Kenya takes the AIDS fight to its slums

Poverty, malnutrition and sexual violence are pushing up HIV/AIDS rates in Kenya's sprawling slums, but the government and local people are fighting back, reports Patrick Mathangani from Nairobi.

A year ago, Deborah Akinyi lay unconscious in her tiny room in Mathare slum, a sprawling settlement of rusty tin shanties just outside Nairobi.

Now fully recovered from a paralytic attack that left her immobilised for two months, she looks back on those painful days with gratitude.

"People used to stop by my house and whisper: 'See this woman, she is going to die because she has AIDS.' But look at me now," Akinyi said, running her hands down her body.

"I have learnt that having AIDS does not mean you are going to die. I am not as strong as I would wish to be, but I can now move without having to be carried around."

She owes her transformation to free anti-retroviral drugs that she gets at a local dispensary and care given to her by a group of courageous women from the slum. Anti-retrovirals are drugs that prolong the life of people infected with the HIV virus that causes AIDS.

Akinyi's relatives and neighbours walked out on her when they discovered she was HIV-positive, but the women offered to help. They would visit her at her little tin shack, squeezed between other cardboard huts and gullies flowing with waste, and give her food.

She said: "When I was healthy, my relatives used to visit me. Now they don't. If it wasn't for the women, I wouldn't be here talking to you."

An estimated 1.5 million people have died from AIDS-related illnesses in Kenya since the first case was detected in 1984. With 1.3 million people infected, households are sagging under pressure in a country where more than half the population live below the poverty line and cannot afford costly medicine.

More than 430,000 of those infected live in towns, where slums are located.

Battling stigma

Poverty and stigma are a major hindrance to combating the HIV/AIDS crisis, said Anne Wanjiru, an official of the Mathare Women Development Centre that cares for Akinyi and other AIDS patients in the slums.

At the same time, there are people like the women of Mathare who have broken down barriers and have shown love to patients.

"Many people think you get HIV/AIDS because you are immoral," Wanjiru said. "We want to change that so that more people can join us in caring for the sick."

She said women in slums faced a higher risk of infection because rape was common in unlit alleys at night. In the congested slum, women and girls also share tiny rooms with men, increasing chances of sexual abuse.

But she said a campaign against stigma, coupled with provision of anti-retroviral drugs, was helping bring down infection rates.

The government has put 90,000 patients on free treatment with the life-saving drugs. That compares with 263,000 adults and 39,000 children who require the medicine, according to figures released by the National AIDS Control Council.

With only a month to the end of the year, the government may not reach the 140,000 people it wants to put on the drugs by January.

Most of those being targeted for the free drugs programme are people who live in abject poverty in rural areas and slums.

"It is a very ambitious target," said Peter Mutie, a spokesman for the council. "We know it sounds difficult, but we must put targets on ourselves and stop deaths of more people."

To try to meet its own deadlines, the council is reaching more patients through the "Rapid Response" initiative - small projects that seek to produce results quickly. That way, funds are distributed to local outfits such as the Mathare women's group to help them cope with the crisis.

Government figures show that new infections are still high. Approximately 164 people get infected every day, which adds up to 60,000 new cases each year.

But against this gloom, recent figures have raised hopes that efforts are paying off. The prevalence rate has dropped to 6.5 percent from a high of 14 percent in 2003.

The number of HIV/AIDS-related deaths has also fallen to 315 per day from 700 daily in 2003. Mutie attributes this drop to provision of the life-saving drugs, which is, however, eating up a big chunk of the Ministry of Health budget.

Mutie said infection was high in slums where people were trapped in poverty and often skipped meals.

To ensure patients keep on drugs, the council is encouraging its partners to introduce nutrition and feeding programmes.

"We want them to eat good food," Mutie said. "These drugs are very strong and if you take them on an empty stomach, you don't want to take them any more."

Patrick Mathangani is a journalist with Kenya's East African Standard. He can be contacted at mmathangani@yahoo.com

This article is part of a series commissioned by AlertNet from alumni of Reuters Foundation HIV/AIDS reporting courses. Any opinions are those of the author and not of Reuters.