issue 169 - March 1987
Medical safari in Kenya
Kenya has an alarmingly high incidence of AIDS. There have
been few cases of the full-blown disease diagnosed, but the virus is
widespread. Reba Linden, reporting from Nairobi, looks at what
fuels the epidemic, describes Kenyan reactions, and profiles three
who are directly affected - Tom, infected but not yet sick Mary, a
prostitute and Wanjiku, a nurse in direct contact with AIDS patients.
"Is AIDS a disease of deadly evil spirits called demons? Is AIDS madness?
If demons can be cast out of the madman, possibly AIDS can be cured. Therefore,
scientists and church leaders, show us the way before the world comes to an end."
(Letter to Kenya Times, 1.10.86).
PETER Munyasi Viola, who wrote that letter to the Kenya Times is not the only Kenyan to be troubled about AIDS. It has become a common topic of conversation in Nairobi bars, and is even the subject of sermons. 'God can heal everything, including AIDS,' preaches an Anglican Minister in a Nairobi church. 'If we pray and trust, God will heal.'
In another part of town, Ahmed Mohammed, a Muslim healer, scans the Koran. He believes that the Holy Book contains a cure for every disease; if he studies it hard enough, he'll find the answer to AIDS.
Meanwhile, myth feeds on fear and fear on myth. 'You can get it from mosquito bites. You get it from touching an infected person.' And there are those who do not want to believe. 'Fat women are not suffering from AIDS, and I only go with fat women.' 'AIDS is not actually here.'
But AIDS is here. According to the Kenyan Minister of Health, 250 cases have been diagnosed and 38 people are known to have died of the disease since 1983, when it was first discovered in Kenya. A recent survey of Nairobi prostitutes revealed that while only 8 per cent had antibodies to AIDS in their blood in 1981, now more than 65 per cent are carrying the deadly virus.
'So far, only three or four have died,' says Dr Frank Plummer, head of the research team which carried out the survey. 'But I think that over the years a large number will die.'
No-one knows how many people in Kenya have antibodies to AIDS because there has been no general study. What research there is concentrates on high-risk groups - prostitutes and their clients.
But there is no doubt that AIDS is a serious and growing problem. In 1983, one case was diagnosed. In 1986, there were 109. According to Dr Peter Piot, a WHO AIDS expert, initial research suggests that more than one per cent of blood donated in Kenya is carrying the AIDS virus. That means that one in a hundred bottles of blood is infected. It is possible that one in twenty patients receiving blood in Kenyan hospitals becomes infected, on the assumption that each transfused patient receives five bottles of blood.
AIDS is not as widespread in Kenya as it is in neighbouring Uganda, and about a third of AIDS victims in Kenya are from Uganda or other central African countries. But, says one doctor, 'Although it's not the number one health problem now, it will be soon. It hasn't killed many people in Kenya yet. But it will.'
How and where AIDS began remains an unanswered and fraught question, but how and why it is spreading is easier to discover. While AIDS in Europe and the US is spread primarily by homosexual contact, in Kenya, as in other parts of Africa, an equal number of men and women are contracting the disease, which is being passed on mainly through heterosexual intercourse.
In Nairobi, sex is part of social life. 'If you're going out with a friend and his girlfriend, they'll bring along a girl for you,' says Ben Omoro, a journalist. 'Men are under high pressure to be seen moving with women.' Many men in Nairobi have left their wives in the village, so they find city girls to keep them company. 'Many of my friends sleep with two or three different women in a week,' says Omoro. 'If you're a Kenyan man you can even sleep with ten.'
It is normal for the man to pay on a date and women's wages in Nairobi are normally so low they simply could not afford an evening out. Ben Omoro points out that men are an important source of income for women. 'Even working women because of economic pressure want to supplement their earnings by catching the right guy, even if it's not cash for service.'
AIDS is changing people's behaviour, but only slightly. Some men say that they are wearing condoms for the first time. But the message has not hit home hard enough. 'One girl was always ringing me up, saying "Take me out for lunch, take me out for dinner",' said another male journalist. 'In the end I wanted something back. That was when she brought up the subject of AIDS! We talked about it... then we decided to forget about it temporarily and go to bed anyway.'
