When the sun rises in Garrisa county at 6am, it is a new dawn for the residents. A day to go to school, get a new job and make a living.
However, people living with HIV in this county find it hard to look forward to a new day. In between the streets of Garissa town, harsh voices can be heard from locals who have distanced themselves from those living with the virus.
Watu wa machupa, wakonde wakonde, haram, watu waliolaniwa, maiti inayotembea, watu wa CCC (Those who are on medication, slim slim, sinners, those who are cursed, the walking dead, those who get treatment at the Comprehensive Care Clinic) are some of the names used to refer to people living with HIV.
The 786,547 residents of this town, who are mostly from the Somali community, believe the virus does not belong to them but to other communities in Kenya.
Suleiman Dagane, 39, and his wife Siyatho Guhad know exactly what it feels like to live in a community that can kill you silently by its words and actions.
January 13, 2003, is the day Suleiman found out he was HIV-positive, a few days after the death of his first wife.
He met his late wife when he was transferred from Dadaab Primary School to Liboi Primary School in 1999.
“It was in 1999 that I met the love of my life, my late wife, who was divorced. She was a business lady. We dated for a few years and got married. She was a very beautiful woman and I did not think she was HIV positive,” Suleiman says.
They were married for three years. During this time, they tried to have a baby but were not successful, as she had three miscarriages. She was living in Garissa town while Suleiman was living in Liboi.
She died in April 2002 after developing opportunistic infections in Hagadera Refugee Camp under the care of her husband.
All along, Suleiman had been hearing rumours that his wife was HIV-positive. He then took a leap of faith and went to the Comprehensive Care Centre at the Garissa Provincial General Hospital to find out his status.
Suleiman tells me it is at that point that he encountered his first form of discrimination from a health worker.
“Instead of the medic counselling me about the test, he took that opportunity to assure me that I would be frustrated in my entire life if the test turns positive,” Suleiman remembers, while scratching his eye.
The test turned out positive. After knowing his status, Suleiman didn’t go to work for three days. Neither did he eat because he did not know what to do next, as the person who was supposed to help him did the opposite.
“After lying in bed for three days, I decided to go and see the district education officer, requesting to be transferred to Garissa town, but with the same responsibilities, so I can be put on treatment. When I told the DEO about my status, he looked at me in shock. There was pin-drop silence in the room, and when he realised I was not kidding, he wrote a letter demoting me from my then position to classroom teacher because of my status,” Suleiman vividly recalls.
He said the DEO was careful not to indicate the exact reason for demoting him, because it would pin him down.
As if that was not enough, when Suleiman returned to Garissa town, he was posted in 2004 to a primary school where he was discriminated against for third time, this time by the parents of one of his students, as well as his colleagues.
“One parent came to school and withdrew her child from my class. When I asked her why, she looked at me in the eye and made it clear that she cannot allow her child to be taught by a teacher who is HIV-positive,” Suleiman says.
He added that his colleagues treated him differently whenever they were in the staffroom having meals or talking about the curriculum.
“My colleagues were very funny. They would hide their cutlery from me because they thought that if I used them, I would infect them. They would not even shake my hand when I stretched it out to say hi. Some would also avoid me whenever we were walking on the same pathway,” Suleiman says, while playing with his two-year-old child, who is HIV-negative.
He now works at Tumaini Primary School and has married two women, one of whom is blessed with two children who are negative. His wife was also chased away from her home after her husband died and she found that she was also HIV-positive at the tender age of 16. She has also been stigmatised by the community.
“Whenever I go to fetch water, I am told to stand a bit further and they will fetch the water for me. I can’t go near the well when my neighbours are around there,” Siyatho says.
Besides the Dagane family, I meet *Asha Mohammed at the CCC centre, tying her ninja around her face. She has been chased away more than six times from rental houses after her landlords found out about her status.
“The moment members of the community find out about your status, they will treat you like an outcast. I remember in one home, each time I asked my neighbour for a basin to wash my clothes, the owner would break it before me. Others would cut would the clothing line for fear that they will be infected with the virus,” Asha says.
She added: “Even when I walk along the streets, members of the community who know me would ask me how I’m still alive and kicking. They think that when one is infected with the virus, that is a death sentence.”
Before she had moved into several houses within the town, she had also been chased away from her in-laws after her husband died and she tested positive for HIV.
“I remember feeling a bit unwell and my sister-in-law took me to hospital at 11pm. I had pneumonia and my health had deteriorated. When the doctor took an Elisa test, I had tested positive for HIV. My in-laws left me in the hospital alone for 10 days and my brother-in-law even came to check if I was dead, but was disappointed to find that I am alive,” Asha remembers.
