the Bible says that money is the root of all evil, my philosophy is that for
Failed initiatives
Elizabeth Wanjiru, a community worker in Kibera, says despite the many donor organisations working in Kibera on HIV/Aids initiatives, little has been achieved as many of them have taken slum dwellers as stepping stones and therefore have not made any remarkable achievements towards reducing the spread of HIV especially among the youth. Economic empowerment programmes set up have collapsed midstream due to lack of donor sustainability. “There have been initiatives that help empower the young women and especially sex workers economically but these have not been effective because they are short term,” observes Wanjiru. She adds: “Some of them are abandoned midstream and, therefore do not bear any fruit.” According to Wanjiru, sensitisation needs to be accompanied by meaningful and lasting solutions that will empower youth to total change of behaviour. This can only come from consultative effort between the government, donors and the community.
ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
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Stigma, a time bomb waiting to explode By OMWA OMBARA In 2005, a strange incident happened at Kisumu Boys’ High School that left the country trembling with fear and stigma. An English teacher at the school went public about her HIV status on an interview with a leading local newspaper in which she confessed to being positive. In her interview, she encouraged Kenyans that they could still lead normal lives as long as they accepted their status. However, as soon as the story appeared the teacher started facing discrimination from colleagues. Some of the teachers took advantage of the tea break in the staffroom to discriminate against and abuse their colleague. One specific female teacher took the HIVpositive teacher’s tea and poured it out. She further took the cup and threw it in the dustbin. She then made it a daily habit to pour out the tea and abuse the teacher. “My colleague really abused me. She called me a prostitute and warned other teachers that if I continued teaching at the school I will sleep with their husbands and relatives and infect them,” recalls the teacher who now lives in Nairobi. “The next time I went to the staffroom, I found my chair had been broken and thrown out. It was only when the headmaster intervened that I had some relief but I was already deeply traumatised.”
Blame
As if that was not enough, the writer of the story was confronted by members of the public who demonstrated outside the media house and demanded an explanation on why journalists were allowing prostitutes to brag about their HIV infections in the press. After a kangaroo court, the public warned the reporter not to repeat the scandal and forced her to apologise. However, while previously many people who tested HIV positive would not mind going public, incidents like the one that took place in Kisumu has affected people declaring their status publicly. From then on, many HIV activists and survivors who had the courage to speak in public have gone underground. “The moment I appeared on the seven o’clock news on television to protest the fact that the Global World Fund had suspended aid to Kenya on account of corruption, my landlord threw me out,” says Mary Sitati, 41, an HIVpositive activist.
“Neighbours complained that they did not feel safe with me and that they did not want my children to play with theirs. Now I am forced to live in the slums where no one knows me or my children,” Sitati told the Reject. Kenyans are living in denial as stigma entrenches itself at the very core of what could be the turning tide for an Aids free generation. Thirty years after the first case of Aids was reported, there are still may people who are pretending that HIV/Aids does not exist.
Secrets
According to Dr AL Gondi who is a physician most patients refuse to accept the diagnosis and always blame typhoid or Demonstrations against discrimination and stigma in Nairobi for persons who have been malaria for their condition. infected or affected with Aids. They have argued that stigma fuels HIV infections and the “Even within the medical demand for zero tolerance must be accompanied by respect for human rights of the affected fraternity the HIV status of docand infected. Picture: Reject Correspondent tors remains a deeply guarded secret,” notes Gondi. condition. It was a form of taboo and Kenya Some people still believe that HIV/Aids is a The HIV/Aids stigma is tickwas supposed to be seen in the eyes of internataboo caused by witchcraft and prefer cleansing like a time bomb despite the awareness that tional community as a country with very low ing sessions or alternative medicines while still has been created around the disease. Already it rate of infection. spreading the virus. is causing more harm than good and the situIn case of death, medical staff did not inSome Kenyan communities still practice ation must be addressed urgently to save lives. dicate the right diagnosis in fear of reprimand communal sex either for fun or for better perInvestigative reports from several hospitals whether from the Government or relatives of formance. Polygamy remains a major cause for across the country show that a number of pathe dead. concern. Some still keep many wives. tients disguise their looks and sneak into hosMortuary attendants would connive with pital late at night to pick their anti-retroviral the relatives to request. “Mortuary attendants drugs. Widows and widowers do not reveal their would conspire with relatives to request the Many husbands send their wives to pick status and continue with life as usual. These are particular doctor to change the diagnosis in the drugs yet they too are positive but want to be components of the time bomb in HIV spread. death certificate, what then ensued was that relconsidered decent and will at no point want to “Professional wife inheritance” as opposed atives would jam the doctor’s office and engage be associated with HIV. to “wife guardianship” is still prevalent in some him in long hours of discussions, persuasions According to a section of the media, a cerparts of Kenya despite knowing what killed a and even corruption,” explains Gondi. tain Member of Parliament professing to the husband. These communities expect a woman Christian faith wears a Bui Bui (Muslim womto be inherited by members of the community en’s garb) once a month as ‘she picks her ARVs and the widower is expected to marry another This was because the relatives considered from a Nairobi hospital for fear of being stigmawife. the infection a form of curse to their kin. tised and discriminated against by colleagues Some religious activities are potentially danOn the other hand insurance companies According to Gondi, certain factors have gerous for the spread of HIV. These are night would not compensate families of the deceased. encouraged HIV/Aids in Kenya. Early in 1990s, prayers, retreats, meditations and youth prayers. “While there were all these denials, the Aids HIV was found to be prevalent in Kenya but Unless stigma issue is addressed and HIVscourge spread,” Gondi told the Reject. quite a number of factors hindered its awaresurvivors accepted by the community at all In the early 1990s, when the Government ness. levels, people will continue spreading the virus came to reality with the situation, HIV/Aids The Kenyan Government was the first culindiscriminately and others will not access antiawareness was started. Decent burials began prit. They did not stamp their authority to recretrovirals. and education commenced. ognise that Aids was a devastating illness or
Wife inheritance
Taboo
Economic empowerment boosts women’s morale By MARTIN MURITHI Getting people who are living in poverty and are living with terminal illnesses to generate wealth and be economically independent is a dream of that many organisations would like to realise. Stigma and discrimination remain a stumbling block. However, many have not had their smile over success because they have persistently relied on donor funding for all their activities such as feeding, clothing and housing. However the story is different for Kithoka Amani Children’s Home (KACH), an initiative of the International Peace Initiatives (IPI). While the organisation has managed to cater for many orphaned and vulnerable children, more appealing is the fact that they have been able to bring together more than 200 women living with HIV and inculcating in them the spirit of art work and making them independent. Women mainly drawn from Meru County have undertaken to recycle magazines, newspapers, waste paper bags to make ornaments such as bracelets and necklaces which are then sold locally and abroad. The women have also undertaken to collecting bones from slaughter houses, restaurants and other sources.
The bones are furnished and dyed to make ornaments which have realised a competitive market in the United Kingdom and USA. The proceeds accrued from the sales are used to uplift their standards of living by providing better diet and access to antiretroviral drugs. “Women are involved in collecting the raw materials whereas the high school students are taught how to shape and furnish them to complete ornaments,” says Dr Karambu Ringera. She adds: “The course is to enable them work in the workshop takes two weeks.”
Sales
The yearly sales in the UK and America alone, which are the major markets of their products, realises proceeds of upto $60,000. “This is what we get in the international market and it plays a major role in increasing the annual budget income to sustain the livelihoods of the women, pay fees for the children and meet other needs of the home,” explains Ringera. Apart from these, the children at the home are now engaged in weaving and making of shirts, place mats and shawls of African descent from locally available materials. The unity of the women began with a single group of 18 members. It now has five groups with more than 200 members.
“Three quarters of these women are living with the virus and the rest have been relying on collecting firewood,” notes Ringera. She adds: “The projects have created economic independence because recently the firewood collection activity was banned.” In partnership with Equity Bank, the women have been taught business skills. However, due to the high lending rates charges of the bank, most of them avoid taking loans. They normally conduct HIV and Aids awareness campaigns with the National Aids Control Council (NACC) and encourage behaviour change to create awareness and empowerment. “Sex workers are shown alternative entrepreneurial skills and ways of earning a living,” notes Ringera. She adds that the women have learnt that stigma is not their problem but that of the society. “They have established their own health facility at Tutua Market and even employed personnel who will be advising them on their needs,” observes Ringera. She adds: “Women in Buuri already have a VCT centre to spread the awareness campaign. It is also the point from which they can access the ARVs.” The women believe that information is power and is used to create solutions to their
problems. According to Ringera, the women do not need handouts but skills to understand what it takes to eradicate their problems and take charge of their own lives. Ringera who is also the founder of International Peace Initiatives says gender healing and reconciliation needs to be encouraged to bridge gaps of misunderstanding on the basic family setup.
Independence
She says the spirit of complementing each other is vital and they are currently educating the women with alternatives to violence by training them on good communication skills in times of conflict. KACH has managed to educate, feed, house and clothe about 200 orphaned and vulnerable children through its own income generating activities since its inception in 2009. “Our survey indicates that all other children’s home in Meru and Tharaka Nithi counties depend on donor funding and help from well wishers. In the next five years, we expect KACH to be a model facility across the country where people will come to learn how to manage such homes to gain self sustenance,” says Ringera who also founded the home.
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Discrimination proves to be an impediment in the fight By BENARD OCHIENG WESONGA Stigma against people living with HIV and Aids still abounds despite efforts invested in fighting it. In a country where an estimated 65 per cent of the populations know their HIV status, this has remained a menace especially in work places, at homes and other social joints. The National Aids/STDs Control Programme (NASCOP) has identified stigma as an impediment in the fight against HIV/ Aids. “Many people are not willing to get tested for fear of discrimination at their places of work or with family members,” says Dr Peter Cherutich, Deputy Director at NASCOP. He adds that many with such behaviours do not even know their HIV status. These are revelations came after a round table meeting to dissect on the need for routine HIV testing. Survivors narrated their experiences on the kind of treatment they received at work, home or other social places. According to a woman identified as Eddah had much to share at the discussions. “Though the issue of stigma is slowly reducing, much still needs to be done to help people living with HIV and Aids enjoy a comfortable life,” she said. The 33-year-old widow also narrated the kind of murky ordeals that she has had to wade through at work. “Someone wipes the chair you have been sitting on just before he/she sits, the cleaners are pumped daily with instructions to ensure they wash and rinse the utensils I use so that I do not contaminate the rest who perhaps do not know their status,” she told the meeting.
Routine testing
The panellists at the forum emphasised on the need for routine HIV testing as this enables one to live freely without fear. Massive awareness campaigns by NASCOP and other interest groups have made Kenya stand out as one of the best countries in subSaharan Africa where HIV testing has infiltrated with much positive impact. According to Cherutich, this has been backed by the willingness of Kenyans to know their status. NASCOP has now moved to HIV Testing and Counselling (HTC) instead of Voluntary Counselling and Testing (VCT) with a view of vesting the responsibility of HIV testing to someone else and not the one undergoing the test. Cherutich said this will be done through the regular health care tests in antenatal and post-natal care where if a couple turns up, they get tested and are given relevant counselling. HTC and VCT in homes and households especially in slums and rural areas will also play an integral role towards achieving NASCOP targets. A beneficiary of this, Momanyi, a journalist also narrates on how the post-natal care helped him and the wife know their status. “My wife developed complications after delivery and had to go for regular post natal check up,” said Momanyi. Throughout the check up, the doctors managed to convince him to undergo a HIV test of which they tested positive. “Since then, I went through rigorous counselling and I am now living happily with my wife,” narrated Momanyi. According to Cherutich this testing has borne much fruits and up to date about 350,000 Kenyans living as discordant couples are routinely tested, educated and further counselled to prevent subsequent infections.
It has been a long way to breaking the silence By ADOW INA KALIL Idris Hassan Kunyo did what many among the pastoralist Somali community held as a suicidal mission by openly declaring his HIV status in North-Eastern region. However, his bravery caused him unexpected outcome — stigma and discrimination — that saw him avoided more than the plague in mosques, public places and even health facilities. He went on like this for many years before he would be accommodated by just a few. The 56-year-old father of three passed through what many would call hell on earth for declaring: ‘I am infected with HIV’. His intention was to create awareness but he found himself rejected and received a dose of more than what he expected for stating his status in public. It was around 10.30am on December 1, 2005, when the unknown Kunyo stepped out of a mammoth crowd, who were part of the World Aids Day celebration at Garissa Primary School. Majority had not heard about the disease as he made his way to the dais to break the silence on the disease by declaring his HIV positive status.
Harrasement
“Immediately I stood up on the dais and declared that I had HIV, uniformed security officers manning the event which was presided over by a former provincial commissioner, now ambassador Mohamud Swaleh came and took me off the platform,” recalls Kunyo. He adds: “At first the security officers manhandled me in bid to get me off from the dais. They thought I was a deranged man, who was disrupting a very important international day.” It took the intervention of the Provincila Commissioner to restrain the officers from further harassing him. “The administrator called me to where he was seated and asked if I was normal. But when I showed him my health report, he took the microphone and continue with my declaration,” Kunyo remembers of the event six years ago. Speaking during an interview with Reject in Garissa, Kunyo says the Provincial Commissioner was happy because there was no one in the entire region who wanted to declare their status openly. In many instances the disease is spoke about in hushed tones. In workshops and public functions, statistics are provided without the faces behind the numbers. Kunyo remembers how when he declared his status after being allowed by the PC to spill the beans on his status, the crowd at the function rapidly grew thinner as many took to their heels for fear of catching the disease from the air. “At the time, many people even among those perceived most learned in the Government and society at large were not equipped with adequate information about the disease,” says Kunyo.
Withdrawn
He recalls: “The microphone I used for addressing the public on my status had to be changed when other dignitaries came to address the gathering.” Kunyo, a former bus conductor says for months he was ostracised by all and sundry to the extent that locals avoided sharing space with him. His presence in the mosques would see the faithful flee from him whenever he joins the congregation for prayers. “I later decided to stay away from mosques and pray alone at home because I thought there was no need of disrupting prayers at a holy place every day,” says Kunyo. He adds: “I never got hurt by the actions of my brothers who rejected me when I needed their prayers most. I understood they were behaving harshly towards me out of ignorance.”
Idris Hassan Kunyo during the interview in Garissa. He went open about his HIV status and faced challenges of discrimination from his Somali community in North Eastern Kenya. Picture: Adow Ina Kalil Kunyo who talks of his positive status with a lot of pride says he developed signs of having contracted the disease early in 1998. Despite showing signs that he had most likely contracted the HIV virus, Kunyo avoided visiting the clinic for testing for fear of been discriminated. According the country’s Demographic and Health Survey of 2008-2009 accepting attitudes towards HIV infected people are least common in North-Eastern region, where only eleven percent of women and 14 percent of men express accepting attitudes compared to the nation’s acceptance of over 90 per cent for both men and women. In the survey, a paltry 27 per cent of the respondents in the North Eastern Province were willing to purchase fresh vegetables from a shopkeeper who has HIV compared to other eight regions which stands at a low of 66 percent to 87 percent. However, on December 1, 1998, after the former President Daniel Moi declared HIV/ Aids as a national disaster, Kunyo got the courage to go to hospital for testing. “I remember vividly it was at this time when speaking on the disease was heightened in radio programmes. The radio programmes were therapy for me to agree to go for testing, Kunyo explains: He adds: “However, I was afraid of the backlash from the society if I were to test positive.” At the time he was overwhelmed by myriads of health complications that later led to him having the entire right side of his body paralysed noting that this was the straw that broke his denial and promoted him to look for a Voluntary Counselling and Testing clinic. “Since I did not want my status to be known by anybody who knows me including the nurses, I decided to go to Malindi District Hospital at the Coast to have my test,” recalls Kunyo. He notes: “At the time I was discouraged again by an Islamic religious leader who advised me to go to the village for six months and drink raw camel milk and its urine. He assured me I will be treated.” In mid-2001, he visited Malindi District Hospital for testing after six months in the bush dieting on camel milk and urine which failed to improve his deteriorating health condition. His long held fears were revealed to him by an Indian VCT counsellor at the health facility three days after he had been tested. “Despite thoroughly counselling me, the woman had a lot of reservation on how to dis-
close the results to me. When she eventually revealed the results to me, it was as if I had been struck by a bomb,” says Kunyo. “I attempted to commit suicide several times for the fear of how my family, particularly my first born daughter would react.” However, his family accepted the results and were centrally very supportive despite avoiding to share anything with him. After knowing his results, Kunyo went back home to Garissa and in 2003 his health worsened leading to his hospitalisation at Garissa General Hospital. He was admitted at the local Tuberculosis (TB) Manyatta for six months for treatment. “At the time I was too weak and weighing about 28 kilogrammes and my CD4 count was one. I was put on anti-retroviral therapy (ARVs). At the time I lost all my hair, got scalded on all over my body and was severely diarrhoeing,” recalls Kunyo. “Due to his bad condition, some nurses instructed that he should be put on expensive diet, with food like eggs and fruits thinking that he was going to die. “I even wrote a will on how my family should share the plots I own in Mororo and Madogo. However, by Allah’s grace my health improved and I was discharged from the isolation ward and sent back home,” says Kunyo.
