Living in city streets with HIV and TB, and no medication

Rebecca has struggled with life-threatening illness after three years sleeping on the streets with no ARVs and no healthy food

In Summary

• Rebecca moved into the streets after her parents died, with no relative willing to take her in

• She was married by age 16 but the man disappeared on her, and she ended up with a street lover who died of Aids

Rebecca Karemi during a interview on December 22
SICK Rebecca Karemi during a interview on December 22

It is 5am on Moi Avenue in Nairobi. Rebecca Karemi, 32, has just been woken up from a makeshift gunny bag, her home on the city street since she was a teenager.

The floor is damp after it drizzled the entire night, which is unusual in January.

The mother of three, two boys and one girl, quickly cleans the gound from her daughter's face as she prepares her for school before the hot-tempered city askaris pounce.


After several arrests by askaris, who force them to spend nights in crowded and dirty police cells, Rebecca and her fellow street mothers were forced to seek the services of a point man to watch over them and alert them.

This person plays a major role to many single homeless mothers, who seek shelter outside closed shops in the Central Business District of the city at night.

Breakfast is out of the question for Rebecca's 10-year-old daughter, a class five pupil at a nearby primary school. Her only hope is the meal provided under the school feeding programme.

The girl is thirsty for education. She hopes to become a police officer, perhaps to protect the most vulnerable in society in future.

But Rebecca is sick. She has Aids — the last stages of untreated HIV — and recurrent tuberculosis. She has been without anti-retroviral drugs for the past three years until recently when the virus took a toll on her health.

“We were ambushed by county askaris who pounced on me while sleeping on Moi Avenue. I lost all the medication and hospital documents I would use at any medical facility while trying to save my life and that of my daughter," she explains.

Rebecca, a class 8 dropout, was diagnosed with TB in 2017 after a friend noticed her never-ending cough and advised her to seek medical attention.


She gave up on TB drugs, which have to be taken daily for six months.

Rebecca Karemi's on December 22, 2019. Her eyes are dark and sunken, a deathly reflection of disease progression, dehydration and lack of enough sleep.
STREET SICK Rebecca Karemi's on December 22, 2019. Her eyes are dark and sunken, a deathly reflection of disease progression, dehydration and lack of enough sleep.

Dr Elizabeth Irungu, an HIV prevention researcher and faculty at the Jomo Kenyatta University of Science and Technology, says people respond to HIV infection differently, depending on their immunity.

She explains there are people who live with HIV without being aware of it for a long time, calling for the need for one to be tested.

"However, there is danger in not taking ARV treatment because the HIV strain may become resistant to drugs," she says.

People who stop taking TB drugs, too, can also become sick again, and the TB bacteria may become resistant to drugs. Drug-resistant TB is harder and more expensive to treat.


Rebecca was born in Meru but came to Nairobi 20 years ago to work as a house girl.

She was married by age 16, but her life took a turn for the worse when she was locked out of her first husband's house.

“I was working as a house help in Eastleigh after my parents died. I met a man whom I stayed together with for three years but he later disappeared, never to be seen to date.”

With no relative willing to take her in, she moved into the streets. Rebecca felt betrayed by her brothers and relatives, who sold their only family land.

“I met other street mothers in Eastleigh, who welcomed me into their circle. We later shifted to the CBD as a family in search of food and shelter,” she said.

She recounts how street life was all rosy before death struck.

“In these streets I found love, and together we lived as a couple. My man guided me and shielded me from other street boys," she said.

"He acted as a good father to my two boys. As naïve as I was, being with him made me forget my sorrows. I eventually bore him a daughter and a year later, he succumbed to Aids."

She discovered she had HIV after her daughter was born. She says her husband refused to take ARVs and he died at Kenyatta National Hospital in 2011.

Without treatment, people with Aids typically survive only about three years, Dr Irungu says. 

Rebecca and her three children know no home apart from these streets.

Two of her elder children, the boys aged 14 and 15 years, have, however, been adopted at a children's home in Kikuyu, Kiambu county, and are pursuing their education, something she is grateful for.

The death of Rebecca’s husband took a toll on her. She started abusing drugs and other substances.

