IRIN Web Special on World AIDS Day

"It is time women rejected men who don't use condoms," says Ahmed Seif, the heads of Isiolo District AIDS Control Commmitte. Credit: UNAIDS

It is Wednesday morning, 20 November. A small convoy of four-wheel-drive vehicles winds its way along the hot and dusty paths of Isiolo town, central Kenya, heading for a cluster of corrugated iron-roofed structures just across the dry river bed.

The advancing cars spark a flurry of activity in the small compound, where Pepo la Tumaini Jangwani (Kiswahili for Wind of hope in the desert), a project for people living with HIV/AIDS, is located.

Women and children who live in the compound begin to sing and dance as the new arrivals, who comprise government officials, politicians, religious leaders and representatives of an NGO, take their seats under an improvised canvas canopy.

The guest of honour is not yet among them, but he soon arrives and opens the event with prayers. At the age of nine, Salim Yasin, an HIV/AIDS orphan, has become a household name as an HIV/AIDS activist in Kenya. By way of songs and poems, the boy and other orphaned children at the project frequently preach the HIV/AIDS message, often targeting much older listeners.

Today, however, Yasin is on a special mission - to inaugurate a new voluntary counselling and testing (VCT) centre, the latest addition to the structures in the compound.

Yasin was born with HIV and recently suffered his second bout of tuberculosis. "Parents must know that they have a responsibility towards their children. Everyone must fight this disease, young and old," he says.

Taboo and stigma

Ironically, HIV/AIDS is an almost taboo subject in Yasin's home town of Isiolo, particularly among his Borana community. Salim was himself rejected by his relatives and left to fend for himself when both his parents died of AIDS.

"There is very high stigma here. The issue of acceptance is still a problem. The community does not want to discuss AIDS," Chris Ouma, the national HIV/AIDS coordinator for the British charity, Action Aid, said.

Shoba Lamkin, a gender expert from the local Borana community, also working for Action Aid, told IRIN that because of the high stigma attached to HIV/AIDS among the local community, relatives often dumped their sick people outside the Pepo la Tumaini centre at night.

Once treated, they would quietly return to their homes. "Our community does not want to accept HIV/AIDS. They don't come out when they are sick. We are pushing ourselves into more problems that we will never be able to solve," she said.

Potentially explosive situation

Although Isiolo has relatively low levels of HIV prevalence - roughly 10 percent, compared with the national rate of about 15 percent - a combination of factors, notably the local attitudes and the town's strategic location at the centre of the country, makes for a potentially explosive HIV/AIDS situation.

Described as the gateway to the northern frontier, Isiolo is a major lodging hub for truck drivers and business people who frequently travel between northern Kenya and the rest of the country.

There are also four military installations - two training schools and two camps - in the district due to its close proximity to the insecure and banditry prone border towns of northern Kenya, a situation which frequently serves to pour thousands of soldiers into the town.

In addition, extreme poverty in this drought-prone region, where many people live on one meal a day, is pushing many young girls - many already orphaned by AIDS - into the streets, where they make a living as sex workers in order to support their siblings. "Add all this together, and you have a silent but explosive situation," Ouma said.

Moreover, the combined issue of religion and culture serves to undermine the struggle against HIV/AIDS in the district.

The two largest communities in Isiolo are the Borana, a largely Muslim pastoralist community, and the Meru, a mainly Christian agriculturist community. The district is also prone to frequent politically motivated ethnic clashes. "Isiolo is a religiously schizophrenic town. Islam is silent about sex. The Muslims think HIV/AIDS is an issue of Christians, whom they perceive as immoral," Ouma said.

So far, he noted, the HIV/AIDS project had been supported by Action Aid and the local Catholic church, but little had come in from the Muslim community. He said his organisation had already approached two Muslim clerics in the area and the head of the local Catholic church to sit on the board of the Pepo project, in order to get the Muslim community involved in HIV/AIDS activity.

Rashid Haroun, the coordinator of the Interfaith Movement in Isiolo and a leading imam, told IRIN that Muslim leaders were now getting involved in the fight against HIV/AIDS and had begun preaching in the mosques on the dangers of unsafe sex. "Islam is a religion fighting fornication and bad behaviour," Haroun said. "The local people think people who are infected are cursed."

Ahmed Seif, also a Muslim, who heads the Isiolo District AIDS Control Committee, agrees that ignorance, particularly among men, and the stigma attached to HIV/AIDS are the main obstacles in the fight against the scourge. "AIDS is a disease like any other. The time has gone when men were the leaders. In some communities, they say AIDS is a disease of women," Seif said. "It is time women rejected men who don't use condoms."

