AIDS and community supports

AIDS is an area where much support and help for people is required in Kenya. In the areas I visited there were varying rates of AIDS and HIV reported-most rates are simply estimates. In some of the urban slum area the rate is alt least 40 to 50% though the estimated rate in the country is reported by UNAIDS to have fallen to 7% in 2003 from a peak of 10% in adults in the mid-1990s. UNAIDS reports that more recent sentinel surveillance data indicates that adult prevalence has fallen even further to 6.1% as at end 2004 (Kenya HIV and AIDS Data Booklet, 2005). They say the decline is not uniform however, and in some areas prevalence remains as high as 13%. Gender disparities are of particular concern: HIV prevalence in women aged 15–49 is 8.3%, while for men aged 15–49 it is 4.3%. Young women are especially vulnerable to HIV infection compared with young men; 4.9% of women aged 15–24 are HIV-infected, compared with 0.9% of men of the same age group. However ministry of health officials and community workers estimated prevalence as far higher than this when I spoke to them. They cited difficulties in ascertainment, inaccurate baseline population data from the census and population projections and the issue of stigmatisation that means that people do not admit to the disease or attend for treatment. In some areas the local workers to whom I spoke estimated a prevalence rate of 18% - and in some pockets of the slum areas up to 40 0r 50%

So what can I report from my short visit? - definitely in Nakuru as I walked though the slum areas where there is often no electricity or running water it was clear that many of the people living there were living with AIDS. On www.flickr.com/photos/davida3 I am posting a number of stories of people I met. There was the mother in what seemed the terminal stages of AIDs whose 9 month old daughter was also HIV positive. Perhaps she will have a few more years now that the ICROSS team have moved in and are giving her and her family some practical help in the form of nutritional supplements and dietary advice as well as trying to ensure that her medical care is organised. _ More of that later-
Poor nutritional status precipitates a downward spiral. People live in deprived conditions- so poor nutrition, water problems, and HIV predispose to opportunistic infections- Tuberculosis is a particular problem.

The Kenyan government made antiretrovirals available free of charge about 3 years ago- Similarly TB medications are free. However there remains a stigma in regard to AIDS which means that people are slow to present for treatment or to accept the diagnosis. Allied to that is the problem that although the medications are free, hospital attendance, blood tests and x-rays are not. There is a special waiver system for people who cannot afford to pay, but this is limited. However applying for such waivers for individuals is part of the work that ICROSS KENYA does, as well as where possible funding blood tests and x=rays. They also work with communities to reduce stigma and educate people about the epidemiology and modes of transmission of HIV.
As for the accuracy of disease prevalence data and population census data- I think that sentinel surveillence of people who present for care is an under estimate for the reasons outlined above. Also the baseline census data is inevitably inaccurate. We know that even in western countries such as here in Ireland there are problems in ensuring that everyone is enumerated. In a country such as Kenya, where there is movement of communities as I saw among the Maasai and Samburu,- who are essentially nomadic - and where roads and infrastructure simply do not exist, actually ensuring that people are included is a very difficult task. Allied to that is a reluctance to count family, particularly children, lest counting and acknowledging them openly should bring misfortune. I confirmed that for myself when I asked people how many children they had and the inevitable answer was a few, or not many .