Awareness
Despite the difficulties and challenges he has gone through, Kunyo embarked on a campaign of creating awareness by visiting schools and public functions to speaking publicly about the HIV and Aids. His crusade caught the eyes of the Provincial Commissioner once again. He called Kunyo to his office and advised him to form a community based organisation and look for funds to expand his awareness advocacy in the region. In October 2007, he started Mwangaza Advocacy Group. He called on people hiding to come out and declare their HIV status to create more awareness and reduce stigma on the disease. In a few months, he managed to get many people who came out and joined him in openly talking about HIV and Aids. According to the North Eastern National Aids Control Council field officer Mwanajama Omari, there are at least 2,000 people living with HIV/Aids out of which 980 are on ARVs. Currently, there are 21 VCT centres in designated district hospitals and on average six to ten people visit to know their status.
ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
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Negative perceptions perpetuate intolerance By BEN OROKO Although the first Aids case was reported in the late 1970s in the United States of America and early 1980s in Africa, majority of the African communities are yet to accept the reality of the dreaded disease in the continent. As the disease continues ravaging the continent, posing serious threats to human life as well as economic and social development systems, stigma and discrimination against people living with HIV by the immediate relatives and immediate community remains one of the challenges in the war against Aids. It is within public knowledge that stigma against those infected is based on negative beliefs that those infected are sexually immoral members of the society. Rose Kerubo, 23, a mother of two who is HIV positive and a resident of Daraja Mbili slums in the outskirts of Kisii town, laments that the biggest challenge facing persons living with HIV is stigmatisation and discrimination by immediate relatives and communities. Kerubo who discovered her HIV-positive
status after walking out of her marriage in 2008 discloses she went for HIV testing at a Voluntary Counselling and Testing (VCT) clinic in Kilgoris town of Transmara District. “I went through three HIV tests, till it dawned on me that I am HIV positive after the third test. I had no option apart from accepting the reality and doctors had to counsel me before putting me under Tuberculosis (TB) treatment until in 2009 when they put me on antiretroviral (ARV) drugs,” explains Kerubo. Since that time, Kerubo who is a bar attendant says she has been on ARVs and her health has improved tremendously after defying stigma which she says at first would have contributed to her early death had she not got wise counsel from home-based care givers in the area. Due to her improved health, Kerubo has been able to fight social stigma and currently majority of her relatives and friends who initially discriminated against her have slowly started to embrace her. “When some of my relatives and friends learnt of my HIV positive status, they distanced themselves from me and I remember
how on many occasions some could not even share with me food, let alone use the plate or cup that I had used,” says Kerubo. She adds: “The situation was traumatising and could have easily contributed to my early death had it not been for the intervention of home-based health care counsellors.” Without a reliable income, Kerubo she opted to seek employment in a bar to earn a living and assist in bringing up her two daughters aged five and seven. “If I get capital to start a business today, I will quit working in the bar as the industry is tempting to me and I am not ready to infect anybody with the dreaded disease,” says Kerubo amid giggles. “However, if I am cornered I will prefer using a condom to avert spreading the disease further.” Kerubo regrets that HIV positive members of the society especially among the Gusii community are stigmatised and discriminated upon, making majority of the persons fear going for HIV test. “When one is informed that he or she is positive, they become withdrawn and avoid telling anybody for fear of being discriminated against,” explains Kerubo.
The rejection and isolation goes beyond one’s home to work and social places, leaving the infected persons traumatised and dejected. “From my experience, other people who fear contracting the disease from even casual contact distance themselves from those infected leading to deaths due to lack of support systems,” she observes. Kerubo also notes that majority of the Aids orphans lack people to care for them since most of their relatives have a mindset that all children whose parents died of Aids are also HIV positive. They do not allow them to mix with their children let alone sharing food with them. Kerubo challenges the community as well as political and religious leadership to change the negative attitude among members of the public against HIV positive individuals by publicly sharing platforms with the infected persons. “Without fighting stigma and discrimination the war against Aids will not be won as majority of those infected will not seek treatment for fear of stigma and discrimination,” observes Kerubo.
Fighting stigma enables Njeri to offer support By ALEX NDIRANGU A decade ago, she only weighed 32 kilogrammes, her immune system grinding to a near halt and on her death bed. Besides being stalked by numerous ailments, Euphamia Njeri who is HIV positive experienced stigma and discrimination at its best, more so from the most unlikely source, her own mother. Today, she weighs slightly over 80 kilogrammes and looks remarkably healthy. With the flowing beige suit that drapes her plump body and trendy shoes to boot, she struts casually with a confidence that does little to betray her status to those she mingles with. Her charming laughter and enthusiasm as she serves her customers at her bar business in Gilgil, Nakuru County camouflages all that she has been through. As we World Aids Day, Njeri will spend the day visiting HIV positive patients to ensure there is zero stigma and discrimination.
Support groups
The patients come from a support group that she formed three years ago named Kikopey Diatomite Community Based Organisation. She heads the organisation that has 68 members and about 112 Aids orphans. Like any other day, she has to visit the patients, especially those who are bedridden to deliver the ARVs that she picks at the Rift Valley Provincial Hospital 50 kilometres away in Nakuru. “Most of them are too weak and cannot afford to travel to the hospital for the drugs,” she says. ”I also supervise their drug intake and monitor progress.” With the same vengeance that the virus had applied to throttle life out of her, Njeri, her status notwithstanding, is doing everything to liberate herself and those living with HIV from stigma and discrimination. “I have lived with HIV for the last 15 years and still counting,” says an unassuming Njeri. And her voice is loud enough to attract her patron’s attention. She adds: “I hide nothing and always make my status known to everyone who cares to listen.” A frequent patron at her club concurs: “She frequently engages us in lively debates and lectures on how to avoid HIV infection and on ways of protecting ourselves.” The 40-year-old mother of five who is also a social worker is optimistic that talking openly about the scourge and going public about one’s status will help end stigma in over 1.4 million Kenyans living with HIV. “It is the stigma and discrimination that actually kills,” she says.
Njeri remembers the day in 1995 when her husband, a truck driver came home ill. He had been sent on leave for falling ill constantly and would only go back to his job only after he had fully recovered. “The following day, I accompanied him from our Gilgil home to the Rift Valley Provincial General Hospital in Nakuru where he was diagnosed with acute malaria,” says Njeri with a solemn and pensive face. After administering treatment without recovery and several visits later, she felt something was not right. “I knew malaria as a curable disease and confronted the doctors and challenged them on why they were taking too long to treat my husband,” she says. Her curiosity and persistence forced the doctors to reveal what she rarely expected to hear; her beloved husband was HIV positive. In those days, the mention of the word Aids was almost a taboo. “The first and only option that crossed my mind was to storm out and kill myself,” says Njeri. ”I just could not wait to die of what was termed as a disease of prostitutes,” she says reaching for a handkerchief to wipe her tears. She was also at pains to explain to her husband what he was suffering from. ”I also felt that this information would have killed him instantly.” Njeri regards counselling highly as this is what saved her life that day. “We were immediately enlisted in counselling therapy and this made us accept our status and go on with life.” Her husband’s death in 2000 was the final straw that broke the camel’s back. “I felt my time had also come and lost all hope to live,” she says,
Euphamia Njeri who is HIV positive experienced stigma and discrimination from close family members because of her HIV status has taken to creating awareness on the disease. Here she is seen visiting a bedridden member of her support group in Gilgil where she started to demystify the disease and make those who are infected seek treatment. Pictures: Alex Ndirangu choking with emotion at the painful memories. Her husband’s death notwithstanding, the stigma she faced from family members and even her church only made the situation worse. Her worst encounter was with her own mother. While the disease took its toll on Njeri, her condition deteriorated and she was forced to take her children to her mother’s house. She thought this was a safe sanctuary from the harsh and discriminating world. Stigma raised its ugly head here. “My mother used a long stick to push food to where I slept, bedridden in a goat shed,” she recalls.
Outcast
“My mother used a long stick to push food to where I slept, bedridden in a goat shed.” — Euphamia Njeri
“I was an outcast who was only fit to stay with the animals. I could hardly eat for my mouth was full of ulcers. I even questioned God on what I had done to deserve this treatment.” Njeri, equates her recovery to good health to the resurrection of Lazarus in the Bible. ”I prayed hard to God promising that if I rose again, I would give back by helping people who were suffering and fight stigma since we are equal before him.” Miraculously, she recovered a little and could at least manage to eat. ”I gained a little energy and could at least venture out of the goat shed,” she says with compassion.
Njeri attributes her continued recovery to antiretroviral drugs which she has been taking consistently since then.
High risk groups
Eleven years down the line, Njeri is living proof that ARVs, the life prolonging drugs are effective. And apart from a mild TB strain which she easily manages with treatment, she is remarkably healthy and determined to bring up her five children responsibly. ”They know my status and I advise them to keep off risky behaviour that could expose them to the deadly disease.” Her status and struggle to fend for her family notwithstanding, Njeri dutifully serves her members. “I am sometimes forced to dig into my meagre income to provide for them which has adversely affected my business.” Gilgil, a military town along the Nairobi Nakuru highway has high HIV prevalence rates of about 7.8 percent. According to Kenya Aids Indicator Survey 2009, the national prevalence stands at 7.1 per cent. “Operating my entertainment business offers me an opportunity to mingle with high risk groups especially at night when prostitution is rife,” she says. In Gilgil these include prostitutes, military personnel and long distance truck drivers.
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Culture hinders efforts to reduce mother to child transmission By BEN OROKO Though prevention of mother-to-child transmission (PMTCT) in HIV continues attracting attention, majority of HIV-positive women have not been adequately informed on the availability and importance of the services to their health and that of their unborn babies. The worrying trend has been compounded by conservative cultural beliefs and practices that disempower women, frustrating their efforts in accessing PMTCT services. Conservative cultural beliefs and practices among communities, which vest powers of women’s reproductive health decisions on their spouses and community members, continue frustrating HIV-positive women in the rural parts of the country from accessing PMTCT services. The conservative practices contribute to new HIV infections through mother to child transmission of HIV since majority of the HIV-positive women fear seeking PMTCT services for fear of being divorced by their spouses if they were discovered to have gone against their community’s cultural beliefs and practices which entrust decisions on women’s reproductive health to male household heads.
Belief
Traditional beliefs that HIV-positive women are cursed and have no opportunity of giving birth to healthy HIV-negative children leads to majority of the HIV-Positive women shying from seeking PMTCT services for fear of being ostracised by their spouses and immediate communities. Statistics indicate that in 2006, an estimated 530,000 children were newly infected with HIV, contributing to an estimated 2.3 million children living with HIV worldwide. The same statistics indicated that majority of these infections occurred in sub-Saharan Africa and these infections were acquired from mothers during pregnancy, labour, delivery or breast-feeding. Milkah Moraa, a resident of Daraja Mbili slums in Kisii town, who is living positively with HIV, admits that even when women are tested
during pregnancy, negative cultural attitudes and practices continue preventing them from accessing PMTCT services. Moraa who went public on her positive status in 2008, regrets that efforts to prevent new HIV infections through mother-to-child transmission have been frustrated by conservative patriarchal society which hardly allows women to enjoy their sexual and reproductive health rights. “In such situations it is difficult for HIV A paediatrician attending to an infant in ICU at Gertrude Children’s Hospital. Conservative cultural practices contribute to new HIV infections through mother to child transmission because they hinder them from seeking drugs to protect the unborn babies from the virus. Pictures: Henry Owino and Ben Oroko
“It would be a noble idea if the Government and other policy makers ensure PMTCT services reach those women who deliver at home to reach out to more women with unmet needs of the services and other HIV related services in the rural parts of the country,” — Milkah Moraa
positive pregnant women to access PMTCT services as part of the efforts to scale down the rate of new HIV infections through motherto-child transmission,” laments Moraa. Concurring that prevention of primary HIV infections is the viable strategy for preventing mother-to-child transmission of HIV, Moraa calls on the Government to identify HIV-positive pregnant women and provide them with antiretroviral (ARV) as well as guidance on infant feeding to avoid transferring the virus to their unborn or new-born child during delivery. Despite being HIV-positive, Moraa, a beneficiary of PMTCT services discloses that she was able to give birth to a HIV negative and healthy daughter through the guidance of the health workers. “It is possible for any HIV positive woman to give birth to a HIV negative child if she accesses PMTCT services and adheres to the doctor’s guidance,” she observes. Moraa attended ante-natal clinics during which she was professionally counselled and guided by health workers on the importance of delivering in a health facility to avert transmitting the HIV virus to her new-born child. Before she gave birth to her daughter, midwives at the health facility gave her Nevirapine (NVP) tablets and NVP syrup to her new-born baby within the first 75 hours as required to avert transmission of the virus. After
delivery, Moraa’s daughter went through three consecutive HIV tests which revealed she was HIV-negative and prompted the doctors to declare her HIV free. The integration of PMTCT services within the ante-natal clinic makes it easier for women to access HIV related services. Moraa regrets that most pregnant women in the rural areas do not access PMTCT services. She expresses fear that preventing motherto-child-transmission of HIV is not an easy task since majority of the women are held back by negative cultural beliefs and mindset about HIV tests.
Advice
However, she advises that the Government and health policy makers to consider providing counselling before conducting HIV tests on women to facilitate identification of women in need of the tests and related services as part of the strategy to enhance efficient PMTCT programmes in the country. She encourages HIV-positive pregnant women to give birth in health facilities to avert transferring the virus to their new-born babies. “To achieve its objectives, PMTCT programmes also need to reach those who deliver at home through supply of Nevirapine pill to each HIV-positive pregnant woman in advance. This should be kept at home and taken at the onset of labour,” advices Moraa.
Best practices must be engaged for infected and affected children By KARANI KELVIN The number of children who have been infected and affected by HIV remains a challenge as they keep on increasing. Currently, over 2.3 million children in subSaharan Africa are infected with HIV. About 90 per cent of these cases are a result of mother to child transmission of the Human Immunodeficiency Virus (HIV). These children, among many others, have been severely affected by the HIV/Aids scourge. A significant number of them have been orphaned and left in the care of their elderly and often times poor grandparents. The levels of poverty among the people among whom these children live make their plight even more difficult. As a result several non-governmental organizations have risen over time to respond to the challenges of affected and infected children. However, it is only those that have engaged best practices that have been able to meet their needs and reduce suffering among them. According to Peter Omondi Akelo, Project Manager ACE-Africa Bungoma Site, his organization has over time used a holistic approach to help children and people living with HIV/Aids.
“We work very closely with communities to assist children who have been infected and affected by HIV/Aids,” says Akelo. He explains: “These children fall under three categories; those under five years, those in school and those past basic school level.”
the affected or infected children get the necessary assistance, the organization works with communities to identify such children. “We have area advisory committees that are tasked with selecting the children who we eventually enrol in our programmes,” says Akelo. Achieng explains: “Once the children have been selected, our task then is to go to their homes, carry out a survey and decide what kind of assistance we will give.”
Assistance
According to Akelo they do not set up orphanages but ensure that orphaned children get the necessary assistance in their communities. This is in alignment with one of ACE-Africa’s core values which states: It is important that children affected by HIV/Aids be cared for and supported within their own communities in a culturally relevant area. According to Goretty Achieng’, ACE-Africa Bungoma Child Welfare Officer, there are many programmes that are currently in place to help children who have been affected and/ or infected with HIV/Aids. “We are currently working with about 3,642 total orphans and 5,420 partial orphans to ensure that they get the necessary support,” explains Achieng. She adds: “We are also working closely with selected schools to train teachers and children on counselling, peer education and the rights
Strengthen structures
Peter Omondi, the Project Manager ACE Africa Bungoma during an interview. Picture: Karan Kelvin of children.” Helping the children also entails Achieng also supporting families by giving them food and supplements. “We also give children seeds to start their own kitchen gardens to provide more food,” notes Achieng. In order to ensure that the most needy of
The organisation works towards strengthening community structures so they are able to take care of infected or affected children as well as people living with HIV/Aids. They do this through educational support, providing medication and nutritional supplements, sanitary towels, supporting community livelihoods initiatives and counselling. “This is what Action in the Community Environment (ACE) stands for,” he observes. While quite a number of children who have been affected or infected by HIV/Aids have found help through such initiatives, many others are yet to find help. Achieng admits: “We have not managed to cover all areas at the moment.”
