My first encounter with the carnage that is HIV/AIDS was when the neighbours; whose children I had played with and whose chicken I had chased about, died within days of each other. Mother died on Friday. Father died on Sunday.

Obviously we were shocked. When you are a child nobody really dies. They just disappear one day and fade into the refuse pit that is a child's memory. The memory of the weekend the neighbours died though has always lingered on the dermis of my mind, like spinach between my teeth. Always there, always visible. For years after that we would sit on the steps and speculate as to the events that had preceded that fateful weekend. Armed with a portfolio of facts and graphic images from my mother's pre-1980's med school texts, we misdiagnosed and re-diagnosed the neighbours until we were burnt out.

All that was left were prognostic patterns. They were fat, then they grew thin, then they died. That was AIDS in the mid-90s for an urban child. Years later, when everyone had either grown out� or moved away and my childhood stolen by time I was reluctantly reacquainted with that same foe. Walking through homesteads in rural Nyanza I saw a society wasted and dying and a landscape transformed into one colossal gravestone where one read only of decay and destruction.

First day on the job my boss said to me, 'Assume everyone is HIV positive, including yourself�.' I felt like Pandora. A struggle had begun and I had no idea what to do with the box of ills released into my world. I don't think AIDS is a particularly impressive disease. I've seen children wasting away from cancer and witnessed the waste that meningitis can render a human mind. With AIDS though there is no respite. Mankind is made as Sisyphus; rolling the boulder to the top of the hill only for it to roll down again. Toiling uphill endlessly.

What's worst about modern life is our equanimity towards death. Funerals are big business and the best many of us can do is sigh at the thought of sitting through more perorations, always beginning ,'I haven't much to say' or 'I will tell you briefly'� and proceeds to last but three hours.

Out in Nyanza funerals were our weekend do. Our big rave if you will. We went to eat and drink and meet new people. Every weekend without fail. It was only more death after all and everybody was too drunk on battery acid anyway to tell us who it was we were mourning. In the aftermath of death, however, one realizes what it means to say that someone has died. I could never accurately describe the despair I felt every time one of my students walked up to me and said, Japuong, I cannot come to school anymore. Mother is dead and father is very sick. � The fact that the economic impact of AIDS on households is so dire means that many children's chances of staying in school after their parents deaths are slim. They have to assume new responsibilities to support the family.Further,as many communities view sex education as taboo and without the protective factor of parents, many more of these children are vulnerable to STIs and especially HIV infection themselves, as well as unintended pregnancies.

When I first moved to Nyanza I could think only of how unlucky I was to have ended up in a community where there was no one my age that I might hang with. I figured I mustn't be in such a great place if all the young people thought to leave it. Like a chameleon's tongue shooting out, reality hit me square between the eyes. The youth hadn't left. They had died.

HIV/AIDS is a disease just like any other. Less severe than some, worse than others. There's no grading its deaths though, its results are no worse than any others. No score is kept in death and there are no winners. But we must accord AIDS special priority as opposed to mainstreaming it as just another disease because its effects are non-discriminate. It touches past, present and future; young and old no stone of jargon and clich left unturned. We are all affected or infected and oftentimes both.

Through the plight of the orphan the untold agony of the AIDS pandemic is made incarnate. Due to cultural, practices, inferior education and limited economic freedom, more women than men are infected in Africa. With Africa leading the world in number of infections, I sometimes feel the weight of the world rests on my shoulders. No matter how many views I take it is my inescapable responsibility. Nine out of ten times when someone debates the demographic details of AIDS they will be describing me. The African woman; the face of AIDS.

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Sambo was once Indian
written by Stephen Wanyama , July 28, 2007

There's a large large number of non-African HIV sufferers primarily on the Indian sub-continent, doesn't have quite the same photogeny though so it does not hit the front pages nearly as much.

The drop in life expectancy is not just due to HIV-AIDS. Part of it is the sycophantic adherence of African governments to Bretton Woods policies which caused widespread social stress and endemic poverty, which are more responsible for AIDS than sexual habits as I argued in this article here. In Nyanza which you speak of for example, the death of the cotton industry, rural-urban migration has wrought severe damage across the whole region. 90% of HIV is about poverty and the conditions it brings, so any campaign against HIV needs to concentrate more than anything else on improving standards of living.
The Millenium Village of Jeffrey Sachs' in Sauri, Yala is a great example of this, watch video here.

