Public Health

Dandora Waste Site Under the Spotlight

Posted on 18 December 2009. Filed under: Environment, Public Health |

A truck delivers waste at the Dandora rubbish dump

Eight years after Dandora, the site of Nairobi’s only rubbish dump, was declared full and a health hazard, tons of fuming waste from more than four million city dwellers continue to be added daily, exposing local residents to illness but also profiting a few.

More than 100,000 people live around the dumpsite, a 13-hectare grey zone in the eastern Korogocho slum area of Nairobi, where children grow up deprived of basic services such as water and electricity and play on smelly waste ground, around rotting food, broken bottles, medical waste and much more.

“Because of the toxic fumes, every day people come to the Catholic Dispensary with chest pain and breathing problems,” said Father Paolo, from the Comboni missionary in Korogocho.

A 2007 UN Environmental Programme (UNEP) report highlighted the prevalence of respiratory and gastro-intestinal problems, skin infections and different kinds of cancer among residents living close to the dumpsite. UNEP called for immediate action in either regulating waste collection or relocating the dump.

“Little progress has been made on the recommendations and people keep on getting sick,” Comboni’s Father John told IRIN.

However, Michael Njoroge, 26, who works at the dumpsite collecting paper and steel to sell, did not want the dumpsite relocated, despite experiencing chest pain and breathing problems for the past three years. “This is my only source of income,” he told IRIN. “If the dumpsite moves, I will follow it.”

Cash from rubbish

Recyclable waste is a profitable business: every day, children from slums around Dandora go to the dumpsite in search of food, recyclables and other valuables they can sell.
With 1kg of plastic selling for KSh2 (about US$0.03), in a day one can earn an average KSh50 ($0.67), John Webootsa, a Catholic priest and coordinator of Kutoka Network, which is lobbying for the closure of the dumpsite, told IRIN.
Webootsa said whatever is collected is then sold off to middlemen, the “scavengers”, who sell it to companies for recycling.

The poor are the best recyclers in the world. Nothing gets wasted but they should have an alternative to earn an income without having to put their health and lives in danger.

“If a controlled and well-managed waste-processing system is established, the health and environmental impact would be reduced while generating jobs and income for the local community,” he told IRIN.

Medical records collected by the Kutoka Network show that between 2004 and 2009 there was a 44 percent increase in the number of patients treated at the Catholic Dispensary. Respiratory cases went up from 765 to 3,356 in the period.

In the UNEP study, samples taken from 328 children aged two to 18 living around the dumpsite showed low haemoglobin, and iron deficiency anaemia, which are symptoms of lead poisoning, according to experts. Some of the children were also suffering from chronic bronchitis and asthma.

Soil samples from the site showed dangerously high levels of lead, mercury and cadmium.

Half the children tested had concentrations of lead in their blood exceeding internationally accepted levels, while 42 percent of the soil samples recorded lead levels almost 10 times higher than what is considered unpolluted soil (over 400 parts per million against 50).

A cleaner Dandora

On 10 December, Kutoka launched a “Stop Dumping Death on Us” campaign to lobby stakeholders for the closure of Dandora, its relocation to a non-residential area and the creation of a recycling plant. They are also advocating for alternative jobs for those living off the dumpsite.

The campaign brought together government representatives and is aimed at improving the livelihoods of the people living in the Korogocho area. At present, children are still going to the dump to collect trash, putting their health at risk, said Kadija Juma, a representative of the Korogocho Slum Upgrading Programme, a joint initiative of the governments of Kenya and Italy.

An Integrated Solid Waste Management plan for Nairobi is being developed and UNEP is supporting the City Council of Nairobi, the National Environment Management Authority and relevant government ministries in developing it.

It will incorporate waste minimization, segregation, collection, transportation, reuse/recycle, resource recovery, treatment and disposal to maximize resource efficiency, Annemarie Kinyanjui from the Division of Technology, Industry and Economics at UNEP, told IRIN.

A sanitary landfill for the city is also expected to be established.

Kinyanjui added that the plan would incorporate awareness raising and capacity building on proper waste management.

UNEP plans to launch it in early 2010 at a national workshop, for replication in other East African cities. “The hourglass for Dandora is flowing and people at Korogocho will get back their right to health and life,” said Kinyanjui.

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Anger and Anxiety in Kenya Over “leaky” Condoms

Posted on 14 September 2009. Filed under: Public Health |

Photo: Laura Lopez Gonzalez/PlusNews
An electronic test found holes in the condoms

Kenyan AIDS authorities are struggling to restore public confidence in condoms after an alarming news report recently showed locally stocked brands to be defective.

KTN, a local TV station, showed the condoms, purchased from vendors in the capital, Nairobi, being tested by the Kenya Bureau of Standards (KEBS). Subjected to an electronic “freedom from holes” test, which involves filling them with water, the condoms sprung leaks.

“This will seriously affect the confidence of those who have always been consistent in using them – how do members of the public know what brand is safe and which is not?” asked Hilary Okoth, a 30-year-old Nairobi resident.

“Imagine a woman who is supposed to negotiate condom use as they are always told,” he added. “The man will simply tell her ‘those things leak, it doesn’t make a difference’.”

Hot, one of the condom brands featured in the news report, was recently banned in Zambia after the Zambia Bureau of Standards found holes in them.


According to Nicholas Muraguri, director of the National AIDS and Sexually Transmitted Diseases Control Programme, NASCOP, most condoms imported into the country are of sound quality.

“I want to assure Kenyans that those are isolated cases and the condoms that are distributed by the government – which account for 75 percent of what is used – are actually of high quality and pass WHO [UN World Health Organization] standards,” he told IRIN/PlusNews.

KEBS – responsible for quality control of products sold in Kenya – does not routinely test imported condoms.

“We cannot deny there are cases of low quality condoms in the country because they have not been passing through the Kenya Bureau of Standards for quality assurance,” Muraguri said.

“The government is joking; how can a product that involves saving human life be allowed into the country without going through rigorous quality tests?” Okoth questioned.

Muraguri said NASCOP had asked KEBS to test all brands of condoms sold in Kenya for safety, with a view to banning those found to be defective; the bureau is due to release a preliminary report on 11 September.