ISSUE 052, December 1 - 15, 2011
More effort needed in prevention of mother-to-child infection
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Unfiltered, uninhibited…just the gruesome truth
Halting paediatric HIV infection remains a challenge
By DORCAS AKELLO Mary Awuor who has been living with HIV for the last 15 years says she didn’t know about her status until when her second born child tested positive six years later. Only then did she realise that she had been infected. Awuor was shattered that when she attended the ante-natal clinic but was not told about her status. She still questions herself to date how the doctors did not find out she had the virus while attending to her ante-natal clinic because she is well informed to know it is safe to give birth in a hospital. “If I had known I would have gone for the PMCT prevention just like I did during my third pregnancy and I was successful enough to give birth to a HIV free baby girl,” she notes. Awuor observes: “It’s better to be HIV positive as an adult but not as a child because children don’t have any information on what they are going through.” According to Maureen Murenga of the National Empowerment of People Living with HIV (NEPHAK) most women living with HIV give birth with the help of Traditional Birth Attendants then go to hospital later only to realise they are positive after all. “Most young women will not go to hospital because of the fear of getting tested and also in most hospitals little counselling is done to prepare them on their HIV status,” observes Murenga.
Target
She notes that most of women find out that they have been infected much later because of fear of stigma that follows those who have tested positive. According to Dr Nduku Kilonzo, Executive Director, Liverpool VCT if every woman of reproductive health age and every man who is sexually active is also not identified to know their status then it’s highly unlikely to that the Millennium Development Goal number six that seeks to combat HIV, malaria and other diseases by 2015. The first target for this goal is to halt and begin to reverse the spread of HIV/ Aids. It also seeks to achieve universal treatment for all those who need treatment for Aids. “If the answer of achieving the universal access of knowledge of HIV status in this country by 2015 is ‘No’, then the answer to the possibility of us being able to prevent paediatric HIV infection is also ‘No’,” observes Kilonzo. She notes: “We will not be able to address the pandemic if men are not engaged in maternal health programmes because we are not engaging men as long as prevention to mother child transmission (PMCT) is concerned.” According to James Kamau, coordinator of the Kenya Treatment Access Movement as long as there is no budget line and funds keep dropping as it has been lately then there can be no guarantee for prevention and treatment for those on Anti-Retroviral Therapy and “we know what that will do to our country.” “The slowdown in spending is worrying because it comes at a time when treatment prevention has been proposed to curb HIV infections, which will require heavy investment,” noted Kamau.
Mothers waiting at the Githogoro Children’s Clinic in Runda Estate which is run by Gertrude Children’s Hospital. Those who are infected are able to access care and It is estimated that 40,000 to 50,000 infants in Ke- treatment from the facility that has been brought to their doorstep. Pictures: Henry Owino nya could be born HIV positive as result of mother to child transmission of HIV every year. This He urged the Government through ministries of translates to approximately 100 new born babies vails in Kenya. Chief Executive officer of Kenya Treatment Ac- health to take serious the fight against Aids to both infected per day. Currently, in the world today more than 1,000 cess Movement (KETAM) James Kamau, noted that infants and mothers. Other countries have tried to comply with the children worldwide are infected with HIV and an the WHO guidelines recommend HIV testing of exposed infants as part of routine care should be as Abuja Declaration of 2000 that at least 15 percent alarming 700 die from Aids-related complications. of national budgetsbudget be allocated to the This can only be prevented if ante-natal and early as six weeks of age. He observed that diagnosing HIV infection in health sector. Kenya is still far much beyond the post-natal care is taken serious by mothers. Speaking at a media workshop organised by infants is also a major challenge in resource limited expectation making it even difficult preventing the transmission. Gertrude’s Children’s Hospital, the Chief Executive settings such as Kenya. “The fact that equipment used for HIV testing in “HIV and Aids was declared a national disaster Officer, Dr. Gordon Odundo said a demonstrated study showed a remarkable efficacy of the drug babies is not the same as that of adults is a big chal- in 1999 on the roadside by then President Daniel Moi about 18 years after it was discovered in Kenya. zidovudine in reducing mother-to-child transmis- lenge to paediatricians,” regretted Kamau. In Kenya, there are only three Polymerase Chain Now 12 years after the declaration, the Government sion of HIV. This has helped reduce perinatal HIV has not yet gazetted HIV/Aids as a national disaster, that has been virtually eliminated in high income Reaction machines (PCR) serving over 15 million. Initially they were five PRC machines that had and therefore no money can be allocated for it as a countries. Odundo noted that in countries most affected been donated, however, two arehave broken down. special kitty,’’ Kamau reiterated. by HIV, however, particularly those in sub-Saha- Of the three working machines, two are stationed ran Africa and Asia, prevention coverage remains in Nairobi and one in Eldoret at the Moi Teaching and Referral Hospital. Currently Gertrude Children’s Hospital has appalling. opened a free medical clinic at the Githogoro As at the end of 2010, reports indicated that slums in the larger Runda Estate which provides less than one third of children who needed antiHIV/Aids services to children and their parents. retroviral therapy were receiving it. Without treatThis has helped many low-income families inment, one third of children born with HIV die befected with the virus access treatment and other fore their first birthday while 50 per cent die before medical services. they turn two. The clinical and community coordinator at Githogoro paediatric HIV/Aids clinic Dr Frasia Karua said the project is sponsored by Pathfinder InResearchers say that there are many reasons for ternational and was established in 2005 due to high this unacceptable state of affairs. One of the most child mortality rate. glaring and yet often overlooked is that treatment Karua explained that most children in Githogoro options for children, particularly the youngest and were dying from preventable diseases such diarmost vulnerable, are insufficient. rhoea, and pneumonia which could be treated Odundo noted that children living with HIV/ yet the parents did not have funds to take them to Aids in low or middle income countries such as Kehealth facilities. nya are a largely neglected population. It was for this reason that Gertrude’s Hospital in He reiterated that vertical transmission of HIV partnership with the locals, intervened to prevent is preventable and in wealthy countries effective further loss of lives. The clinic serves a population interventions for preventing mother-to-child transof nearly 30,000 and receives about 600 patients a mission have virtually eliminated HIV infections in month. newborns. “There was high rate of child mortality at In low and middle income countries, however, Githogoro slum of the larger Runda estate. So there are numerous barriers to prevention and anGertrude Hospital in partnership with the comte-natal care attendance is low. This is particularly munity and the local church, teamed up to help the in rural areas where pregnant women hardly have residents,” explained Karua. He added: “The local access to HIV testing. In the rural areas access to church donated the land where the clinic is conoptional anti-retroviral prophylaxis or therapy is structed. Gertrude offers health services and Pathinsufficient and alternatives to breast-feeding are finder International provides funding and thus how uncommon. it came about.’’ “In the 2010 progress report, the WHO indiAccording to Karua, the Gertrude Hospital cated that only 25 per cent of pregnant women unspends approximately KSh1.5million per month to derwent a HIV test, and among those identified as HIV infected, only half received any antiretroviral run the clinic in terms of purchasing drugs, equipprophylaxis during pregnancy or at delivery,” said ment, staff salary, special food diets for the patients Odundo adding that this is a situation which preand other expenses to keep the hospital running. — Dr Frasia Karua
By HENRY OWINO
Free clinic
Neglected population
“There was high rate of child mortality at Githogoro slum of the larger Runda estate. So Gertrude Hospital in partnership with the community and the local church, teamed up to help the residents.”
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Big dreams can be realised through positive living By CAROLYNE OYUGI It is 6.30 pm in the sprawling Kibera slum and the streets are busy. Most people have alighted from the commuter train and the crowd keeps reducing as people follow the feeder routes leading to their houses. Traders are selling goods along the road, especially food while children are playing. Among the crowd are pupils in torn school uniforms, books in plastic paper bags. Some are wearing shoes which are very muddy while others have bare feet. It is very easy to dismiss the crowd and go away but among them everyone has a story to tell. Stacey Akinyi, is one of these children but she is rushing home for a different reason. She forgot to carry her medication to school and she has to rush back home despite the chilly weather and the mud. Her medicine has to be taken at a particular time failure to which she could develop resistance to the drugs. Stacey has been on anti-retroviral therapy (ARVs) since she was one year old. She is familiar with all the terms and can even explain how the medicine works.
Uncertainty
According to her mother, she is not sure whether her daughter was born with the disease or contracted it from her. “She started getting sick frequently and one day a doctor advised me to take a HIV test together with her. The result was positive,” she says. When she arrives home from school, the first thing Stacey does is take her medication. “These medicines prolong my life. I have to take them at a prescribed time in order to stay alive,” she says while sweeping the floor of their single room in the slum. After which she has to wash her uniform and socks because it is the only one she has and likes it clean every morning. The Standard Two pupil is best described as a jovial and ambitious girl. Despite being infected with the virus, she is living positively and happy.
Stacey has huge dreams. She is determined that she will be a doctor when she grows up. To achieve this, she has been working hard in school and is always among the top three in her class.
determination
According to Stacey, that is not enough, so she is working towards being the top pupil in the coming exams. She is determined to be the best despite challenges of poverty and disease. Her mother who is also HIV positive and unemployed wants the best for Stacey. She is happy and healthy and does not seem bothered with her status. All she is thinking about is how she can excel. From the surface, it looks like everything is okay and you have to take time with her for you to know the load that this eight-year-old girl is carrying, though with a smile. Her mother who is currently a single parent and unemployed is also HIV-positive. Life has not been easy for this 32-year-old mother of three. She has to search for casual labour every morning and use the little that she gets to care for the children. On a good day, she makes an average of KSh300. However, many times she is not lucky at all. Life gets even worse when she is down with opportunistic infections. During such days they have to go hungry, which is not good for their health. Her husband left her when she discovered that their second born child, Stacey, was HIV positive. He accused her of being promiscuous and swore never to come back to that house. “I have never seen him again since that conversation. He even refused to be tested and I do not even know his HIV status,” she says. “My daughter was born with HIV and I have always told her the truth about our health situation and she has come to accept it and is determined to excel in life,” explains Stacey’s mother. As young as she may be, Stacey is a source of hope to other people who are living positively. She is always smiling and looks at the bright side of life. According to Rose Mwende, her mother’s friend, she has always found strength in this girl.
Stacey Akinyi, doing her homework. The girl, who is living with HIV, is a source of hope to other people living positively. Picture: Carolyne Oyugi “I was once down with Tuberculosis and I knew I was going to die, but when my friend visited me with her daughter I found a reason to smile. She told me not to worry because I have only had the virus for two years while she has had it for eight years and she is still alive,” explains Mwende who was encouraged and embarrassed at the same time and swore to fight the disease. Though her schoolmates do not know her status, her teachers are aware and they are taking good care of her.
Support
One of her teachers, Madam Kate, as she is commonly referred to by her pupils, describes Stacey as a very hard working girl. She is always reading ahead of the teachers and is always among top three. The teacher is, however, not happy with her regular absenteeism in class. Her mother is always late in paying fees and as the school policy
dictates, she has to go home and miss class until it is paid. “I have, however, realised that at times she worries about their problems at home. I have severally had to share my lunch with her when I notice that she has not gone home for lunch,” she said. The school she goes to is a church based private institution that supports the orphans. Most of them are orphaned by HIV and some of the children are also positive. “Life does not end at being diagnosed with HIV. I believe if I get the right opportunity and work hard just like any other person then I will become a doctor and cure many diseases. I might even discover a cure for Aids who knows,” she says with a broad smile. According to Stacey, if she can have her fees paid in time so she does not have to keep going back home while others are studying and the right food to keep her healthy, then the sky is the limit.
Slum women struggle to maintain Aids orphans By ALEX NDIRANGU Amid the sweltering midday heat and the putrefying stench of raw sewage, a middle aged man lurches along an alley in drunken stupor. He halts momentarily, to gaze at the two children wading in the murky trenches with naïve bliss. In a daze he throws his hands resignedly and staggers across the road before he disappears into the tin shanties. After skipping and jumping the filthy rivulets snaking their way into the mud walled shanties that characterise Korogocho slum, one gains the panoramic view of cluttered, rusty iron sheets that spread yonder. Despite the adversity and abject poverty that is the hallmark of slum life, determined women are massaging young bleeding souls of HIV orphans and vulnerable children (OVCs) under their care in the miniature dwellings. In the heart of the slum, is Margret Agot. The widowed mother of nine is a social worker in the Korogocho slums where she is voluntarily caring for people living with HIV. She is foster mother to six children. Agot’s husband died
dren aged between four to 13 years. ”I take six years ago leaving her with the responsibility them as my own since their mother died five of seven children. years ago.” Despite the challenges of bringing up her Despite her age, Mama Were as she is fondly children, Agot’s motherly instincts forced her known by her neighbours possesses an uncanto foster four other orphans whose parents sucnily sharp memory. She still remembers the day cumbed to the Aids pandemic. They are aged five years ago when her bedridden neighbour between four to 13 years and in school. died of an Aids related ailment. But just how does she manage to fend “I had to take them in naturally for they had for all these children single handedly? no other refuge,” she says exhibiting a smile that “I normally wash other people’s clothes at a belies the gravity of her struggle to provide for fee but I have become asthmatic of late due to her foster children. continuous exposure to cold water,” she laments Mama Were’s trying moment comes when drawing a long sigh. One captures the dejection children are at home for the holidays. “They are that now envelopes her lurched frame. given lunch at school but when they are here, “I have no other option lest the children go the burden becomes too much,” she says addhungry,” she says, glancing at a pile of clothes ing that she depends on well-wishers for provioutside the two roomed house where she lives dence. with the children. However, the adoptive parents are full of ”I have to wash all this to ensure there is suppraise for African Network for the Prevention per today.” against Child Abuse and Neglect (ANPCAN). Several shanties away, Florence Nyangweso, The organisation has linked over 100 families 69, is humming a solemn tune outside her one in Korogocho to microfinance groups to help roomed house which she shares with her four them start income generating activities. adopted children. The childless widow takes care of four chilContinued on page 13
“I normally wash other people’s clothes at a fee but I have become asthmatic of late due to continuous exposure to cold water. I have no other option lest the children go hungry.” — Margret Agot
ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
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Gumbo takes the long journey to discover himself By VALERIE ASETO His face blossoms with hope and joy as he tries to absorb the rays of the mid morning sun when I am ushered to his work place in Kariobangi North Estate. Even though my arrival leads him to probe of what I am after, he remains composed with endless smiles. He is barely 22, but soldiers on with his condition of being positive since he was born. Geoffrey Gumbo’s story is unheard of in Kenya today. He has been living alone with no one to depend on or even a care to look after him. Not many people could do this since there are moments when most of those who are living with HIV need at least someone around them for comfort and support. Gumbo says after both his parents succumbed to Aids, leaving him under the care of his aunt. He stayed with her throughout his primary education. After his primary school, the ordeal began when he joined Loreto High School in Nakuru. He started being sick on and off and when he was taken to the school hospital. The doctor said he was suffering from malaria. He got treatment and went back to class as usual. He would get some relief after taking medication but later on, his body became weak again.
Kicked out
Gumbo says the principal called his aunt and what he overheard was “beba mtoto upeleke nyumbani (take your child home)”. Gumbo says while in Loreto, he always had wanted to become a priest and most of the time he liked socialising with the priests in the school. Little did he know that it was a dream that would never come true. They went home and later on he joined Form Two in Nakuru High School. Here, he encountered more complications. He had rashes all over his body and he spent most of the time sleeping while other students studied. This condition earned him a nick name. Everyone in the school called him ‘yule boy msick (sickling boy)’. Gumbo started isolating himself from others and during school holidays he would ask his aunt to take him to a better hospital where they could know what he was suffering from. She turned a deaf ear to him. Before end of the term, he was forced to transfer to another school, this time Shiners High School in Nakuru. However, his condition became worse. The school could not contain him anymore and he was sent home to get better medication. He stayed home for some time and later on joined Dr Mwenje High School where he was not boarding.
“Even though I kept on jumping from one school to another my performance was superb,” says Gumbo. He adds: “ While at Dr Mwenje, the head teacher noticed and he would once in a while call me to his office to try and find out my family background. I told him the whole story about my life and that what I did not know what I was suffering from.” One day the head teacher called Gumbo and said he would take him to hospital. Gumbo did not hesitate since he always wanted to know what was wrong with him. He says at this time even his eye sight had been affected. They went to Mater Hospital where he was screened and the result came out that he was HIV positive. He also had meningitis and tuberculosis. His aunt was called and after a closed door meeting with the doctors, she refused that Gumbo should be placed on antiretroviral therapy. “I was a minor and I could not make certain decisions on my own though out of the pain I was going through, I was very willing to take the drugs,” explains Gumbo. He went back to school without the drugs but at least this time he was aware of the nature of his illness. It did not take too long before he fell sick again and this time he was about to sit for his Kenya Certificate of Secondary School Examinations (KCSE). The head teacher took him to Getrude Hospital and he was put on ARVs. He was taking these medication secretly with the help of the head teacher who also provided him with food. He stopped going to his aunt’s place and to his surprise she did not bother to look for him.