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invisible killer
written by Jayawardene , July 28, 2007

A poignant end to the article : The African woman; the face of AIDS.

When put like this you begin to understand how potent this silent killer is. The hardships that the orphaned children face are the only indicator of its silent presence.

Only recently parliament was discussing re-equipping the Kenya Airforce with a new fleet of used Saudi Airforce at a cost of billions. The ageing fleet that needs replacement was never used in any offensive action, as far as I know. The numbers had fallen over the years due to crashes.

Could this money not be better spent on improving living standards and fighting HIV infections as Wanyama argues?

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L.A.P
written by Hon. , July 28, 2007

Ms. Akitelek, I cannot help admiring your literary prowess.From your very first post, you caught my eye!
Lady, I'd love to meet you one of this days!

When you talk of Nyanza, it tears my eyes. For over 6 years, I called it home. The chain of week end funerals. By late 90's my tear dams were running dry.It was heart wrenching.
I once thought that my girlfriends death at 20, of AIDS, was MUCH better compared to the desperate situations surrounding me. Well, she would be missed for sure, but there is no other burden left behind.
I watched `as my siblings playmates were moved to rural places they had never been to, to be raised by grandparents they'd never met. Engineer Amollo is dead and 9 children whose future is bleak, left behind 3 widows (whose lymph nodes look swollen, a sign of unhealthiness)...and I'd cry for the kids, and cry, give my 20 bob donation and cry some more!

You walk the streets of Kisumu, the forlorn look in people around the district hospital tells it all. Busineses abandoned.
It hits hard when u realize there is a whole generation caught up in this. The future, the children. The situation gets murkier with malarial parasites out of control. As a chemist I believe DDT should not be released in the environment, but Nyanza needs it, if only to end malaria.

How best do we bring this AIDS menace under control, using homegrown solutions?. The catch-all 'education/sensitizing' is not working. In Mid 90's, packets of condoms were pinned on trees for people to pick free of charge. I don't know if that helped reduce new infections, but i know that it was a loosing battle.

I think people need to first increase food production. As Sach noted, helping farmers use better seed, fertilizer and such...no money donation, the real thing.
If we can get people food, then other things can be thought of.
Viracept has been recalled as being unfit for AIDS management, I wonder how many African people will get help here. It was used in Africa, and probably is.

If people can eat well, they don't need this poorly researched medication from the west that will kill them faster than AIDS.

To sooth my soul, I occasionally entertain the notion that the condition is a western biological weapon against Africa, for it has done a great job! Socially, economically...it brings whole regions to the ground. And not just the poor....nnoooh, the learned and the young. Just like slavery robbed Africa, AIDS is too, taking away its strongest!

Mr. Wanyama (are you one and the same Waswa Opoti. One of u sent me an excerpt of Sach's interview in 2006. Well, I agree with the prof. on his take when it comes to eradicating poverty in Africa-help is needed, but are not sure about the on-off aid as reason for the continued mess)
This is not about Bretton Woods or International Mother and father policies.
It is the reality of AIDS in Kenya.

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written by from Nyanza , July 28, 2007

there is this little village in a HomaBay that has literally no working age adults-- only children and their grandparents. How does something that wipes out a population like this not get its due attention.

when I was growing up, I was so afraid of AIDS, so afraid that I was not in a relationship until my mid-20's! And even now when I watch how careless people get, with all the information that they have, I am dismayed!

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written by Marangu , July 28, 2007

What a reflective piece, it's unlikely that none of us has been touched by the reality of HIV/Aids. I wish this was one evil plot that was switched on and can at some stage can be switched off, I would like to buy the conspiracy theory, but for what it's worth, I doubt that we are likely to see some solutions soon. The best that can happen is to use this challenge to reinvigorate our health infrastructure, do the best we can for those affected, and add some quality to their remaining days. Todate Kenya is doing probably as good as any country in Africa on HIV /Aids treatment and Surveillance, those who have the caurage to attend screening are able to access treatment and essential followup. People are better informed and though stigma is still rampant, people are seeing the need to access available resources.. that is encauraging.

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RE: from Nyanza
written by Hon , July 28, 2007

The sex carelessness is not my problem in my view. What is one person dying?

Figure this, an American couple on average have sex on the 3rd date. Kenyans are not more promiscuous than their counterparts. Hormones rage, poor judgement is the order of the day for young people.

