Bell Tolling for Kenya Families as AIDS Ravages Nation’s Adults

In her 70s, Selina Abongo is back in the role of a young mother. AIDS has killed four of her eight children and one daughter-in-law, leaving her to raise eight of her 12 grandchildren.

A subsistence farmer with no government support, Abongo faces a common predicament in Kenya, where AIDS has mowed down thousands of people in their prime, ravaged families and left the very old to care for the very young.

The Ministry of Health in this country of nearly 32 million people says 13% to 14% of adults, about 1.9 million people, have the human immunodeficiency virus, which causes AIDS. In a country with about as many people as California, an estimated 500 die each day of the disease--more than 20 an hour. Up to 80% of the victims are between the ages of 15 and 49, leaving about 500,000 AIDS orphans.

With an estimated 8 million Kenyans threatened with HIV/AIDS infection by 2002, the government in November finally broke nearly a decade of silence over the seriousness of the disease and declared it a national disaster.

The initiative came in the midst of a campaign of rallies and seminars organized by nongovernmental organizations. The government promises to introduce AIDS education in schools and impose mandatory HIV testing before marriage.

But opposition leaders believe that officials acted only to curry favor with foreign aid donors. The government of President Daniel Arap Moi has been under pressure to combat AIDS more directly. The declaration of a national disaster came as Kenya approached talks with the International Monetary Fund about a possible resumption of aid, which has been suspended because of corruption and mismanagement.

Kenya Faces Crippling Epidemic

Health care activists, opposition politicians and local community leaders say the government woke up much too late. And the price will be high.

Unlike countries such as neighboring Uganda as well as Senegal in West Africa, where distribution of condoms, counseling and other efforts have radically curbed the spread of AIDS, Kenya faces a crippling epidemic. The troubles of Abongo and others here in Nyanza province, which has the country’s highest number of HIV/AIDS cases, are a warning of what is to come.

Local health officials say the vast majority of deaths in the villages are related to AIDS. An estimated 20 to 30 teachers die monthly. Most of Nyanza’s 200,000 AIDS orphans are dropouts cared for by elderly matriarchs such as Abongo.

Chrispin Wilson, UNICEF representative for Kenya, said the country’s late start allowed AIDS to spread silently. “Because of the conspiracy of silence, we were surprised by the figures,” he said.

Eric Gor Sungu, a member of parliament from Kisumu, Nyanza’s main town, lamented government inaction. “It’s like shutting the stable door when the horse has already bolted, because right now, whatever we do, we cannot stop it,” he said. “It’s more than a disaster. It’s a catastrophe.”

Government officials said that they have always been open about AIDS but that by declaring it a national disaster, the battle would pick up momentum. Local nongovernmental groups already had boosted the number of rallies, workshops and seminars. Politicians now have started to use public forums to discuss the impact of the disease and the need to counter it.

“We expect leaders of the party at the grass-roots level to actively articulate the concern through public meetings,” said Joseph Kamotho, chairman of the ruling Kenya African National Union.

Community elders are being encouraged to counsel adults and teenagers. Rateng’ Oginga Ogego, coordinator of a local nongovernmental organization, said the only way to talk about sex to youth in Nyanza’s predominantly Luo culture is through parents and elders.

Sex education until now has been omitted from the school curriculum, even though the Ministry of Education recently revealed that 128,000, or 20%, of the estimated 640,000 teenagers in Kenya’s secondary schools have HIV.

The education campaign faces widespread apathy, cultural taboos and a deep-seated belief that AIDS is caused by witchcraft.

Although the Ministry of Health estimates that 90% of the population is aware of AIDS, detailed knowledge is limited. In Nyanza, where inheriting wives and polygamy are acceptable practices among the Luo, almost every home has an AIDS victim buried in the family plot. Local health officials estimate that seven out of 10 deaths in villages are related to AIDS. Attending funerals has become as common as going to market.

“The age group most affected is 25 to 40, people who are very productive,” said provincial medical officer Ambrose Misore. “We have lost a large part of important people in the population.”