Survival
Gumbo says one day the head teacher was going for a seminar and he had to go back to his aunt. No one noticed his presence and she behaved as if things were normal. He went to his room and kept the medicine. Later, the house girl who was cleaning the house found the medication and took them to his aunt. That day, he was chased away never to return. Looking emaciated, Gumbo admits to exhaustion and says that was the day his life changed and he knew he was to fight for his life alone. He went to Kariobangi South where he met a Maasai watchman at the balcony in one of
Continued from page 12 According to ANPCAN programme director, Susan Chege, the organisation advocates for foster care other than adoption in children’s homes. ”We try to convince prospective foster parents to adopt orphaned and vulnerable children in their homes from where we can plan ways of helping them,” observes Chege. She wonders why it is only the poor with little to offer who are willing to adopt children. ”However, we are planning to recruit middle and upper class society on the need to foster the over 2.5 million orphaned and vulnerable children in Kenya in their own homes.” According to ANPCAN, there are over 600 foster families in Korogocho alone. However, with the rapid rise in food prices and essential commodities, foster parents have a tough time ahead. “If we don’t take it upon ourselves to take care of these children, needy children might end up in the streets and cause problems to us all,” notes Chege. Despite the hard economic times and myriad problems associated with slum life, the women strive to provide for foster children under their care. “They rely entirely on me, my helplessness notwithstanding,” notes Mama Were as her ever present smile slowly creases into lines of deep thought. “God demands that you should always love your neighbour,” she says lifting her old Bible which she holds in high esteem.
Geoffrey Gumbo who has lived with HIV since birth. It took the intervention of his head teacher for him to know what he was suffering from but faced rejection from relatives. Picture: Valerie Aseto
the flats. After narrating his ordeal, he agreed to offer him a place to keep his clothes and books. He did not tell his teacher that he had been chased out of the house since he did not want to be a bother. Gumbo had the uphill task of taking care of himself single handedly but once in a while he got financial support from the head teacher. He stayed there until he did his KCSE exams. The results came out and he had a B+. He decided to take advantage of his certificates. He went to one of the day high schools and asked to be a part time teacher. He was lucky and was told to take the Form One students where he would teach Chemistry, Biology and Mathematics.
Employment
For the first time, the doors opened and the school was paying him KSh12,000 per month. He went ahead and rented a house of his own and even managed to go to college Kenya Institute of Social Work and Community Devel-
“I was a minor and I could not make certain decisions on my own though out of the pain I was going through, I was very willing to take the drugs.” — Geoffrey Gumbo
opment. Through a friend, later on Gumbo left teaching and joined ‘Lean On Me’, an organisation that works with young boys and girls in schools who are HIV positive and especially living in slums. The organisation is based in Kariobangi with the main office in Kisumu. As a parting shot, Gumbo says: “I do not regret having been born HIV positive but sometimes it hurts so much living with stigma that I never invited to myself.” Gumbo is still on first line ARVs since he started and according to him, the only way out is to follow the doctors’ prescriptions and eat well and one may live as any other person who is not infected. According to Deputy Programme Director Kenya Aids Vaccine Initiative (KAVI) Prof Walter Jaoko, the first line ARVs that are prescribed to a patient the first time the CD4 count is 300 and below is the best and it requires adherence and dedication. “The minute a patient begins to skip his/her medicine, the more resistant he/she becomes and second line would become the alternative though not very good,” Jaoko explains. As the World Aids Day is marked today, Jaoko sends out a message to those living with HIV to adhere to their medication and follow the right prescription as the only way to cope with the disease.
An aerial view of a slum in Nairobi. Many Aids orphans in the slums have found themselves without extended relatives to take care of them and have been taken in by kind neighbours who have no relationship with them Inset: Josephine Nyangweso who is taking care of her four adopted children. Pictures: Reject Correspondent and Alex Ndirangu
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Risk of men having sex with men prevails within prisons By GEORGE MURAGE In the vast prison grounds, the inmates come in all sort of manner. Some with scars on their faces, others with scared faces, some innocent looking but majority lost in the new world. The dressing is not different since the traditional white-stripped and torn prison gear has been the order of the day. However, on a keener look, one notices that some of the inmates are clean, well shaven and healthy looking. They can afford a smile now and then. To the thousands of inmates in the country’s penal institution, the manner of dressing among inmates tells a lot. The inmate could be well-connected or rich and in some cases a mende (cockroach) as they are known within the high walls. Within prisons circles the term mende refers to homosexuals and mainly men who have been turned into ‘women’ by their colleagues for sexual purposes. They are in some quarters detested and looked upon as sinners of the first class who should be hanged without delay. However, elsewhere, fellow inmates have gone hungry as they toil within the prison to make their ‘ladies’ look good and ensure they are well fed.
‘Mendes’
According to those within the circles, the mendes are usually the new inmates who are young, innocent and desperate. As the number of inmates and the mendes rise, so do cases of unprotected sex go up within the penal institutions. It is common knowledge that homosexuality in the country’s prison is on the rise, a move that has contributed to a sharp increase in HIV and Aids among inmates. This is because the prisoners do not have access to condoms and homosexuality is considered a crime within the laws of Kenya. According to a report dubbed Kenya Analysis of HIV Prevention Response and Modes of HIV Transmission, things are not rosy in the prisons. The report indicates that homosexuals are more significant contributors to HIV incidence
in Kenya than had previously been suspected. The study entailed using existing data and collecting new data to better know the country’s HIV epidemic and the national HIV response. A review of the most recent HIV epidemiology data shows that heterosexual transmission remains the most prominent mode of transmission in Kenya. However, there is now also evidence that men having sex with men, including those who are in prison, are a most-at-risk population that needs to be recognised in Kenya.
New effections
Inmates at the Naivasha GK Prison. The facility has 140 inmates who are HIV positive. The National Incidence Model Challenges of getting infected is high in the prisons where men are having sex with men indicated that men having sex with without any protection. Picture: Reject Correspondent men and prison populations accounted for 15.2 per cent of new infections. the support group Aids is a major concern in Stima. Within the past couple of years, the extent penal institutions. Stima who HIV positive says: His sentiments are echoed by Tom Ochieng’, of the men having sex with men issue in Kenya “We admit that homosexuality is there in our 35, who was jailed by the Makadara Court in has begun to be revealed. prison and it’s the main cause for Aids cases.” 2006 for robbery with violence. However, for the hundreds of inmates at A former GSU officer, Stima says that Ochieng’ who is also HIV positive admits the renowned Naivasha GK Prison, the fight among those serving life sentence, there are 140 that it is a challenge to live with a disease in against homosexuality started long ago. cases of inmates who are HIV positive. prison but once you accept your condition, a The prison with close to 3,000 inmates, maThe group has several peer educators whose heavy weight is lifted off your shoulders. jority on life sentence, has faced challenges like main responsibility is to talk to those engaging “Though there is stigmatisation in the first other prisons in dealing with mendes. sexual activity within the prison and have them days, we have supported each other in our With the harsh realisation that many could change their ways. group,” Ochieng’ told the Reject. die from HIV and Aids, a group of inmates “We talk to them for a number of days and have embarked on a campaign to fight the vice refer them to our counsellors who in turn counthrough HIV testing and counselling. The officer in charge of the prison Patrick sel and test them,” explains Stima. Incidentally, the inmates leading the camMwenda has led by example in the whole exerThe group’s patience has paid off and a few paign are suffering from Aids either contracted cise of counselling and testing. weeks ago, 322 inmates serving life sentence in prison or before they were jailed. He admits that the issue of homosexuality is agreed to be counselled and tested within the They have formed a support group with asa complicated as it is well hidden and done with prison. sistance from Kijabe Mission Hospital which consent from all parties. “Our campaign to get rid of mendes is gainoffers anti-retroviral drugs (ARVs). “The support group is doing a good job ing popularity among fellow inmates who are According to Dennis ole Stima, a member of and we shall support them as much as we can,” turning up for counselling and testing,” notes notes Mwenda. According to Mwenda inmates found to be HIV- positive get a special meal from the prison so that the ARVs do not adversely affect them. He admits that segregation is not an issue in the prison adding that all the inmates are treated equally despite their illness.
Complicated issue
A review of the most recent HIV epidemiology data shows that heterosexual transmission remains the most prominent mode of transmission in Kenya.
Demystifying misconceptions around male circumcision By PAM INOTI There has been a sustained campaign to encourage male circumcision among communities that have not been practicing. Between 2002 and 2006, three randomised controlled trials of male circumcision to prevent HIV infection in Orange Farm, South Africa, Rakai, Uganda and Kisumu, Kenya showed a consistent 60 per cent protective effect for circumcised men from heterosexual contact. After further numerous studies, the findings prompted the endorsement by the World Health Organisation and Joint United Nations Programme on HIV and Aids of male circumcision as a welcome addition to HIV prevention strategies.
Evidence
The compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by up to about 60 per cent elicited a positive reaction among men in Kisumu and the surrounding environs largely occupied by the Luo community who
culturally do not carry out the practice. With a highly publicised campaign in Kenya from both the Government and development geared towards encouraging male circumcision, many men opted to undergo the procedure in a bid to reduce chances of getting infected with HIV. However, because male circumcision provides only partial protection, it should only be emphasised as an element of comprehensive HIV prevention measure that includes promotion of safer sex practices, specifically provision of male and female condoms as well as promotion of their correct and consistent use. The misconception among majority of the men who have opted to undergo circumcision may not have to do with use of extra protection during sex since they cannot catch the HIV virus. According Josephat Khamasi, head of Youth for Peace Kenya initiative based in Kibera, such gross misconception dilutes the importance of carrying out the practice among Luo males. Khmaisi says the Luo males that he has interacted with discourage one another from having protected sex since they have already
undergone circumcision, a practice they believe will hinder them from catching the virus. In the sprawling Kibera slum, a large concentration of social workers and non-governmental organisations are working with the local population in an effort to mitigate the HIV and Aids impact to the community. In addition to emphasising behaviour change, such outreach programmes should focus on demystifying misconceptions around the male circumcision.
Research findings
Whereas the procedure has been linked to about 60 per cent less chance of contracting the HIV virus, it does not give one the green light to engage in casual unprotected sex. Such practices are hazardous and reduce the benefits of the Ministry of Health and other stake holders in promoting and carrying out the voluntary medical male circumcision campaign and procure. According to findings of a research article carried out last year by Westercamp et al. in Kisumu titled Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about
Protection, Risk Behaviours, HIV, and STIs, ‘preference for circumcision was increased with understanding that circumcised men are less likely to become infected with HIV’. The study deduced that preference for being or becoming circumcised in males was associated with inconsistent condom use and increased number of sexual partners. These findings, alongside many other studies carried out and also taking into account the verbal report from field workers suggest that measures should be taken to demystify myths surrounding male circumcision and HIV. In this regard, a comprehensive campaign on safe sex practice should be geared towards enlightening those that take part in the voluntary procedure as a means of guaranteeing proper protection against HIV infection. In 2009, Dr Kawango Agot, while working with the Nyanza Reproductive Health Society that encouraged and conducted male circumcision in the region, sounded a note of caution. “If circumcision encourages people to have sex with more partners, or riskier sex it will negate the benefits of procedure and speed up the spread of Aids,” noted Agot.
ISSUE 052, December 1 - 15, 2011
15
Unfiltered, uninhibited…just the gruesome truth
From being suicidal to a beacon of hope Celestine Ndege lives to tell her moving story By MACHARIA MWANGI She attempted suicide three times following marital strain that left her emotionally drained and frustrated. Having been continuously battered by her husband, Celestine Ndege lost all hope in life and the thought of suicide kept creeping in her mind. Having been diagnosed with HIV, her self esteem hit rock bottom and taking away her life seemed the easier way out. “All I wanted was to die. Life was no-longer rosy, it was not worth the troubles that I was undergoing,” Ndege recalls bitterly. In her first attempt, she swallowed an assortment of pills that she found in her house but was lucky enough to survive the ordeal. Two other similar attempts but she still survived. “It was a miracle how I was surviving these suicide attempts may be God wanted to use me,” says the mother of two. Matters were not helped by the fact that her husband was a drunk who kept tormenting her in all fronts. “He needed the slightest provocation to pick up a fight,” she confides.
Early marriage
Having been married at an early age, young Ndege was full of optimisms and despite the stories about difficulties in marriage, she was determined to make it work. Whether it was infatuation or love, she totally ignored signs of violence, she kept the faith. “I kept hoping that things would improve. When the violence got worse I sought refuge in my sister’s house,” explains Ndege. Her mother was also constantly on her side, encouraging her to hold on. “Things will improve one day as your husband will change his lifestyle,” she remembers the motherly advice. Her husband was also engaging in extra marital affairs with costly ramifications. “On more than one occasion I was diagnosed with sexually transmitted diseases,” says Ndege. Her naivety prevented her from reading the warning signs. Telling her husband she has contracted an STD would encourage his wrath that would be topped with beating. “I was beaten senseless after I confronted
him with the findings. I chose to remain mum to save my skin,” says Ndege. Thoughts of the beating she was receiving from her husband kept tormenting her with remorseless intent. “I was never at peace with myself. I was either on the run or knocking at my sister’s door after another whacking episode. It was a cycle of violence.”
Intervention
Ndege’s brothers noticed that something was amiss and volunteered to take her back to school to let her pursue a course and acquire skills that could help her get a job. However, their interventions were short lived and Ndege was back to her marital home. After a struggle she conceived and it was a joyous moment. “After nine months, I was blessed with a baby girl, having four years earlier been blessed with a boy. I was over the moon,” she adds. However, the joy was short-lived. More than a year later, she started being sickly and decided to go for a test. “I was least worried as I looked healthy and energetic,” explains Ndege. After waiting in what seemed like eternity, the results of the test would deflate her ego. The results were positive. It was a moment of reckoning. She could not think straight. The eerie feeling kept reverberating in her ears. “I walked for more than four kilometres to my sister’s place. What was the need of boarding a vehicle and I was dying anyway,” she fought with the inner thoughts. She could not surmount enough energy to eat. Why waste food while she was only a few
“I was beaten senseless after I confronted him with the findings. I chose to remain mum to save my skin.” — Celestine Ndege
Celestine Ndege at her home during the interview. She attempted to end her life thrice after she found out her HIV status but is now a source of inspiration to many. Picture: Macharia Mwangi days away from the grave. She went straight to bed and fell into heavy asleep. She was emotionally drained. When she woke up, Ndege thought of her daughter and felt sorry for her. Maybe she was also dying. Hot tears kept rolling down her cheek. It was more than she bargained for. The reality of the findings was sinking in. Just like many in her situation, it was denial at the beginning nothing mattered any more. Whom would she confide to? It all seemed lost. Ndege was very close to one of her brothers. It was time to spill the beans. “I called him to a secluded place later that night and gave him the diagnostic findings. He was holding a torch and let it go, he was also in a state of shock,” she says. He quickly composed himself and reminded Celestine that after, all, it was not the end of life. “Celestine, you are not dying. Maybe the doctors were wrong in their analysis,” he revealed. It was the reassurance that she needed to move on with life. “I was touched by my brother’s words,” she observes. After a lot of soul searching, she invited her husband to a nature walk to enable her get ample time to reveal her condition. The reaction was anticipated. He hit the roof questioning her rational in deciding to go for the test. Did he have prior knowledge of his condition? His words were cautious. “Now that we are suffering from the same condition, it’s time
to be closer to each other more than ever before,” he told her.
Moving on
However, the peace was short lived. After some time, he was back at it again and the outburst in front of her eight-year-old son left her shocked. “He, with the least care, revealed our condition to our son. My son soon started asking uncomfortable questions. It was traumatising,” says Ndege. However, today the agony of knowing her condition is water under the bridge after she did the noble thing of accepting her condition and going for counselling. Ndege was later trained to be a peer counsellor and is now a beacon of hope for people living with HIV and /Aids. “I encourage them that all is not lost and urge them to live positively,” said Ndege, 33. She has also mended fences with her husband and they are speaking with one voice. “At least now I am enjoying my freedom. We amicably resolved our differences,” she says. She encourages those already infected to stop the blame game and live healthy. Despite staying eight years with the virus, she only started using ARVs recently after her CD4 count went down. “I have been lucky throughout and luckier that my daughter did not contract the disease. It’s a miracle that I live to tell my story,” she concluded.
Police officer seeks justice 21 years later By KIPKOECH KOSONEI When Constable David Kosgei left his house at the Parklands District Office staff quarters on the evening of June 22, 1990, little did he realise that the woes that would lead to his dismissal were about to begin. He was headed to Pangani Girls’ High School, where he had been deployed to protect the girls from rowdy youth who were then agitating for multi-party democracy. On his way to report for duty at Pangani Girls, Kosgei together with a colleague, were attacked by young men. They fought them off and the youths escaped to a nearby pub. Kosgei and his colleague, whom he remembers only as Constable Kuria, went into the pub in a bid to arrest the youth. There, they found fellow Administration Police officers who were off duty. “Some of them were senior in rank and we explained that we were pursuing youths who had attacked us on our way to work,” Kosgei recounts. The officers advised Kosgei and his partner to abandon the search and report to work at Pangani, saying that the matter
would be investigated. Three days later, Kosgei was shocked when he was summoned by then Parklands District Officer for disciplinary action known as Orderly Room Proceedings. There he was accused of absconding duty and drinking alcohol while armed and in uniform, and one of the officers who had been in the pub on the said day testified against him. Kosgei denied the allegations, gave his account of events and was let back to work as usual.
