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Infections in Kenya: Environment, Resources and Culture

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Infections in Kenya: Environment, Resources and Culture International Journal of Sociology and Anthropology Vol. 2(4), pp. 55-65, April 2010 Available online http://www.academicjournals.org/ijsa ISSN 2006- 988x © 2010 Academic Journals Full Length Research Paper Human immunodeficiency virus and tuberculosis co- infections in Kenya: Environment, resources and culture Mario J. Azevedo 1*, Gwendolyn S. Prater 2 and Sandra C. Hayes 1 1Department of Epidemiology and Biostatistics, School of Health Sciences, Jackson State University, Jackson, Mississippi. 2School of Social Work and Department of Behavioral and Environmental Health, School of Health Sciences, Jackson State University, Jackson, Mississippi. Accepted 2 February, 2010 Between 2003 and 2007, out of 34.3 million Kenyans, over one million aged 15 and 49 years were HIV positive. In 2008, it was estimated that 1,500,000 Kenyans were living with HIV/AIDS. Approximately 85,000 Kenyans died from the disease. Mortality rates are expected to rise and perhaps peak at some point in the near future, as persons infected during the late 1990s, perhaps being treated with anti- retroviral drugs, reach the stage when their immune system turns dysfunctional. Tuberculosis is the leading cause of death among individuals with HIV/AIDS. In Kenya, the mortality rate due to tuberculosis is 133 deaths per 100,000. Yet, the prevalence rate of HIV/AIDS, aggravated by TB in the country, seems to have oscillated between 5.7 and 9% over the past five years (2004 – 2010). Based on primary data, including interviews with scientists in the country, and secondary sources gathered in situ and the US, this review of health in Kenya addresses three issues: The extent to which HIV/AIDS/TB co-infections exist in the country; government strategy to stamp out the crisis and the impact of cultural and historical factors. The authors argue that, while the environment, resource mismanagement and history account for much of Kenya’s crisis, the role of culture and ethnicity requires a much more scrutiny from the researchers. Key words: HIV/AIDS/TB, culture, traditional healer, circumcision, prevalence, breastfeeding, “dry sex.” INTRODUCTION Human immunodeficiency virus (HIV) infection is a potent accompanied by indescribable human suffering and risk factor for tuberculosis (TB) infection. HIV increases socio-economic helplessness, with little hope of rapid the risk of reactivating latent Mycobacterium tuberculosis change in sight. The objective of the following study infection and the rapid progression after infection or re- conducted by the three authors trained in public health, infection with TB (Bucker et al., 1999: 501 - 507; Corbett social work and history, is to analyze the actual rates of et al., 2003). While persons infected with TB only have a incidence and prevalence of the disease burden in the 20 - 30% life time risk of developing TB (Vynnicky, 1997; country based on the most accurate data and literature Girardi, 2000), those co-infected with TB/HIV have an available; examine historically the cultural and globalizing annual risk factor that may exceed 10% (Bucher et al., risk factors affecting Kenya; gauge the impact of the 1999; Lewis et al., 1989). current pathogenesis on people’s economic and social Kenya is considered to have one of the highest co- conditions; highlight the response of the Kenyan govern- infection prevalence rates of HIV/AIDS/TB in the world, ment and the international agencies to the crisis from the mid 1980s to the present period; and suggest strategies toward a better understanding of the association between disease and culture in Kenya. Given the correlation *Corresponding author. E-mail: [email protected]. inconsistency between low income- poverty-illiteracy and 56 Int. J. Sociol. Anthropol. HIV/TB co-infection rates in Kenya, where the upper ment notes that “approximately 8.5 million Kenyans are at class is at high risk, the authors suggest that more risk of contracting malaria, and the disease is a leading research and health-related strategies be focused on cause of morbidity and mortality.” Malaria causes 34,000 culture, if the spread of HIV/AIDS/TB is to be understood deaths a year in Kenya (Republic of Kenya, 2006 - 2007). properly and reduced. Tuberculosis is on the rise as a disease on its own as well as a sequel of HIV/ AIDS. Indeed, the Global Tuber- culosis Control of the World Health Organization (WHO) METHODOLOGY notes that sub-Saharan Africa is “one of the six regions” of the world still experiencing the greatest number of TB This work is a critical analysis of the state and the social deter- infections (Africa: South of the Sahara, 2007). In 2005, minants of HIV/AIDS/TB in Kenya, using transdisciplinary socio- behavioral and public health methodology that assesses disease the rise in TB incidence compelled African Ministries of burden’s incidence, prevalence and relative risk, while weighing its Health to declare TB a continental