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.