Writes Key Correspondent, David Njagi.
At the laboratory diagnosis wing of the Wajir District Hospital, a room at the eastern end of the department lies lone and deserted.
Except for the three letter ellipsis that stands out in a startling mix of yellow and purple, there is little to tell that this serene quarter is part of the usually busy hospital, sitting at the heart of Wajir town.
On a wooden plank where the three letters V, C and T have been carved out indicating that this is a voluntary counselling and testing facility, an eager Marabou Stork which appears to be brooding for a mating session perches itself on the five feet high sign post.
Inside at the reception, Mrs Idhow Abdille, the only member of staff present today, is treating herself to soul winning Somali tunes, manufactured by her equally sophisticated cell phone that lies on her desk undisturbed. Occasionally she will raise her veiled face and level a bored glance to any visitor who stops here.
It is easy to understand Mrs. Abdille’s boredom. Days go by without her attending to a single client seeking VCT services although the HIV prevalence level in this sparsely populated province has recently increased to 1.3 per cent, according to the 2007 Kenya AIDS Indicator Survey (KAIS). Kenya Demographic and Health Survey (KDHS) said prevalence was at 0.5 per cent in 2003.
Yusuf Mohammed, the District AIDS/STI Coordinator in Wajir, estimates the increase in prevalence to be more than 160 per cent in just four years. And though this alone confirms that HIV/AIDS is a disaster waiting to happen in North Eastern Province (NEP), the society continues to shy away from the reality of the half a century old disease.
“Most of the people we talk to tell us those among society living with HIV should be publicly announced so that they can be avoided,” says Mohammed. “As a result there is wide fear of being found HIV positive. Therefore few people are willing to visit this VCT facility to be tested.”
At the moment, Mohammed estimates that only 30 per cent of the population knows their HIV status. But that has been made possible through the AIDS, Population, and Health Integrated Assistance project which introduced mobile VCT services in 2008.
The mobile VCTs are part of an outreach campaign where, saddled on a motorbike, health medics take the services deep into rural villages often cruising along parched and sandy terrain that begs for an inch of decent road.
And just as isolated as these villages are, so are their residents hostile to anyone who comes calling with a message that goes against the ingrained culture like the importance of knowing one’s HIV status, like Mohamed and his colleagues often bear.
On this front, he and his team are faced with a society whose 90 per cent of the population is yet to break from the shackles of institutionalised stigma. So they have introduced moonlight VCT services which take them to the few ‘converts’, during twilight hours.
“Here we target most at risk populations or what we call MAPS,” says Mohammed. “These are miraa traders and their clients, youth who go to video dens, club goers and bar attendants, for five days every month from 7pm until 2am.”
In his field escapades, Mohammed has come face to face with stigma and discrimination facing PLHIV. At the moment, he is looking for a home for two children who were thrown out of their home for being found to have HIV.
“I have been trying to talk to the catholic mission to accommodate them because here we do not have an orphanage,” says Mohamed. “They are denied even their right to go to school. At night, they have to brave the chilly night outside the family house where they are supposed to sleep. They cannot mix with other children.”
In the scale of Dr Salat Girad Mohamed who is a superintendent at Wajir district hospital however, HIV/AIDS prevalence in the province is still low, but this cannot be said to be a safe level as a mix of people from the East and Horn of Africa continue to filter into the region.
The movement and infiltration of people from the region and a vibrant 24 hour economy in most towns here ensures free flow of money, and according to Dr. Mohamed, the double standard of chastity in the shelter of home and risky behaviour in the anonymity of urban night is beginning to catch up.
“HIV/AIDS prevalence here has been low but we fear the movement and interaction of NEP residents with people from other parts of the country and the region may accelerate higher infections,” says Dr. Mohamed. “What we need to do is sensitize the communities about HIV/AIDS so that the levels can be kept as low as possible. However stigma and acceptance of HIV/AIDS, as with any other disease, is still a problem.”
So problematic is institutionalized stigma that few residents are willing to speak freely about HIV/AIDS. Those who can at least listen will dismiss the subject with a harmless chuckle. This is how Mrs Khadija Abdi (not her real name), a community worker with the TB Manyatta facility in Wajir town, often shrugs off nosy visitors.
“I have never seen a person with HIV/AIDS,” says Mrs. Abdi although the harmless giggle that follows betrays that there is more behind her neatly clad veil than the almost solemn admission that she fronts.
Faced with incessant droughts due to the arid terrain, struggling to break from the shackles of stigma may not come as cheaply as a visit from the District AIDS/STI Coordinator.
According to Sheikh Mohammed Shakul, however, stigmatizing PLHIV is evil and goes against the doctrines of Islam.
“The holy book of Quran disowns any form of stigma affecting the human being,” says Sheikh Mohamed, an Imam who preaches in Nairobi. “What we are seeing in NEP is a case of perception and is not guided by any religious doctrines.”