“I think we need to do more in monitoring the condoms that enter the country,” said James Gesami, assistant minister of public health. “We are endangering the lives of our people by letting condoms that cannot stand the quality test into the market.”

Condoms are a key component of Kenya’s HIV prevention strategy, with at least 160 million distributed in the country annually by the government.

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New Code of Practice in Kenya Protects HIV+ Employees

Posted on 23 July 2009. Filed under: Governance, MDGs, Public Health |

“Your CV is great. But we need your HIV test”

NAIROBI, 22 July 2009 (PlusNews) – When Doreen Aluoch*, 32, got a job as a chef at a leading hotel in Kenya four years ago, she was told she had to have a medical examination before she could be employed, but she did not know that the routine checkup would include an HIV test.

“I was taken to the clinic and my stool, urine and blood samples were taken. I was shocked when I was told that I cannot work as a chef because I had HIV, yet nobody even bothered to tell me that I was undergoing an HIV test,” she said.

“I am now running my own restaurant and I perform just like anybody else, and there are many people like me in every sector. Even people who know my HIV status eat at my restaurant and none of them has ever come to tell me he or she contracted HIV because they ate food cooked by me. If one should not be employed because they are HIV positive, then equally even somebody having about of malaria or hypertension is not fit to work either.”

The Federation of Kenya Employers, in conjunction with the International Labour Organization, the Ministry of Labour, the National AIDS Control Council and other bodies in the Kenyan labour sector have instituted a new code of practice that prohibits employers from compelling employees and prospective employees from undergoing HIV tests without consent.

Applicants selected for a job are routinely given medical tests to ensure that they are healthy and qualify for insurance cover. Employers of people with medical conditions such as hypertension and HIV have to pay higher insurance premiums.

“There is nothing wrong with an employer asking for medical examination results from an employee, because this helps them help the employee manage their health conditions better,” said Jacqueline Mugo, executive director of the Federation of Kenya Employers.

“[But] we are saying it is wrong to use this, and specifically in relation to HIV and AIDS, to deny one employment opportunity so long as they are fit to work. It is immoral to single out HIV as a reason for denying one employment.”

Patchy implementation of workplace policies

''It is immoral to single out HIV as a reason for denying one employment''

She noted that “While 60 percent of employers in Kenya have HIV and AIDS policies, they vary in nature and we envisage that this code of practice will act as a guideline, and set the ground rules for employers in implementing workplace and world of work HIV policies.”

Irene Opiyo, a labour policy consultant, said most employers did not want to employ people living with HIV because they perceived them as unproductive, and would increase the company’s health care costs. She called on the government to draw up labour legislation regarding HIV and crack down on companies with discriminatory policies.

In July 2008, a woman won a landmark case in the Kenyan High Court when she sued her employer for dismissing her on the basis of her HIV status, and her doctor for revealing her HIV tests results without her consent.

In the only case of its kind in Kenya, the court awarded the former waitress US$35,000 and ruled that it was unlawful to end a person’s employment on the basis of being HIV positive.

AIDS activist William Kundi told IRIN/PlusNews that the new code of practice was long overdue. “Some employers do not even tell you the reason they are not employing you, and only tell you that you are not fit to work. It is traumatizing and … stops those who are positive … from revealing their status.”

The new code will help organizations in the management, care and treatment of employees living with HIV, and will also help them set up HIV-related interventions in places of work.

“I believe this is the best place to reach them [employees] with HIV-related messages, like those that promote reduction of stigma, abstinence and faithfulness,” said Mugo. “Employers must work closely with employees to reduce stigma at the workplace to increase productivity of employees.”

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Preparedness Gaps Evident As First Flu Cases Diagnosed

Posted on 4 July 2009. Filed under: Lifestyle, Public Health |

Photo: Julius Mwelu/IRIN
A nurse at work at a Kenyan hospital: Overall pandemic preparedness in East Africa and the Horn of Africa remains “relatively inactive”, according to a UN agency, as the first cases are reported in Ethiopia, Kenya and Uganda – file photo

2 July 2009 (IRIN) – Although some countries within East Africa and the Horn region have scaled up their influenza A (H1N1) contingency plans, overall pandemic preparedness remains “relatively inactive”, a UN agency has said, as the first cases were reported in Ethiopia, Kenya and Uganda.

According to an overview prepared by the pandemic influenza coordination (PIC) unit in the UN Office for the Coordination of Humanitarian Affairs (OCHA PIC) in Nairobi, the countries that have updated their contingency plans include Ethiopia, Eritrea, Kenya, Tanzania, Djibouti, Rwanda, Burundi, Democratic Republic of Congo, Central African Republic (CAR), and the Republic of Congo.

“These countries are considered well prepared in mobilizing both health and non-health sector measures in the event of a pandemic,” OCHA PIC said on 1 July.

OCHA PIC is a member of the regional rapid response team, which is planning technical support missions between July and September to accelerate preparedness and response in countries considered most vulnerable to so-called swine flu, including Somalia, Sudan, Kenya, Equatorial Guinea, CAR, Chad and Eritrea.

OCHA PIC said regional partners had expressed concern over the inadequate communication messages and channels used to reach the public with regard to pandemic preparedness and responses.

''Countries that have updated their contingency plans include Ethiopia, Eritrea, Kenya, Tanzania, Djibouti, Rwanda, Burundi, Democratic Republic of Congo, Central African Republic, and the Republic of Congo''

“It is recommended that a communication centre be hosted within respective ministry of health structures but supported by technical agencies in disseminating well-packaged messages on H1N1, H1N5 [avian flu] and other trans-boundary diseases,” OCHA PIC said.

Symptoms of A(H1N1) were confirmed in Kenya on 29 June in a British student visiting the country. “[Another] three suspected cases are under investigation,” OCHA PIC said.

In Ethiopia, the Ministry of Health has confirmed a third A(H1N1) case and is investigating four suspected cases.

“Out of 17 suspected individuals, 10 of them were found to be free and returned to their homes,” Ahmed Imano, head of the public relations service at the Ministry of Health, said. “Four of them are still under surveillance.”