Dismisal
However, that was not the last he heard of the matter. One month later he received a dismissal letter. The letter dated August 3, stated the reason for his dismissal as being absent from duty at Pangani Girls High School and drinking beer in a public place while armed and in uniform. The letter termed him a disgrace and liability to the force for committing serious offences that endangered his life and the lives of others. He was dismissed from service without benefits, after serving the police force for six years.
Kosgei was shattered as he left his job and went to his rural home to Kabiyet in Mosop, Nandi North District. He suffered depression, married and was expecting his first child when he fell sick. He was admitted at Kapsabet District Hospital where he was diagnosed with tuberculosis and pneumonia. He was plagued with illness for several years, during which time his wife left. In 2000 when he recovered, he found a job as a security guard in a local secondary school and remarried. The former AP Constable fell sick again and was hospitalised with a recurrent case of tuberculosis and pneumonia. Doctors advised him to take a HIV test and the results showed he was infected with the virus. Kosgei who says he has suffered stress, coupled with stigma and financial strain due to his illness is now seeking to be reinstated into the force 20 years after he was dismissed. “The claims that led to my dismissal were false and I feel I was sacked unfairly,” he says. “Moreover after reading the Constitution I realise that the law protects me from discrimi-
nation based on my status that is why I am appealing to be reinstated as an Administration Police Officer.” Kosgei wrote to the Administration Police Commandant in June this year, appealing against his dismissal from the force, which he says was unfair. “I had never been disciplined for any offence or for being absent from duty and I did not break any law,” he writes in a copy of his letter to the commandant. However, he has not received a response to date, despite many futile attempts to follow up the matter with the Administration Police office in Nyayo House. He also sought help from Mosop Member of Parliament David Koech, who said that the personnel officer had indicated that Kosgei could not be employed because he is sick. Kosgei now wants the AP Commandant Kinuthia Mbugua to look into his case and have him reinstated, saying he was dismissed unfairly. “My status is not an issue. I have strength and capacity to work for the next ten years before I reach retirement age,” he says.
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Loliondo concoction must not interfere with ARV therapy By ODHIAMBO ODHIAMBO Kenyans living with Aids have been advised not to stop taking anti–retroviral drugs even when they resort to herbal therapy. The National Aids Control Council (NACC) director Professor Alloys Orago said many people had lost their lives when they stopped the intake of ARVs after visiting Mzee Ambilikile Masapila in Loliondo Tanzania. “Never stop taking your usual drugs even after taking the wonder drug because this will weaken your body’s immune system and expose you to several ailments,” Orago advised during a live radio talk show. However, he said they had made significant strides in tackling the spread of HIV/ Aids in the country after most infected people accepted their status and were now enrolled in various health facilities where they were taking drugs. He asked Nyanza residents to embrace the male cut because it reduced chances of getting infected by about 60 per cent. Orago spoke as residents of South Nyanza continued to throng the now busy Loliondo village to seek treatment for their various ailments.
Business
Quacks defeat efforts to manage HIV By AGGREY BUCHUNJU As we mark World Aids Day, it is important to reflect on the failures and success on the fight against the disease. Although the Human Immunodeficiency Virus (HIV) was discovered three decades ago, a cure for the infected is yet to be found. However, efforts in the fight against the pandemic have been thwarted by quacks who purport that they can treat survivors of the virus. According to senior nursing officer in charge of Comprehensive Care Centre at Bungoma District Hospital clinic, Jemima Okonji, quacks impede HIV management and prevention in the county. “Patients go to quacks that treat them for malaria. They discover too late when the damage caused by the virus is irreparable,” notes Okonji. About 5,200 people living with HIV have enrolled with Bungoma District Hospital for treatment and care. Okonji points out that those on ARVs at the moment are 2,700 people adding that the rest could have either died or defaulted. “Some clients fall out of clinic and stay home due to stigma,” she observes. She says infection rate in Bungoma is higher among married people than among the singles. In the fight against HIV, Okonji reveals that Bungoma District Hospital clinic works closely with Aids Population Health Integrated Assistance (APHIA) Plus, capacity, NASCOP and other local CBOs and NGOs.
The famous Mzee Ambilikile Masapila in Loliondo, Tanzania preparing his herbal concoction is claimed by those who are suffering from Aids to cure the diseases. There are loads of buses travelling to this old man in the hope that they will be cured of the virus. Pictures: Reject Correspondent
Some matatus plying Migori-Kisii – Kisumu routes have now shifted to the Loliondo due to the booming business occasioned by high number of sick travellers. Sick people including businessmen and politicians seeking solutions to their ailment are trooping to Masapila’s compound in their droves every week. The vehicles from Migori, Rongo, Awendo and Kuria West Districts pass through the Isebania border point to Tarime District before taking a murram stretch to the Mzee’s home. “We charge KSh7,000 return trip because we normally wait for our clients for two or three days in the queue before they receive the herbal drink,” explained Jared Onyango, a matatu driver plying the route. He said the distance from Migori to Loliondo is 502 kilometres through the shortest route. “Since the road is bad, many people are not using their private cars and have instead turned to matatus,” observed Onyango. The matatus are usually serviced after every trip to make them more efficient. “We normally collect our passengers from their homes at night. Many avoid being seen by others as they fear being mocked and stigmatised over their sicknesses,” observed Barrack Momanyi, a
matatu operator. “We are under firm instructions from our commuters not to reveal their identities to anybody sometimes even to their spouses and we respect their wish because they pay us handsomely,” noted Momanyi. Each matatu carries at least 14 passengers which translate to KSh9,800 per trip. “We normally give KSh1000 to Tanzanian police manning roadblocks in order to avoid wasting time with bureaucracies although we seek formal clearance at the border when entering the neighbouring country,” explained Momanyi. At Mzee Masapila’s home, Kenyans pay TSh1,500 while Tanzanians pay TSh500 to get “a
sip of life”. Recently, a Kenyan trader who was HIV positive died after he stopped taking his ARVs soon after visiting Loliondo. The drivers noted that wealthy people from East Africa including tourists from Europe were still landing in the village in helicopters just to take a sip of the wonder concoction. Most people in Nyanza are now jealously guarding the Ochuoga tree after it emerged that it formed part of the herbal mix being prepared by Mzee Masapila. The old man claims to have been sent by God to cure illnesses afflicting mankind. Some are now boiling the tree roots at home and drinking in order to stay healthy.
Leaders accused of laxity in the fight against Aids By ROBBY NGOJHI A civic leader in Taita Taveta County has questioned the laxity by local leaders towards the campaign in the fight against HIV and Aids. Speaking at a full council meeting in Wundanyi, nominated Councillor Dixon Babu of Mwatate constituency expressed concern that local leaders have been shying away from discussing issues pertaining to the disease. He observed that councillors tend to concentrate on other issues at the expense of addressing HIV and Aids in spite of the fact that the disease was declared a national disaster. “I am a member of the Taita Taveta Council committee on HIV/Aids but since the committee was formed this year, we have received virtually no agenda from fellow councillors. This is disgusting because it is with us and there is no way we can assume it does not exist,” noted Babu.
He observed: “When it comes to debating issues you will find other matters being given special attention to the extent of extending our debates. However, this does apply to matters related to HIV/Aids.” He called upon councillors to partly shift their attention from politics and start focusing on possible ways on how to successfully counter the pandemic. “It is perturbing to see that even in our schools the issue of HIV/Aids awareness has been ignored. By what magic can we achieve zero infection if we do not want to face the problem head on?” posed Babu adding that by keeping the leaders will be dodging their responsibility. However, he reminded the civic leaders that it is possible to dodge responsibility but not possible to evade the consequences. The councillor spoke at a time when a non-
government programme of USAID on population and health (APHIA) Plus cited some of the major hot spots in Taita Taveta county where caution needs to be taken. According to APHIA plus’s service delivery coordinator in charge of the area Felix Mulama, towns such as Voi, Maungu and Manyani are leading in terms of HIV/ Aids prevalence. “Currently Moi District Hospital in Voi has over 4,000 clients on anti-retroviral drugs which is a very high rate for such a small town,” observed Mulama. He said the rate is catapulted by the high number of students from the middle level colleges and a local campus which started recently. He added that in Maungu the rate is growing because being a highway township, it serves as a stopover for truck drivers who are the main clients of the sex workers.
Home based care
The coordinator Bungoma Home Based Care (BHBC) Martin Lukhale claims that his organisation has 400 community Health workers who ensure that their 1,375 clients take ARVs. They refer to hospital those whose health deteriorates. Bungoma Home Based Care is one of the community based organisations in Bungoma County that give psychosocial support to people living with HIV. According to Lukhale, the organisation trains patients on positive living as well as gives seeds and poultry to affected households for nutritional value among other things. During the current financial year Finance Minister Uhuru Kenyatta allocated KSh903 Million to the health ministry for anti-retroviral therapy. However, according to Jane Mwangi of Kenya Aids NGO’s consortium more that 300,000 people living with HIV are at risk of dying because they cannot access treatment. Mwangi claims that only 38 to 45 percent of people living with HIV and in need of treatment, care and nutrition are reached due to inadequate budgetary allocation to the health sector. “The civil society organisations (CSOs) have been demanding that the Government allocates at least 15 per cent of its revenue to the health sector. However, the highest the Government has ever allocated the sector is eight percent,” noted Mwangi.
ISSUE 052, December 1 - 15, 2011
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Unfiltered, uninhibited…just the gruesome truth
Asha boldly confronts stigma By ELIZABETH AWUOR When she learnt about her HIV status in 2006, Asha Nyakundi went through a rough time as she faced discrimination from relatives who rejected her because of her condition. At the time she was getting to know about her HIV status, Asha’s son who was then in Standard Eight was diagnosed with Tuberculosis. On visiting a health facility, the medical officer asked her to take a HIV test. Asha thought that this was an insult to her since she had been faithful to her husband. At the time she knew that the HIV virus can be transmitted through sexual intercourse. “I felt that the doctor was insane to think that I could be infected with HIV since I trusted myself,” she says. Asha ignored the first advice and the second time she visited a health facility to get treatment for a scabies infection, the doctor she saw asked her to consider taking a HIV test.
Testing
At this point Asha felt there was need to take this test after two different medical practitioners had advised her to do so. She went to a Voluntary Testing and Counselling Centre for the test that turned positive. “The results shocked me. I knew I had been careful with my sexual life even if I had four children with different fathers,” she notes. She could not comprehend how and where she got infected. She worried for three months without revealing her status to her husband or any other relative. However, one day while having a discussion with her niece, Asha started getting hints of where she could have picked the virus from. Asha had jokingly told her niece that she wanted to go for a HIV test and the answer she
got was appalling. Her niece claimed she would not be shocked if Asha tested positive because she had nursed their late grandfather who suffered from Aids. Asha recalled how she had carelessly nursed her father-in-law and connected her infection with HIV to that period. “My father-in-law had blisters in the mouth that used to bleed, he had a tin that he spat on and I could clean it every now and then. There were times when I had cuts from the kitchen and wounds on my fingers but I still cleaned the fresh blood without wearing gloves,” recalls Asha. It was a bitter reality for her to swallow but she had learnt to calmly handle issues. She confronted her husband that evening about their father’s illness and he admitted that the old man died of Aids. Upon asking why they never informed her that the sick man she was nursing was HIV positive, her husband asked casually if she had intentions of getting sexually involved with the old man. Asha persuaded her husband to go for a HIV test and he eventually did but the result was negative. That was a turning point in their marriage. He became abusive calling her a prostitute who slept around with men and got infected with HIV. With the reaction she got from her husband, Asha knew she would have to be strong to survive. She was bitter with him and the other relatives for failing to inform her that she was nursing someone who was living with Aids. “My husband would come home from work at night and heap abuses at me till daybreak,” she recalls. After going through three years of psychological torture and discrimination, he eventu-
ally divorced her. It was Asha’s husband who told the other relatives about her status. Her own brother went around informing neighbours and friends to be wary of her lest she infects them with the virus. Asha who used to sell snacks within her residential area lost her customers because of what her brother was telling anyone who cared to listen. Family members would not allow her to make any contributions during gatherings with the brief that a ‘sick’ person cannot make any serious contribution.
Disclosure
However, she did not lose hope and made her status known to all who were willing to listen to. Eventually she managed to win back her customers. “I got involved in community work and I am currently a member of the Kisauni Constituency Aids Control Committee. My main responsibility is to represent people living with HIV in the constituency,” says Asha. She adds: “Since I accepted my status, I vowed never to infect anyone.” Her pledge saw her win the Women Ending Aids (WEA) in Kenya 2011 Award. She reiterates that her campaign is to remain vocal about HIV and Aids, reveal her status to as many people as possible because it was lack
Asha Nyakundi has been with the HIV virus which she contracted from giving care to her father-in-law. However, she is facing discrimination and has since been divorced by her husband. Picture: Elizabeth Awuor of disclosure that made her contract the disease. Asha discovered that holding one’s head high and preaching the rights of persons infected with the virus is a sure way of reducing stigma towards those living positively.
Grassroots women take leadership in fighting pandemic By OMWA OMBARA In 1997, a small group of women in Kiamuria village, Gatundu South Constituency started a social welfare group. The dedicated mothers, so full of love and warmth, knitted sweaters for school going orphans and bought for each other exercise hooks. “In 1999, when President Moi declared HIV and Aids a national disaster, our team started taking care of HIV-positive individuals,” says Jane Nyokabi, a caregiver with a Community Based Organisation -Gatundu Mwirutiri Women Initiative. In 2003, the team of 24 women joined Groots-Kenya, a national movement for grassroots women. “We were trained by Trainer of Trainers as home care givers and community health workers. We started a programme on communication response to HIV. Our mandate was to offer care and support to people affected and infected by HIV and Aids,” explains Nyokabi.
Support group
The team started the first HIV support group in 2004 in Gatundu and called it Giving Hope Project. “There were no drugs then and people were suffering a lot of stigmatisation. Those who were tested positive went into hiding. People were bed-ridden in pathetic situation, with bedsores all over the body. Four men and one woman volunteered to join our group and became caregivers,” recalls Nyokabi. The group soon got busy dealing with orphans and vulnerable children. They mobilised 120 households and those who were infected in schools. They gave vocational trainings to 65 youth through Youth Empowerment Pro-
“We felt something had to be done. We consulted Groots Kenya and it helped us do a base-line survey (mapping) to assess the magnitude of the problem,” The problem was deeply rooted. We did understand why girls’ rights were being violated.” — Jane Nyokabi, Caregiver
grammes. In 2005, most of the men died leaving women behind. Nyokabi says some of her friends and relatives were chased out of their matrimonial homes with their children. Where both parents died and the children were girls, the young ones were sent to live with their grandmothers. “We felt something had to be done. We consulted Groots Kenya and it helped us do a base-line survey (mapping) to assess the magnitude of the problem,” says Nyokabi. She notes: “The problem was deeply rooted. We did understand why girls’ rights were being violated.” Their concerns led to community intervention strategies created by the community itself, caregivers, opinion leaders, administrators and paralegals. “We formed property watchdog groups to protect the interests of orphans. Today, many women have returned home to Gatundu, Kakamega, Limuru and Kendu Bay.” “It had a lot to do with selfishness and greed,” explains Nyokabi. The women were blamed for all the HIV infections in the village. They were accused of infecting vijana wetu (our sons). Ignorance took centre stage with the motto, “If a parent dies, the children will also die. They will be buried on our land. We are only safeguarding the property,” claimed the villagers. Even brothers saw their own sisters as a threat. In rebellion, the women moved to the shopping centres and deliberately infected the men. The scene became so chaotic that something had to be done to stop further destruction. The women who had moved to live in the shopping centres were then ostracised and whispers went round. “What do you expect from a woman who has been chased away from her matrimonial home? If she does get food from your husbands,
they will steal from your farms.” Today, Nyokabi is happy to reveal that the matter has almost ended. She is grateful to the community for their response to HIV. She particularly appreciates the support of the Home Based Caregivers Alliance that brought together home care givers at the district level. She further compliments the Ministry of Health.
Rights
“We advocated for our rights as caregivers and demanded for recognition. We wanted HIV funds to come directly to the community. We wanted to deal with the Global Fund directly as we were fed up with briefcase CBOs,” observes Nyokabi. She adds: “We sought good governance especially where devolved funds were found. We wanted women property inheritance programmes.” Nyokabi was speaking to the Reject when she narrated the long journey towards fighting for the rights of HIV-positive women. The women in Gatundu took over leadership despite initial lack of funds and set themselves as role models to groups. The team started a forum for women’s groups to help women access justice. They pushed for voices of women to be heard. They formed a task force that moved all over the district educating women in leadership and localised the Millennium Development Goal Three that pushed for Gender Equality and Empowerment. “Women carry the burden of their communities, something not found in men who only vocalise but do not do anything practical. Women can prioritise their needs while men prioritise on issues that favour them,” claims Nyokabi. One of the core activities of the team is to contribute to a revolving fund called the Merry-go Round Health Mutual Fund. Here, you contribute a little money every month that goes towards your treatment or health issues.
