Sunday, June 20, 2010

It’s Not an Emergency, it’s in Kenya

If Ireland, my country of birth, had a HIV epidemic like Kenya's, there would be 173,250 HIV positive people there, instead of 5,500. HIV prevalence in Kenya is estimated to stand at 6.3%, in Ireland it's 0.2%. Instead of having one HIV positive person for every 818 HIV negative people, Ireland could have one for every 26. Then it would not be unusual for every person and every family to know or be related to at least one HIV positive person, as is the case in Kenya.

Nyanza province, in the South West of Kenya, has a prevalence of 13.9%, twice that of the next highest prevalence, Nairobi, at 7%. But the Luo tribe, consisting of only around three million people, has the highest prevalence of any tribe in Kenya. At 20.2%, it’s over two and a half times the next highest tribe, the Maasai, at 7.9%. If Ireland had an epidemic like that of the Luo, there would be 555,500 HIV positive Irish people. Think of the dependency ratio and the health care bill.

I like to think that if that number of Irish people were infected with a chronic, life threatening illness, it wouldn't take long before it was established how people were becoming infected and measures were taken to ensure that transmission be reduced to as small a number as possible. I would like to think that the epidemic would be seen as an emergency far more significant than foot and mouth, bird flu, H1N1 and BSE all put together.

555500 is probably similar to the number of World Cup visitors currently in South Africa. The total number of HIV positive people in Kenya is about three times that number, or a third of the population of Ireland. And Kenya doesn't even come close to having the worst HIV epidemic in the world. South Africa itself is estimated to have well over 5 million HIV positive people. And prevalence in some countries, such as Swaziland, is even higher than that found among the Luo tribe.

But imagine if Ireland were to have such an epidemic, what would the government and various international health institutions say and do? Would they say that the epidemic was caused by promiscuity and that Irish people need to have less, or even no, unsafe sex? Would they say or imply that it was due to vague 'cultural' or 'tribal' practices? Or would they say it was due to low levels of circumcision? After all, circumcision levels in Ireland are low, as they are in all European countries.

And if many Irish people, either infected with HIV or affected by it, were to deny that they were promiscuous or careless, would they be believed? Would the government and various international health institutions investigate their claims and try to find out how they could have been infected if they were not infected sexually? If large numbers of infants and young children were HIV positive and their mothers were HIV negative, would that be seen as a possible indication that many of them, perhaps all of them, were infected by unsafe medical procedures or by some other non-sexual route?

A friend pointed out to me that the latest figures show that 53% of married HIV positive women in Kenya have HIV negative husbands. How did they become infected? Would the relevant authorities in Ireland, under similar circumstances, say or imply that these women were promiscuous, give them condoms and drugs and tell them to be careful in case they infect their husbands? Would they circumcise all their husbands as a priority?

Perhaps you would object and say that the scenario I present is futile and that the questions I raise are meaningless. Well, I'm tempted to agree. It seems brutal to ask if the world would be indifferent to the plight of such huge numbers of people, of whole nations, of a whole continent. Could health, economic and political professionals be so inhumane as to humiliate sick people and refuse to protect those who are, as yet, uninfected?

The number of people newly infected with HIV every two years globally is about the same as the population of Ireland. HIV has been recognised for nearly three decades. Since it was first identified, it was clear that it was transmitted, not just sexually, but also through contaminated blood and bodily fluids and by mothers to their infants. After HIV was identified, various measures were taken to reduce transmission, whether transmission was sexual or non-sexual.

But now, people here in Kenya seem almost unaware of any threat aside from that of unsafe sex. Many people, on finding they are HIV positive, assume they must have been infected sexually because that's what they are told, over and over again. They have not been told how to protect themselves from unsafe medical or cosmetic practices, only that they should abstain, be faithful and wear a condom, three things that will never protect them from non-sexually transmitted HIV. It's no wonder people think they must have been infected by mosquitoes or by someone putting a curse on them.

Perhaps the eminent people of UNAIDS, CDC, WHO and other institutions would like to tell the president of the US that many members of his father's extended family and fellow tribespeople are HIV positive and that this is so because most of them are extremely promiscuous and that they need to stop having sex, start using condoms and get circumcised if they are male. Because that’s what they are telling Obama’s father’s people. So perhaps this is what they would say to Irish people under the scenario I mention above.

I would like to think that this would not be their reaction, but what evidence is there that their reaction would be different? Because I don't believe that there has ever been a sexually transmitted disease that has spread like HIV is said to have spread among the Luo people or among the Swazis. I'm not sure if such a sexually transmitted disease is even possible, I certainly hope not. But if HIV prevalence among the Luo and among other populations exceeds our worst nightmares, why is it not considered to be the emergency that it clearly is? I'm not asking why HIV spreads as fast as it does but why it spreads so fast among some people and not among others. And please don't tell me that it's because Luos are 100 times more promiscuous than the Irish.


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