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Victims of Our Success: Education and Ethics in a Time of HIV/AIDS, Lessons from Nairobi for the Future

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Victims of Our Success: Education and Ethics in a Time of HIV/AIDS, Lessons from Nairobi for the Future Victims of Our Success: Education and Ethics in a Time of HIV/AIDS, Lessons from Nairobi for the Future Author: David J. Cote Persistent link: http://hdl.handle.net/2345/3852 This work is posted on eScholarship@BC, Boston College University Libraries. Boston College Electronic Thesis or Dissertation, 2014 Copyright is held by the author, with all rights reserved, unless otherwise noted. Victims of Our Success Education and Ethics in a Time of HIV/AIDS: Lessons from Nairobi for the Future David James Cote Advisor: James Keenan, SJ Boston College April 2014 Submitted for Scholar of the College consideration and in partial fulfillment of graduation requirements for the degree of Bachelor of Science. _______________________ Advisor Rev. James Keenan, SJ Founders Professor in Theology Boston College _______________________ Reader Rev. Andrea Vicini, SJ Assoc. Professor of Moral Theology Boston College II CONTENTS Preface: What Will This Paper Do? -------------------------------- PART ONE: HIV/AIDS and Kenya I Introduction to the Global HIV/AIDS Pandemic II History of HIV/AIDS in Kenya III Current Responses to the Epidemic in Kenya -------------------------------- PART TWO: Ethical Issues of HIV/AIDS in Kenya IV Gender Inequality V Sexuality VI Poverty III VII Instability and International Aid VIII Pharmaceutical Access ------------------------------- PART THREE: Moving Forward IX Lessons for the Future X Conclusion ------------------------------- Bibliography IV ACKNOWLEDGEMENTS his project is seriously indebted to a great number of wonderful people who have forever affected my life. I would first like to thank each of the T experts who made time to meet with me while I was in Kenya, especially Ms. Carole Inguru, Rev. Elias Opongo, SJ, Rev. Pat Mombe, SJ, Rev. Richard Rwiza, Ms. Judy Onyango, Rev. Agbonkhianmeghe Orobator, SJ, and Mr. Samuel Ebale. Their assistance in researching this project was immensely helpful, and added a level of insight to the discussion that follows that would have been unattainable otherwise. I would also like to thank the many people who supported me while I taught at St. Aloysius Gonzaga Secondary School in Nairobi, including my fellow science teachers—Barack, Henry, Daniel, and Kevin—my friends Jim and Ambrose, the school’s principal, Beatrice Maina, and the rest of the faculty, staff, and students who made me feel as welcome as possible. Special thanks go to Rev. Terry Charlton, SJ, who arranged my placement at the school, and Lilian Onyango. I am extremely grateful for the opportunity to have traveled to Kenya, which would not have been possible without the support of the Boston College University Fellowships Committee, with funding specifically in the form of an ACC-IAC Thesis Research Grant. I know that my words here will never adequately convey the daily realities of Kibera, but I nevertheless feel an obligation to try. C.S. Lewis is often quoted as having said, “Experience: that most brutal of teachers. But you learn, my God do you learn.” I have never found those words to be truer than during my time there, and I will forever be thankful for the experience. I would also like to recognize the people who have most inspired me to work on this project: Bill Gates, Paul Farmer, Pope Francis, and most of all, my advisor, Rev. Jim Keenan, SJ, who not only instilled in me a great passion for theological ethics, global public health, and the fight against HIV/AIDS, but also provided invaluable support, suggestions, and editing over the past several months. Your respect and friendship mean a great deal to me. Last but certainly not least, I would like to thank my friends and family for their support and encouragement over the past year—and long before—and my parents for loving me unconditionally. V ACRONYMS What follows is a list of acronyms commonly used throughout this paper. Each will be spelled out on first reference but all are listed here for convenience. ABC Abstain, be faithful, use condoms—the most common approach to HIV prevention in sub-Saharan Africa. AHAPPY AJAN HIV/AIDS Prevention Programme for Youth—a curriculum developed by AJAN to prevent the spread of HIV and AIDS and to educate young people holistically. AIDS Acquired Immune Deficiency Syndrome—the final stage of HIV which causes severe damage to the immune system. AJAN African Jesuit AIDS Network—a network of Jesuit priests in sub- Saharan Africa involved in the ministry of AIDS care and HIV prevention. ART Antiretroviral therapy—a type of drug regimen used to manage HIV that can prevent or delay the onset of AIDS. CBO Community-based organization—an organization that focuses on working with a specific, small, independent community on a particular issue. CDC Centers for Disease Control and Prevention—the national public health institute of the United States. GDP Gross domestic product—a key indicator