Picture this, at any one time, 70% of college kids have STIs. D'u think they dont know about protection? They do.
The pains/joys of growing.
We just need to manage the disease. People will continue having unprotected sex, it is a given.

Marangu.
So now that Kenya is doing as good as its 'neighbors', hata kama yote ni mbovu, we should be consoled?
Daktari, vipi wewe!

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nosepegs
written by Stephen Wanyama , July 29, 2007

Honey, no I have not sent you any link. The link I have there is to an article I wrote. I did not even know you existed in 2006!
Like you however, I am certain that money is not all that is needed to turn Kenya's AIDS story about. There has been great progress, partly due to increased education and also because of the quick acting nature of the virus in Kenya.
Does anyone know, are we allowed to buy Indian generics with the US or EU aid? Certainly the progress we have made so far is cause for relief, even if not consolation, just compare the effect on life expectancy with South Africa, Lesotho, Namibia, Swaziland, Zimbabwe or Zambia. There have been measures, and these have made a considerable difference.

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ummmm.......
written by papakemus , July 29, 2007

Mr. Wanyama,
as far as i know the only restrictions on how EU and/or US aid is used are in relation to how many medical and/or teaching personnel can be employed by a recipient country. for example a country like Malawi can only employ five in every twenty two medics or teachers that it might require. this is called a user fee and apparently is to put a stopper on resources available to the corrupt government official. in my circles it's called murder.

EMMO!!!! its about time you read something i wrote. missed you!

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written by Marangu , July 29, 2007

Wanyama:
Much of the EU and US aid comes with inbuilt directives on how exactly it will be used and what it can and cannot buy. Not really sure but if they allowed purchase of ARV generics from wherever, we would have made major inroads to the pandemic.
Hon:
Agree with your observation, totally, on the universality of youth behaviour. of course it suits certain peoples' opinions that the reason Africa is decimated is because of it's peoples' promiscours nature and whatever other reasons they have advanced.
The point I was making is what Wanyama has stated in his post, that some progress has been made, I did not want to create the impression that we have done enough. We are very far from consoling ourselves.

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Folks
written by Hon , July 29, 2007

Do not agree with my post so fast. There is possibly a divergent thot down the line.

Marangu:
Before I forget, I am putting in my request that you expound on how the availability of generic ARVs will slice the pandemic considerably. I don't seem to see how it will work. Are they really necessary?
Help stretch my mind on this one!

I have watched activists demand for them, nikaona ni upuzi tu.

I have also observed the poor in the following areas: Western (Busia, Bungoma), Nyanza (Kisumu, Siaya, Ahero), Central (Nyahururu, Maragwa), Coast (Ugiriamani/uswahilini) and of course in our Nairobi slums. Been to Daadab, the refugee centers in the North.
I was not studying anything in particular, just interacting and trying to understand their views on life.
Somehow, I am skeptical about generic drugs helping a majority in these areas.
Of course they will be availed to the sick in the local health centers.
What am afraid of is creating some kind of dependency on these drugs that can be turned on and off.
Please put this in mind:
1.HIV has tormented man due to its ability to mutate, and so far, there is no cure.
2.Secondly, pharma companies are profit oriented firms. Half the time what they put out for use works, or seems to, but very little effort is put on determining how the drugs work. why? because it costs money. Currently, an argument is simmering on whether drug research should be left to academia in the light of a number of drugs having to be pulled off the markets and firms paying heavily in compensations. Pfizer, Merck and Abbot were dented most with the law-suits. On this issue (I don't know where u at), but here, HIV carriers have the opportunity to discuss with their doctors which therapy suits them best. They just do not get ARVs, they have kidney and liver tests often, and drug combinations changed. It is affordable to have each patient, or two with a caretaker to monitor them. Can we afford that?. In my opinion, if the drug is not a cure, we don't need it if we can do without it.
3. Most deaths resulting from AIDS in Africa are largely due to the simplest opportunist infections. Diarrhoea na kadhalika. From the five deaths I observed, the only serious condition I noted was the Herpes Zoster boils, that got suppressed after a while.
My friend's death was as a result of personnel error at Agakhan, kisumu. (That facility is one of the most useless i have encountered. See how a doctor prescribes 80 anti-biotics for a common cold.)
The next two women diarrhoead all the fluids out shutting the system down.
The men had bronchial infections bring them down.