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Woman evicted from matrimonial home for testing positive By JOSEPH MUKUBWA Violence against women remains a challenge even as we are in the middle of 16 days of activism against gender based violence. While this is an abuse of their human rights, most women suffer especially when they fall sick or have been found to be infected with HIV. For 52-year-old Margaret Kaluki Nderitu, a woman living with HIV in Kiawara slums in Nyeri County, life has never been smooth. Her trouble began immediately after marriage to the man she loved. She not only experienced violence during their stay together, but also suffered eviction from the land they owned together. And now 11 years down the line, Kaluki has been selling vegetables in the streets of Nyeri town to earn a living. The eviction from her matrimonial home and the subsequent loss of the plots they coowned has subjected her to untold psychological torture. Kaluki got married to the man, a former airport police officer in 1984. She had two daughters by then and they were blessed with another two girls.
Mission
One year later, the husband was sent on a peace keeping mission to Bosnia. While there, he advised her to go for their other two children from Machakos and move with them to his father’s home in Kigogo-ini in Nyeri. They stayed there until his return in 1994. “With our savings, we bought two plots measuring in Kiandere in Tetu District of Nyeri County, a two-acre piece of land, a pick-up and dairy cows among other things,” explains Kaluki. She adds: “We built a six-bedroom stone house and left our parents’ home in Kigogo-ini to live in our new house.” Her husband later allowed her to be using the pick-up so as to supplement his earnings. She used it for transport business until 2000 when he demanded that she gives him the car keys and ordered her never to touch it again.
He not only kept the key away from her reach, but also warned her against taking any other thing from that house. That is when their problems started and the marriage began getting sour. One day her neighbours needed to use the car and pleaded with her to transport some goods for them, which she did.
Beating
“When my husband came back home, he beat badly me for using the vehicle to the extent that I was admitted in hospital for two weeks,” explains Kaluki. “I had suffered broken bones on my back. Since then, I was advised by the doctor not to be doing heavy duties due to the injuries sustained in the attack.” Later, she developed some complications in one of her hands and after undergoing some tests, she was diagnosed with syphilis. The doctor turned curious and upon further screening she tested positive for HIV. “I went home and informed him of the results. Instead of accompanying me for testing and counselling, he turned furious and evicted me from our house, claiming that he could not live with a HIV- positive person. He gave me a room in one of our plots and told me to live there alone,” says Kaluki. He never gave her money for maintenance and after sometime she started doing menial jobs to make ends meet. These included picking tea leaves among other jobs. Her deteriorating health could not allow her to continue doing these jobs. She was hosted by her first born who also struggled to provide them with basic needs. Since her eviction, Kaluki and her husband have had several unsuccessful reconciliatory sittings with elders and members of the provincial administration. Her efforts to have him give her a share of property have not borne any fruit. He claims neither knows her nor owes her nothing, though they had lived together as man and wife for several years. They had even
changed her third name from her father’s to his. After a lot of persuasion from the elders, the man agreed to allocate two of their 16 acres land in Gatarakwa to two of his daughters. “Though he had committed himself in writing in front of the elders, he sent the children away when they went to get a share of the land. However, the youngest went there forcefully where she lives to date,” she claims.
Struggle
Regardless of the fact that she is not in good working health, Kaluki decided not to stay with the children as she regarded herself as a burden to them. She has to work hard to get food and other daily needs including clothing and house rent. “Many a time I go hungry due to lack of food. I have been taking ARVs and the doctors advise that I must feed well before taking the drugs,” she says. She is now appealing to the Federation of Women Lawyers (Fida) and other legal organisations dealing with women’s rights to help her so that she can get her rightful share of the land from her husband. May be when the Marriage and Matrimonial property Bill will be enacted then Kaluki will get what rightfully belongs to her.
Margaret Kaluki Nderitu preparing vegetables for sale in her single roomed house in Kiawara slums in Nyeri Town and (inset) opening the door to her shack. She was divorced and denied rights to her matrimonial property because of her HIV status. Pictures: Joseph Mukubwa
In-laws make life difficult for widows By FRANK OUMA Women living with HIV face numerous challenges when it comes to issues of land rights in Butula District, Busia county. According to Mary Makokha, Executive Director Rural Education and Economic Enhancement (REEP), cases of women being evicted from their homes particularly when the husbands die are too many. “It is sad that when a man dies, his wife also becomes part of the properties that must be inherited and those who decline are kicked out,” notes Makokha. Through her programme, they have created awareness among women to be vigilant whenever they lose their husbands so that the in–laws do not take away their property.
Landless women
Makokha says there are also corrupt administrators who instead of defending the women, instead collude with the in-laws in robbing them of their rights. Butula District has a number of women who are landless and who need Govern-
“Women are now sensitised and are able to choose who to live with after the death of their husbands without being forced.” — Mary Makokha
ment support so that they are able to fend for themselves and their children. REEP, a community based organisation in Butula has been at the forefront of promoting the rights of women and protecting those who are infected and affected by HIV/Aids. According to Makokha, people in the area previously created perception that women cannot own land but that seems to be changing due to the ongoing civic education. The organization has been forced to take certain take in-laws to court for disinheriting widows and take away their land of just because their husbands died of Aids. “The few that we have taken to court have acted as a warning to others out there,” explains Makokha. “Through civic education we have managed to reduce stigma.” Educating the community on the need and importance of protecting the rights to land and property of widows in the district is key. REEP has sensitised the community on inheritance so that no one is forced into the
arrangement. “Women are now sensitised and are able to choose who to live with after the death of their husbands without being forced. Some have continued to stay single and are happy,” noted Makokha. Through the initiative where children are total orphans, the organisation steps in to protect them whenever they feel that their relatives want to grab and sell their land.
Descrimination
Women may not have a lot of resources that allow them to acquire land but those who have had money have been able to buy land and pay rates. However, she regretted that those who cannot afford to pay land rates have had their land sold to other by local authorities. Makokha noted that discriminatory culture is to also blame for the state of affairs which make women believe they are inferior to men. “Even in education in the past girls could be compromised to allow boys to proceed in case there was not enough school fees,” she said.
ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
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PATH supports sweet potatoes growing for a healthy population By DUNCAN MBOYAH The Programme for Appropriate Technology in Health (PATH) has embarked on the promotion of growing and consumption of orange sweet potatoes in Western Kenya. According to PATH’s President Dr Chris Elias, orange sweet potatoes are good because they help reduce the risk of blindness in Kenya since Vitamin A deficiency is prevalent in the region. “We are giving farmers seedlings to help boost the growing of this nutritious food stuff since it is effective in providing vitamin A to malnourished women and children,” Elias said while addressing journalists in Nairobi. He observed that the crop is a cheap, nu-
tritious solution for farmers who need to grow more food on less land for rapidly multiplying populations. Orange sweet potatoes are an important source of beta-carotene (the precursor to Vitamin A). Just 125 grammes of fresh roots from most orange-fleshed varieties contain enough beta-carotene to provide the daily pro-vitamin A needs of a pre-schooler. This is particularly important in Kenya and other sub-Saharan Africa countries. Vitamin A deficiency can lead to impaired immune defences and eye damage that culminates in blindness and even death. Annually, 250,000 to 500,000 pre-school children go blind from Vitamin A deficiency and about twothirds will die within months of going blind.
Elias noted that the production of cost effective vaccines have helped save lives adding that 82 percent of children are protected by vaccines worldwide. “There will be celebration once the antimalaria vaccine is launched in 2015 since eradication of malaria has remained elusive in sub-Saharan Africa where it is killing many children yearly,” he explained. In a bid to help reduce HIV/Aids prevalence amongst long distance truck drivers, PATH has designed an innovative campaign to catch the attention of drivers on East African highways. “The campaigns are placed on billboards and are written in Swahili to help drivers and other road users make healthy choices about
sexual behaviour to protect themselves and their families from HIV infection,” said Dr John Waimiri, programmes officer. In collaboration with the Ministry of Roads, PATH has erected six billboards in major border towns and truck stops between Mombasa and Western Kenya. Waimiri also said that PATH is keenly working with the Uniformed Services Aids Control Units with the aim of strengthening the forces technical assistance and capacity building. “This is to help strengthen the delivery of high quality tuberculosis and HIV/Aids treatment as well as care at health care facilities managed by the uniformed services,” he added.
Burden of care puts a heavy load on grandmothers’ shoulders By JOHN NDOLO Mukeli Kiteme, 76, from Makutano village, Kimu Location in Kyuso District takes care of two orphans. The children are in class five and eight at Kwakatile Primary School. One of the children’s parents died in 1997 and the other in 2001 leaving the two boys under the care of their grandmother. “Since then I have struggled in caring for my grandsons singlehandedly before they were absorbed into the cash transfer programme,” explained Kiteme. The cash transfer programme is managed by Ministry of Gender, Children Services and Social Development to cater for orphans and vulnerable children. Kiteme is among a large number of growing grandparents who have found themselves left with the responsibility of caring for their children. Kiteme says she invested the cash and bought four goats and six chickens which she has been rearing. This, she would occasionally sell to cater for the children’s basic needs. Speaking to the press during a programme monitoring exercise, Kiteme said she had bought 14 pieces of iron sheets which she will use to construct a house for her grandchildren to ensure that they have a decent shelter. She said the two boys would inherit their parent’s land without any dispute so long as she lives to see them in their adulthood.
Epilepsy
However, for other grandparents like Katonyi Mwaniki of Wanzia Village, Kimangao Location, things are not easy. She suffers from epilepsy and is a beneficiary of the programme due to her vulnerability condition. The 51-year-old widow is also taking care of her a 13-year-old grandson, who more often than not takes the role of caring for her whenever she falls ill. The boy occasionally has to miss school to help his grandmother in attending to appointments at Kyuso sub-District Hospital. Katonyi is a member of Wendo wa Kimangao Women’s Group that is involved in stone crushing business. This they sell to local contractors. However, Katonyi says she was exempted from working due to her health condition. Katonyi bought three goats with the cash transfer money and these have multiplied to tens and now boasts of a sizeable herd of goats which she says is a source of their livelihood. “During the dry season I can take one goat to the market and sell it for between KSh3,000 and KSh4,000. I use the money to buy food for
the family,” Katonyi explains. The ailing grandma was full of praise for the programme which she attributes to their survival after the death of her only son and his wife ten years ago. She says her grandson will inherit her land. Another beneficiary of the cash transfer is Josephine Illai, 80, of Kaliluni Village, Migwani District. Illai is taking care of four orphans.
Benefits
Illai joined the programme in 2006 and says A grandmother (in it has helped her educate two of her grandchilorange wrapper) dren to secondary school. “One of my granddaughters aged 17 just sat who is taking care of her grandchildren for her Kenya Certificate of Secondary Educaafter the death tion this year while the second born who is 15 of their parents in Form One. The other younger two are in pribreaks down as mary school,” explains. she speaks about For sustainability, Illai bought two donkeys the challenges. which she uses to transport goods for people The Government is at a fee. She also has a herd of about 20 goats now offering cash which she occasionally sells to buy food and to orphaned and other basic items for the orphans. Eunice Mutave Kilonzo, 54, is a guardian to vulnerable children living with poor one orphan and eludes her success in educating extended relatives. him to the cash transfer programme. The 17 year old boy also sat for the Kenya Picture: John Ndolo Certificate of Secondary Education at Thokoa Secondary School in Migwani District. abuse and exploitation due to their vulnerabilMutave, is a member of Umiisyo wa Migwani ity circumstances. Women’s Group that has a poultry project which It is against this backdrop that the Governthey use to sustain their livelihoods. Started with ment established the Cash Transfer for Orabout 80 local breeds, the 15 member group phans and Vulnerable Children Programme in started the project with each member donating 2004 with a view to addressing the problems four chicks. facing orphans and vulnerable children. One of the greatest challenges that has been posed by HIV and Aids pandemic is the burden of caring for children left behind. After Ministry of Gender, Children and Soburying their children, grandmothers have cial development under whose docket the to take up the heavy task of caring for their Children’s Department falls manages the grandchildren. These are mainly old women programme with funding comes from the in their sunset years who are forced to find a Government and support from development source of livelihood to cater for their grandpartners including UNICEF, DFID and World children. Bank among others. Mwingi District is one of the 47 districts out of 73 old administrative units in which the proAccording to the Ministry of Gender, Chilgramme is being implemented. dren Services and Social Development report, According to Jacinta Mwinzi, Mwingi Disthe impact of Aids accounts for about 48 per trict Children’s Officer through the cash transcent of orphaned and vulnerable children out fer programme extremely poor households are of the estimated number of 2.5 million. periodically provided with cash subsidies. About 48 per cent of the population live be“The cash support enables poor families low the poverty line and this includes about 8.6 who are taking care of the orphans and vulmillion children. nerable children to foster and retain the young Most of the orphaned and vulnerable chilones within their families in the community,” dren are deprived of their basic needs due to explained Mwinzi. high levels of poverty at their respective villages Selected caregivers receive cash payments after their parents die. after every two months through respective post They are also prone to different forms of offices.
Funding
Poverty
Mwinzi noted that the overall objective of the programme was to provide social protection through regular and predictable cash transfers to extremely poor families as well as promote their human capital development. “The key strategic response in addressing the situation of orphans and vulnerable children is to strengthen the capacity of families who care for them within their community,” noted Mwinzi. She observed that the family remains the most natural unit for proper socialisation and growth for every child and, therefore, reiterated the need to retain them in their homes regardless of the social outfits.
Implementation
The cash transfer programme is implemented through four key thematic areas including education, health, food security and civil registration. The caregivers are encouraged to liaise with civil registration office to obtain birth certificates for the children, death certificates for the deceased parents and national identity cards. An Assistant Chief of Maseki sub-Location, Paul Katee says for a household to be considered in the programme it must have orphans and vulnerable children, must be extremely poor and should not be benefiting from a similar programme.
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Elderly demand money to care for orphaned grandchildren
Calls for female-specific medical research By a correspondent
By OMWA OMBARA There is a group of the Kenyan population that is not happy. These are 720 elderly Kenyans who are upset, very upset. They are citizens of this country and are entitled to their human rights. The Government has ignored their plight and before Kenyans know it they will soon be cursing the people who are sitting on their money in high offices, specifically The Ministry of Gender, Children and Development. These curses may cause untold suffering not only to individuals at which they may be directed but to the country as a whole. The curse of one elderly person according to African culture can be quite toxic with unfavourable results. So the Government should prepare for 729 curses.
Care of grand children
The Karika elderly of Kawangware are struggling under the burden of their grandchildren whose parents died from HIV-related illnesses. In their sunset years between 65 and 90, they have walked endlessly to Government offices and to the Children’s Department seeking answers on how they can be assisted to help make the children live. “Our backs are bent from old age and we suffer backaches, our joints and knees are stiff and painful. Some of us have lost our sight. Our teeth are gone and we cannot even smile with these Government officers. We suffer from high blood pressure, diabetes, arthritis, ulcers as well as take care of our grandchildren. How does the Government expect us to make these endless trips in our condition,” queried Mama Monica Wandia, 70, on behalf of other elders. She added: “We have no more energy left in our aged bodies to follow up an inhuman and faceless Government.” The Karika elderly have 26 school-going orphans aged between three and 16 years. They have come together as a group to ensure
An elderly speaks on behalf of the Karika elderly group who live in the sprawling slums of Kawangware in Nairobi where they take care of orphans. The elders now want the government to pay them their dues from the cash transfer meant for the elderly. Picture: Omwa Ombara the orphans get access to proper education. The elderly sacrifice KSh20 every week per person and pool the money to raise school fees. Some of the children on anti-retroviral are not able to feed well and are often overwhelmed by the side-effect of the drugs. “Let them at least give us the money, if not for our sake, then for the sake of our innocent children,” said Jacob Njuguna Gitahi, 84. The Ministry of Gender, Children and Social Development signed an agreement on September 3, 2010 with the Kenya Postal Corporation to disburse KSh590 million in the current financial year to the 33,000 older persons so far enrolled under the older persons cash transfer programme. Signing the agreement on behalf of the ministry Assistant Minister Manyala Keya said the main mandate of the ministry was to provide social protection interventions to poor and vulnerable individuals to enable them lead dignified lives. In regard to the above, he said that the ministry has five programmes that include the Orphans’ and vulnerable children (OVC) that targets 115,500 households with a budget of KSh835 million this financial year, the Older Persons Cash Transfer of KSh530 million targeting 33,000 poor and vulnerable older persons of over 65 years and the Women Enterprise Fund (WEF) with an allocation of KSh400 million this financial year.
