HIV-Aids is a thorn in the side of Homa Bay county. It is among the leading counties nationally in HIV prevalence, with 26 per cent of its 1.1 million people affected, according to the National Aids Control Council.
County NACC coordinator Kenneth Okeyo says the prevalence is four times that of Kenya. Moreover, it has increased from 25.4 per cent in 2013 to 26.0 per cent as of last year.
The HIV-Aids estimates prompted the Star to research on the high indicator.
HIV expert George Orwel, who worked with Egpaf and Maisha Trust, says they did a lot of research on the spread of disease in the county. He points out unique behaviours which he says contribute to the high prevalence.
Many residents living with HIV enrol and collect ARVs, but they do not take the drugs. They throw them away instead because they are living in denial and do not want friends or family to know they are positive.
The behaviour is so rampant in Homa Bay town, there is a place nicknamed ARV Corner. This corner is about 250m from Homa Bay County Referral Hospital. It has several disposed containers with drugs. Other patients dump the drugs in toilets, dust bins, rivers and sometimes Lake Victoria.
“We observed that most people who throw away the drugs are youths who are also sexually active,” Orwel says. He says adolescent youths are key drivers in transmitting HIV because they fear going for testing but engage in sex.
“In fact, if they are tested positive, they fear or don’t register for ARVs, because of stigma from their colleagues,” Orwel says.
SEX FOR FISH
Homa Bay has more than 70 per cent Lake Victoria water cover, compared to other counties around the lake. Many residents fish for a living. County Beach Management Unit chairman Edward Oremo says they have 134 beaches.
Most of the time, the beaches are full of fishers. However, Orwel says, the high HIV prevalence among fisher folk is due to social interactions. Shortage of fish forces businesswomen to have sex with fishermen to acquire them.
“Most of these women become desperate when they fail to get fish. Fishermen take advantage and lure them into sex,” Orwel says.
The women enter into sexual deals with particular fishermen for assurance of regular fish supply. A fisherman who engages women in sex for fish is called Jaboya. “Some women confess they have a Jaboya who provides them with fish at their time of need,” Orwel says.
He says the prevalence increases in beaches when an infected Jaboya has sex with several women. A Jaboya who catches a lot of fish may end up having sex with more than five women in a day because they scramble and fear returning home without fish,” he says.
Most sex for fish is done in bushes near the lake, after which they take a bath. “The prevalence is promoted because they engage in unprotected sex and do it in hurry,” Orwel says.
Many expectant women give birth with the help of traditional birth attendants. More than 60 per cent of women in Shauri Yako, Misita and Sofia estates in Homa Bay town deliver children at the homes of TBAs instead of hospitals.
The women say TBAs are accessible and handle them with respect. They call TBA women as min Jossy (mama Jossy).
“They say they better seek prenatal services and deliver at TBAs than hospital, where they are quarrelled by arrogant nurses and clinicians,” Orwel says.
Two of five women you meet in Shauri Yako estate confess they have delivered twice at the homes of min Jossy. The women have trust and believe min Jossy is capable of handling all prenatal services and complications.
“They believe the herbal medicine used by min Jossy is better and God-given,” Orwel adds. However, the women are at high risk of contracting HIV at min Jossy’s homes because the TBAs are untrained. For instance, they commonly use unsterilised tools. A single razor blade can be used to cut more than two umbilical cords of different babies.
“TBAs handle things manually, hence high risk of HIV transmission from mother to child when they mishandle placenta and umbilical cord,” Orwel says.
BODA BODA RIDERS
Other key drivers of high HIV prevalence, according to the Homa Bay Multisectoral Aids Strategic Plan, are boda boda riders and single mothers.
Orwel says boda boda riders sleep with women whose husbands have left home for work. “The women assign motorcyclists some household duties, and they develop friendship that eventually ends in bed,” he says.
Cases of marriage break-ups that involve boda boda riders are common, Orwel says. Some women have sex with the riders for family conflict vengeance.
“Most riders brag at their parking yards about the large number of ‘trucks’ they drive in the absence of their owners,” Orwel says. He says the riders have baptised such women as Lori (lorry). “The riders are stress doctors to most working class women,” he says.
The prevalence will continue to rise should residents fail to change their habits.
County deputy AIDs and STIs coordinator Philip Bondo agrees that the social behaviours contribute to the high prevalence. He says they have identified about 70 famous TBAs who assist expectant women in delivery.
“The worry is that TBAs are celebrated by most women in Homa Bay. Several women visit them but we appeal they refer them to hospitals for safe delivery,” Bondo says.
County director of health Gordon Okomo says poverty also contributes to the high prevalence. “High poverty index, especially among adolescent youths, makes them vulnerable,” he says.
Okomo says the county, together with partners, is fighting the prevalence. “We’re fighting stigma, urging people to go for testing and enrol for ARVs to reduce HIV-Aids and other related deaths,” he says.
In 2015, Governor Cyprian Awiti declared HIV-Aids a county disaster due to its high burden and scourge. Awiti said the decision was taken to enable them have a generalised and standardised approach of managing the disease.
In his Multisectoral Aids Strategic Plan, Awiti says they have rolled out a number of plans that will help them deliver on devolved, integrated and cost-effective HIV services. Elders in the county advise youths on the community cultural and moral values.
“We have a huge task in achieving zero new HIV infections, zero AIDs-related deaths and zero HIV stigma. But I urge residents, stakeholders and partners to double their efforts in prevention,” Awiti says.
The Turkish government donated 15 fishing boats to women at Rambira beach in Karachuonyo in an effort to combat sex trade among the fisher folk.
“These are efforts to eradicate the culture of ‘sex for fish’, so women can have the dignity they deserve in the society,” Awiti said.
On May 7, Homa Bay received six Viral Load machines donated by the Medicine Sans Frontiers. Awiti says the machines are used for testing HIV concentration in blood. “Nobody should die of HIV and related diseases. Let our people make good use of the machines,” he said.