Facing all round rejection

As the AIDS pandemic continues to take its toll on Kenyans, those infected by the deadly virus have been condemned to a life of total rejection by society. Stigma and discrimination have been the major obstacles to effective HIV/AIDS prevention and care, in a country where a climate of “AIDS prejudice” is highly prevalent. So deeply entrenched is the stigma that many people are hesitant to be seen at the Voluntary Counselling and Testing centers (VCTs), which have been established in most parts of the country.

Similarly, those who test positive for HIV are wary of seeking out treatment at clinics known to provide AIDS care, for fear of being stigmatized by relatives or friends. This is because HIV/AIDS has been associated with sex and anybody testing positive is considered promiscuous.

During celebrations to mark the International World AIDS Day, whose theme was “Stigma and discrimination: Live and let live”, the Kenya Inter-religious AIDS Consortium - a joint faiths initiative - said in a communiqué read by Bishop Margaret Wanjiru of Jesus is alive Ministries that stigma continues due to the myths and misconceptions associated with AIDS and the cultural taboos that militate against free discussion of sexual matters.

Early last month, the Kuria District HIV/AIDS/STI co-ordinator, Charles Odembo said a programme targeting pregnant women in that western district faced imminent closure, after being shunned by patients, due to the stigma that community attaches to AIDS, high prevalence rates in the area notwithstanding.

Odembo said the Prevention of Mother to Child Transmission (PMTCT) programme, funded by the German Technical Co-operation Agency (GTZ) and the Government of Kenya (GOK), is being severely underutilized, with only 3 out of a possible 350 cases being treated at the unit, based at Kehancha District Hospital. “We are perturbed that the target group has refused to come forward for free treatment even after undergoing counseling”, said Odembo, noting that the drugs meant for the unit may be moved elsewhere.

Pauline Kariuki, a programme officer attached to the PMTCT programme at the Kenya Aids NGOs Consortium (KANCO) - an umbrella organization of Aids NGOs and other interest groups in Kenya - concurs: “We have a similar problem at all the hospitals where this programme is available. The clients simply vanish after testing HIV positive.” Kariuki notes that this attitude has slowed down programme activities.

The stigma attached to AIDS has made it even difficult for bereaved families to openly announce the cause of death of their loved ones who die of AIDS. All that people see is part of the obituary advert, which goes: “The death has occurred after a long illness bravely borne”.

Being used to a culture of stigma, Kenyans were stunned in July 2001 when the family of Paul Tito Omukuba from the western district of Kakamega placed an obituary in a local daily, replete with two red ribbons - the international symbol of compassion for those living with the virus. Omukuba’s was the first family in Kenya ever to have overtly declared that their loved one died of AIDS.

Whereas HIV/AIDS does not discriminate and decimates all sections of population irrespective of gender, race, creed or social status, those infected often face rejection from the society and have to contend with discrimination from all quarters. Because of rejection, some of those who test positive for the virus resort to acts of vengeance by willingly infecting unsuspecting partners.

Early October, panic gripped the western lakeside town of Homa Bay when a civic leader, who had reportedly died of AIDS left behind a “list of shame”, bearing the names of 43 women he had slept with and whom he claimed would soon “follow him”. His wish to have the list read at his funeral was, however, turned down by family members.

Discrimination of People living with AIDS (PLWAs ) takes place at the family and community levels, workplaces, hospitals and insurance companies. Most people are reluctant to publicly declare their sero-positive status lest they are shunned like the plague.

Joyce Opany, a 33-year old mother of 4 narrates her harrowing experience at the hands of her brothers -in-law: “They blamed me for bringing the disease even after their brother admitted that he was the one having extra-marital affairs. They even threatened to throw me out of our house in Kayole but the husband, who is also ailing, stood by me”.

Elsewhere, Christine Awuor, a counsellor and AIDS educator at Women Fighting AIDS in Kenya (WOFAK) - a local NGO that provides home care and income generating activities to those infected and affected by AIDS - says that a cereals project they had initiated for their clients at Nairobi’s Kayole Estate simply collapsed after customers learnt that those selling the cereals were HIV positive. “They simply stopped buying, claiming that the cereals were laced with the HIV virus. We therefore had to close shop”, Awuor sadly recalls.

