HIV/AIDS a major health issue in western province

HIV/AIDS remains a major health concern in Kenya despite the fact that a recent study showed a drop in the national prevalence rate. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), the overall adult infection rate reduced from 10 percent in the late 1990s to 7 percent in 2003.

Despite the reduction, which was mainly due to awareness-creation programmes, UNAIDS estimated that some 1.2 million Kenyans were living with the virus, of whom 100,000 are children. Some 650,000 children have been orphaned as a result of the disease.

To contain the epidemic, Kenya has set up national institutions and local committees in communities and is working on a new strategic five-year plan for its fight against HIV/AIDS.

"HIV/AIDS continues to pose a great threat to our society. [...] The virus is destroying the gains made over the years attesting to the fact that the disease has impacted negatively on our country's economy" said Patrick Orege, director of the National AIDS Control Council (NACC), in a statement.

According to the NACC 2000-2005 work plan, the disease increasingly affects the poor and people with low levels of formal education.

"The profile of HIV-infected people has been changing and is becoming a disease of the poor with educated people in a position to respond to information available - and adopting safer sexual practices, meaning that the share of new infections is rising among low income and less educated people" NACC noted.

"Substantial reduction in poverty levels is key to subsequent lowering of HIV prevalence rates" the agency maintained.

Gender is also a factor in HIV/AIDS infection. HIV/AIDS prevalence among women aged 15-49 in Kenya is nearly 9 percent, compared to less than 5 percent for men in the 15-54 age group, according to a 2003 demographic and health survey."

"This female-to-male ratio of 1.9:1 is higher than found in most population-based studies in Africa and implies that young women are particularly vulnerable to HIV infection compared with young men", the report noted.

The national HIV/AIDS strategic plan acknowledged that women are more vulnerable to HIV infection than men – largely as a result of women's lower position in the hierarchy of traditional societies, powerlessness and lack of adequate information about the disease.

The "majority of women have little control over their own sexual behaviour, and less over the sexual behaviour of their husbands or partners", the NACC observed.

"In addition women have biological factors that increase their risk of HIV infection. As a strategy to fight HIV/AIDS women should be empowered to enforce faithfulness within relationships," it noted.

The government estimated that by 2003 the level of public HIV/AIDS awareness had risen to more than 90 percent across the country. It noted, however, that information, education and communication campaigns (IEC) were being undermined by custom and a lack of trained personnel at the community level.

As a result of increased awareness, condom use has risen. "There has been a change in sexual behaviour among Kenyans" observed Rachael Arungah, permanent secretary for special programmes, in a statement. "Use of condoms [has risen] from 15 percent in 1998 to 24 percent among the women in 2004 and from 42.5 percent in 1998 to 47 percent in 2003 among men."

Similarly, the proportion of men and women with more than one sexual partner reduced by more than half between 1993 and 2003. Over the same period, more adolescents delayed the onset of sexual activity.

According to the government, awareness raising, scaling up VCT centres and other strategies are part of efforts to realise the March 2003 declaration of "Total War Against HIV/AIDS".

According to Miriam Were, NACC chairwoman, the government anticipates "further reduction in new HIV infections through stepped up behaviour change communication, especially targeting young women and other groups with greater vulnerability to the virus."

NACC noted in its 2000-2005 HIV/AIDS strategic plan, however, "Successful IEC interventions for behaviour change are complicated by the fact that matters of human sexuality are closely tied to traditional beliefs and cultural practices.

In no other place in Kenya, perhaps, is this demonstrated as strongly as in Nyanza province in western region.

While the national picture indicates some progress in the fight against the disease, the situation in Nyanza province is completely different.

The province - with an average HIV/AIDS infection rate of 14.7 percent - continues to face a crisis and offers a lesson in the role culture and tradition play in the transmission of the HIV virus.

Traditions such as wife inheritance and widow cleansing, a fish trade in which women often fall prey to sexual exploitation, a tribal culture that views sexual intercourse as a harbinger of good fortune, and the lack of male circumcision have been cited as factors that contribute to high HIV/AIDS infection rates.

In this special report, IRIN explores the HIV/AIDS crisis in Nyanza province’s Bondo, Homa Bay, Kisumu, Migori and Suba districts.

In villages surrounding Kenya's Lake Victoria, the pandemic continues to wreak havoc, awareness levels remain relatively low, traditions that facilitate the transmission of HIV persist, and medical facilities are too far away for many of those desperate for help.