Outside the city limits, few people are aware of AIDS, and no-one knows how widespread the disease may be. City men must be carrying it back to their rural wives, but there are no facilities to test blood for AIDS in the bush. Venereal diseases have always been a well-kept secret amongst African women. 'Most African women live in fear of their husbands,' says Wanjiku Kamau, a nurse. 'If they get sick they won't dare say anything in case they are accused of going with other men.'
While many married women remain in the countryside, an increasing number of single girls are coming to the towns. They come for many reasons; some have lost traditional land rights, so there is no viable way of surviving in the village. Others are simply bored, and want to try something new. A large number come on a visit to stay with relatives and see if they can find work but discover that the easiest way an uneducated woman can make a living is by being a prostitute.
'Going back to the village means admitting you've failed,' says anthropologist Achola Pala. 'No-one likes to admit they've failed.' The nurses in clinics where sexually-transmitted diseases are treated encourage the prostitutes to 'go back home and dig', but the normal response is, 'I'll only go back home to die.'
In Nairobi and the coastal resorts of Mombasa and Malindi, sex is cheap and easily available. Girls as young as 14 and15 linger in the shadows by the big hotels and tout for tourists. But while cheap sex has undoubtedly been one of Kenya's tourist attractions, AIDS has made it very dangerous. 'It's fine to come to Kenya and see the animals in the game parks, and lie on the beach, but if you're coming on a sex safari, you're taking a big risk,' said one AIDS researcher, who spoke anonymously.
He did so because he does not want to get into trouble with the Kenyan Government, which is afraid that the AIDS scare is going to discourage tourism. During 1985, 451,000 tourists visited Kenya and the industry was worth $250 million. The 1986 figure is likely to be 600,000 visitors and the Government is aiming for the 'magic million', with tourism growing by 19 per cent each year until 1988.
It is to defend this lucrative tourist industry more than anything else that has made the Kenyan Government defensive and secretive about the AIDS epidemic. But the theory that AIDS has an African origin is another factor that has lead to obfuscation: 'We categorically refute any allegations that there is an AIDS scare or epidemic in Kenya,' trumpeted the Daily Nation as recently as December 1986. Then, like the lady who protested too much, the Nation went on to add: 'To associate Africans with AIDS, as has been the case in the Western world's scientific community, is to attempt to place a racial label on an otherwise international disease.'
Yet the story of Kenya's response to the AIDS epidemic is not solely that of an ostrich sticking its head in the sand. More positively, the first reliable information on AIDS in Kenya was published in July 1985, and four months later the Government established a National AIDS Committee, and embarked on a national AIDS programme. In January 1987, the Government and the Kenya Red Cross launched a major education campaign distributing leaflets at bus stops about AIDS.
Health workers, many terrified of treating patients with AIDS, have attended seminars on how to manage AIDS cases, and information about AIDS is available at family planning clinics. The Ministry has printed and distributed posters explaining how to avoid AIDS, and a series of articles was published in the Kenya Times. How much impact this will have is debatable, but it at least signals the Government's growing wish to tackle the problem.
None of this, however, makes up for the fact that there is hardly any money going into AIDS research in Kenya. And in a country where children die daily from pneumonia, measles and diarrhoea, AIDS seems like a potential rather than an immediate problem. One child aged 18 months is known to have died of AIDS so far, while 92 of every thousand born perish before their first birthday because of diseases caused by poverty, lack of medical care and poor sanitation.
'How can you divert money from the immunisation programme, which is actually working and preventing deaths?' asks Dr Marcus French.
People with AIDS are not going to get adequate hospital care, nor will preventative measures including a nation-wide effective public education campaign happen unless massive funds from overseas are made available. Meanwhile, in the bars and hotels of Nairobi, no-one quite knows what to do. 'We just carry on,' explains Sarah, a prostitute. 'But underneath we are all sweating.
Tom doesn't have AIDS - yet. But when his blood was tested for antibodies in October 1986 the result was positive.
For two months he made peace with himself. He read a lot about AIDS, and understood how it is transmitted and thought about the likelihood of him developing the full-blown disease. Unlike many of his friends, he is faithful to his wife. In early December, he plucked up his courage and told her.