At the workplace, discrimination takes place in the form of mandatory pre-employment HIV testing. Banks, insurance companies, prestigious hotels and multinational corporations subject job applicants to rigorous medical tests, including HIV as part of the selection criteria.

Employers usually justify their stand on HIV testing on the grounds that companies invest a lot of resources in training the staffers, particularly those joining at managerial level and it would be futile to “waste” such resources on employees who are soon going to die. “The investment per employee is enormous and you can’t risk that on somebody who is going to die tomorrow”, quips a manager of a leading bank who does not want to be named.

Those seeking employment in most companies undergo certain ordeals. The procedure is to call them for the first round of written and oral interviews, followed by medical tests conducted by company doctors or appointed agents. In most cases, applicants never have an idea what they are being tested for and never get their results. But the most traumatic part is that unsuccessful applicants only get regret letters, and are never in a position to tell whether they failed the interviews or the medicals.

But on a positive note, thanks to spirited campaigns by KANCO and the Federation of Kenya Employers (FKE), a few employers have now seen the light. Taking the lead is Tetra Pak Limited, which has adopted a policy of no discrimination and is offering free anti-retrovirals to its Aids-infected employees and their families.

Eveready Batteries Limited also took the cue mid last month when its Managing Director Steve Smith announced that the company would start offering anti-retrovirals to its infected employees early next year. It is also encouraging to note that some organizations currently advertise for posts to be held specifically by those living with the virus.

“I am sure we shall eventually get rid of the stigma. The problem has been the way AIDS was portrayed initially as a disease of commercial sex workers, drug addicts and homosexuals”, observes Miano Munene, a policy assistant at KANCO.

Insurance companies require those seeking to buy life policies, where the sum assured is US $ 1875 and above, to submit to an AIDS test. Consequently, many people living with the virus, but who can afford to pay the requisite premiums have been denied life cover.

Dr Walter Onanda, a virologist at the Kenya Medical Research Institute (KEMRI) says a lot of awareness needs to be created among insurers to enable them understand the situation. “You journalists should take the lead in trying to convince insurance companies to set different premium rates for those infected instead of denying them a cover”, he suggests.

But unknown to insurers, this discriminatory practice has led to the loss of potential customers. “The moment you mention HIV test to a prospect, he simply vanishes”, says Malachi Otieno, a sales executive with a leading insurance company. Otieno observes that clients now prefer to go for the endowment policies which mature after a few years, and which do not require clients to take HIV tests.

The stigma becomes a vicious cycle when beneficiaries of insured people who die of AIDS related illnesses are denied compensation. The few lucky ones only get a portion of the due amount. This has led to a situation where relatives who suspect their kin to have died of AIDS connive with the doctors not to disclose the real cause of death in the death certificates.

Discrimination also occurs at embassies and high commissions. Whereas the Kenyan government does not subject foreigners visiting the country to AIDS test, Kenyans seeking to visit certain countries have to undergo the test as a prerequisite of obtaining a visa. Kenyan student going to India and the US have borne the heaviest brunt of this practice.

In June 2000, a diplomatic row almost erupted between Kenya and the US when former Kamukunji MP Norman Nyagah claimed in parliament that he and his four parliamentary colleagues were forced to strip naked at the American embassy in Nairobi in order to undergo a battery of medical tests including HIV/AIDS. The tests were to enable them acquire visas for a trip to the US, sponsored by the US government.

Nyagah, was however, hard put to explain why he accepted that kind of humiliation instead of turning down the trip. The US Ambassador to Kenya Johnie Carson denied Nyagah’s claims, clarifying that such tests are only demanded of those seeking permanent residency in the US. But undaunted, Nyagah further took his case to the BBC radio.

What cannot be denied however is that discrimination of those living with HIV/AIDS continues unabated due to lack of a clear legislation. In 1996, KANCO forwarded policy recommendations aimed at tackling discrimination to the Ministry of Health. These recommendations were included in the Sessional paper No. 4 of 1997 on “Aids in Kenya”.

Although the government responded by including a chapter on Aids in the seventh National development Plan, no specific legal standards have been developed. Hopes of having a law on AIDS were dashed when parliament was dissolved last October, before the AIDS Bill could be debated. The Bill inter alia seeks to prosecute those who infect others willingly, to abolish pre-employment HIV testing and to compel insurance companies to provide cover to all those who can afford it.