Postal services
The National Fund for Persons with Disabilities (NCPWD) with an allocation of KSh200 million this financial year. The well-targeted Urban Food Subsidy is yet to be inaugurated. According to James Nyikal, Permanent Secretary in the ministry, the use of postal services
will not only reach a wider scope nationally, but will also save the District Gender and Social Development Officers from carrying huge sums of money to disburse to the older persons in their respective districts.
Agreement
He expressed optimism of the cash transfer mechanisms through Postal Corporation saying it is working well with the Orphans’ and Vulnerable Children cash Transfer (OVC) since it was launched in May this year. Kenyan Aged Require Information, Knowledge and Advancement (Karika) is a community based organisation that was started in 2002. It was registered under the Ministry of Culture and Social Services in 2003 to support the elderly in a bid to reduce poverty. Karika entrenches feeding programmes for the children and grandmothers. It provides guidance and counselling to those affected and infected with HIV and Aids. This move is in tandem with Millennium Development Goals (MDGs) and Kenyan Vision 2030. Signing on behalf of Kenya Postal Corporation, Major General (retired) Ali Hussein said the Corporation was happy to be associated with alleviating the plight of the poor and vulnerable members of the society. He said since Postal Corporation has more outlets than the banks, it will guarantee effective and efficient services to the beneficiaries of this programme. However, for the Karika elderly these remain empty promises. They say the only way they can celebrate the World Aids Day with hope is for the Government to remember their plight and pay them their dues. The children are waiting, is their plea. Additional information from Ministry of Gender, Children and Social Development website.
For women in their reproductive years, HIV and Aids is the leading cause of death and disease. In every region of the world, more adult women than ever before are living with HIV. On this occasion of World Aids Day, Medical Women’s International Association (MWIA) want to draw attention to the fact that women worldwide constitute more than half of all people living with HIV and Aids. As medical doctors and members of the oldest international medical association worldwide, the women are deeply convinced that promoting research on prevention and intensifying education are the most effective tools in preventing HIV infections. The Medical Women’s International Association, is therefore, demanding further action to reduce the burden of the epidemic among women worldwide The organisation’s President, Prof Afua Hesse of Ghana states: “It is now 30 years since the first article on HIV and Aids was published. Initially it was thought that the disease belonged to intravenous drug users and gay men. However, it is now a disease where most new cases are women who have been infected through heterosexual transmission.” She adds: “About 67 percent of the disease burden is in sub-Saharan Africa, where women outnumber men in new cases.” Gender inequalities are indicated as key drivers of the epidemic as well as physical, sexual and emotional violence against women which additionally increases the vulnerability to HIV.
Success
According to Dr Waltraud Diekhaus of Germany who also serves as the Vice-President of Central Europe states: “Nowhere is the impact of gender and health more relevant than in the HIV and Aids epidemic. Gender and health consists of biology, cultural behaviours and norms as well as power relations between men and women.” She adds: “Prevention in women is difficult due to their anatomy making them more prone to infection and the tilted power relations in that women are often not in control of sexual practices making it difficult to negotiate safer sex with the use of condoms.” Most success has been in the decrease of maternal to child transmission during pregnancy and delivery. It is a shame to lose the value of this success by having women succumbs to Aids once they are sexually active. However, according to Dr Shelley Ross of Canada who also serves as Secretary General of MWIA: “In addition to the knowledge that using microbicide gels containing antiviral medications decreases transmission of HIV, the use of prophylactic anti-retroviral medication in the unaffected partners of infected individuals has been shown effective in preventing transmission.” She observes: “Also the lack of a ‘woman controlled’ method of HIV prevention 30 years after the first case, Aids research should be a catalyst to make this a priority for HIV prevention research both nationally and internationally.” Ross noted that most of the funded research is on treatment not prevention and that both female condom and vaginal virucide have not been effective. The MWIA is an association which was founded in 1919 in New York and is representing women doctors from all the five continents.
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Unfiltered, uninhibited…just the gruesome truth
Tracing defaulters as denial takes centre stage By LYDIAH NGOOLO Fear of being tested and denial has hindered the fight against Aids in Mwingi. However, there are those who have decided to take it upon themselves to trace those who have been tested and placed on antiretroviral therapy and defaulted. Meticulous counselling is done to such patients and advised on the benefits of starting the clinic. Those who admit start taking ARVs to boost immunity. Even though the ARVs are enough, those who rebuff are not compelled to start the clinic since they are all grownups. Time is given to them to go and think. Some show up later while others go for good. “Disclosure is the dilemma we are facing. As we try to trace these people, we find out many of them have married but never told their spouse about their status,” says Mati Kilonzi, a defaulter tracer.
Literacy
“Another problem is the literacy level. After they test positive, they start the clinic then stop. Many think that the witchdoctors will help them. To their disappointment, their condition worsens. Others do not follow the prescription making it hard for our peer educators,” explains Kilonzi. He adds: “Some ignore while others forget. The activity has yielded fruit for many are back. We have a patient who tested positive in 2008 and has continued to come to date. She was in a pathetic condition and finally accept-
ed to start medication.’’ The rains also pose a challenge to the fight. Many a times rivers flood after rains making it difficult for tracers to access survivors who are then forced to go without drugs for some days.
Aged caregivers
The situation is further compounded by cases of old caregivers not picking the drugs on time. It gets complicated especially where grandparents are taking care of infected children. Mukaki Mumbo* says she is taking care of her only daughters’ child. The daughter died from aids related complications. “I am old and my age no longer allows me to walk for long. It is hard for me to follow the prescription. Ni tei mwingi muno na ninitikasya methoi kana kaa kangulya ndawa ii ni syaki susu ninyusaa kila muthenya (It is pathetic and sometimes I find myself shedding tears when my granddaughter asks why she is always on medication),’’ explains Mukaki. Defaulter tracers in Mwingi are supported by International Centre for Aids care and treatment Programme (ICAP) which pays their salary. The organisation has also bought them bicycles to ease the tracers’ movement. Bicycles are a convenient mode of transport considering the landscape. The default tracing programme works with the government and this has improved the condition of patients in general. According to Eunice Nduku Ndemwa, a clinical officer at the Mathuki Health Centre in
Mati Kilonzi who is a defaulter tracer. His job entails looking for those who have been recorded for ARVs and TB drugs but are not coming to pick their dosage. Picture: Lydiah Ngoolo Mwingi East District, Kitui County denial is the reason why the number of HIV infections keep increasing. She says they established a comprehensive care clinic in 2008, and today only 250 have enrolled as HIV and Aids survivors. Majority of these are women in marriage. “My greatest fear is that this is only the figure of the people who have been tested It is
Initiative launched to halt preventable deaths By OMWA OMBARA Thirty years since the first Aids case was reported, news for HIV survivors is positive. People living with the virus have graduated from being victims to being survivors. It is a time for hope, a time to move on and of course a time to celebrate the advances the community has made to ensure that HIV positive individuals are accorded health and human rights. In the early stages of the arrival of the HIV virus in Kenya, patients were condemned to die and the media had a challenging time reporting and showing pictures of patients who looked like ghosts and succumbed to full blown Aids. There was so much fear that those who died from the virus-related illnesses were buried in polythene papers in case they spread the infection to the living. Both men and women recall horrid tales of how they were abandoned by families. Many women recall how they were chased out of their homes by their spouses together with their children, while others lost property. The launch of the Let’s Live campaign two months ago bears great news for HIV survivors. Nobody with HIV needs to die. It is indeed time to live. The Let’s Live campaign seeks to reduce preventable deaths. The campaign is out to ensure that mothers and children do not die unnecessarily and it outlines strategies for more successfully preventing HIV-related deaths as well as deaths related to certain cancers and other noncommunicable diseases.
“Twenty two women die every day due to pregnancy-related causes and noncommunicable diseases are becoming a leading cause of death in Kenya.” — Jonathan Gration Although the country has made major strides in the public health sector, much more can be done to prevent deaths that should not have occurred in the first place. Specifically, HIV remains a killer despite massive investment in treatment and progress in curbing the spread of HIV infection. US ambassador to Kenya, Jonathan Scott Gration, recently convened a high level meeting to address practical approaches to halve preventable deaths in the
next year. “Twenty two women die every day due to pregnancy-related causes and non-communicable diseases are becoming a leading cause of death in Kenya,” noted Gration. The Let’s Live campaign has key positive themes of linking universal testing to treatment and treatment to care, including test and treat. It strengthens the role of community health worker, including task shifting such as adherence. The campaign emphasises the need for the watchdog role at multiple levels that involves Government and partners as well as an expanded role in technology. It determines current gaps, works and strategies for scaling-up to have greatest public health impact. It hopes to minimise overlap and duplication of activities. The meeting was attended by top level health decision makers including USAID administrator Dr Rajiv Shah, Lois Quam who heads President Obama Global Health Initiative, the World Health Organisation (WHO) representative in Kenya, Dr Rex Mpazanje and Public Health Minister Beth Mugo, as well as Kenya’s key health scientists. Gration, while speaking to health journalists in Nairobi noted that only 40 per cent of mothers get pre-natal care. “Women have babies at home in areas such as Turkana and Pokot but if there are complications they cannot be assisted, yet deaths from such complications are preventable,” he said. He called upon journalists to hold the stakeholders accountable as the Let’s Live initiative takes off.
rare to find a volunteer. Many people come to us when they are too sick. They complain of malaria, typhoid and so on,” notes Ndemwa. She adds: “It is until we carry out several tests with no positive results that we decide to test for HIV and many patients’ test positive. I tend to believe that many people are just at home and do not care about knowing their status.’’
Orphanage faces risk of closure for lack of funding By OMONDI GWENGI The lively banter of children playing fills the air. Most of them have never tasted the warmth and love of parents, yet this does not stop them from living like other children. Welcome to Glad-Toto Orphanage. The school which is under the aegis of Victoria Widows Group was started in 2001 with only 27 pupils and three teachers. This was the brain child of Mary Sewe who was touched by the plight of children orphaned by HIV and Aids scourge. As the group was going round carrying out Home Based Care to people living with HIV/Aids, they realised that there were many children who were supposed to be in school but were instead not. This is when they thought it was the right time to establish a school that could accommodate them starting with a nursery.
Well wishers
According to the deputy head teacher George Atiang’, the school was established to cater for orphans. Today, Atiang’ says they have 250 pupils derived from three categories. “We have total orphans, partial orphans and non-orphans,” explains Atiang’. However, it has been an uphill climb for the school to be what it is today. Atiang’ says that they have always depended on well-wishers to provide them with learning materials and other facilities. “We entirely depend on well-wishers for the daily running of this school,” he notes. Among the strong supporters was Action Aid. However, the organisation is winding up its project in Usigu Division, Bondo, and the school’s future is bleak. “Action Aid supported us by building
two permanent classrooms as well as the feeding programme,” he noted. Action Aid built a classroom at a cost of KSh900,000, supported the feeding programme by injecting KSh25,000 and also purchased textbooks for the school. The school has also been supported by the Kenya Red Cross which built them a water tank and also chipped in the feeding programme.
Registration
However, efforts to have the school registered have met several setbacks. “Regulations set by the Ministry of Education requires that a school has finances which Glad-Toto does not have given that they don’t have a sponsor,” notes Atiang’. For the last three years, they have been transferring their candidates to other school for KCPE exams. Atiang’ says that their candidates have been topping in those schools. “The candidates that we transfer have been doing well in the exams and this is an indication that our school is the best,” he says. Even though they perform well, this affects the development of the school as the enrolment also goes down. “With the inception of Free Primary Education, many children opt to go to public schools and this leaves us with a few pupils,” says Atiang’. Another challenge the school is facing is payment of the teachers. “We now impose fees on non-orphans in order to cater for teachers’ salaries,” noted Atiang’. In order to kill the stigma and bring equality among the children the management raises some funds to buy uniforms for the children. “Feeding together is also a way of bringing the children together,” Atiang’ observes.
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Violated reproductive health rights on them at night,” laments Akinyi who says the problem is now putting her at loggerheads with her husband who does not understand why it happens. The International Federation of Gynaecology and Obstetrics (FIGO) has released strong new guidelines on “Female Contraceptive Sterilization” recognising the long history of forced and coerced sterilisation of marginalized women and providing detailed recommendations for when and how consent to sterilization can be obtained.
By CAROLYNE OYUGi As we mark the World Aids Day just a few days before marking international Human Rights Day, there are women who are weeping. These are the women who have had their human and reproductive health rights violated just because they are HIV positive. Virginia Wanjiru was forced to undergo sterilisation and no one ever told her that it had been done to her. Wanjiru recalls giving birth to her son in 1995 and got sick two years later. She was admitted for some days. Her husband abandoned her in hospital. The nurses took her blood sample for testing but did not tell her why they were doing it. All Wanjiru remembers is being told that she had a growth in her stomach and was taken to the theatre. “My husband who was HIV negative left the house so I did not get him when I left the hospital,” says Wanjiru. “I then got another man who is also positive. I am not on any family planning method and I have never conceived since then. When I shared my predicament with a friend in the support group, I realised that I had been sterilised,” she said.
Lost womanhood
Wanjiru is not alone in her predicament. She is among many other women in Kenya and across other developing countries who have lost the power of their womanhood simply because they have the virus. Majority of them have not understood the consequences of having their tubes tied or uteruses removed. According to those who have come across proponents of sterilisation, a woman going by the name Barbara has been going round the country convincing women to undergo sterilisation. Her main target is HIV positive women because she believes they are poor and don’t deserve to be mothers. Barbara pays for the procedure and even gives a token of $40 to those who agree to be sterilised. Her campaign is popularly known as Project Prevention. She was in Nairobi for some time and when she realised her intentions had been discovered, she moved to Kakamega. This surgery is also done in public hospitals by doctors who believe that they are doing the women a favour. They have taken it upon themselves to decide for the women and in some instances they do not even consult with the patient. As with any type of surgery, there are risks involved with having fallopian tubes tied and these include infection and uterine perforation. Additionally, women who have had their tubes
Guidelines
A woman who was sterilised without her consent is overcome by emotions as she recounts the tribulation she went through. Many women have undergone violation of their reproductive health rights just because they are HIV positive. Picture: Carolyne Oyugi tied and become pregnant are more likely to experience an ectopic pregnancy. Other possible risks associated with having the tubes tied include menstrual cycle disturbances and gynaecological problems. Women interviewed for this story have complained of feeling weak all the time. Some of them cannot carry heavy objects like water in a jerri can and they cannot walk for long. However, Ruth complains of losing her sexual desires. “I am just a woman physically but I have no desires for a man completely,” says Ruth who was sterilised without her knowledge. She recalls that in 2009 she got very sick and was admitted at Kenyatta National Hospital, only to gain consciousness two days later. She would only discover that she was HIV positive when she went for the routine antenatal clinic. However, before that she had had suffered a miscarriage. “What annoys me is the fact that they did not treat me first and then ask me about sterilisation after I had recovered or at least gained my consciousness,” says Ruth. “Instead they told my mother to put her finger prints so I could go through an operation.”
According to Ruth, her mother is illiterate and no one told her what the operation was about so she placed her finger print, implying she gave consent not from an informed position but because she thought she was saving her daughter’s life through surgery. “Eight years later I found out that my child was HIV positive and I had been sterilised,” she said. When she told her mother what her finger prints did that day, the old woman was very apologetic and regretted having done so. Ruth, however, does not blame her mother but the doctor for not giving them full information. “Now I cannot give birth again and yet I desire to have more children. It is really traumatising and I wish they could have counselled me before doing it just the way any patient is counselled before undergoing surgery,” she says. For Grace Akinyi, the action that led to her being sterilised is strange indeed. Although she is HIV positive, she had to undergo the procedure after she has started wetting the bed. “It is very embarrassing for someone of my age to air her beddings outside after urinating
The updated guidelines specify: Only women themselves can give ethically valid consent to their own sterilisation. Family members, including husbands and parents, legal guardians, medical practitioners, and public officials cannot consent on their behalf. Sterilisation should not be performed within a Government programme or strategy that does not include voluntary consent. Health care providers should not initiate judicial proceedings for sterilisation of their patients or serve as witnesses in such proceedings. Sterilisation to prevent future pregnancy is never an emergency procedure and does not justify departure from general principles of free and informed consent. Consent to sterilisation should not be made a condition of access to medical care, such as HIV/ Aids treatment, delivery of a baby, or termination of pregnancy, as well as any other benefit, such as medical insurance, social assistance, employment, or release from an institution. Consent to sterilisation should not be requested when women are vulnerable, such as when requesting termination of pregnancy, going into labour, or in the aftermath of delivery. Women considering sterilisation must be informed that it is a permanent procedure, which does not protect against sexually transmitted diseases, and provided information on nonpermanent options for contraception. Information should be provided in language women understand, through translation if necessary, in plain, non-technical terms, and in an accessible format, including sign language or Braille. The guidelines further recognise the importance of protecting women’s access to sterilisation while ensuring consent. Forced sterilisation is an “act of violence”, necessitating an ethical response by health care providers. However, voluntary sterilisation is an important reproductive option for women, and once an informed choice has been made, barriers to sterilisation should be minimised.
