Back in Isiolo

Photo: Isiolo Youth Against Aids and Poverty (IYAP), setting up camp to provide mobile voluntary HIV counselling and testing (VCT) services in Isiolo town centre.

The trip to Isiolo is, in itself, a culture shock. The bus is always a buzz of conversation and loud music and the roads could be the source of hundreds of road movie anecdotes. I know the 14 seater minibuses here, called matatus, have a reputation for taking risks. But I saw one that had "14 Gamblers" painted on the door, instead of "14 Passengers". Aki Kaurismaki really should make a movie here.

Anyhow, the town of Isiolo no less disappointing. It was still hot, thought the sun was going down, and a constant, gusty wind drove up mini dust devils and covered everything in a thick, gritty film. But I was there to see IYAP, the Isiolo Youth Against Aids and Poverty, who were running a mobile voluntary HIV counselling and testing (VCT) clinic in the town centre.

Mobile clinics have been very successful, compared to the static clinics, which most people seem to avoid. It costs more money and requires more work to go out and set up a camp where people can visit for VCT services. But it is worth it and the IYAP team can test 60 or 70 people in a day. And they are not confined to the town, they can also visit distant villages and rural settlements.

A short while ago, IYAP was also able to do what they call "moonlight testing", whereby they go out at night and set up camp. Many people who are reluctant to go during the day seem happy to turn up for the moonlight sessions. Many of them are people who work at night or who are out at the pubs and clubs.

However, there have been terrible food and water shortages in and around Isiolo and many other parts of Kenya. This has had a knock on effect on security and has resulted in tribal clashes. Many people have been injured and some have been killed, farms have been damaged, stock has been stolen and destroyed. Hopefully, government efforts to reduce food insecurity and civil disturbances will alleviate things soon.

IYAP have many plans for the future, which they will be writing about in their forthcoming blog. I'll post up some further details about my visit here in the next few days and also, the URL for the new IYAP blog.

Return Visits to Kibera and Isiolo

Photo: Work in progress on the new Kibera School for Girls

It's good to be back in Kenya again, despite all the bad news I keep hearing. And I have heard some good news too. I went to see a Kibera based organisation called SHOFCO, who work with young people and HIV positive women. Their founder, Kennedy Odede, has attracted a lot of funding while on a scholarship in the US and they are busy building a school and a maternal health clinic. When I went to visit them some time ago they were unable to do much due to lack of funding but they are really flourishing now.

Meanwhile, quite a number of people have died of hunger related conditions in the past few months in Kenya. Drought and food shortages continue and many more are suffering from the effects of extreme hunger and malnutrition. Even in areas where food is being distributed, the unbalanced, high-starch diet contributes to malnutrition related diseases.

Friends in Isiolo have told me that the drought has meant that people need to move their livestock many kilometres in order to find water and grazing. This leaves their families very vulnerable to the attacks by bandits, which have become more frequent recently. In particular, a group of HIV positive women, who joined together to buy goods and livestock, have lost some of their livestock to bandits.

Eastern and North Eastern provinces, where much of the extreme poverty and food shortages occur, are somewhat isolated from the very centralised Kenyan administration. They are far away enough for most politicians to forget about them until it comes to electioneering. Then, small gifts can be distributed until votes have been safely cast.

These areas have also long been ignored when it comes to HIV related programmes because HIV prevalence is relatively low and people are not seen as being 'high risk'. This oversight is slowly being corrected, but for many years, HIV was spreading, albeit slowly. Populations are not dense but many of the people are very mobile, having to move around seeking pasture, water and trade.

I'm looking forward to visiting my friends in Isiolo who run IYAP (Isiolo Youth Against Poverty) this week. Hopefully I'll have more and better news then.


Photo: IYAP go out into the streets to attract people to be tested for HIV but this service is being compromised by the current security situation.