In Uganda, the Ministry of Health announced on 2 July that one case of H1N1 had been diagnosed at Entebbe International Airport. The ministry said the 40-year-old had been isolated at a medical facility at the airport.

In Africa, Algeria, Egypt, Morocco and South Africa have also reported A(H1N1) cases.

Although no deaths have been recorded, more than 10 cases have been confirmed on the continent, according to the World Health Organization (WHO).

Ethiopia reported its case on 19 June. The first cases were detected in two teenagers returning from the United States. The third was reported on 29 June, of an air hostess with Ethiopian Airlines.

“All of them came from abroad,” Ahmed said. “It is not necessary at this time to reveal where they came from.”

He added: “We have a good mechanism of tracing [the epidemic.] All flight attendants have received training and are doing a good follow-up.

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Struggling to Meet Demand for Male Circumcision in Kisumu

Posted on 2 July 2009. Filed under: MDGs, Public Health |

Photo: Manoocher Deghati/IRIN
A mother comforts her son who has just been circumcised at a Marie Stopes clinic in Nyanza

KISUMU, 1 July 2009 (PlusNews) – Demand for medical male circumcision has been rising in Kenya’s south-western Nyanza Province since it became available as part of a package of HIV prevention services in November 2008.

Although local communities do not traditionally practice male circumcision, intensive sensitization programmes by governmental and non-governmental organizations are boosting acceptability.

“We are ensuring that this public health measure is implemented in a culturally sensitive environment, and that men and their families have the information they need to make informed choices,” said Dr Jackson Kioko, Nyanza’s director of public health.

So far 20,701 men have been medically circumcised at 124 private and public health facilities across Nyanza, the only province where the programme has been rolled out.

Nyanza has the highest HIV prevalence in Kenya – 15.3 percent, more than double the national average – and a low level of male circumcision.

A national task force will coordinate wider implementation of the procedure, and the National AIDS Control Council has set aside 16.1 million Kenya shillings (US$212,500) to encourage greater acceptance of it.

Dominic Oyier, 30, a member of the Luo community, which does not traditionally circumcise men, feared he would be ridiculed by his friends and relatives if he decided to get circumcised. “Later, when I received the information from community sensitizers, I thought it was a good thing, especially when I was told that it can even benefit my wife by reducing her chances of getting cervical cancer,” he told IRIN/PlusNews.

“I decided to go for it … It is a scary experience but it is worth it and even some of my friends consult me because they also want to try it out.”

''There are men who will come to the clinic seeking these services, but the moment you mention that they have to abstain for six weeks…they change their minds''


Dr Walter Obiero, a clinical manager at the Nyanza Reproductive Health Society, said the biggest challenges were the shortage of trained health workers, and persuading men to abstain from sex for six weeks following the surgery.

“There are men who will come to the clinic seeking these services, but the moment you mention that they will have to abstain for six weeks, as is required after the circumcision, they … change their minds,” he said.

“Then there is the issue of staff constraints, especially in government facilities. The number of staff already trained to offer circumcision services falls far below the  demand, and other health services also need to be attended to by the same health workers.”

Most of the 450 government health workers able to offer male circumcision services including counselling, performing the procedure safely and ensuring infection control, have been trained by the Male Circumcision Consortium, which includes Family Health International, the Nyanza Reproductive Health Society, the University of Illinois at Chicago and EngenderHealth, a reproductive health organization.

Read more:
Rising demand for male circumcision
Male circumcision sparks controversy
Government to roll out male circumcision
At the cutting edge – male circumcision and HIV

Less than one percent of male circumcisions have had an adverse reaction. “Any complication that may arise could be mainly due to the client ignoring the advice of health personnel on how to care for themselves immediately after the procedure,” said Dr Obiero.

Until more government health workers can be trained, the consortium is providing more than 75 percent of circumcision services, and taking a lead in informing people that male circumcision provides only partial protection against HIV infection, and they should keep using condoms.

Women have been targeted with information about how male circumcision can benefit them by reducing their risk of cervical cancer and improving hygiene to ensure they support the programme.

Models for providing circumcision services through outreach and mobile services are also being explored.

“The outreach services involve sending providers to health facilities that do not have capacity to offer male circumcision on a regular basis, due to lack of space or insufficient health personnel,” said Kioko.

The government and its partners have set a target of circumcising 80 percent of all uncircumcised men between the ages of 15 and 49 in Nyanza over the next 10 years, reaching a total of one million men.

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Mombasa Watchmen and Sex Workers in Unity Pact

Posted on 16 April 2009. Filed under: Lifestyle, Public Health |

Photo: Julius Mwelu/IRIN
Sex workers use alleys to avoid paying for hotel rooms

(PlusNews) – Over the course of the long nights Richard Omwenga spends guarding a building in Kenya’s port city of Mombasa, a series of young women accompanied by men duck into the alley next to the building. While Omwenga keeps watch, they have sex and then walk away, usually in different directions.

The young women are sex workers and Omwenga “rents” them the alley for a few minutes at a time as a cheaper alternative than paying for hotel rooms. At the end of the evening, the women either pay him a cut of their earnings or, more frequently, offer him sex.

“Initially, all we wanted was to offer the corridors [alleys] for some fee, but standing around watching people making love makes us boil,” he told IRIN/PlusNews. “As such, some of us came up with the give-and-take agreement with the girls.”

Several Mombasa watchmen, or askaris, said the women also used the alleys to hide from police. “One sex worker promised to do anything for me if I hid her in the corridors from policemen conducting a raid one day,” said Wallace Wanyama.

He said he had had sex with at least five sex workers who used the alley next to the building he guards, but did not use condoms and had never been tested for HIV.

Sex work is widespread in Mombasa which has high levels of poverty and illiteracy and large numbers of international tourists, truckers and sailors. HIV prevalence is about seven percent, slightly lower than the national prevalence of 7.4 percent.

Condom use is erratic among the sex workers. Anne Jambi, patrolling Mombasa’s Moi Avenue, told IRIN/PlusNews that she always used condoms when she had sex with askaris, but Sue Pekeshe said she could not remember whether she had used a condom during a recent encounter with a watchman because she was drunk at the time.

