Publication Date
September 10, 2012
NAIROBI, KENYA – To many, Sylvia Munyao, 19, is a statistic.
She is an HIV-positive AIDS orphan turned teen mother. Her story is sadly familiar here. But in Kenya, a new focus on HIV prevention and care for orphans, children and marginalized populations may have an impact on young people like Munyao.
Munyao was born in the Mathare slums of Nairobi. In Mathare, there are no sanitation facilities or electricity. The area is wrought with disease and crime. She became an AIDS orphan as a toddler.
Soon after her parents died, she ended up in the Good Samaritan Children’s Home, a local facility that provides housing, food and some basic education to more than 220 children from Mathare who were orphaned by AIDS or abandoned by parents thanks to the abject poverty that is a cornerstone of life here. Munyao says she spent her days there dreaming of the parents she never had.
Munyao describes her childhood as “painful.” Recurring illnesses forced her in and out of school, where she was often made fun of for fainting and being sickly.
“School was the last place I wanted to be,” she says.
As a child, Munyao says she developed a persistent cough and suffered abdominal pain, headaches, constant vomiting and diarrhea. Before she was tested for HIV, her caretakers at the orphanage say they had a feeling she would test positive. Eventually, they sent her to Kenyatta National Hospital for the test.
“I stayed in Kenyatta National Hospital for three months,” Munyao says. “No one visit[ed] me [except] than the matron from the hospital and a sister from the orphanage.”
No one told her when she tested HIV-positive. She says everyone just kept telling her, “It would be all right.”
Five months later when Munyao was released from the hospital, she was told she could not play with the other children because she would infect them with HIV. From then on, she says the orphanage became a living hell.
When staff members told her she would have to repeat a grade in school for the work she missed while in the hospital, Munyao says she decided to run away from the orphanage and join the thousands of children who live on the streets of Nairobi. She says she eventually missed having food and a warm place to sleep, but the older children threatened to kill her if she went back to the orphanage, since younger children were more successful as beggars on the streets.
“The big girls would send us to go and ask [for] money from the people and they would snatch it immediately,” she says. “They said, ‘If you want to be safe in the street, you need to have a boyfriend so that he would protect you.’”
At age 12, Munyao was raped by one of the boys in her group. His name was Kinyajui. She says he told her he was her husband now and offered her some protection from other boys. Munyao says Kinyajui – whose nickname “Noma,” which means “bad” – frightened her. The two of them, both HIV-positive, began living together in the streets.
Soon, Munyao started getting sick because she had no access to her antiretroviral medications on the streets. Then, she got pregnant.
Eventually Noma and Munyao went to a nearby hospital, where doctors repeatedly bribed the couple with food so that they would continue to return for prenatal care checkups.
Last June, Munyao had her baby, who was born HIV-negative.
That is when things started to turn around for Munyao. Doctors Without Borders, an international medical humanitarian organization, pledged to help Munyao. The organization put her through tailoring school so that she could earn a living and support her baby. In December, Munyao shared her story at the Kenyatta International Conference Center in Nairobi on World AIDS Day.
Kenya has long voiced a commitment to increasing access to HIV/AIDS prevention, care and treatment services – especially for children. Together with international AIDS groups, Kenya is now also embarking on a series of projects aimed at changing attitudes toward marginalized groups, like orphans and children on the streets, so they, too, can receive access to care and treatment. While many here are advocating for a new universal health care policy, others say there is simply no available funding to make it a reality in Kenya.
Kenya declared HIV/AIDS a national disaster in 1999 and created the National AIDS Control Council, NACC. In the years since, Kenya has launched several national-level strategic plans to address all aspects of HIV/AIDS-related problems, including care, prevention and legal support.
Kenya’s most recent initiative, developed by the NACC and launched in 2009, is called the Kenya National AIDS Strategic Plan, (2009 to 2013). The plan aims to create strategies on how to deliver universal access to services in order to reduce new HIV infections by 50 percent and AIDS-related mortality by 25 percent by 2013.
But Kenya has already celebrated some significant successes when it comes to HIV/AIDS progress in the country. In the last 10 years, the HIV prevalence, or proportion of individuals with HIV, in Kenya has been drastically reduced – from 14 percent in 2000 to 6.3 percent today, says Esther Murugi Mathenge, special programs minister, citing the latest Kenya Demographic and Health Survey, KDHS.
But Mathenge says there is still more work to be done, with more than 166,000 new HIV infections in Kenya every year. According to the United Nations General Assembly Special Session, UNGASS, on AIDS and HIV, there are as many as 1.6 million people living with HIV in Kenya.
