Incoherent policies exacerbate pandemic

While declaring Aids a national disaster on 25 November 1999, President Daniel arap Moi said: “Aids is not just a serious threat to our social and economic development, it is a real threat to our very existence……Aids has reduced many families to the status of beggars…..no family in Kenya remains untouched by the suffering and death caused by Aids…..the real solution to the spread of aids lies with each and everyone of us. Aids is a war we must win.” Equally confident is Dr Margaret Gachara, the Director of the National Aids Control Council (NACC), who says, “We cannot afford to lose the war against Aids”. But going by the latest statistics on Aids in Kenya and misplaced government policy, the war is far from being won.

Although Public health Minister Sam Ongeri claimed at celebrations to mark the World Aids Day that prevalence rates went down from 14 per cent in 1999 to 10.2 per cent this year, these are figures collected from sentinel surveillance, and which cannot be relied on considering that it is only women who attend antenatal clinics. Kenyans cannot afford to be complacent when the Central district of Nyeri is having a prevalence rate of 40 per cent while most of the districts in Nyanza province have prevalence rates well above 30 per cent.

With an estimated 2.2million Kenyans infected with HIV, the virus that causes AIDS, the government is increasingly finding it difficult to cope with the burden, considering that it also has to tackle a host of other diseases, including epidemic levels of malaria, cholera and Tuberculosis (TB).

Early last month, Dr Meshack Onguti - the Director of Kenyatta National Hospital, the country’s largest teaching and referral hospital, said that over 80 per cent of inpatients at the hospital suffer from HIV/AIDS. Added Onguti: “The sad situation, coupled with the breakdown of Nairobi City Council health facilities, is frustrating our efforts to offer quality heath care to Kenyans”.

Yet Kenya could have been spared this grim scenario had the government been serious with its Aids control programmes. Although the first attempt to address the scourge was made in 1985 - only a year after the first Aids case was diagnosed in the country - serious intervention only came after the pandemic was declared a national disaster in 1999.

Thus, it took the government a whole 15 years to come to terms with the devastation that Aids was causing. The country failed to borrow a leaf from neighbouring Uganda, which has been considered a success story in the fight against the scourge in Africa. Uganda diagnosed its first case in 1982 and when president Yoweri Museveni’s government ascended to power in 1986, Aids was declared a national disaster.

Uganda then embarked on a voluntary door -to -door testing campaign, with Museveni mentioning Aids in almost all his speeches. By 1993, prevalence rates had stabilized or declined in some areas. Museveni was supported by his cabinet and the late musician Phylli Lutaya, whose song “Alone and frightened” of the late eighties inspired the Ugandans to fight against Aids.

In Kenya however, no politician ever talked openly about Aids before Moi declared it a national disaster. And to date, no celebrity or politician has ever gone public about their HIV status. Hence lack of political commitment has also been responsible for the continued devastation by the pandemic.

Kenya could also learn from the West African country of Senegal, which started serious awareness campaigns way back in 1997, when only 45 Aids cases had been reported in the country. To date, it has one of the lowest prevalence rates, standing at 2 per cent.

Government Aids programmes have often been implemented without clear policies. In 1985, the national Aids Committee (NAC) was established, followed in 1987 by the Aids Programme Secretariat (APS) in the office of the Director of Medical Services. In 1992, the APS was elevated to the National Aids Control Programme (NACP) under the Ministry of health. All these programmes never made any impact, despite being headed by prominent medical personnel such as Dr Sobbie Mulindi, Dr Malachi Owili, Dr Mboya Okeyo and the late Dr Martin Kayo.

Later that year, in recognition of the role of Sexually Transmitted Infections (STIs) in the spread of HIV/AIDS, the National Aids/STIs Control programme (NASCOP) was born. Funded by the World Bank under the STI project till 1999, the programme recorded some success. During that period, STI prevalence rates fell by 9 per cent. Otherwise the omnipresent Aids billboards dotting major towns were all there was to show for the efforts.