Isiolo Youth Against Aids and Poverty

I have just had the pleasure of visiting Isiolo, a few hundred kilometres North East of Nairobi in the Eastern Province. From the time I got on the bus to Isiolo, it felt like being in a different country. The bus was filled with people who look different, sound different, play different music and chew miraa all the time. As you leave the more fertile central areas of Kenya, which consist of green fields of intensively farmed crops and rather less green horticultural polytunnels, everything becomes a bit more dusty. Eventually, there are a lot of dry plains, dotted with steep volcanic hills and thorny, low level trees and bushes.

And when you arrive in Isiolo, you really are in a different country. You have left the people who mostly think of their 'tribes' around election time and meet people whose lives are affected by tribal disagreements on a more regular basis. There are still abandoned houses and farms from the last serious land, property and livestock disputes. Many owners have left the area, often for the cities, especially Nairobi. The area is a tough environment for people to live in and to gain a living from. It is mainly pastoralist, although some people are now trying to diversify and depend less on herding animals.

I went to Isiolo to visit a group of people I met, by accident, in Dar es Salaam. They run a voluntary counselling and testing (VCT) centre in the town. We exchanged notes about Kenya, HIV and various other matters. The people invited me to visit and I did. I was met off the bus and taken to the home of some of the IYAP (Isiolo Youth Against Aids and Poverty) members, where I was to stay for my time in the town. I have been to the houses of various other members and been fed and watered thoroughly. If I hadn't already developed an ugali (and beer) belly this would have been a good opportunity (although I drank no beer there).

IYAP's VCT is located in a region where, for cultural reasons, sex is not talked about. Not that that is so unusual in East Africa, but people are even less likely to talk about sex in more Northern regions than in other areas. Clothing, behaviour, manners and lifestyles are less influenced by Western values than they are in the cities and even other rural areas. So the VCT often has to go out into the community to mobilise people, raise awareness about HIV and about the availability of counselling, testing, support and treatment for those infected.

There have been limited mobile VCT facilities available in Kenya for some time but they don't seem to penetrate the most isolated areas. In fact, I have only seen specialised mobile units in urban areas where there are already fixed facilities. But IYAP organises what are called 'moonlight' clinics as well. They go to isolated areas at night and people can turn up in the cover of darkness. It sounds like a desperate measure. But in isolated areas, most people know all of their neighbours. There is little opportunity to visit a VCT clinic without many other people knowing that you have been there.

In fact, all over the world there are people who are naturally shy about the possibility that everyone in the neighbourhood could end up knowing what they are doing. I don't tell everyone I know when I've been for a HIV test and I don't think my friends and acquaintances do, either. But in many parts of East Africa, the very admission that you may be at risk of being infected with HIV can have serious social consequences. People from the area do not openly associate with sex workers. Sex workers themselves are neither talked to nor talked about by many. They are outcast, regardless of the fact that they may have become sex workers because of circumstances beyond their control. As for their clients, they always seem to be above reproach.

But not all things are so different in Isiolo than in many other parts of East Africa and probably many other countries. Sex is a difficult subject in Ireland, where I come from and the UK, where I have lived for many years. Few people talk frankly about their sexual experiences to anyone and everyone. Few would expose their private lives to the censure of all those around them, friends, family, employers, peers, neighbours, etc. And why should they? People are entitled to privacy, even if they live in closely knit communities.

Isiolo, and Eastern Province in general, are home to some of Kenya's poorest people. Together, Eastern and North Eastern Provinces have long been marginalised while Nairobi and Central Provinces have seen most of the benefits of economic growth, and even the large amounts of donor money that comes into the country. This is not to say that there are no poor people in the well off provinces. On the contrary, the majority of people are poor, even in Central and Nairobi. But people in Eastern Province feel they have been overlooked and forgotten. And I think they are right to.

IYAP is one of several organisations in the area that concerns itself with poverty, poor health and inequality, some of the very things that drive the HIV epidemic. As well as providing VCT, sex information, support for those with HIV and those who are in danger of being infected, IYAP work with other local groups, such as women’s' groups, giving them advice and support, helping them raise funds and advocating for their interests.