of a country’s economic condition. GLBTQ Gay, lesbian, bisexual, transgender, queer/questioning—an inclusive acronm used to describe the group of people who identify as one of the above (less frequently, LGBTQ, or LGBI, for intersex). GUD Genital ulcer disease—any sexually transmitted disease that causes genital ulcers, such as syphilis or herpes. HDI Human Development Index—a composite development statistic that combines life expectancy, education, and income data. HIV Human Immunodeficiency Virus—a general term for the several different lentiviruses that can cause AIDS. VI HIV+ HIV positive—indicates a person who is living with HIV, but not necessarily AIDS. IDU Intravenous drug users—often have higher risk of HIV infection. KNACC Kenyan National AIDS Control Council—a council established by President Moi in 1999 to control the spread of HIV/AIDS. NASCOP National AIDS and STI Control Programme of Kenya—an organization established in 1987 to spearhead the Ministry of Health’s response to HIV/AIDS. NGO Non-governmental organization—a large and diverse definition that includes organizations that work towards social goals without direct connection to a government or political party. NIAID National Institute of Allergy and Infectious Diseases—one of the institutes that makes up the National Institutes of Health. NIH National Institutes of Health—a biomedical research facility under the auspices of the U.S. Department of Health and Human Services. ODA Official development assistance—a term used to refer to the total amount of international aid flowing from one country to another. PCP Pneumocystis carinii pneumonia—a relatively rare disease in the West that was common in early AIDS patients. PEPFAR President’s Emergency Plan for AIDS Relief—a commitment of USD $15 billion made by President George W. Bush to fight the global HIV/AIDS pandemic. PMTCT Prevention of mother to child transmission—usually accomplished through antiretroviral medication and specific birthing procedures. PSI Population Services International—a non-governmental organization that works to promote health and education in the developing world. SIV Simian immunodeficiency virus—a retrovirus that infects primates the same way HIV infects humans, thought to be a precursor to HIV. SJ Society of Jesus—indicates a person’s membership in the Society of Jesus (Jesuits), a male religious congregation of the Roman Catholic Church founded in 1534 by St. Ignatius of Loyola. VII STI Sexually transmitted infections—a broad phrase that includes all infections transmitted sexually, of which HIV/AIDS is one. TRIPS The Agreement on Trade Related Aspects of Intellectual Property Rights—an international agreement made in 1994 that sets standards for international intellectual property law. UKAID United Kingdom Department for International Development—an agency of the U.K. government that administers foreign aid. UNAIDS Joint United Nations Programme on HIV/AIDS—an advocacy organization which focuses on cooperative global efforts to stop the spread of HIV/AIDS. USAID United States Agency for International Development—a U.S. government agency that administers foreign aid. VTC Voluntary testing and counseling—the process of determining one’s HIV status through medical testing and then working with health professionals to address the result. WHO World Health Organization—an agency of the United Nations that is concerned with international public health. VIII This project is dedicated to the students of St. Aloysius Gonzaga Secondary School in Nairobi, Kenya. IX PREFACE: What Will This Paper Do? s deaths due to HIV/AIDS continue to mount around the world after more than 30 years, A one question has been raised more than all others: when will this end? While research on HIV cures and statistics on infection and transmission have been promising of late, with total new infections worldwide decreasing since 2001, the answer to this question is quite simple: we don’t know.1 We don’t know when HIV/AIDS will be cured, and we don’t know when the last death that results from the virus and its associated complications will be. What we do know is that HIV/AIDS continues to cause the deaths of millions of people—1.7 million in 2011 alone—particularly in 1 UNAIDS, “UNAIDS Report on the Global AIDS Epidemic,” (Geneva, 2012), 9; for accounts of recent work into cures for HIV, see Erik Ortiz, “Early signs for HIV cure are ‘promising’ as Danish scientists begin test on humans,” The New York Daily News, April 28, 2013. 1 Preface areas of immense poverty and instability, like Sub-Saharan Africa.2 This information shows that despite the encouraging statistics on new infections and the promise of some research into cures, more needs to be done to prevent the spread of HIV/AIDS in the immediate future. This paper’s title indicates that it focuses on Nairobi, Kenya. Some of the content is derived directly from experience living and working in Nairobi, specifically in Kibera, Africa’s largest urban slum. Relevant anecdotes from this experience will be included in the footnotes, and occasionally interspersed throughout the discussion.
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