A 2007 study found that female sex workers in Mombasa who were binge drinkers were more likely to have unprotected sex, experience sexual violence, and contract sexually transmitted infections than those who did not drink.

Chewing khat – a widely used but addictive herbal stimulant – is common among watchmen trying to stay awake through the night, but has also been shown to increase risky behaviour.

Hard to reach

The odd hours that askaris work have made it difficult to reach them with HIV services. “Most of these guards are not easily accessible because of the demanding nature of their jobs,” said Dr Esther Gitambo, the provincial director of medical services. “Due to the poor package they earn from their guarding jobs, most of them opt to work on other casual jobs during the day.”

The risk of being mugged at night while trying to provide services to the watchmen was another complication said Rosemary Kenga, an administrator and counsellor at the AIDS Population and Health Integrated Assistance Programme (APHIA II), funded by USAID.

The APHIA II project provides “moonlight” voluntary counselling and HIV testing services to watchmen, sex workers and minibus-taxi operators during evening hours, but project coordinator Filberts Oluoch said the watchmen had been slow to make use of it.

“Watchmen are the most complicated to deal with,” he said. “Some say their company policies don’t allow them to speak to strangers, especially when they are on duty, a good example being those watching over huge business premises like banks.”

APHIA II is now working with companies that employ watchmen to introduce workplace programmes that encourage behaviour change, such as condom distribution and workshops on preventing HIV.

“We often hold workshops and brief in-house meetings to enlighten our staff on the importance of self discipline when they are at their workplace,” said Carlos Kioko, the communications manager of a large security company, Group4 Security. “We also supply them with free condoms.”

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Playing At Home is Safer

Posted on 16 April 2009. Filed under: Governance, Lifestyle, MDGs, Public Health |

Photo: Flickr Creative Commons
Two-thirds of HIV-positive Kenyans are either married or cohabiting

(PlusNews) – Marriage is not a safe haven from HIV; in fact, the pandemic is spreading rapidly among married people in Kenya. This is the core message of a new campaign to discourage extramarital sex.

“Wacha mpango wa kando; epuka ukimwi” – Swahili for “stop relationships on the side; avoid HIV” – is the name of the initiative developed by Population Services International (PSI), a social marketing organisation, in conjunction with the Ministry of Health, the National AIDS and Sexually Transmitted Infections Control Programme, and the National AIDS Control Council.

“Our campaign is necessitated by the increasing number of infections in marriages,” said Lucy Maikweki, deputy director of HIV and communication at PSI.

Print ads warn cheating married people that their “spare wheel” could have their own spare wheel, who could also have a spare wheel, who could be HIV-positive, putting the whole chain in jeopardy.

A series of TV spots feature a couple sitting in their living room watching a televised HIV message on fidelity. The woman is warned that if her husband is very secretive with his phone, it may be because he is cheating. The man is warned that if the woman is keen to change the channel when the HIV message comes on, she may be hiding something.

According to the 2007 Kenya AIDS Indicator Survey, in 10 percent of monogamous couples and 14 percent of polygamous unions at least one partner is HIV positive, while two-thirds of HIV-infected Kenyans are in stable relationships.

“There are signs of an increased number of discordant couples [where only one partner is HIV-positive], which is a clear indicator of rising levels of infidelity in marriage and other long-term sexual relationships,” Maikweki said.

A 2007 study by Kenya’s University of Nairobi found that 17 percent of men surveyed and eight percent of women reported having extramarital relationships.

''I trust the woman I go out with and so that advert is not meant for me''

PSI’s campaign targets men like Joshua Omondi*, an upwardly mobile sales representative who says he is happily married but gets bored with the monotony of a single sexual partner. For the past year, he has been having a relationship with a young university student.

“I cannot be with my wife every day … I just need a break from the family boredom, so we meet in a night club every weekend where we have a good time and later get to spend a night somewhere; after that I go home to my wife and children,” he told IRIN/PlusNews.

Omondi does not use condoms with either his wife or mistress. “Initially [my girlfriend] and I used a condom while having sex but we later stopped because I thought I could trust her enough,” he said. “Using a condom with my wife when I get back home is unthinkable, because that will definitely lead to mistrust.”

Maikweki said many people involved in extramarital affairs did not use condoms for similar reasons. “There is some false sense of trust over time,” she said.

The “wacha mpango wa kando” campaign also encourages couples to be tested for HIV, not just at the start of a relationship, but well into marriage and other long-term relationships.

Omondi has seen the campaign, but is ambivalent about its message. “The campaign is a good one, but, you see, I trust the woman I go out with and so that advert is not meant for me,” he said. “After all, it encourages sticking to my wife, which I am not ready to do anytime soon.”

Read more:
Where does married love fit into Uganda’s prevention plan?
Sharing more than just the matrimonial bed
Love in the time of HIV/AIDS

PSI is conducting a survey to assess the impact of the campaign, but it appears to be having a positive effect on Agatha, a married woman who admits to having lovers besides her husband.

“The new TV campaign strikes you when you watch it,” she said. “You have the feeling you should use a condom with an extramarital partner.”

*Not his real name

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When Words Hurt – Kenyan University Students Get Lessons in Sensitivity

Posted on 9 April 2009. Filed under: Lifestyle, Public Health |

Photo: Anthony Kaminju/IRIN
Insensitive language creates stigma

MASENO – Young people have always been adept at creating witty ways to describe everyday life, but the language they use can be hurtful to people living with HIV; western Kenya’s Maseno University is now helping its students to stop using insensitive, stigmatizing language.

“When you hear people make jokes about HIV, without caring about anybody in the group who might be living with it, it makes you feel out of place and withdraw yourself to isolation. Somebody is killing you without knowing it,” said William Kisia*, 22, an HIV-positive student.

“These young people might be using these words – not necessarily to create stigma amongst their colleagues, but to ease communication amongst themselves – but then stigma is created in the process, without the originators of these kinds of words knowing it,” said Dr Maurine Olel, coordinator of the AIDS Control Unit at Maseno University.

“We are working with student clubs, student leaders and other partners to ensure that students are … sensitive to their colleagues who might be living with HIV,” he added. “When you create stigma, other efforts geared towards fighting HIV become hard to implement.”

