Outreach

Today I travelled with one of the outreach team to the slums. The outreach teams consist of a group of young adults who are trained at the center and get paid a small salary to go out every day of the week to different sites around the city and offer HIV testing and counselling. There are also two professional counsellors who do the testing and the training. The group I was with was composed of kids (the oldest was 21) who were in recovery - mostly from alcohol abuse. All had graduated or nearly completed high school (a relativelly rare feat) and then had found themselves with nothing to do and fell into drinking and smoking weed (there are few harder drugs, like cocaine or heroin in Kisumu). The unemployment rate in Kenya is estimated to be THIRTY FIVE to FORTY percent!! The youth center also offers a drug treatment center which all these kids had been through and were now employed there.

The most fascinating part of the day was talking to the kids between their recruitment efforts about their experiences. Although they joked about it frequently, they were clearly frustrated by the poverty and lack of opportunities in their country. They were fed up with the government corruption and lack of government action to create jobs. Barak Obama, whose father is from Kisumu, had recently visited the region and there was frequent talk about how great they would have it if someone like him was in charge. They thought their own government was old and inbred (which it is a bit). They also thought Obama being the president of the U.S. would make their lives better as well. Emigration was universally seen as the best option - but not really a feasible one for most of them, both because of the cost and the lack of visas. Their life goals basically centered around staying sober and keeping a job. One or two of them mentioned wanting to go to college but not being able to because of funds. The same acceptance and depression I saw in the patients newly diagnosed with HIV was visible here. And I can see why. We were in the middle of the horrible poverty of the slums and these kids were faced with few options.

The point was illustrated later in one of the patients I saw with one of the counsellors. Her husband had died in 2000 (of an accident - not AIDS for once) and had left her with four children to raise and no income. She is now 28 years old and has gotten by the past seven years by essentially working as a prostitute (though she described it as having multiple boyfriends). She had never yet been tested for HIV but was engaged and wanted to check before she settled down. Not suprisingly, her test was positive. This is the fourth time in two weeks, I have seen a positive test done - and that is aside from all those newly diagnosed and referred to our clinic. She came back later with her fiancee who was negative. They walked off together, looking oddly happy. She had seemed visibly reassured by the promise of treatment.

I don't know that the kids I was working with would feel the same way. Their disbelief extended to their own work. Though each of one of them swore they would never die of AIDS (the prevalence rate is 30% among their age group), they also felt like their country had no chance of recovering from the disease, that they are being ignored by much of the world because they were young and African. We had some interesting discussions about putting HIV + patients in concentration camps (which is actually what was done in Cuba - though they weren't exterminated - just exlcuded from the rest of society) and whether condoms and ARVs really worked!

I am reading "And the Band Played On", a book about the early AIDS crisis in the U.S. and the parallells between the attitudes of these kids and that of the gay community in the U.S. at that time is eery. Prevlance rates of HIV in the Castro in the mid-80's were similarly estimated to be 30%. The difference, of course, is there were "only" a few tens of thousands of people affected in the U.S. then - and mostly people who had access to information and education and ultimately medication. In Kenya, a recent survey showed that condoms were used only 23% of the time and it is estimated that only 5% of people who should be on ARVs are. Scary numbers.

(I took the pictures above while one of the kids took me on a tour of the slum area. There's also a picture of two members of the outreach team.)