October 1, 2003—The first AIDS victim in Kenya was identified in 1984. Since then, an estimated 2.5 million Kenyans are living with HIV infection, with an adult infection rate estimated at 10 percent, slightly higher than the 8.8 percent average for sub-Saharan Africa. More than 1.5 million Kenyans have died of AIDS, leaving behind almost 1 million orphans.
Pamela is a single mother living in a boarding house in Kayole, a slum in eastern Nairobi with one of the country’s highest prevalence rates. At 24, Pamela has been HIV-positive for nine years, developing symptoms of AIDS two years ago. She has little strength nowadays. What paltry income she has comes from selling wire placemats and stuffed animals that she makes while lying in bed, so as not to drain her energy. “I have three priorities for my survival,” says Pamela as she describes her basic needs. “To eat nutritious food, plan for my children’s future and get counseling every week.”
The counseling comes from Women Fighting AIDS in Kenya (WOFAK). WOFAK also pays the school fees of her youngest child, delivers a hot meal to her family four times a week and brings traditional medicine to help her with opportunistic infections associated with AIDS. But most of all, Pamela relies on WOFAK for the emotional support she receives from other women living with HIV. This, she says, is essential to her survival.
Kenya is one of 24 countries that are part of the World Bank’s Multi-Country HIV/AIDS program (MAP) for Africa. Implementing the National Program on HIV/AIDS, which receives MAP assistance, is going to depend on a wide range of organizations, including private sector, NGOs and community organizations. In June 2003, the National AIDS Control Council (NACC), which is financed through the Kenya MAP and plays a key coordinating role with a wide range of government bodies,published details of disbursements to more than 800 community organizations in Kenya, amounting to more than $6 million.
Among these organizations, WOFAK received $25,000 for its program with orphans and vulnerable children. In Kayole, the focus area for WOFAK’s work, the population is transient and hovers between 70,000 and 100,000 with a mixture of female-headed households, families and single men working to support families elsewhere. Clean water is scarce, as are government services. There are schools, but health centers are few and far between. Although there are at least 15 VCT sites in Nairobi, there is not one in Kayole WOFAK has five home-based care practitioners who support 100 to 200 clients that need home-based care.
The stigma associated with HIV is still so strong that visitors to the WOFAK center in Kayole enter surreptitiously through the back door to avoid being seen. HIV-positive women like Pamela trust WOFAK counselors because they know that they too struggle with stigma, the difficulties of deciding whether or not to tell their families about their status and the risk of being ostracized.
WOFAK was founded in 1993 by 10 women who felt that existing support organizations were largely male-dominated and did not address the gender dimensions of HIV/AIDS . WOFAK works at both community and political levels to help women deal with the burden of care-taking for sick family members and the social stigma associated with the pandemic. It runs a variety of programs including feeding programs for orphans and vulnerable children, home-based care training, counseling services, the development of traditional alternative therapies, and educational outreach programs for girls to help reduce the disease’s profound effect on women.
Women age 15 to 24 are more than twice as likely to be infected as men in the same age group. Social, cultural, and economic factors place a majority of African women of reproductive age at risk for AIDS. Due to cultural norms, including polygamy or marriage to a brother of a deceased husband, women are particularly vulnerable to the virus and few are able to negotiate condom use to protect themselves against infection. Believing younger women are more likely to be free from HIV, older men often target them as sexual partners.
The Kenyan Ministry of Health reported an adult prevalence of 10.2 percent in 2002, with some estimates of pregnant women reaching 20 percent prevalence. Kenyan governmental and relief agencies recommend treating HIV/AIDS patients at home as a way to enhance comfort and relieve overcrowded medical facilities. The result of this policy is increased pressure on women as primary caretakers.
WOFAK has developed a home-based care program to help alleviate this burden and problems associated with home-based care including increased medicinal expenses, premature discharge from hospitals, lack of funding to support patients, and isolation from familial and community support. Home-based care teams, consisting of nurses, caregivers, and counselors that visit homes twice a week, and prescribe and distribute drugs as needed.
WOFAK partners include World Vision, the Global Fund for Women, Kenya Network of Women with HIV/AIDS (KENWA) and the Society for Women with AIDS in Kenya (SWAK).
Pamela, who suffers from AIDS, with her WOFAK counselors
Child receiving food through the WOFAK program
WOFAK bus in Kayole