Some of the slang terms in the Kiswahili language, commonly used by university students to refer to HIV, include: “mdudu”, a word for a small creepy-crawly; “huyu jamaa anatuacha”, which says, “this guy is leaving us”; “ogopa”, meaning fear, a word used by young men to describe HIV-positive women; “huyo jamaa amekanyaga live wire”, or “that guy stepped on a live wire”, a euphemism for someone who had unprotected sex and contracted HIV.

“The person you are telling about another person living with HIV, using that kind of language, might also be positive, and you could be hurting them without knowing it. We need to desist from using such demeaning language to describe others,” said Evelyn Wanderi, who participated in a recent workshop on stigmatizing language.

“Imagine being positive, and you hear somebody make a joke that somebody with HIV is a walking corpse; it kills you emotionally and physically – it kills your spirit,” she said. “Those who know their status and are willing to speak out will never do so, and those who do not know their status will keep away from finding out their status – this is the surest way to lose the battle against HIV.”

Read more
Mind your language – a short guide to HIV/AIDS slang
Mind your language – a guide to HIV/AIDS slang
Scrutinize! An in-your-face HIV prevention campaign

Rosemary Wambui, a psychologist and counsellor at the university’s AIDS Control Unit, noted that “Students are generally aware of HIV, but it is important to fight stigma … and what it is that causes it, including the language, because it leads to silence and denial, which are big hindrances to the fight against HIV.”

The Ministry of Health and the Commission for Higher Education have partnered with I Choose Life Africa, an NGO working in HIV management and control among university students, in a programme that has trained around 4,000 HIV peer educators. Several universities, including Maseno, now also have compulsory HIV courses that all students must take as a prerequisite to graduation.

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KENYA: From The Classroom into the Bedroom

Posted on 9 April 2009. Filed under: Education, Public Health |

Photo: Kenneth Odiwuor/IRIN
Girls who become involved with their teachers are often admired by their schoolmates

For the past year, Karen Awuor*, 15, has had a new daily ritual– taking antiretroviral (ARV) drugs. She discovered she was HIV positive during an unintended pregnancy that forced her to drop out of school; her baby died after just four months.

“When I was in class seven, I got into a relationship with one of my teachers; he promised to pay my school fees if I agreed to be his wife,” she told IRIN/PlusNews. “But when I got pregnant with his child and dropped out of school, he turned against me and behaved like he never knew me in the first place.”

Teacher-student relationships are not uncommon in Kenya’s southwestern Nyanza Province, where Awuor lives. Geoffrey Cherongis, the Nyanza Provincial Director of Education, said sexual relationships between teachers and students were a threat to the health and future of the province’s girls, who make up less than 40 percent of students.

“Some teachers are living with HIV and spreading it to young girls, who hardly know the kind of thing they are getting into,” he said. “It is even more complicated because parents, especially those in rural areas, support these affairs for perceived economic gain.”

According to Kenya’s Centre for the Study of Adolescence, Nyanza has one of the highest teen pregnancy rates in the country, as well as one of the highest school dropout rates. Girls in Nyanza become sexually active at an average age of 16, compared to 19 in Nairobi Province. Nyanza’s high HIV prevalence of 15.3 percent, twice the national average, makes them particularly vulnerable to HIV infection.

Extreme poverty appears to be the main reason why girls in Nyanza become sexually active at a young age. More than 60 percent of residents live on less than US$1 per day, and the region also has the largest number of children orphaned by the HIV/AIDS epidemic.

“Poverty and high death rates, which leave girls orphans at an early age, make them want to get money by any means – not only to take care of themselves, but also to take care of their siblings,” said Luke Opondo, Bondo District’s AIDS and sexually transmitted infections coordinator.

Teachers are well-educated, earn a steady income and are often more affluent than most people in the province. Saulina Ondoro, 65, a grandmother caring for five teenage orphans, told IRIN/PlusNews she would not discourage a sexual relationship between her grandchildren and anybody who could offer money to help her care for them.

“They are old enough and I can hardly take care of them – if any of them can get a man to provide for them, why should I get in their way?” she said. Opondo noted that “Parents who bless these affairs to get money need be sensitised.”

''I get money and my peers in school respect me because dating a teacher is a big achievement for us girls''

The material benefits of such relationships mean that girls who become sexually involved with their teachers are often admired by their schoolmates. “I get money and my peers in school respect me because dating a teacher is a big achievement for us girls,” said Viviane Aoko*, 14, who is having a sexual relationship with her married teacher.

Some male teachers complain that girls actively seek out relationships with them in order to raise their economic status. “Some girls even put pictures of their nude bodies inside exercise books as they bring them to teachers for assignment assessment,” said Daniel Oloo, a teacher at a local girls’ secondary school.

Opondo said it was irresponsible of teachers to put the blame on students. “The claim by some teachers that these young girls approach them to create affairs does not wash, because these are teenagers, and they are adults who should act as their parents; a 45-year-old man cannot claim to be influenced by a 14-year-old girl.”

Many girls were, in fact, coerced into relationships with teachers. “It is a double tragedy for these girls; they cannot negotiate for safe sex because they are vulnerable, and they cannot report to authorities for fear of being victimised,” Opondo said.

“More sex education and punitive measures on teachers are the surest ways to deal with this kind of problem,” he told IRIN/PlusNews. Addressing poverty and the lack of economic support for orphaned girls was also important, he said.

The Ministry of Education has an HIV/AIDS prevention and sex education curriculum that focuses on upper-primary and secondary schools, but does not address the issue of teacher-student relationships, leaving school heads to deal with it at their discretion.

A 2006 study by the Population Council, an international non-governmental research organization, found that although Kenyan teachers were relatively well-educated, they were “confused or uninformed” about important aspects of HIV and AIDS.

Read more:
Grandparents struggle to keep teens in line
Young girls the new bait for fishermen
More education equals less teen pregnancy and HIV

“For example, many teachers are uncertain about the effectiveness of condoms in protecting against HIV infection,” the study said. “This means that they are not likely to advocate their use, despite the existence of a generalised HIV epidemic in Kenya.”