She started having multiple sex partners without protection, despite her HIV status. This is despite asking her partners to use protection in vain.

At some point, she met a trolley pusher, with whom she would have unprotected sex in city lodges. Her HIV status did not bother him. 

"I would leave my daughter with other street mothers for a night watch to go engage in unprotected sex. This happened for three months, with the man in full knowledge of my HIV status," Rebecca says. 

Exposing others to HIV through unprotected sex was always criminal in Kenya, until 2015, when the High Court declared section 24 of the HIV and Aids Prevention and Control Act unconstitutional. 


After contracting TB, Rebecca separated almost all the thing she used to share with her daughter, who accompanies her everywhere, to avoid infecting her.

But the knowledge that she cannot fully protect her from rape and sexual abuse in the streets still sends shivers down her spine.

According to the Ministry of Health National Guidelines on Management of Tuberculosis in children released in August 2017, the susceptibility of a child depends on their immune status upon exposure.

Kenya Aids NGOs Consortium policy manager Jack Ndegwa explains that such infection will depend on whether the child has a weakened immune system, a scenario most likely to propel TB transmission from the mother to the child.

Rebecca says her daughter has not exhibited any symptoms of paediatric tuberculosis.

“In one of my regular check-ups, I had to bring along my daughter to be tested, and lucky enough, she turned out negative for both TB and HIV,” she says.

Nonetheless, Ndegwa is adamant the risk is still too high for the child.

“The stake is too high for the child to continue being on the street as she can fall victim to rape and be infected with HIV, she can get TB and other respiratory-related infections, such as pneumonia and bronchitis,” he says.

Ndegwa says it is in the best interest of the mother and the child to undergo rehabilitation.

Rebecca spends a better part of the night coughing incessantly. With no beddings, at dusk, she lies down to rest on old cartons she has picked from dustbins. 

Her body state is deteriorating as she shows me. She covers her head with a scarf to the forehead, hiding the scaly, bald patches of ringworm that cover her head.

Her eyes are dark and sunken, a deathly reflection of disease progression, dehydration and lack of enough sleep.

She finds an urge to scratch her body almost throughout the night but feels itchier when she stops. Eczema, which causes the itchiness, has turned her skin pale and creased.


Kenya has struggled to address the plight of street families in urban areas. Their number has swelled, despite the existence of the Street Families Rehabilitation Trust Fund.

Rebecca and her children are part of the growing statistics of over 20,000 street families in Kenya, who barely enjoy basic rights, including healthcare, food, clean, safe water and proper education.

Access to guidance and counselling and HIV testing for free at any public facility are some of the rights the sickly street families barely know to exist for them.

“It is sad that in many cases, the government that is tasked with protecting us ends up assaulting us and not providing us with the required medical attention when needed,” Rebecca laments.

“No one cares about street families. The high rate of ignorance among us is blamed partly on the society for the negligence and attitude they inflict upon us.”

She recalls the countless times she has been insulted by pedestrians. She blames society for stereotyping them as rude and arrogant, saying it has impacted the sick homeless negatively. They are not willing to seek medical attention in public hospitals, and many abuse drugs and substances as depression hits.

“Getting ARVs in public hospitals as a street mother has not been easy. Attendants ignore us as soon as the foul smell from our bodies reveals we're from the streets,'' she says, choking back tears. 

There is no data on the number of homeless people living with HIV and tuberculosis, as many of them are never tested.

Rebecca Karemi begs from passers-by on Moi Avenue on December 22, 2019
Rebecca Karemi begs from passers-by on Moi Avenue on December 22, 2019

Rebecca regrets her past and hopes none of her children would choose her path.

None of her three children has ever sniffed glue and she is prayerful that none will.

“My only regret now is I thought street life is easy and the only way out, but I would advise otherwise to anyone who would wish to join.”

She dreams of starting a business and renting a house and reuniting with her children.

Rebecca has recently begun taking ARVs and TB medication religiously, which is being given free of charge at a public hospital. She hopes her health can be restored.

She no longer engages in unprotected sex. She only begs to make ends meet after her efforts to hawk confectioneries on city streets were thwarted by county officials.