Fast-forward to 2008, when she disclosed her status at a public forum. She attests that it was the best decision she ever made, as she used that opportunity to educate her community about HIV and the effects stigma has to a person living with HIV.
Asha adds that since that time, she does not speak about her status openly for the sake of her children, who are negative.
“In this community, it does not matter if your children are HIV-negative and you are positive. It is worse on the children’s side because their peers and even teachers stigmatise them, which has forced a number of them to drop out of school,” Asha added.
She is currently staying at a rental house in the town with her second husband and three children, who are all negative. She is also a counsellor at the CCC.
According to the Stigma and Discrimination index, Garissa, Mandera and Wajir counties record more than 60 per cent HIV-related stigma and discrimination among people living with HIV, despite the countrywide prevalence standing at 45 per cent.
The HIV related stigma in the remaining counties is below 50 per cent.
The index also shows that 97.5 per cent of people living with HIV in the Northeastern region do not have close ties with their families. Some 82.8 per cent of the residents believe that people who are HIV-positive are punished for a bad behaviour by God, while 72.4 per cent believe that the virus is spread by sex workers.
“Sadly, we have one of the highest HIV-related stigma rates in the country. In the rural areas of Garissa town, the residents believe that when one a person is infected with the virus, he must have been cursed,” county Aids and STI co-ordinator Noor Sheik Ahmed said.
HIV-related stigma is the devaluation of people living with HIV. The person who is stigmatised is seen as having less value or worth than other people. This usually happens when someone’s condition is attributed to behaviours the society considers improper.
The types of stigma experienced in Garissa are self-stigma, community stigma and stigma from the health workers. Those living with HIV told the Star that they prefer to get medical attention from non-locals, as they do not stigmatise them and disclose their status to other people without their consent.
“It would be better if the health workers at the CCC clinics were non-locals, because the kind of treatment we get from our brothers and sisters is very painful,” Suleiman said.
Noor added: “Even clinicians routinely discriminate against people who are HIV positive, but I am suspecting that here, it is mostly from the local communities, as well as some non-locals.”
Head of the Anti-Retroviral Care and Treatment at Sisters Maternity Home, Simaho, added that as a result of the high stigma levels, those who are HIV-positive are cautious when replenishing their drugs because they do not want the community to know about their status.
“Most of them come and get the drugs but they throw the boxes in the trash can. They only carry the medicines in paper bags. Some would come to the health facility every day to take the medicine, as they do not carry them home,” he says.
According to data from National Aids and STI Programme (Nascop), 4,023 people are living with HIV in the county. Some 3,100 are adults, while 923 are children.
The 2014 estimates also show that 127 new infections were recorded annually then, of which 12 were from children and 115 from adults.
“Out of all those who have tested positive, only 69 children and 869 adults are on treatment. Those who are not on treatment, we can attribute it to the stigma they face from the community. In some instances, mothers do not attend all antenatal clinics, despite the services being free of charge. All of those who are on treatment, their viral load has been suppressed,” Noor added.
The county has recorded 549 Aids-related illnesses.
He added that they have also addressed the issue of rapid divorces rates in the county, which he termed as a major risk factor in the spread of new infections.
“Close to 70 per cent of women who get married end up being divorced and re-married in a series of inconsequential marriages that hardly last, what we call serial monogamy. This is one of the biggest risk factors of acquiring HIV in our setting,” Noor said.
The county is urging partners to engage with them on how they can win the fight against HIV in the county, as they only have one partner supporting HIV programmes.
“Apart from Unicef, we do not have any other NGO investing in HIV programmes in this county. Most of them closed shop, including Amref’s Afya-plus, a few months ago. If we had more partners in this programme, we could make great strides in the fight against HIV in Garissa, where the prevalence rate is at 2.1 per cent,” Noor says.
A number of religious leaders have been trained by Amref before they closed on how to sensitise the community on HIV matters. Last week, the county launched its five-year strategic plan, which is tailor-made for Garissa county, and it has put in place measures to reduce new HIV infections.
The plan will also be in line with the 90-90-90 target set by the UN Aids programme. This target aims to ensure that 90 per cent of all people living with HIV will know their HIV status, 90 per cent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90 per cent of all people receiving antiretroviral therapy will have viral suppression by 2020.
Tto address the stigma in Northeastern region, political will and leadership is needed, as they are considered key contextual influences on the outcomes of HIV-Aids programmes.
This will also help more people have a health-seeking behaviour of knowing their HIV status.
As President Uhuru Kenyatta once said, “You cannot change one’s HIV status but you can change your attitude.”