Economy

When Mary Chiku, a 35-year-old single mother of two boys was diagnosed with the HIV virus five years ago, she literally stared death on her face.

"I passed a death sentence on myself. Life didn't matter anymore", said Chiku.

Desperate and confused, she sought assistance from hospitals, but the anti- retroviral (ARV) drugs used to manage HIV infection in sufferers were very expensive for this lady who earns a mere US$60 (Ksh4,000) a month from selling groceries.

"I was desperate to get medical care, but I could not afford it, so I sought help from herbalists, despite the perception that they are witch doctors. I had no choice," Chiku tells Bus/ness in Africa as she prepared to serve customers at her grocery in Nairobi's low-income estate of Kawangware.

Chiku is visibly healthy and she has added weight since she started taking a concoction of herbal medicines her herbal medicine practitioner told her boosted human immunity.

Access to care, medical or otherwise for Chiku and the 2.2 million other Kenyans infected with the virus that causes Aids has emerged as one of the key focus areas in the fight against Aids in Kenya. Kenya's official focus, like that of the non-governmental organisations concerned with Aids-related issues, is now emphasising provision of care and better health for victims.

Rejection

Jakayo Owour, 26, has undergone tribulations which he says cannot be equated to any form of suffering.

"Mine is the case of 'ejection. Once my parents and relatives discovered that I was suffering from Aids, they chased me away from home. I could not comprehend what the future had for me were it not for spiritual counselling I received from our church leader back in Homa Bay (a rural town in the Western part of Kenya)". He decided to travel to Nairobi to escape from the family rejection and find a job so that he could be able to take care of his illness.

"Now as you can see, I look healthy. I am a casual labourer in Nairobi's Industrial Area and have been recruited into a programme by Medicines San Frontiers (an international NGO specialising in health) where I have access to antiretroviral (ARV) drugs", says Owour.

However, not all the 2.2 million people suffering from Aids in Kenya are as lucky. Already official figures place the number of dead at 1.5 million people, with the daily death toll from Aids-related illnesses at approximately 700 people. Experts say the Aids situation is Kenya is still 'worrying' because on one hand, the infection rates have not dropped despite the fact that a vigorous anti-Aids campaign has been carried out by the government, the private sector and non-governmental organisations. On the other hand, management of the disease through care and use of ARV therapy is scarce and usually expensive.

Costs

Cost is now forcing more Aids sufferers to explore herbal medicines. Alex Akunga, an Aids researcher in Kenya, says an increasing number of patients are now turning to herbal medicine to manage the opportunistic infections because the conventional medicine is expensive.

In September this year, the Kenya government launched an ambitious programme to provide ARV drugs at US$21 (Ksh 1,600) for a monthly dose. This presents a major drop from US$900 (Ksh70,000) for a similar monthly dose just two years ago. The first phase of the programme will involve treating 6,000 people. The programme has much ground to cover when one considers that at least 200,000 people need these life-prolonging drugs. While launching the programme, Health Minister Charity Ngilu, said those who cannot afford the drugs for now will be able to get them free.

To increase and improve access to care for the Aids patients in Kenya and Africa in general, participants at the recently concluded International Conference on Aids and Sexually Transmitted Infections in Africa (ICASA) held in Nairobi, said that the world must provide enough financial resources to the fragile African economies to enable them meet the cost of ARV drugs. Matshidio Moeti of the World Health Organisation office for Africa said at least 4.5 million people living with Aids in Africa need ARV medicines but only 70,000 to 80,000 people are on treatment.

In a new report 'Accelerating Action Against Aids in Africa', the UN admits that international spending on Aids programmes in developing countries has grown substantially. Among the funding sources is the commitment by Washington authorising increased spending on HIV/Aids in African and Caribbean nations from US$5 billion to US$15 billion in the next five years.

Another is the World Bank's Multi- Country Aids Programme for Africa, which by July this year had disbursed US$106.3 million to African countries and has pledged further US$800 million.

In addition, the Global Fund to Fight Aids is playing a major financing role of anti-Aids programmes. By July 2003 it had approved US$238.4 million in grants to support national Aids programmes across Africa, of which US$15 million has already been disbursed. Kenya is already benefiting from these initiatives.

Studies in Kenya indicate that women are the most vulnerable to Aids infections. This has been attributed to their disadvantaged position in the society particularly in matters of finances, and due to cultural practices like wife inheritance and polygamy. Infections rates for women in Kenya are more than five percent higher than those of men.

Local situation

According to a yet to be released United Nations Children's Fund (UNICEF) study, in Kenya, women aged between 15 and 24 years are twice as likely to be HIV infected than men of the same age. The study, to be released in November this year, also notes that 18 percent of Kenyan women become infected within two years of becoming sexually active. The majority of Kenyan girls have their first sexual intercourse without consent.

Alice Akung, a researcher with Girls's Education Movement in Africa blames this on a lack of sex education and the 'myth' about sex that is fed to children by their parents. "Because Kenyan girls are just expected to grow up without talking to adults about sex, they are much more likely to get involved in relationships they cannot control and be led into situations in which they can be raped or abused."

Another issue that is still fuelling Aids infections in Kenya is poor health practices especially in rural areas where medical equipment is scarce. During the ICASA conference in Nairobi, a consensus emerged that unless safe medical practices were put in place in Africa, HIV infections will continue to rise specifically because of the reuse of contaminated syringes.

Although the WHO says only about 2.5 percent of new Aids cases are as a result of the re-use of syringes in Africa, medical experts here put the figure at close to 30 percent.

Lilian Salerno of the Geneva- based International Association of Safe Needle Technology (IASIT) said it was not only misleading but also 'dangerous' for the WHO and the United Nations Aids agency to focus exclusively on the role of sexual transmission in Africa to the point of virtually excluding all other causes. "Our recent research indicates that needle re-use may account for as much as 30 percent of new Aids cases," she said, adding that the problem was worsened by the fact that between 70 and 90 percent of injections in developing countries like Kenya are 'unnecessary'.

Like Chiku, many Aids patients in Kenya are now turning to herbal medicine, which is seen as inexpensive, relatively effective and has no side effects.

James Njoroge, a researcher with the Institute of Herbal Treatment in Kenya, said that researchers have now made great strides in ascertaining the effectiveness of herbal medicine in management of diseases like HIV/Aids. He said that unlike the conventional drugs, herbal medicines are cheap, accessible and have no side effects.

Herbal medicines for the management of Aids, mainly for boosting immunity, costs only four dollars (Ksh300) for a one-month dose. The use of herbal medicines is also fuelled by the fact that public expenditure on Kenya's health services as a percentage of gross domestic product is about two percent, according to official statistics.

Based on these facts, Dr Erick Gbodossou, president of the Association for the Promotion of Traditional Medicine in Africa (PROMETRA), said traditional healers could supplement efforts in the fight against spread and management of Aids.

"There should be strengthening of trust and collaboration between conventional and traditional medicine for the benefit of Aids patients", he said. "We have varied and valuable experience in treating Aids related illness, and accept the great responsibility of continuing to do so," said Dr Gbodossou.

"The future of an Aids cure is herbal," he added.