Friday, January 23, 2009

Kenyan Politicians Hold Key to HIV Prevention

After the civil unrest in Kenya early last year, many Kenyans ended up in camps for internally displaced people (IDP). They went to these camps for immediate security but many have stayed because their security is still not guaranteed and, in many cases, they have nothing to go back to. There are hundreds of thousands of Kenyans in IDP camps, although not all of them are there as a result of last year's post election violence.

Whatever about the conditions in IDP camps, people leaving these camps face acute hardships. They need to find a safe place to live and a way of making money, for a start. For some, cities are considered the best place to find work. If work cannot be found or if the pay is not adequate, some resort to various forms of transactional sex for survival, at least for a while.

Unemployment is very high in Kenya, people are facing high prices for basic goods such as water, food, fuel and accommodation. Therefore, finding work is not always enough. When employers know they can get cheaper, they pay less. The same applies to the clients of those depending on sex for survival. For some time, it has been a buyers' market. Certain bars in Nairobi have noticeably more females than males. The men can find what they want and negotiate a low price and even refuse to pay. There is no one to protect those engaging in survival sex.

This scenario can increase the pressure to have more clients per night and to take more risks, such as agreeing not to use a condom, agreeing to anal sex, group sex, anything that will attract more money. This increases the probability of contracting and transmitting HIV and other sexually transmitted infections (STI). It also increases other dangers that sex workers face because of their increased vulnerability, the increased amount of time spent on the street and numerous other considerations.

To make matters worse, there are extreme food shortages in many parts of the country right now. More and more people are moving to urban areas, especially Nairobi and Mombasa, but also other towns and cities. They are looking for work and access to basic goods. This is adding to the existing flow of people and creating a very dangerous situation.

Something curious happened in the mid 1980s in Nairobi. At this time, there were far more men than women in the city (and there probably still are). But in 1986, rates of HIV (and gonorrhoea) peaked among commercial sex workers (CSW). HIV peaked at 81%, one of the highest rates experienced anywhere. But the reasons why HIV peaked at this time, nearly a decade before HIV incidence (the rate of new infections) peaked in Nairobi, are not clear.

I have yet to hear a plausible explanation of why HIV peaked among CSWs, especially as the figures are for those who were new to sex work. There was very little prevention work being carried out at the time and what work had been done would hardly have had much time to produce results. Is it possible that there was a reduction in the number of CSWs, possibly because of an improving economic climate, and a consequent sellers’ market?

Well, rather than speculate further on that phenomenon, after all, I could just research it, I would like to speculate on what is happening right now in Nairobi and other parts of the country, especially urban areas.

If an increasing number of people are currently depending on survival sex, this could give rise to a huge increase in transmission of HIV and other STIs. Current crises, such as the water, food, fuel and economic crises, all increase vulnerability. An estimated 10 million people face starvation. A huge percentage of the population is extremely vulnerable.

HIV can take ten or eleven years to kill you. But you can die of thirst in a few days. Starvation is pretty quick too. Add to this the fact that you may have children and other dependents and survival sex doesn't seem nearly as dangerous.

Whatever politicians may say and whatever newspapers may publish about biofuels, world economic crises, global food shortages, global warming or any other reasons for current food shortages, around 70% of recently acquired maize has disappeared. Those to whom the maize was entrusted are known to those distributing it, but no one has yet been held accountable. Somewhere in the country, there is either a large amount of maize or a large amount of money.

Kenyan politicians are asking international donors for help, yet help may be closer at hand than they think. Their colleagues may have the maize or the money or they may know where it went to. Politicians raise a lot of questions but they should be closer to the answers than anyone. Ultimately, large stocks of food are under their care. If anyone can answer the questions, it is politicians or their friends and associates, people close to the top.

A survey in 2007 found that HIV prevalence in Nairobi had fallen slightly since 2003 (although it has been increasing in most provinces). In years to come, if HIV transmission is rising right now, it will probably be said that there was a food crisis, a fuel crisis, an economic crisis or any other crisis that has yet to come. But poor people in Kenya have been poor and vulnerable for a long time.

True, these crises make things a lot worse, but HIV is increasing because vulnerabilities are still not being addressed, more than 25 years after HIV was identified. Many social indicators have been disimproving since the 1980s but these issues continue to be ignored. Perhaps politicians can continue to hide behind multiple crises but when has there been a time that there wasn't some crisis, ostensibly beyond their control, that they could blame?

We may have the opportunity, right now, to intervene and prevent a significant number of new HIV infections that are about to occur under our noses. The technology to prevent these infections is well known and widely available. It's called food.

Will the Kenyan government do what it can to reduce the vulnerabilities faced by so many Kenyan people? Or will they just allow them to die and later attribute their deaths to circumstances beyond their control? Not all circumstances are beyond their control.



Barman said...

Nice Blog! keep up the good work.

Simon said...

Thanks Barman, that's nice to hear! S