It is difficult to please everyone when doing this kind of work. Some religious leaders see the sexual behaviour of their people as a religious matter. Politicians see community based organisations and NGOs as either for or against their interests. Older people see young people as in need of education and experience; they don't think they have anything to learn from the young. So a youth based organisation is viewed with suspicion by some. But that is what makes the work organisations like IYAP do so special. It is not easy to go against the current, especially in small and traditional community. But over time they have gained some of the respect they deserve.

The work that IYAP and other similar organisations do is vitally important for the future of Kenya and other developing countries. Let’s hope they are allow and enabled to continue working to reduce poverty, inequality, injustice, prejudice and bad health.

Moonlighting in Isiolo

I have observed VCT (voluntary counselling and testing) HIV clinics in various settings and various towns but last night I went to see a 'moonlight' clinic for the first time. Many people are cautious about going to the town VCT, for various reasons. So someone came up with the idea of running the clinics at night.

My friends who run Isiolo Youth Against Aids and Poverty set up the moonlight clinic in the centre of town. They placed themselves strategically near the biggest and busiest bars and clubs, where people wander around at night. The loud music and announcements from the PA system attract people, some of whom just watch or dance to the music, many of whom want to be tested.

There was something of a carnival atmosphere, with street children (sniffing glue), people working in the area (chewing miraa), drinkers, late night shoppers and miraa vendors all coming along to have a look.

More importantly, the clinic attracted as many people as they had the capacity to test, so the exercise was well worth the effort. Most of the people who turned up were in their twenties and there were a lot more men than women. This contrasts with other contexts, where far more women than men get tested. Some of the people were older, as old as fifty, and some were below 20. No one admitted to being below 18, but some of the girls looked a lot younger.

Around the corner there are several bars and a club. Women and girls (but mainly girls) walk up and down the street, some stand outside the bars, others go inside the bars; the men sit or stand around searching and waiting. There are lots of motorbikes, ready to transport people to wherever they want to go.

IYAP is a community based organisation that provides VCT and various other services for people who may be or are infected with HIV. The organisation also works with poor people, young people and sex workers. They aim to address the problems that people face in their everyday lives that may put them in danger, whether the danger is HIV, sexually transmitted infections, poverty, discrimination or anything else.

It may seem obvious that people are afraid to be tested or don't want others to know they are being tested for HIV but many clinics are static and make little or no provision for going out into the community to try to persuade more people to be tested. It is only recently that mobile units have been implemented in some areas, most areas don't have them yet.

It may also seem obvious that there are very different circumstances surrounding the transmission of HIV in different locations. There is sex tourism in Mombasa and on the coast, there are labour practices that are involved in transmission around the Mumias sugar growing area, the Kericho tea growing area and the Naivasha horticulture area, Nairobi is a big city, where people go to look for work, the borders are notorious for holdups that give rise to truckers and other drivers spending much of their time being bored, drinking and hanging out in bars.

Here in Isiolo, there are different pastoralist tribes, often forced to radically change the way they live because of political interference, civil disturbance, poverty, water shortages and other problems. The town has a big army barracks, many traders coming and going, it's on a major trucking route, there is a high level of poverty and there are very few jobs or opportunities for most people; these are just some of the issues involved.

IYAP, being an indegenous organisation, are well aware of the sort of things people face. They know most of the people that live in the town. And they go out into the community and talk to people who are very often ignored; street children, sex workers, alcoholics and homeless people, for example.

There are huge amounts of money coming into Kenya and other countries with serious HIV epidemics but little of this money seems to go to addressing the circumstances that result in people becoming vulnerable to HIV and other diseases, that result in people being poor and desperate.

Every village, town, city and rural area in the country has a different set of problems. Therefore the solutions need to address these specific problems, not the problems that donors think are most important.

HIV transmission is not just about people having sex or having too much sex or having sex with too many people; it is about people's lives, their circumstances, their vulnerabilities, poverty, hunger, poor water and sanitation, bad health, poor education and social services, inequality and discrimination.