Legal aid integrates health care with human rights By FRANK OUMA While many people have regarded HIV/Aids as a question of health, when it comes to discrimination and stigma, then the human rights aspect comes in. This is why, the Moi Teaching and Referral Hospital set up the Academic Model Providing Access to Healthcare (AMPATH) that has demonstrated itself as a successful model of HIV/ AIDS control and prevention. The AMPATH was started in 2001 to provide healthcare to people living with HIV/Aids. At the moment, it serves about 2.5 million people in Western Kenya and provides them with anti-retroviral therapy (ARVs). However, through AMPATH, another arm was started to handle legal cases for HIV and Aids survivors as well as those who are affected. She noted that cases of succession or child negligence by either partner are also handled by the organisation. Since it was set up in 2008, the Legal Aid Centre of Eldoret (LACE) at the Moi Teaching and Referral Hospital in Eldoret within AM-
PATH has been of great help to the HIV/Aids patients. According to Milka Chepting, a legal director with the Centre, many Aids survivors as well as those who have lost their kin to Aids have had their properties given back to them and others rights protected. “We have helped those who are living with HIV and Aids deal with violence that comes as a result of stigma in society,” noted Chepting. She observed that women suffer most because when there is HIV in the family, they are the ones who get blamed. Chepting noted that in the case of discordant couples, it is the women who are stigmatised. “If it is a man with the disease you are asked to care for him, but if it’s the woman who is infected, she is kicked out and this becomes a threat to the unity of the family,” observed Chepting. LACE provides free legal services to people affected and infected by HIV/Aids. According to Chepting with the passing of a new Constitution, at least women feel protected
by Article 45 as far as their rights are concerned in terms of property inheritance. The Centre has handled about 100 cases of rape, gender based violence as well as wrongful dismissal due to HIV infection. Some who have sought services at LACE have had their property rescued from greedy in–laws who have attempted to disinherit them. Since it was launched, the programme has represented hundreds of people all of whom have been affected or infected with HIV/Aids. “Once a person who was harassing a survivor of Aids discovers that the person knows his or her rights and has taken them to court, they just stop their discriminatory activities,” noted Chepting. She appealed to the Government to also support the initiative instead of leaving it to foreign donors alone. The innovative approach of integrating health care and human rights led to LACE being invited to present overviews of the programme at the 2010 International Aids Conference in Vienna and in the 2010 conference of all the American
public health associations. Meanwhile, cases of sexual and gender based violence are still rampant in North Rift due to cultural norms in the community . Eastern Rift Valley Regional Commissioner Wanyama Musiambo said that there was need to educate and sensitise the public on their rights and particularly sexual rights. He said a number of suspects were being released due to lack of evidence because witnesses in most cases were being comprised at home and ended up declining to give testimony. “The Government will not hesitate to take action against parents who are compromised at home,” Musiambo reiterated. Eldoret chief magistrate Charles Mbogo told the forum organised by the Refugee Consortium of Kenya for court users committees that there was need to educate the community of women and children rights. “Most witnesses in cases of rape and defilement were not willing to come forward and testify against their relatives who are involved in the vice as they fear being victimised back home,” noted Mbogo.
ISSUE 052, December 1 - 15, 2011
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Unfiltered, uninhibited…just the gruesome truth
She took the risk to have a baby By JIRONGO LUYALI When 34-year-old Rose Mbeneka discovered that she was HIV positive seven years ago, all her plans came to a standstill. All she could do was to wait for death. She suffered denial, discrimination from friends and relatives and faced hopelessness. Not even the dream of having children remained alive in her mind. She knew she had received a death sentence. Indeed the events of 2004 are what she does not want to recount. Her health deteriorated so much to an extent of her being bed ridden. At one time her weight was 28 kilogrammes, with a CD4 cell count of 69. Her relatives held a fundraising to take her back to the countryside in Ukambani, in anticipation of avoiding funeral costs just in case she died while in Nairobi. “I really wanted to gain weight for fear of stigma from those around me but now I am now doing everything to reduce my weight,” says Mbeneka who is now weighing 104 kilograms. Mbeneka appreciates that she is where she is today due to counselling and use of ARVs. She emphasises that the biggest step to success is accepting one’s status first. After joining the AMREF discordant support group in 2005, Mbeneka decided to get married to a man who was also HIV positive, since she was ashamed of staying with her father in a one roomed house in Kibera’s Line Saba. However, the relationship did not work, something that led her to staying with a friend just to avoid going back to her father’s house. It was not until 2007 when she met her current husband who did not know that she was HIV positive as she looked healthy not to mention that she had put on much weight. With
the counselling she had received together with having a kind heart, she told the man the truth about her status. As expected in most cases, that man did not believe as he thought it was her way of putting him off. It was not until they went for an HIV test together that the man believed. The man disappeared for four months and even went to the extent of changing his phone numbers. However, due to the love he felt for her, he later called her and they met. This meeting that culminated to what they have today. Last year they decided to have a baby. With Prevention from Mother to Child Transmissions (PMTCT), it is possible for a woman who is positive to have a child free from HIV. But this is a unique case, one that involves discordant couples (where one of them has HIV). The husband is HIV negative.
Counselling
It is always advisable for discordant couples to practice safe sex to avoid either infection or re-infection. According to Mbeneka, it takes more than a risk to get to a decision of having a child. The couple had to go for counselling to decide whether indeed the man was ready for such a step. In Mbeneka’s case, her husband was counselled by a different person, despite her being a counsellor. She adds that it is not advisable for one to offer counselling to his or her partner. The important thing to note during the counselling involves learning about the safe and unsafe days and the CD4 cell count of the wife. Normally, for a woman who is HIV positive to have a child, she must have a CD4 cell count of above 500. A normal CD4 cell count is 515. In Kenya today, it is too expensive to conduct a viral load test which determines the amount of the HIV virus in the blood.
Rose Mbekeka, a woman living with HIV in Kibera holding her certificates for the trainings she has undergone as a peer educator with Amref. Picture: Jirongo Luyali The alternative is a CD4 cell count which states that the lower the CD4 cell count, the higher the viral load and vice-versa. After this, the couple then decide to have unprotected sex to enable fertilisation to occur. Mbeneka says that it has to occur on the days when a woman is on unsafe period so she can conceive immediately. When a woman’s CD4 cell count is high, chances of her passing the virus to the man are low but it is not a guarantee that the man will not be infected. According to Mbeneka, it is not a guarantee that a woman will conceive immediately, which requires the couple to try the process again the following month until the results are achieved. ”In my case we were lucky to do it only once and the results were positive,” explains Mbeneka. Once the woman has conceived, the man has to go for an HIV test after three months to determine whether he is still negative. ”Not all those who go through the same
regimen remain negative but I am happy in our case my husband and my child are negative,” she explains. Mbeneka notes that is also not guaranteed that the unborn baby will remain negative and that much has to be done.
Training
Discordant couples and those living positively are advised to practice safe sex as well as go for family planning to avoid getting babies when they are not ready as it depends on many factors. Mbeneka is working for AMREF as a peer counsellor, a job she has done since 2008. Although she earns little, she believes it is a calling from God to assist many who have lost hope after becoming HIV positive. She has received a lot of trainings in capacity building, counselling and community development from AMREF and many other colleges including the University of Nairobi.
Second chance gives hope to HIV positive mother By ELIZABETH AWUOR When Emily Kathaka got her first pregnancy she was very happy and looked forward to start a family. However, her hopes were nipped in the bud when she the child died in 2000. Later Kathaka would get tested for HIV and it turned out she was positive. However, she was determined to have another child. She got pregnant again and today she has a healthy baby boy who is HIV negative but she is positive. The happy mother of an 11-month-old Nicholas Mwenda is grateful to God that she has had a chance to bring up a child after losing the first one ten years ago. Kathaka took precautions not to infect her child and has pledged to ensure he remains negative as long as he is under her care. In 2007, Kathaka was diagnosed with Tuberculosis. When she visited the hospital she was advised to take an HIV test which turned out positive. She informed her husband then and that was how their marriage of two years broke. “He could not take in the fact that I was HIV positive but refused to get tested and just ordered that we bring an end to our marriage,” she says. After three years as a single woman, Kathaka was re-married, however, this time she did not tell her new husband about her status. She was afraid of this new husband’s reaction Emily Kathaka plays with her son. Despite her positive status she was able to have and kept the information to herself. However a child who is HIV negative and has continued to breast feed him. she made sure they used a condom every time Picture: Elizabeth Awuor they had sex, telling the husband that she did not
want to get pregnant yet. After sometime the husband said he wanted a baby and rejected the use of a condom. Kathaka was still too afraid to reveal her status and just let her husband proceed with his wishes. She fell pregnant and upon visiting the prenatal clinic, she was tested and it turned out positive. She took the chance to tell her husband about her status, and even revealed to him that her main reason for insisting on the use of a condom was to protect him just in case he was negative. To her surprise, her husband took everything lightly and easily accepted to be tested, his first results were negative, and he underwent other tests that also turned negative. “We used condoms while I was pregnant and we made sure that I delivered at a health facility,” she says. Kathaka who had a normal birth says her child was tested after six weeks and the results were negative. She breast feeds her son and has extended it past the mandatory six months because she fears stopping him from breastfeeding would be harmful to his health since she does not have enough income to sustain him on milk supplements and other foods. However, she says, following instructions from health officers in the clinic she attends she will stop breastfeeding him when he turns one. “My dream is to have my son’s results negative when he will be one and a half-years old, that will prove to me that I did not pass on the virus to him”, she says.
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ISSUE 052, December 1 - 15, 2011
Unfiltered, uninhibited…just the gruesome truth
Burden of infection among disabled people By CAROLYNE OYUGI
John Makokha, 45, lives in Nairobi. A jovial man, Makokha is always smiling and laughs frequently whenever you engage him in a conversation. From the surface everything looks okay despite the fact that he is disabled and is always sitting on a wheel chair. Makokha was not born with the disability, in fact he spent the better part of his life walking on his feet and going around his duties as any other normal person. “My life changed in 1995 when I was travelling upcountry from Nairobi by bus. I was on leave and decided to go home to complete constructing my house which was half way done,” explains Makokha. However, his plans never came to pass. The bus he boarded was involved in an accident in Nakuru. Makokha does not know what happened because he had fallen asleep. “I was woken up by the noise around, everything happened so fast. I only remember being trapped under some metal and the next thing is I remember when I came to my senses two days later I was lying on a hospital bed,” he narrates. Makokha was later informed by a doctor that he suffered a spinal cord injury and, therefore, will never walk or use the lower part of the body effectively again. He was traumatised but the real shock came when Makokha was told he was HIV-positive.
Suicide
“My life crumbled, I was confused and did not know what to do. I don’t know what pained me more being paralysed or living with HIV,” he recalls. He contemplated suicide, since to him, life no longer made sense. After undergoing some counselling and being encouraged by friends and family he decided he was going to live his life to the fullest, at least for the sake of his daughter. “Life has never been the same since then, I have used a lot of money on medication and I have never been compensated for the accident,” says Makokha. He says the worst part is he has become dependent on people when it comes to doing some activities around him. “My house must be designed in a special way in order to cater for my needs. For example I cannot live where there are stairs because I must have someone to push or carry me to the floor. The washroom and specifically the toilets have to be made in a special way too,” explains Makokha. His movements outside the house are also very limited. It is cumbersome and expensive at the same time.
Costly movement
“I am usually forced to pay for an extra seat in a public vehicle, the conductors call it ‘mzigo’ or an extra luggage,” says Makokha. “I also have to get someone to help me board the vehicle as the conductors find that to be extra work.” He notes. Makokha recalls how public service vehicles have left him on the way severally because either there was no space for his wheelchair or there was no one to lift him up to the vehicle. He also has to cope with the stigma related to his HIV status and being disabled. Links between disability, social marginalisation, and HIV starts from childhood for those who were born with the conditions and follows them into adulthood.
A disabled person is pushed on a wheelchair. The physically challenged continue to be marginalised because of their disability and face further discrimination if they are HIV positive. Picture: Carolyne Oyugi Despite the need to have a good financial base in order to live comfortably, eat well due to their medical needs they still find it hard to get employment. In Kenya, the unemployment rate among the disabled often reaches 80 per cent. The World Bank estimates that people with disability make up 20 per cent of the world’s poor. Routinely they are the poorest of the poor. Women with disability and disabled members of ethnic and minority communities face additional marginalisation. Some of the risk factors for HIV and Aids are poverty, illiteracy, stigma, and marginalisation. These are identical to those for disability. Illiteracy is brought about by the family members not taking the required initiatives to take them to school. Most people find that to be very expensive or an extra burden since pupils and students living with disability need special care. Currently, the global literacy rate for adults with disabilities is only three per cent; for females with disability, it is as low as one per cent. Education, where it exists, is often sub-standard and dropout rates are double or triple those of non-disabled children. UNICEF estimates that globally, one-third of all street children are disabled. The millions who end up on the streets can easily become involved in crime, sex work and drugs. They are vulnerable and in most cases all they want to do is to survive. The girls and women are also sexually abused by their fellow street children. The relationship between disability and HIV infection within the physically challenged population is filled with myths. One common
“I am usually forced to pay for an extra seat in a public vehicle, the conductors call it ‘mzigo’ or an extra luggage.” — John Makokha
misconception is that disabled people are not sexually active and, therefore, not at risk of being infected. Another misconception is that substance abuse, sexual abuse and violence, homosexuality and bisexuality does not exist among disabled people. These are all wrong assumptions that lead to their exclusion from HIV and Aids prevention and care services of a large group of individuals that face all known risk factors for HIV and Aids at equal or up to three times greater risk of infection than those not disabled. Disabled adolescents are frequently excluded from social activities, limiting their opportunities to learn to set boundaries and, ultimately, lowering their sense of self-worth. This often compromises their ability to refuse when pressured to have sex or try drugs. Out of ten women with disability who were interviewed for this story seven of them said that they, while often thought of as potential sexual partners, are nonetheless often considered unmarriageable. In some communities in Kenya, women with certain disabilities cannot be married and may have no options other than to live in unstable relationships with a series of sexual partners. With few prospects for employment or marriage, these women have a limited ability to negotiate safer sex hence they are at high risk of contracting HIV and Aids. This is also worsened by the fact that the most common form of employment for individuals with disability continues to be begging. Women with disability are up to three times more likely to be raped than non-disabled women; boys and men with disability may face equal risk of rape and sexual abuse as these disabled women. Many people with disability are physically unable to defend themselves. Others must relegate part or all physical care to attendants who may see them as easy victims. Hundreds of thousands of individuals worldwide live in institutions where physical, psychological, and sexual abuse from staff, visitors, and fellow pa-
tients is known to be common. In communities, outside of institution settings, individuals with disability are frequent targets of physical and sexual assault. A variant is reported from West and East African communities where widows must remarry to maintain inheritance rights. Widows whose husbands have died from Aids related consequences have been reported to seek out disabled men especially deaf or intellectually disabled individuals assuming that, because of communication barriers or their inability to understand how AIDS spreads, these men may be more willing to take a woman who is HIV-positive. In Kenya, there are few legal consequences for those who abuse people with disabilities. Police, judges, and social workers often attribute accounts of abuse or rape of individuals with disability to ‘confusion’ or ‘misunderstandings’.
Executive Director: Rosemary Okello
Editor: Jane Godia Sub-Editors: Florence Sipalla, Omwa Ombara and Mercy Mumo Designer: Noel Lumbama
www.mediadiversityafrica.org
No protection
In most cases, individuals with disability cannot submit police reports or give testimony. Legal counsel is unaffordable to many people with disability, and law offices, police stations, and courts often lack rumps, sign language interpreters or provisions to explain proceedings in simpler terms for individuals with intellectual disabilities. Having no police protection or legal recourse is an invitation for abuse. Disability status compounds other HIV-related risk factors. In Kenya it is almost normal to see pregnant women with mental health conditions. The question that should cross our mind is who is responsible for her pregnancy? What is his HIV status? What action is being taken to ensure that the child will be born free of HIV? Many people with disability are dependent on parents and other family members for assistance with dressing, eating, and toileting, as well as for social, psychological, and economic support. When caregivers within a family die from Aids, the person with the disability — already in a vulnerable group — is at even greater risk.
Contributors: Arthur Okwemba, Duncan Mboyah, Odhiambo Orlale, Henry Kahara, Pam Inoti, Boniface Mulu, Joy Monday, Dorcas Akello, Ruth Omukhango, Martin Murithi, Bernard Ochieng Wesonga, Adow Ina Kalil, Ben Oroko, Alex Ndirangu, Karani Kelvin, Henry Owino, Carolyne Oyugi, Valerie Aseto, George Murage, Macharia Mwangi, Kipkoech Kosonei, Odhiambo Odhiambo, Robby Ngojhi, Aggrey Buchunju, Elizabeth Awuor, John Ndolo, Frank Ouma, Joseph Mukubwa, Lydiah Ngoolo, Omondi Gwengi and Jirongo Luyali.
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