*Not her real name

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Desperate Times in Isiolo as Women Sell Sex to Buy Food

Posted on 4 March 2009. Filed under: Lifestyle, Public Health |

Photo: Manoocher Deghati/IRIN
The price of maize-flour more than doubled in 2008

ISIOLO, 3 March 2009 (PlusNews) – By day, Angela* does odd jobs at a primary school in Isiolo, a town in Kenya’s Eastern Province, but by night she and her two daughters rent a house in town where they sell sex to local men and truckers passing through. According to health workers, more and more women are turning to sex work to survive the ongoing food crisis and rocketing food prices.

“Life is no longer the same; reputation is not an important issue anymore,” Angela told IRIN/PlusNews. “Everybody is concerned with food, with survival.”

Food and water shortages have led to migration from rural areas to Isiolo, and many of the town’s new female residents were also selling sex to buy food. As a result, she and her daughters often did not insist on safe sex. “Most of our clients don’t like using condoms; you have to accept it or die of hunger,” she said.

The town is on the north-south highway through Kenya, and also hosts four military camps, creating an abundant demand for sex work. According to Mohamed Guyo, the Isiolo district HIV/AIDS and sexually transmitted infections officer, HIV prevalence in Isiolo district rose from 2.8 percent in 2007 to 4.7 percent in 2008.

“Isiolo town has been invaded by a high number of women and young girls … we are concerned,” he said. “Most of these women are either single mothers or young girls who have dropped out school – they are victims of poverty, conflicts, and HIV.”

An estimated 10 million Kenyans are facing a food crisis as a result of crop failure due to poor rains and drought, high food prices, and the effects of election-related violence in early 2008 that disrupted farming activities. The price of a 2kg packet of maize flour or ‘unga’, a staple food, more than doubled in 2008.

Besides crop failure, the northern and eastern areas of the country, largely populated by pastoralists, have seen their herds of goats and sheep decimated by ‘goat plague’, a viral disease related to rinderpest in cattle. Clashes over water and pasture have also increased in these areas as a result of food shortages, leading to even more migration.

Mary*, who was a sex worker in Isiolo town for several years, quit three years ago when she was diagnosed with HIV. She took up domestic employment but since food prices have shot up, she has had to return to transactional sex.

''Life is no longer the same; reputation is not an important issue anymore. Everybody is concerned with food, with survival''

“I have struggled to raise the children but it was impossible with only one job,” she told IRIN/PlusNews. She lives in fear that her employers will discover she is a sex worker and sack her, but the fear that her family will starve is greater.

“I am happy that the little money I get at night is helping my children; I want them to complete their studies so that they can help themselves,” she said. “I still take my drugs but my clients do not know my status.”

Health workers in the eastern district of Makueni said they had heard reports of men sending their wives out to sell sex so as to have money to buy food. Rebecca Lolosoli, who runs a local NGO in the northern district of Samburu, said rising levels of poverty were forcing many rural families into Samburu town.

“Most of them are from remote parts; they are ignorant and desperate, and are not aware about HIV and how to protect themselves,” Lolosoli said. “Many young girls and women are migrating to urban centres because of insecurity and poverty; these two factors are contributing to new cases of HIV in our districts – it must be addressed.”

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KENYA: Maureen Kiwinda, “It was not my desire to sleep with people to get a job”

Posted on 4 March 2009. Filed under: Lifestyle, Public Health |

Photo: Manoocher Deghati/IRIN
“It was not my desire to lead a life of sleeping with people to get a job”

NAIROBI, (PlusNews) – Maureen Kiwinda*, 22, came to the Kenyan capital, Nairobi, in 2003 to stay with her brother, a casual employee in the industrial area. She has also taken up casual employment, but told IRIN/PlusNews that handing out sexual favours was a regular requirement for getting work.

“I could not proceed with my education due to lack of school fees, so I came here and stayed with my brother for two years, but I left because he was not happy that I became pregnant.

“I later went to stay with a friend and started doing laundry work for people … but whatever I was getting from my work was too little to take care of my child. Also, I could not work most of the time because he was still too small and needed my constant attention.

“A friend of mine used to work at the EPZ [export processing zone – an industrial area established by the government in 1990 to boost Kenya’s export capacity]. I went there with her several times but I could not get a job.

“When I was almost giving up, she told me the truth and advised me to talk to one of the supervisors. She told me it would be difficult for me to get a job without giving something small, which I thought was money, but I later learnt the small thing was my body.

“At first I found it hard to comprehend, but I weighed living without knowing what tomorrow brings and having sex to get a job and I decided to give it a try.

“I have been doing it and I have been getting jobs frequently [but] I have paid the price, because now I am HIV-positive.

“The problem here is that you cannot stick to one partner. Even if you decide to get a job through sex, these supervisors are changed almost on a monthly basis, so you know you have to please each of them to survive.

“At times I feel guilty about what I am doing, knowing that I am HIV-positive, but I cannot tell my colleagues or even those who solicit for sex from me. I need food and I need money – what do I do?

“God knows it was not my desire to lead a life of sleeping with people to get a job. At times I feel sorry for myself and my friends, but that is the society we live in.”

*Not her real name

See also: KENYA: Sex for jobs in export processing zones

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KENYA: Changing Lifestyles Put Indigenous Communities at Risk

Posted on 27 February 2009. Filed under: Governance, Lifestyle, MDGs, Public Health |

The Ogiek have battled eviction from their home in Mau Forest for decades

MAU FOREST, 23 February 2009 (PlusNews) – One of East Africa’s last remaining hunter-gatherer communities, the Ogiek people, has largely remained separate from the rest of society, but NGOs warn that their ignorance and isolation from HIV/AIDS prevention efforts could heighten their vulnerability to the virus.

According to the Centre for Minority Rights and Development (CEMIRIDE), an NGO promoting the rights of indigenous peoples in Kenya, total ignorance of HIV among the Ogiek is not uncommon.

“There are no HIV campaigns at all directed at the Ogiek … the government do not even have statistics about the prevalence amongst them,” said Pattita Tiongoi, a programme officer with CEMIRIDE.