With the declaration of Aids as a national disaster in 1999, the National Aids Control Council (NACC) was created. It was established under the State Corporations Act and mandated to co-ordinate efforts in prevention and control of HIV/AIDS.

NACC has a chairman, who is a presidential appointee and a director who is the secretary to the council. Membership comprises representatives from government ministries, private sector, religious sector, AIDS NGOs women organizations and HIV positive people.

But since its inception, NACC has always operated under inexorable controversy. Unlike the previous Aids control programmes, which were implemented under the Ministry of Health, NACC was established under the Office of the President. Critics have seen this move as a ploy to access donor funds.

But Gachara argues that Aids is a national disaster and only the office of the president can handle such disasters. “For some strange reasons, we face outright rejection by ministries and NGOs, which see us as their controllers, yet we are only co-ordinating”, says Gachara.

The council has always been in a crisis because of allegations of financial misappropriation. The June 2002 internal auditor’s report revealed that the council had irregularly paid out US$ 240000 to suppliers in contravention of public procurement regulations.

Complaints also abound over the criteria used in nominating organizations to the council. For instance, Women Fighting Aids in Kenya (WOFAK) is the only Aids NGO represented at the council, while Maendeleo Ya Wanawake is the only women’s organization.

The council also lacks a permanent desk for People Living with Aids (PLWAs), with the council only using the few PLWAs for window dressing during celebrations such as the World Aids Day. “There is a need to establish a permanent PWA desk at the council to offer assistance to them, since they are highly stigmatized”, observes Dorothy Odhiambo, WOFAK programme Adviser.

Following the establishment of NACC, it is evident that resources are being duplicated. While Gachara says that NASCOP is in charge of the medical component of prevention and care, it is also in charge of monitoring the epidemic to know the trends of infection - a function it shares with NACC.

The whole NACC hierarchy is further complicated by the presence of Aids Conrol Units (ACUs), whose role is to co-ordinate implementation within each ministry, the Provincial Aids Control Committees (PACCs), the District Aids Control Committees (DACCs) and the Constituency Aids Control Committees (CACCs) to co-ordinate activities at the provincial, district and constituency levels respectively. In the absence of proper harmonisation, these efforts are bound to go to waste.

It has also become difficult to tell which ministry is in charge when it comes to Aids matters. Quite often, conflicting statements come from the Minister in the Office of the President whose docket covers Aids and the Minister for Health. This confusion was brought to bear in July 2001 at the height of campaign for generic drugs, when the then Office of the president minister Marsden Madoka and Public health minister Ongeri publicly took different stands on the issue.

NACC has also come up with a five -year strategic plan to fight Aids. The “Kenya National HIH/AIDS Strategic Plan 2000-2005” aims at reducing the prevalence rates by 20 -30 per cent among youth aged 15 -24 years by 2005. The document, to be implemented at a cost of US$ 180 million, is however silent on how this is going to be achieved.

The situation might, however, improve if the current presidential candidates keep their promises once they come to power. Both the governing party Kenya African National Union (KANU) and opposition National Rainbow Coalition (NARC) presidential candidates Uhuru Kenyatta and Mwai Kibaki respectively have vowed to fight the pandemic if their parties form the next government. It is also worth noting that Aids has become a campaign platform, with politicians now discussing it freely.

It is also encouraging to note that the religious groups, initially considered to be hampering the fight against Aids, are now at the forefront. This year’s World Aids Day celebration was dedicated to them. On their part, they vowed to fight Aids at their places of worship and to see an end to stigma and discrimination.

As Dr Peter Piot, the Executive Director of the joint United Nations Programme on Aids (UNAIDS) once said at an international Aids conference in 2000, “We do not need a super-technological weapon to fight Aids. The answers are already in Africa”. In Kenya’s case, the answers would be to come up with practicable and coherent policies, establish more voluntary and counseling centers, enact specific legislation on Aids, strengthen home care services and avail anti-retrovirals to Aids patients.