Sustainable hope

Njoki sits on a wooden chair outside her family’s adobe house, in the central highlands of Kenya. A thick brown cardigan drapes her shoulders, a bright orange scarf winds around her hair.

Like many Kikuyu in the central highlands of rural Kenya, Njoki’s family are subsistence farmers. Plots of land in this part of the world are often small, as land is divided from one generation to the next. In this family allotment, maize, bananas and coffee grow right up to the edge of the house. A stream runs through the lower part of the property. While this year’s crop looks like it will sustain the extended family, it may be one of the last seasons that Njoki sees.

Like an estimated 14 per cent of rural Kenyans, Njoki has contracted HIV/AIDS. Her weight and energy levels have plummeted, and although she is in the most productive years of her life, she depends on family to care for her. They will also have to take on the responsibility of raising her 7 year-old daughter when she dies.

The father of Njoki’s daughter is long gone, and in rural Kenya where people with HIV/AIDS are stigmatised, how will Njoki be remembered? What can she leave her daughter?

The pain of her situation at times overwhelms this young mother. Njoki is only 24, but she does not have the luxury of much life ahead of her. She allows a tear to escape, then dabs at it with a handkerchief. There are other families in the district dealing with similar issues.

Alata, a mother with five dependent children, whose husband died last year from the disease, sits on the mat outside her house. She is gaunt. Her battle with the disease is almost over. Alata’s sisters look after her, just as they will be called on to look after her children.

Perhaps it is because of her closeness to the finality of her earthly existence or her age—somewhere between 45 and 50—that Alata seems to have acquired a level of acceptance that eludes Njoki.

‘There are many responses to HIV/AIDS’, explains Florence Nderitu, HIV/AIDS coordinator from the Good Samaritan clinic in the central highlands town of Nyeri, a two and a half hour drive from the Kenyan capital, Nairobi.

Florence is a woman who understands the complexities that the HIV/AIDS pandemic has on individuals, on families and on the community. A trained public health nurse, Florence was recruited by the Anglican Church to raise awareness about HIV/AIDS in the diocese of Nyeri.

At that stage the disease was not perceived to be a major issue by most people in the central highlands. Yet data taken from the surveillance of pregnant women in the region showed that 17 per cent were HIV/AIDS positive. A community mobilisation campaign began, raising awareness of the issue by working with community leaders, church groups and schools. What became apparent, says Florence, who began the campaign, was the need for people to know their HIV/AIDS status.

Eventually the second stage of the project, a clinic to provide voluntary counselling and testing (VCT) was established with funds provided by the Australian High Commission in Nairobi and Anglicord in Australia.

Florence explains, ‘If you can get people early, it is possible to keep them well for a long time. Then they keep their job and are productive and can sustain their family’.

She also believes that VCT is an empowering tool, ‘If you are positive you can learn to live positively with it, and to protect others around you’.

At the clinic people see a counsellor first. They may discuss the risks they have been exposed to, why they have come for testing, and how they might respond if results are positive. The testing results remain confidential, although health data is passed on to regional and national health authorities. The test takes about 15 minutes, and results are given to patients through a counsellor. It can be exhausting work for the counsellors who often see between 7 to 10 people a day. They are the ones who advise people of their HIV/AIDS status. And for many people the news comes as a shock.

When I ask Florence about the incidence of discordant couples, that is, partners in which one partner is positive and the other negative, she estimates of those coming to the clinic, the rate is around 30 to 40 per cent. It’s not difficult to imagine the stress on relationships this causes.

She also explains that it is important to involve men, not just women, in HIV/AIDS education, testing and family planning, because she says, ‘In the African context, sex happens when a man wants it.’

At this stage of the interview with Florence, we are brought a cup of tea by Maina, the janitor at the Good Samaritan Clinic. When he leaves, Florence says, ‘I must tell you the Maina story.’ It is a story that the bishop of Nyeri, Alf Chipman, an Australian who has spent 35 years in Kenya, also launches into when I finally meet him.

In 1997, Bishop Alf’s wife, Nola, began taking in orphaned babies whose parents had died from AIDS or an AIDS related illness. Over the following year as numbers increased, a decision was made: it was better to have orphaned children fostered into families, than to have them in an orphanage.

Then in 1998, the Anglican diocese that Bishop Alf oversees, received their first funding to train women in the parish as HIV/AIDS counsellors and carers. (Sixty-nine attended the week-long course.) Just before that course, however, the bishop saw a fellow standing outside the office.

‘He was begging, waiting for Nola to help him. He looked like he was on death’s door. I’m ashamed now to say that I wasn’t very kind to him. I told him to clear out. Fortunately he was desperate, so he stayed around’, says Bishop Alf.

That desperate man was Maina. His wife had died of AIDS the previous year, and the stigma of their father having the disease had caused Maina’s children to distance themselves from him. The bishop, in a subsequent meeting with his wife and Florence, had a change of heart.
‘They made me see sense. I went to Maina and apologised. From then on, I put my shoulder to helping.’

It was Florence who invited Maina to attend the HIV/AIDS workshops, and to share his story. At a time when few people with the disease admitted their condition, Maina had taken a bold step. The effect on the local community was profound. A local minister explains:

‘Five years ago no-one in the church wanted anything to do with people with HIV/AIDS. But when Maina began participating in Florence’s workshops, speaking publicly all over the diocese about living with HIV/AIDS, attitudes changed, particularly [those of] the clergy. In a 180 degree turn-around, they realised it was their responsibility to be involved, to offer support. Maina has been such an inspiration to so many of us.’

In Rwanda, the incidence of HIV/AIDS is also high. In fact, in the next decade, the disease may claim almost as many lives as the 1994 genocide. In the Rwandan capital, Kigali, after visiting women with AIDS in the urban shanty towns—women made vulnerable by the potent mix of poverty and disease—I meet with Anglican Archbishop Emmanuel Kolini. He heads Rwanda’s National AIDS Control Commission.

‘In 1997 when I was made bishop of Kigali, I said in my inaugural speech, “I’ll fight HIV/AIDS”.’ It is a promise he has kept. Kolini became Archbishop the following year. ‘The HIV/AIDS program, here in Rwanda, was started by the church. Then the challenge was for the government to pick it up. But we kept up a program within the church so that all the clergy would be trained.’

These days Rwanda’s National AIDS Control Commission, is an influential organisation, having links to a range of non-government organisations, as well as many government departments, and the president. The government even has a Special Minister for HIV/AIDS.

Archbishop Kolini is passionate about reducing Rwanda’s HIV/AIDS rate, which he estimates to be 13.5 per cent.

‘There are 260,000 orphans with HIV. Who is going to take responsibility for them?’ he asks, adding that many church agencies have assumed this role. He laments the number of orphans and households where children have had to assume adult responsibilities. Yet there is some positive news. The World Bank, has recently granted Rwanda $US30 million to set up VCT centres, and to train doctors and counsellors. And the President’s wife, who has taken a keen interest in the AIDS issue, said in February this year, that the HIV infection rate was beginning to decline, particularly in the urban areas.

It seems the fight against HIV/AIDs in Kenya and Rwanda has truly begun. It will be a long battle and continuing international financial support will be a critical factor in the campaign’s success.  

Michele M. Gierck is a freelance writer.

 

 

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