“The disease is penetrating through the Ogiek because of displacement, which has seen them mingle with their infected cosmopolitan neighbours like the Maasai and the Kalenjin.”

Napuoyo Moibei*, who thinks she is about 35 years old, was evicted from the Mau forest in Kenya’s Rift Valley Province several years ago and took up employment on a nearby wheat farm to make ends meet.

“The money was little, and with children and no husband, my option was to have sex with men from other communities who lived in the nearby trading centres,” she told IRIN/PlusNews.

Moibei’s husband passed away three years ago, and she recently discovered that she too was HIV-positive. “I had never heard about the disease called AIDS until I got sick and was almost dying,” she said. “The wife of my employer sympathised with me and took me to Nakuru for treatment.”

“I still do not know much, except that I have to go for drugs [life-prolonging antiretroviral medication] in Nakuru to live – that is what the nurse told me.”

''I had never heard about the disease called AIDS until I got sick and was almost dying''

With no knowledge about the virus, Moibei was unable to protect herself. “I do not know even how a condom looks like,” she said.

Experts say there is an urgent need to start HIV awareness campaigns targeting the Ogiek population of around 20,000, especially as more of them leave the forest for urban settlements and rural plantations, where they interact with higher-prevalence communities.

A study by the Minority Rights Group International and CEMIRIDE found that sex work was increasing as single-parent girls and women sought to fend for themselves, leading to the spread of sexually transmitted infections, including HIV.

“The initial lifestyle of being confined to the forest kind of shielded the Ogiek from HIV spread, but that lifestyle has been disrupted due to displacement,” CEMIRIDE’s Tiongoi said. “This is a small group of people that can easily be wiped out by [HIV] in just a few generations.”

According to Daniel Kobei, executive director of the Ogiek People’s Development Programme, HIV and other health issues have been sidelined as the government and NGOs focused on other Ogiek issues such as landlessness and poverty.

Kobei noted that very few Ogiek were literate, which meant they could not benefit from traditional HIV campaigns and would need specially created messages; health services would also have to be brought nearer the forest to reach the people still living there.

“Those who seek medical help have to come all the way to Nakuru, which is almost 40 kilometres away from where they are; it is a tiring walk for one who is living with the virus,” he said.

Most Ogiek still live in the Rift Valley, which has an HIV prevalence of seven percent, slightly lower than the national average of 7.4 percent.

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HIV Testing From Door to Door

Posted on 23 February 2009. Filed under: MDGs, Public Health |

Photo: Glenna Gordon/IRIN
So far, more than 45,000 people have been tested

TURBO, 17 February 2009 (PlusNews) – Joel Kirwa, a farmer in Rift Valley Province, western Kenya, has never been tested for HIV; he is usually too busy tending his cattle and fields and rarely visits Turbo town, where the nearest voluntary counselling and testing (VCT) centre is located.

Today, however, a health team is going from door to door in his area, offering HIV counselling and testing to every household. “Home testing is very helpful – it is private, so your results and even the fact that you tested are hidden … in the normal VCT centres you can meet people who know you and will talk about you,” he told IRIN/PlusNews.

Kirwa and his wife were both HIV negative, and he proudly displayed the ‘certificate’ the counsellor gave him as proof of his status.

The Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) ran a pilot project in the Rift Valley Province’s Kosirai Division in 2007, testing 19,000 out of 20,000 eligible people. The official programme has been running since August 2008.

“Prior to the start of HCT [home-based counselling and testing], a majority of the HIV patients have been presenting to the clinic late, when their CD4 cell count [a measure of immunity] is low and they are unable to work,” Dr Samson Ndege, the project coordinator, told IRIN/PlusNews.

AMPATH is conducting tests in Turbo, in Uasin Gishu District, and Mautuma, in Lugari District, which have a total population of about 120,000; so far, 45,000 people have been tested, of which 1,483 have been HIV positive.

Anyone over the age of 13 is considered eligible for testing, as well as children under 13 whose mothers are positive; parental consent is required before children can be tested. Personal digital assistants (PDAs) are used for data collection, and coordinates indicating the location of households are marked using a global positioning system.

AMPATH uses community mobilizers, selected by local chiefs, to go from door to door, telling people about the importance of being tested ahead of the counsellor’s visit.

“People have become much more receptive and less suspicious,” said Peter Musili, a nurse and counsellor with AMPATH. “The word of mouth from those previously tested has been very useful.”

Teething problems

Counsellors often have to visit homes more than once. “Many men are normally away from home and may not be found the first time the counsellors visit their homes. It was also difficult to find school-going children at home,” Ndege said.

“We encourage them [counsellors] to make appointments, so that couples can be counselled together during subsequent visits. We have also made arrangements so that visits can be made over the weekend to find children who are day-scholars,” he added.

Photo: Julius Mwelu/IRIN
“Home testing is very helpful – it is private

“Getting couples to test together has been challenging, especially given the high rate of discordance [when only one of them is positive]. Getting those individuals who test positive to go to the clinic has also been difficult – couples who were not tested together may have problems disclosing their status to their partners.”

A recent national survey found that 43.8 percent of HIV-infected married or cohabitating people had an uninfected partner, but more than three-quarters of all respondents who were part of a couple did not know their partner’s HIV status.

Benefits beyond HIV

AMPATH is providing every home in the area with mosquito nets and deworming tablets for children, while counsellors are also collecting data on immunisation and referring parents to health centres where children can be vaccinated.

“We also collect sputum for TB [tuberculosis] tests from individuals who have had coughs for more than two weeks or those who report night sweats and fever,” Ndege said.

Door-to-door testing was successfully piloted in Bushenyi District, in western Uganda, between January 2005 and February 2007, reaching 63 percent of all households. A study on the impact of the programme found that the benefits of home counselling and testing were far-reaching.

“Aside from expanding coverage, door-to-door VCT may significantly improve stigma and disclosure of serostatus, and may also have a prevention effect through improvements in HIV risk behaviour,” the authors concluded.

Kenya traditionally relies on voluntary counselling and testing, in which patients visit VCT centres on their own initiative, but official figures estimate that 63.5 percent of Kenyans have never been tested for HIV.