Still, many people refuse to accept that AIDS could possibly afflict them or a loved one.

Teresa Achieng, an emaciated mother of three, has been diagnosed with acquired immune deficiency syndrome and suffers from diarrhea, oral thrush, skin sores and bouts of vomiting. However, she and her husband, Benson Otieno, whom she shares with another woman, refuse to accept that she has the disease.

“I actually don’t know the disease that has afflicted her; I only know that she is sick,” said Otieno, 35, an unemployed former casino worker.

Stigma, shame and fear of rejection associated with HIV infection have hindered efforts to promote awareness. “Since I became sick, nobody comes to visit,” said Achieng, 25, her mouth foaming with a purple medicine used to treat oral thrush. “I am all alone.”

When parents die, it is grandmothers such as Abongo who step in. “This is the picture you get in every village you go to: a grandmother made almost a prisoner by orphans,” said Misore, the medical officer.

For Abongo, whose eight grandchildren she is raising are younger than 17, the existence of AIDS hits home every day. Two sons succumbed to the complications of the disease in 1993, two daughters in 1994. Last month, her daughter-in-law withered away. She was stricken with tuberculosis, was covered in sores and boils, and was as thin as a rail. Abongo blamed the young woman for straying from her matrimonial bed.

She now seeks to protect the children. “The children don’t really understand what their parents died of,” said Abongo. “But I have already starting talking to my [16-year-old] granddaughter. I tell her: ‘You see what happened to this family. You see your mum went looking for this and fell ill. You have to take care so you don’t fall into the same predicament.’ ”

Efforts to promote safe sex have been hindered by Roman Catholic and Muslim religious leaders’ objections to the use of condoms. Father Alfred Atemo Ogada, a parish priest in Kisumu, continues to preach abstinence.

“We have to be reasonable and try to control our libido,” Ogada said. “The moment we start using condoms or any other gadgets, we are losing our dignity.”

Many community leaders believe that approach is unreasonable. “They have to choose between more Catholics who are alive and kicking, and more dead Catholics,” said Sungu, the member of parliament.

The stench of death already hangs over Ward 3 of the Kisumu District Hospital. Brittle bodies lie limply in rows of rickety cots, surrounded by anxious relatives muttering prayers and words of comfort. Most of the patients are in the last stages of full-blown AIDS.

Patrick Lumumba Okamo, a nursing officer and counselor, said families often sell property and exhaust their funds hoping to find a cure. But most of the 22 million Africans infected with HIV cannot afford the medicine they need. Supplies of drugs often are limited or unavailable.

On Jan. 10, Vice President Al Gore announced that the White House had asked Congress for $150 million for vaccine research and prevention programs in Africa. But activists said that amount was a drop in the bucket. Misore said his province receives about $300,000 a year to fight AIDS, about a third of what it needs.

Driven by a Need for Money

Money, not death, is what occupies sex workers who frequent Kisumu’s nightspots, even though health officials say at least 75% of them are HIV-positive.

At Donna, a sleazy bar and disco, prostitutes openly solicit clients. Scores of drunken men grab and fondle bare female flesh as they haggle over the price for a night of sex.

Cynthia Akinyi, a regular at Donna, lingered at the entrance, frustrated that no business was coming her way. The 17-year-old orphan, who quit school at 9, charges less than $7 for a night. She said that she was aware of AIDS but that she had no alternative to prostitution.

“I am afraid, but I have no other means of support,” said the slight, fresh-faced teenager, adding that she insists that all her clients use condoms. “I will quit once I save enough money to start a small business.” Akinyi said she had not decided whether she will take an HIV test.

Health officials warn that, unless AIDS awareness reaches every hamlet, Kenya’s catastrophe will be immeasurable.

“If we want to see any dent in this epidemic, we must get to the grass roots,” said Wilson, the UNICEF representative. “If this problem is not tackled immediately, it’s going to be the greatest disaster we have ever seen.”