HIV in the Islands

I spoke with a VCT counselor, Bernard, while on Mfangano Island. I had the opportunity to ask him many questions. As most people know, sub-Saharan Africa is in filled with people living with HIV and AIDS. Kenya is no different. In particular, western Kenya has been hit particularly hard by this epidemic.  After speaking with Bernard, he confirmed what I had already learned: the behaviors of the fishermen on the islands of Lake Victoria are the reason for the high rates of HIV out here. The islands are beautiful, yet isolated from the rest of the world by a huge body of water, Lake Victoria. Thus, often women are forced to get into the only industry known, fishing. In order for a woman to become a “fish monger” or get the fish from a fisherman, they must have a sexual relationship with a fisherman or be married to one. Often widows are left to fend for themselves on these unwelcoming islands, and the only way to make money to feed themselves and their children is to become a fish monger. Thus, the practice of Jaboya was born, or “fish for sex”.

Jaboya promotes the spread of HIV in this region by promoting unsafe sexual practices. The women are left hopeless on the rocky islands. There are often many relationships the women of the islands must have in order to actually get the fish sold on the mainland. First, the sexual relationship with the fisherman in order to get the Omena, Nile Perch, or Talipia. Second, the sexual relationship with the Matatu boat driver who is bringing the fish via boat to the mainland. And lastly, the relationship with the mainland matatu driver in order to get the fish sold in the markets on the mainland. Thus, the spread of sexually transmitted diseases, including HIV, exist in high numbers on these islands. We have been given many quotes, the most accurate I believe from the chief and the VCT counselor on Mfangano. He stated up to 30% of the population of Mfangano, 14% of Rusinga, up to 40% of Remba and Ringiti. It is devastating.

VCT counselors are located on Mfangano and Rusinga, but not on many other islands throughout this district. They are working to break the stigma, educating people about the virus that causes AIDS. There are so many myths surrounding the spread of HIV it is a difficult thing to combat, but the communities are working hard at decreasing the stigma. Now we find support groups, especially for women, throughout the islands. As I stated, these were not present in 2006.

Bernard informed me that all VCT counselors are trained by a group called Liverpool in Kenya. It is affiliated with the government, but most VCT counselors are affiliated with an NGO in order to receive salary. At most designated VCT centers, there is also an ARV site for patients diagnosed with HIV to receive treatment and education. The people administering the ARV’s or “anti-retroviral medications” are trained by this Liverpool organization as well. They are trained on side effects, adherence, and nutritional support. ARV’s and VCT counseling are free to the public, and any care associated with HIV is free from the government of Kenya. 

Bernard states that Senna, the A RV facility on Mfangano, is growing. He tests about 8 patients daily, with usually 1-2 testing positive for HIV. He also has run several campaigns to go door to door testing people throughout Mfangano. They also go to Remba on Tuesday every week and Ringiti on Thursday each week, which is funded through IMC or international medical corps, an NGO or non-governmental organization in Nyanza. Senna and each ARV center is supposed to have a functioning CD4 counter. 

Testing consists of a screening test first called “determine”. I believe it is our form of ELISA testing. If that is positive they move onto the “Bioline” test, which is confirmatory. I believe this is similar to the Western blot in USA. Then if there is different results from both tests, a specific 3 test is then completed, “unigold”. ARV’s are given to patients once CD4 count gets below 250 per Bernard and they are also initiated on multivitamins and Septrim (Bactrim). They stated the first line treatment is Stavudine, Lamivudine, and either Nevirapine or efavirenz. The government gives out the medications through various facilities, and there are apparently 1^st and 2^nd line treatments. I have not seen a patient with protease inhibitors, but my information is coming directly from various patient’s medications.

Senna health care facility on Mfangano was nothing more than a corrupt government facility in 2006. We were told patients we sent there  were getting ARVs but we were misinformed. Patients would return to us empty handed in 2006 saying “they ran out”. We found this strange, so we decided to check it out ourselves. We were greeted by staff who showed us around the facility but would not show us any medications. After our visit I felt they were keeping medications for people they may know and withholding it from others or charging some. Now, it is a well run facility, people are getting ARV’s for free. People who are able to get to the facility are initiated on ARVs.

Overtime, Kageno Mfangano and Rusinga hopes to have to have a trained ARV employee administering the medications at the two facilities. This would greatly benefit the communities of Rusinga and Mfangano. Currently they are walking long distances, or paying too much to take the matatu boat to get medications monthly. I hope to see these advances in the future when I return to the islands.