Despite its successes, the government of Kenya has faced international scrutiny. In 2009, the government spent just 7 percent of the 15 percent of the budget it pledged to spend on health care, according to Human Rights Watch, an international organization. Even more problematic for health care professionals and advocates are the harsh stigmas and criminalization of same-sex activities that have continued to deter lesbian, gay, bisexual and transgender adults from seeking HIV/AIDS prevention, treatment and care services.
Mathenge says the government hopes to increase spending by focusing on increasing the number of HIV-positive children and adults in Kenya who receive access to antiretroviral therapies, ARTs. Beth Mugo, the minister for public health and sanitation, says new strategies must be pursued, especially in relation to Kenya’s HIV-positive and high-risk children. She says that reducing HIV infections among children could hold the key to an “AIDS-free generation.”
A new U.N. report released for World AIDS Day 2010 last December, “Children and AIDS: Fifth Stocktaking Report 2010,” indicated that 370,000 children are born with AIDS every year. Each infection is preventable, says Michel Sidibé, UNAIDS executive director. Every day, nearly 1,000 babies in sub-Saharan Africa, which includes Kenya, are infected with HIV through mother-to-child transmission, says Anthony Lake, UNICEF executive director.
According to a press release from the World Health Organization, new guidelines have been issued in order to ensure quality prevention of mother-to-child transmission, PMTCT, for HIV-positive women and their babies.
Millions of women and children still lack the care they need because of inequities rooted in gender, economic status, geographical location, educational level and social status, according to the U.N. report. Advocates are pushing for a worldwide effort to remove these barriers to provide universal access to HIV prevention, treatment and social protection.
But social attitudes are often the primary barrier for marginalized groups to access care and prevention efforts. Mathenge says that violations against human rights fuel the spread of HIV because they put marginalized groups, such as injection drugs users and sex workers, at a high risk of new infection by denying them the care they deserve.
According to NACC director Alloys Orago, awareness remains high in most regions of Kenya, but behavioral changes have not resulted, despite the increased awareness. The stigma against people living with AIDS is still rampant, he says. Orago says this is problematic because it prevents people from knowing their status.
Mathenge says the biggest problem facing Kenya is that most Kenyans don’t know their status, which has led to an increase in new infections in the country. To encourage voluntary testing, the government has introduced oral fluid testing, which doesn’t involve blood and allows results to be interpreted within minutes.
Mathenge says that the government has developed a strategy to address high-risk groups, such as intravenous drug users, gay men, female sex workers and truck drivers. This group accounts for 30 percent of new infections throughout Kenya each year.
But the long-term goal here remains universal health care.
Peter Anyang’ Nyong’o, medical services minister, says he has long pushed for a social health care scheme through the National Hospital Insurance Fund that would help poor Kenyans receive health care, including services related to HIV/AIDS.
In November, the government launched the Health Sector Services Fund in order to collect money to send directly to lower-level health facilities, according to The Standard newspaper. In the past, it has been difficult to get money to the health centers and dispensaries that serve the poor in Kenya’s rural areas.
According to the KDHS, the percentage of the poorest respondents with comprehensive knowledge about AIDS was less than half of the percentage of the richest respondents with that knowledge. At the same time, it also reported that HIV infection tends to rise with wealth.
The World Bank, UNICEF, the Danish International Development Agency and the German Development Cooperation are partners in the new fund, which some say is a step toward universal health care.
But not everyone agrees this is the best step. Since 2004, the Kenyan Parliament has been trying to reform the country’s health care system, while employers, through the Federation of Kenya Employers and the Kenya Private Sector Alliance, and the employees, through the Central Organization of Trade Unions, have urged caution, arguing that universal health care should be actualized in sustainable ways.
Many say with funding for AIDS in Kenya declining, universal health care is not possible.
Mathenge agrees, saying the key to the fight against HIV/AIDS is finding additional funding to support prevention, treatment and care programs. She says that the government needs to invest heavily in HIV/AIDS in order to realize its Vision 2030 under the Millennium Development Goals to combat HIV/AIDS. But the country continues to depend on donor funding.
But donor funding for HIV/AIDS is lagging and has substantially decreased since 2009, when political turbulence fueled international criticism over the way the Kenyan government spent international aid.
But for the tens of thousands of young people, like Munyao, such political progress is essential to survival. The help she received from Doctors without Borders has significantly changed her life. Noma, the baby’s father, still lives on the street, but visits regularly.
Her baby is still HIV-negative.
Editor’s Note: This story was updated to comply with the Global Press Style Guide.
