Africa or Bust: Battling HIV/AIDS

By Jesse Osmun, November 30, 2006

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In honor of World AIDS Day, we hear from young people working to make change on a continent still ravaged by a global pandemic.

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One of the strongest images I have from the entire year I spent in Kenya working as a missionary is of a small graveyard behind an orphanage where I worked as a volunteer. The image of 23 neat little grave sites staring back at me -- the youngest was of a one-year-old boy -- still haunts me. Not that this was unusual; there over one million AIDS orphans Kenya, and the nation is not unusual in this trend, either. According to the United Nations, Sub-Saharan Africa is home to just over 10 percent of the world''s population, but 64 percent of all HIV infections occur there, equaling anywhere from 21-27 million infected people, estimations say.

I was just one of many young people who descend onto the continent of Africa every year. We are drawn in for different reasons and with different objectives. Some come as UN personnel, some come as religious workers, others come to experience what life is really like in a developing country, thousands of miles from home and we all encounter the realities of HIV on some level or another.

Kaitlin Dearham is a good example. She came to Kenya from Montreal to do an internship with an NGO called Indigenous Information Network. Dearham, whose grandfather is part Afrikaner (a mixture of Dutch and German immigrants to South Africa) and had traveled to Swaziland as a teenager, may have felt more at home than most Westerners, but that didn't make the experience easy.

"The HIV epidemic was hugely devastating in every area of Kenya in which I traveled," recalls the 22-yr-old. "Even in the city, where condoms are widely available and people have some knowledge of HIV transmission, protection is still not affordable to a lot of people, and the knowledge is not widespread enough. I saw people fighting for dignity and respect from a government that simply pretended they did not exist." She was also exposed to a number of organizations and aid workers fighting to keep the epidemic from growing."

The NGO where Dearborn worked was based in Nairobi, one of the largest cities in Africa with over two billion inhabitants. But, she says, much of the work she did was with communities at a grassroots level all over Kenya. The work went beyond HIV and AIDS awareness to focus on some of the root causes of the spread of the disease, and involved empowering communities, which she describes as "having been marginalized by the mainstream development agenda" to fight for their own rights and achieve their own developmental goals. More specifically, this meant training Kenyans on issues such as human rights, HIV/AIDS, and environmental management.

Prevention is Key

Amber Bickford went to Africa with the express goal of working to help stop the spread of the HIV virus. She and her husband work in Kenya as AIDS Researchers and activists, but Bickford started working in South Africa, a country known for its sky-rocketing AIDS crisis and staggering rates of infection. She got her first hands-on experience while she was doing work to prevent Mother To Child Transmission, or MTCT. MTCT occurs when a mother passes the virus to her child through exposing them to blood during the birth process or through breast milk. In the US, MTCT rates have been greatly lowered because of the use of anti-viral medication and an increase in Cesarean Section operations among HIV positive mothers. In Africa, little is known about MTCT in the local communities. Activist group AVERT estimates about 70,000 women worldwide give HIV to their children via MTCT.

Bickford believes that education is key to reducing infection rates, in general. And, in some countries, it appears to be working.

"HIV prevalence among pregnant women in the region ranges from approximately 2 percent in Eritrea to 7 percent in Kenya, Uganda, and Tanzania," she points out, adding that this rate peaked in the 1990's at almost 12 percent, according to most experts and government statistics from around the East Africa region.

Burundi and Uganda also report stabilizing epidemics. The Uganda Government waged a campaign in the late 90s and early 2000s that is being seen as very successful. And studies have shown that although many male Kenyans engaging in intercourse with more than one sexual partner, increased condom use and abstinance by young Kenyan women have made an impact. Bickford also says that HIV's hold on pregnant women in Kenya has been declining, especially in urban areas and at least some of this change appears to be the result of more people practicing safe sex.

While countries like Uganda have had success in their prevention campaigns such as "Love-Life" (a condom use promotion and distribution campaign), men are still having multiple sex partners and having unprotected sex with these multiple partners, a common phenomenon in Kenya as well. Because of this, many of these same men die of HIV, resulting in a lack of males in the workforce that puts a great burden on families, and makes many women and grandparents the defacto heads of the households. If the family has children, the children do what they are not prepared or mature enough to do, ie, grow up fast and take care of the younger siblings. Bickford remembers seeing many households run by girls barely in their teens and says that in Africa, "the children are the most acutely affected -- by the death of their parents, not being able to go to school, and by the loss of love and affection they need."