According to Seif, the behaviour of men who find it difficult to have only one wife without a "spare part", or mistress, was largely to blame for the HIV/AIDS scourge in many parts of the country. However, in Isiolo, this general attitude is exacerbated by the common saying among the local nomadic communities that "a bull must die grazing".

The status of women here also is considered much lower compared with other parts of the country. Because girls are generally married off at a tender age to much older men, women generally have no power to resist their men's demands, according to Lamkin. "In the traditional setting here, everything is the man. A woman doesn't even know her husband well enough to discuss sex. Women cannot even speak in public meetings," Lamkin said.

Unorthodox outreach methods

The negative local attitude has forced Pepo la Tumaini to seek indirect ways, some unconventional, to send HIV/AIDS messages to the community, according to Dafala, a teenage volunteer at the centre. "There is a big problem here. The community thinks everyone at Pepo has AIDS. They do not listen to us. So we had to think of other ways of reaching them," he told IRIN.

At night, Isiolo town is a melting pot of sexual activity, despite the HIV/AIDS stigma and taboos surrounding sex. Girls, some as young as nine, come to town to seek male customers, who pay them for sex.

At the bars and clubs, the sex workers are protected by bouncers, who also ensure that male customers pay up for the workers' services. In return, the girls pay "taxes" to the bouncers. If any girl refuses to conform to this system of paying the bouncers "registration fees" and regular "taxes", she is raped, often by as many as 15 of them.

"For new girls who refuse to pay the fees, we give them time. But one day we teach them a lesson," one of the bouncers' leaders, known as Hussein, told IRIN.

The centre now uses the bouncers and a number of young sex workers to support the project's outreach programmes by getting them to help in distributing condoms and educating their "clients", but there are still many hurdles ahead.

Many men in Isiolo still prefer to pay sex workers "risk allowance" - extra money, which can be as little as US $3, just to avoid using a condom, according to Hussein. "We distribute the condoms, and we advise our clients accordingly. But it is difficult to convince a Borana man to use a condom. He would rather pay the risk allowance even if it is three times the original price," he said.

The bouncers themselves fear that they could already be infected, due to their dangerous lifestyle, even though they have not been tested yet. "I know I am infected. We have been doing terrible things. And we haven't been using condoms. Many of my friends have since died. I know that is where we are all headed," Hussein told IRIN.

He also feared that the stigma associated with HIV/AIDS and the disapproval of premarital sex in the Isiolo community might be preventing many sexually active youths like himself from seeking information about HIV/AIDS at the new VCT centre.

VCT targeting youth

The VCT concept in Kenya is less than two years old. Its history began in 2000, with the establishment in September of a VCT task force, which produced a number of guidelines and a strategy for communicating the message. The task force also developed a plan for training counsellors as well procuring of HIV-test kits.

The VCT messages are mostly designed to target the youth, who are considered at high risk. Recently, colourful advertisements, which mostly feature local entertainment personalities, began gracing billboards, while the local media were putting out the message that visiting a VCT centre could prove life-saving.

Experts say VCT is not only a quick way of getting to know one's HIV status, with same-day or even same-hour results, but also incorporates professional counselling designed to influence behavioural change in the client.

Study on effectiveness of VCT

According to Khadijah Rama, who runs the Pepo VCT centre, counselling is an important phase in empowering HIV-positive people to learn to cope with their predicament, while at the same time helping communities to change their attitudes to not only to care for and support such people but also to promote behavioural change among the uninfected.

"Counselling is vital in supporting HIV/AIDS-infected and -affected persons to adjust and cope, and hence live a positive and meaningful life," Rama said. "It enables orphaned children, and especially those in child-headed households, to cope with trauma and to readjust. It is also a vital tool for [bringing about] behavioural change and also in reduction to stigma, prejudice and discrimination against infected and affected persons," she added.

Report on VCT among youth in Kenya and Uganda

Discriminatory government policies

Discrimination, however, is not only a problem at community level but also a salient feature of the Kenyan government's policy on HIV/AIDS, which has so far failed to prioritise HIV/AIDS as an emergency, according to Ouma.

Ouma said although the government had declared HIV/AIDS a national disaster, almost all funding towards fighting the scourge had emanated from donors and NGOs. Furthermore, procurement procedures for anti-retroviral drugs were still too complicated, despite a law passed this year to allow for the importation of cheaper generic drugs.

"These are hallmarks of lack of seriousness," Ouma said. "The government should put its money where its mouth is. The government is willing to sacrifice two million people who are infected - people with HIV - and protect the 28 million who are HIV-negative. HIV/AIDS patients also have rights," he stressed.

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