When I talked to Tom, his wife was still in a state of shock. He is 40, was she 36. They have three children aged eleven, ten and six, and Tom thinks they are too young to be told. He has told his boss, who is sympathetic, but says he won't say anything to his friends or relatives. 'People are very hostile. They think they can get it just by touching you. There is a stigma attached because it's transmitted sexually.'
The most likely explanation for Tom's positive blood test is that the virus was already present in his wife. Since 1976 she has had numerous blood transfusions during a series of miscarriages, and she estimates that she must have 20 pints of alien blood in her body. Moreover, the blood transfusions were carried out in Uganda where the risk of contracting AIDS is greater than in Kenya.
Tom is remarkably philosophical. 'It will not kill so fast. You can adjust and try to go normally. I think I'm lucky to know before it becomes so debilitating. And we all have to die some time. Last April I had an accident on a bus. It was very fatal - seven people died. But I came out with minor injuries, yet I could have been one of the seven.'
What now for Tom and his wife? 'The most important thing is to provide for the children. And I'm not going to die before I die, if you know what I mean. My plan is to work until I feel I'm weak somehow. What will change is the physiology, I suppose. I believe that you should be good to yourself and to your neighbour and that you can lead a happy life. I'm a Catholic, but not so committed. I don't know if there's an afterlife. No-one's been there and come back to tell us.'
Tom is hopeful that maybe someone will find a cure. 'We're lucky that the rich countries have AIDS too, because they will have the money for research. I've read about some guys who found out they had it and committed suicide, but I'll just wait and hope.'
Mary leans across the table in the jostling bar-room and laughs. 'AIDS? I don't give a damn. No-one here gives a damn.'
Looking around Buffalo Bill's, one of Nairobi's notorious pick-up joints, you can well believe it. With braided hair, tight jeans and high heels, the prostitutes are clearly doing a good business. Recent surveys suggest that over half of them are carrying the AIDS virus; but the men who buy the drinks and the bodies don't seem to care. They are German, Scandinavian, British and Japanese, and as Mary says, they don't give a damn.
Some women say that business was slack when the AIDS scare first hit town a year ago, and those who went down to Mombassa in early December 1985 when 8,000 US Marines came to shore, came back complaining that they didn't make enough money for the return train fare. But Mary says: 'These men drink, and smoke bhang (marijuana), and do as they always do.'
Her own attitude is fatalistic. 'We all have to die. Maybe there'll be an earthquake tonight, and we'll never see daylight again, and of us. Or maybe we'll all catch AIDS. Who knows?'
Wanjiku qualified as a nurse last year, and after two months working in a maternity ward, joined a clinic where people with sexually transmitted diseases (STD) are treated. She is 23, still lives with her parents, and loves her work.
'I like the patients so much, when I don't see them I miss them. As a nurse, I'm the main one to deal with the patients, and get to know them, talk to them when they're upset.'
Wanjiku sees herself as a counsellor as much as a nurse. 'I like especially the young people who come with STD. They're very frank, and they don't fear me because we're almost the same age. But the older people are counselled by the doctor.'
Does she see many people with AIDS? 'At the moment, the majority who have positive blood are still very healthy. We advise the prostitutes to change, and go home, but they tell me "Heh, sister, if I've got that disease there's no way I'm going home." But there's one very sick girl, who comes with ulcers. She's desperate, and she's a Kenyan. We give her drugs, but then she comes back with the same problem. She's got AIDS and there's not much hope for her, so we advise her to go home. But she's still moving with men. She blames it all on the friend who brought her to Nairobi in the first place.'
Wanjiku likes the individual relationships she builds up with the patients. 'The People with STD, they really need health education. That's the time to talk about AIDS. Some of these men, you find they just get drunk and then they are dragged around by friends and end up going with a prostitute. So you have to explain the dangers. Even my friends, I tell them. When I told one how serious it was to move with women, how it's very risky, he was so grateful. He said 'You've really taught me something.'
Wanjiku is friendly, open and sisterly. She is a little naïve: 'I'd never heard of homosexuality until I started this work. But some of these tourists on the coast, they go with other men but they have ladies with them too.'