On top of this, she noted with frustration that the outpouring of information to local people has still not dented the infection rate in places like South Africa. "You have to make people WANT to use a condom every time," Says Bickford, "not because they are afraid or forced to, but because it is completely second nature."

Cultural differences

In many parts of Africa the lack for resources combine with a resistance to changing cultural mores that can add to the spread of HIV and AIDS. Many young people working on the continent struggle with their role as outsiders trying to make positive change without intruding. Very different ideas about the role of women and the structure of the family as well as the acceptance of domestic violence can pose a huge challenge. Kaitlin Dearham says she encountered a lot of women stuck in an abusively patriarchal cycle.

"In rural areas, I met a lot of women my own age or younger, who were second or third wives and already had several children. Many of them were beaten by their husbands on a regular basis," she says. "It really struck me that one's life experience is so random; if they had been born in Canada, or even in a different community in Kenya, they would not have to go through this. But those women are no less deserving of respect, or of the power to make their own decisions, than anyone else."

Along with this devaluing of women's rights (Divorcing women lose all property and inheritance, and often feel afraid of asking their husbands to wear a condom), comes the shocking poverty that many aid groups deal with everyday. Dearham, who visited the Mathare area, where friends and coworkers lived, was shocked by the "wretchedness of the conditions" she witnessed, even seeing people passed out, lying in the dirt and waste that covers Mathare and many of the poor neighborhoods in Nairobi.

Dearham also provided some disturbing facts as to why AIDS rates are still an issue in a country that had lowered their infection rate to six percent over 10 years. She points out that many customs allow and often encourage young people to get "practice" with a number of sex partners, especially in more traditionalist and isolated communities. Circumcision, a rite of passage for boys (and to a lesser extent girls) in almost all of the 42 tribes that live in Kenya, is performed with a single knife or blade. Polygamy and wife-inheritance (the remarriage of a woman upon the death of a husband to his next of kin) also helps AIDS spread within family structures. Prostitution, while illegal, is widespread in Kenya, with street-boys protecting local brothels in exchange for sex with the prostitutes. Those who refuse to pay the boys for protection are sometimes raped by them. The number of sex workers infected with HIV is not known, but given the unwillingness of many Kenyan men to wear a condom, the rate is probably quite high.

All of these factors, raise mixed feelings in Dearham. She says, "I think every Westerner working in a developing area goes through this period of disillusionment, where they stupidly feel that they can go out and save the world, and then reality hits home. When you realize that the problems that you thought you could help solve with good intentions are much more complex that you can ever imagine, of course it is frustrating. And it's incredibly frustrating to realize that, as a foreigner, there are certain issues that I can't address directly, such as FGM (female genital mutilation). I can try to talk to people about it, I can try to get funding for local groups who are working on it, but in the end, because it is a cultural issue, I cannot touch it directly."

Deciding to care

Despite the complexity, Dearham has also been inspired by the spirit and resilience she's witnessed.

"The Kenyans that I worked with didn't care whether the world had given up on them or not, she says. "They believed in fighting for better education, for better health care, for women's rights, and so on, so they went ahead and did it."

When I asked Amber Bickford about her thoughts on what we in the Western Hemisphere can do, she revealed what has become an unspoken sentiment among those of us who see Africa in more then black and white, good and bad:

"Honestly, I don't know, except for to prioritize HIV; to make it the world issue, to pay attention, to not patronize the continent by 'rescuing' a young Malawian child out of an orphanage. [Many Westerners] just go about their daily lives and have no perception of how their lives would be different if they were born several thousand miles away. But what they need to do at the most basic level is just start caring."

Jesse Osmun is a freelance journalist, poet, and healthcare services assistant living in Milford, Connecticut. In August, he returned from a 10-month overseas mission to Kenya where he worked as a Social Worker and taught English in a rural village. When he has the time and money, he'd like to go back.