emergency. About socio-economic impact. Unlike the process followed in a clinical 30% of all HIV-infected persons live in East Africa. Even study or laboratory experiment, the authors collected the study’s pri- though sub-Saharan Africa contains only 10% of the mary data, June - July 2007, using a purposive (snowball) sample world’s population, it harbors two-thirds of those currently of experts in the field of HIV/AIDS and tuberculosis in Kenya. Guided open-ended interviews were held with experts from the infected with HIV, or 20 million or more adults and Kenyan Ministry of Health, the University of Nairobi Medical School, children (Nelson et al., 2001). While more than 90% of Kenyatta National Hospital, Aga Khan Hospital in Mombasa, the the HIV-positive adults here have been infected through Medical Training College in Nairobi and other health care heterosexual contact, most children are infected by their institutions in the country. The authors also held non-IRB required mothers, and eventually, become orphans (12 million in interviews with several government officials, including the Public 2007, to rise to 15.7 million by 2010). Health Chief Officer, Dr. Kepha M. Ombacho, Ministry of Health, Ministry of Health Epidemiologist, Mr. John G. Kariuki, Water and The figure below shows the African governments’ Sanitation Head, Dr. Wilfred Ndegwa, World Health Organization daunting task of stamping out HIV/AIDS from the con- representative in Kenya, Dr. Walter Jaoko, University of Nairobi tinent.It is clear that Kenya is among the countries with Medical School, a leading scientist in the HIV vaccine trials an HIV rate higher than five percent of its 15 - 49 year-old currently being underway in the country, Dr. Gidraph Wairire, Social citizens, despite the fact that it ranks much lower than Work Program, University of Nairobi, Consolata Omandi, Epide- such countries as Malawi, Botswana, Lesotho, South miology Lecturer at the Medical Training College, Dr. C. Macau, diabetes expert at Aga Khan Hospital in Mombasa and Ms. Salome Africa, Swaziland, Mozambique, Namibia, Zambia and Lima, nurse at Aga Khan Hospital as well. The guided discussions Zimbabwe. Even though Kenya has done as well as with the experts noted above included such issues as: Views on the Uganda or Senegal in combating HIV/AIDS, government spread of HIV/AIDS/TB in Kenya; the impact of culture and officials were unpleasantly surprised when, in August ethnicity; the status of the projected HIV clinical trials; the role of 2008, a study of 18,000 Kenyans, ages 15 - 64 years, government and non-governmental organizations; reasons why pre- valence rates are higher in some regions and ethnic groups than in conducted by the CDC, WHO and the Kenya Medical and others; the impact of the Nairobi sex workers study on the clinical Research Institute concluded that the HIV/AIDS preva- trials; the factors contributing to the spread of tuberculosis. lence was on the increase, from 6.7% in 2003 to 7.8% Secondary data and materials were obtained from the literature (1.4 million) in 2008. in the various medical libraries in the United States and Kenya. The The CDC study also revealed that 57% of Kenyans had transdisciplinary approach allowed a qualitative and quantitative never been tested for HIV; 26% had been declared nega- detailed analysis based on frequencies, percentages, cross- tabulations and association inferences common in socio-behavioral tive but later found positive; 16% of the tested refused to sciences and public health disciplines. know the results; 14% were unaware as to where to get tested; and 5% claimed that the health center was too distant. Yet, among the tested, only 20% had used a RESULTS condom during their last sexual act. Thus, as of January 2009, the government was still trying to discredit the Kenya in the context of Africa’s disease environment study, claiming that the data included those who lived under anti-retroviral drugs and that a second study was Sub-Saharan Africa suffers from many illnesses, many of needed (Daily Nation, 1/2/09). Government officials con- which stem from tropical environmental factors and tinued to declare, even in 2010, that actual rate did not human-caused conditions. The adult literacy rate is exceed 5 - 6%. estimated at 35 and 75% of the sub-Saharan African po- This also fueled renewal of the debate over a 2006 law, pulation, which makes less than US $2 a day. The World which, by January 2009, the govern-ment had not yet Bank classifies 303 million people in sub-Saharan Africa implemented, criminalizing “the willful transmission of as poor or making only US $1 a day or less, and expects HIV” and mandating notification of the family but, in this number to rise to 340 million by 2015. About 50% of January 2010, it established the first HIV/AIDS national sub-Saharan Africa, including Kenya, does not have tribunal whose responsibility was to hear cases related to access to clean water, and malaria continues to decimate “transmission of HIV, confidentiality, testing, access to more people than any other disease.
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