Women see little hope of anti-retroviral treatment yet



Priscilla Atieno (real name withheld), a 30-year-old mother of six, tested HIV-positive in October last year. She seeks treatment at Nyalenda Health Centre in Kisumu, 380 kilometres West of Nairobi, Kenya. The health centre is 80 miles away from Karachuonyo, her home village.

"I first suspected I was HIV-positive when I started developing wounds and rashes on my body. I had persistent abdominal pains, vaginal itching and pain, and a swollen groin."

Priscilla has been told of antiretrovirals (ARVs) and occasionally gets them, but can't pay for them often enough to get a proper, continuous course of treatment. "I go to the health centre when I have money; otherwise I use herbal medicine whenever I am unwell." The result of this partial treatment — a story becoming common throughout Africa — could be the development of HIV that is resistant to the drugs.

Roseline Achieng, 29, is also HIV-positive. "I have heard of those drugs but personally I have not used them. I cannot use them because I cannot afford them. I hear that they can be harmful to me if I start and then stop using them because of lack of money." Her husband and her eldest and youngest child are also infected. Roseline says she seeks medication for opportunistic infections. "I get headaches often but go to the doctor immediately. For some infections like mouth thrush, I just chew garlic, and they go away."

For Dorine Odida, ARVs are impossible. She is a member of Women Fighting Aids in Kenya (WOFAK), a solidarity group for HIV-positive women. Her husband left her three years ago when she tested HIV-positive. He took with him their only son who is now five years old and uninfected. "I have heard of ARVs but since someone has to be on them for life, they are too costly," Dorine says. "My work at WOFAK earns me a small allowance, just for simple medication." Her policy is never to use ARVs because of their negative side-effects.

"Sometimes I am too sick and feel like using them. At other times I use herbal medicine as an immune booster. At WOFAK we deal with low-income people so we don't talk much about ARVs. Patients may start taking them and then stop, like after three months, which is not good."

Dorine says getting put onto ARVs and keeping to the regimen costs more than the drugs themselves. The CD4 test, an immunity test, costs about US$ 25, while the viral load test is about US$ 100. "These have to be done before one is put on ARVs. Then there is the issue of compliance and the need for a very good diet. Who can afford all this?"

Sixty-year-old Mary Wairimu's story is the same. She is also a member of WOFAK. Her husband left her 12 years ago. She used to raise poultry but when he learnt of her HIV status he went berserk and destroyed everything in their home, including the chickens. She lives at home with their five children. She has heard of ARVs but, she says, "I have no money; if I got help I would use them."

Kenyatta National Hospital is the largest referral hospital in East Africa, but even there the drugs often cannot be found. Even though patients are glad that the prices of ARVs are lower than before, they still remain the domain of the rich, many of whom do not belong to the support groups helping people living with HIV/AIDS. For most patients, the usual practice is to avoid ARVs but as Dorine puts it, "People would want to use them if only there were a sponsor to guarantee the cost."

Catherine Wanyama, Nairobi, Kenya

World Health Organization Genebra - Genebra - Switzerland