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New Cases of Black Fever in North-Eastern

Posted on 11 February 2009. Filed under: Public Health |

Photo: WHO
Lesions, fever bouts and anaemia are characteristic of leishmaniasis

ISIOLO, 9 February 2009 (IRIN) – At least 33 cases of visceral leishmaniasis, a parasitic disease also known as Kala-azar or black fever, have been reported in the past four weeks in the drought-affected north-eastern district of Isiolo.

“New cases of Kala-azar have been reported in Merti and Sericho areas of Isiolo, which are bordering Wajir and Garissa [districts] … 33 people have been confirmed positive,” said a report by the Isiolo drought monitoring office.

Some 30 patients were transferred to Wajir, about 200km north of Isiolo, for treatment due to a lack of medical supplies.

Ali Wario, Isiolo district disease surveillance officer, told IRIN no deaths had so far been reported. Fresh medical supplies were also expected, he said.

Trained medical personnel have been deployed to the district amid ongoing awareness creation to stem the spread of the disease, Wario said.

The disease has worsened the health status of local children, most of whom are malnourished and have lowered immunity due to the prevailing drought. Kala-azar is endemic in mainly pastoralist northern Kenya and outbreaks are common during drought.

Local residents said the response to the outbreak had been slow and more had to be done. “Affected families must be assisted with food and mobile health services. They should not travel all the way to Wajir … to seek treatment,” said Ibrahim Halake, a resident.

“There is an urgent need to provide drugs and mosquito nets to the communities in the affected areas,” Paul Kimeu, Isiolo district drought monitoring officer, said.

The movement of pastoralists in search of water and pasture, Kimeu said, was linked to the spread of the disease.

The leishmaniasis parasite, which is carried by sand flies, migrates to internal organs and bone marrow once it enters the body and if left untreated, infection can lead to death.

Sand flies thrive in the cracks of mud-covered dwellings, in cow dung, rat burrows, ant-hills, dry river beds and vegetation. Some 130 people were infected and nine deaths reported in the last outbreak, which was first reported in April 2008 in Wajir.

Additional information: RSOE Emergency and Disaster Information Service

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Mt. Elgon Conflict: Battle for Land Fought Over Women’s Bodies

Posted on 20 December 2008. Filed under: Insecurity, Public Health |

Photo: Georgina Cranston/IRIN
“They took us to the forest and raped me for days, taking it in turns”

KITALE, 17 December 2008 (PlusNews) – Margaret Sichei*, 37, discovered she was HIV positive during a routine antenatal check-up. The pregnancy, as well as the HIV infection, was the product of a gang rape deep in the forests of Mount Elgon in western Kenya, perpetrated by members of a self-styled militia calling themselves the Sabaot Land Defence Force (SDLF).

She talked about her ordeal while waiting to pick up her supply of antiretroviral (ARV)drugs at the district hospital in the town of Kitale, near Mount Elgon, where she tested positive two years ago.

“I had just prepared supper for my family and we were seated in our house. Suddenly the dogs of our neighbour started barking viciously; we heard footsteps, and before we could even realise anything, our door was kicked open by men in huge boots, and carrying all manner of weapons.

“They accused my husband of being a traitor, and they dragged the two of us out of the house. They then took us to the forest and raped me for days, taking it in turns and saying that I would pay the price on behalf of my husband, forgetting that they had already killed him. He was beheaded as I watched, and they buried him,” said Sichei, tears rolling down her face.

She eventually escaped while pretending to fetch firewood to make food for her captors and fled to the nearby town of Bungoma, only returning to her home after the army had flushed the militia out of the area.

The SDLF began their insurgency in 2006 in response to alleged injustices committed during a land distribution scheme. Some of the area’s residents initially supported them in the belief that they were fighting to reclaim land belonging to them, but before long they started paying the price.

In a report released in July 2008, Human Rights Watch, an international watchdog, estimated that the SLDF had killed more than 600 people and kidnapped, tortured and raped many more.

Lillian Kirei, 20, also contracted HIV after first being raped by militia members and then later by members of the Kenyan security forces sent to Mount Elgon in March 2008 to quell the insurgency. Her 45-year-old mother was also raped but did not survive the ordeal.

“We were three girls and we were coming from the market in the evening when the militia abducted us,” she told IRIN/PlusNews. “One of us who tried to scream was beaten senseless and raped with leaves stuffed in her mouth. We are all HIV positive now.

“When the army came, I went through the same ordeal. I do not know for sure where I contacted the virus but I now take ARVs, and whoever gave me the virus is for God to punish,” she said.

''At the time you do things that haunt you later in life. I am now HIV positive, yet at that time we thought it was cool to rape women''

Erick Wanyama, a clinical officer at the hospital in Kitale, noted that many women who had experienced similar ordeals were now HIV positive. “There are some who are dying silently due to the stigma associated with rape and HIV – it is a double blow to women and girls,” he said.

According to Dr. Charles Onudi, medical officer for Kenya’s Western Province, out of 100 pregnant women and girls from the Mount Elgon region who said they had been raped, 35 have so far tested positive for HIV.

He added that the actual number of women who had contracted HIV during the insurgency was probably much higher, but that most women were reluctant to admit they had been raped.

In its report, All the Men Have Gone, Human Rights Watch accused both the SLDF and the Kenyan army of committing war crimes and blatant human rights abuses. Medical charity, Médecins sans Frontières have made similar claims.

John Kirui*, a former militia member who is HIV positive, said he now regretted raping dozens of women and girls during the time he served in the rebel outfit.

“At the time you do things that haunt you later in life. I am now HIV positive, yet at that time we thought it was cool to rape women,” he said.

Read more:
Land dispute spawns violence, displacement
MSF highlights ‘forgotten crisis’ in Mt Elgon
Security improves in Mt Elgon but fear remains

Jane Kibiwott, 18, was raped for two days by a group of young men belonging to the SLDF; she and her four-month old baby are both HIV positive. “I can say he is twice unlucky,” she said, breast-feeding her son.

“First, he is a child of rape, and now he is HIV positive and being cared for by an equally positive mother. Cruel things happen at times, especially for us, the poor.”

*Not their real names

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