Let me not ramble, and allow you a chance to explain how the 'generic' bullet will save the day!

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from Kisumo
written by emmo opoti , July 29, 2007

Honey,
Even when HIV medication is available, if the sufferer is malnourished, or living under difficult conditions, there is little help it will do to his health. This is why the ideas espoused in the Millenium Villages are so powerful. There is a lot to be said for the success of the Sauri project, although it remains to be seen whether or not it will be self-sustaining once the aid has left.
Can villagers use their increased profits for example to treat their nets themselves, to buy new nets? Can they run and fund their own hospitals, even under cost-sharing agreements with the Central Government? What of CDF, I believe even a half-intelligent MP can see just how much the ideas presented in villages can cause a real revolution in living standards in the villages.
For me this is the true fount of change, a devolution, when the wananchi at the grassroots realise that they can do it by themselves, and do not need to interference from rapacious goons in Nairobi.

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written by aeichener , July 30, 2007

What Honey had written - if you had paid attention, you would have noted it - is that ARVs are useless if not supplemented by adequate nourishment and living conditions, and can in some case even be counterproductive, due to their heavy side effects.

She was not siding with Thabo "The Clown" Mbeki, mind you. Who has killed many more people in his limited time in office through his stubborn HIV/AIDS ignorance than Mugabe ever did in his life.

Alexander

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written by Hon , July 30, 2007

No I don't know what generic drugs are Steve.
Please enlighten me!

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bioequivalence
written by Stephen Wanyama , July 30, 2007

Hon,
Are you simply contrarian or have you some point I am not getting. Are you claiming that ARVs are useless? That the victims of HIV/ AIDS are better off without them? Is it generics you are against? Do you know what generic drugs are?

Or are you saying that good primary healthcare is by itself enough to beat HIV-AIDS? There may a point to that, but I still think ARVs have been shown to work, even though like all other drugs they must be administered with full knowledge of patient peculiarities and possible side effects. The fact that there are people allergic to penicillin does not make it useless.

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written by Stephen Wanyama , July 30, 2007

Before I forget, I am putting in my request that you expound on how the availability of generic ARVs will slice the pandemic considerably. I don't seem to see how it will work. Are they really necessary?
HIV has tormented man due to its ability to mutate, and so far, there is no cure.....In my opinion, if the drug is not a cure, we don't need it if we can do without it.......Let me not ramble, and allow you a chance to explain how the 'generic' bullet will save the day!

In English there's not two ways that could have been understood. Your whole post displays ignorance of what generic drugs are, especially the question you ask Marangu at the end. You seem to make out that it would have been better if the drugs were non-generic.

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written by Marangu , July 30, 2007

Hon:
Generic drugs are medications manufactured by Pharmaceutical companies which are not the patent owners.Patent rights help manufacturers to recoup their investiments in research and technology for their innovation. Big pharmaceutical companies today fight to keep the patent rights for as long as they can and hence hold the monopoly to supply certain medications, hence they dictate the cost. Demand for ARV medications is particulary huge now and these companies capitalise on existing demand to make as much profit as only a capitalist system can allow.
As for your question on whether availability of generic ARVs will reduce the prevalence of HIV/Aids, really not, they only serve to make the disease bearable. Making these drugs available is based on the same principle as Cancer therapy, there is still no cure, but we make an effort to alleviate pain, boost immunity and live as normal a life as possible under the circumstances. What can really help in 'slicing' the epidemic is prevention, prevention, prevention.. and we are not talking about it here!

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woah!!
written by purplr rain , July 30, 2007

perhaps i need to get my eyes checked but is there on this page a statement in defense of one R.Mugabe?

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written by Hon , July 31, 2007

[excised by mod]Marangu:
The issue at hand was not knowing what generics were. I just wanted u to present ur approach of handling. I was not even opposing it!

I simply wanted that u put into consideration what a majority of the people who need this drugs face. It is about exchanging idea, not telling how knowledgeable one is, or how good the english is as emmo wants people to beleive.

It is a solution search, not competition. No one is getting a trophy here! For those who have no idea what real life is, take a whiffff!

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written by Marangu , July 31, 2007

Hon:
You are right in restating what response you expected from me. you are wrong in characterising my response as competition, I have merely given what my view on generics is, it's not expert opinion, nor an entry to a competition, if that is what it was, I would have embarked on some research and demanded that you name the prize before i respond to you.

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