East Africa:
Kenya and uganda
I have successfully survived a week in Kisumu, Kenya, and am having a great time so far!  Chelsea and I were met with such organized and enthusiastic people at Opportunity International in Kenya, it seems like we might be spending more time in Kenya than we originally anticipated. We are currently living a Kenyan host family, Joseph and Joyce Thuku, who have a 2-year-old daughter (who is continuously teaching us Kiswahili) and their adopted 13-year-old son.  Compared to my experience in Ghana last summer where I primarily lived in an apartment, we are being continuously exposed to the culture: hearing the family’s stories, learning their language, and eating their food. We are having a chance to really experience the Kenyan life style. 

Our work with Opportunity International is going really well; in total we have spoken with about 300 clients, interviewing ~90 one-on-one with a tape recorder and doing several group interviews with about 20 people in each.  It’s amazing some of the stories we have heard. The stigma of HIV/AIDS makes people very cautious to open up to us about their HIV status, but when some finally do it is very rewarding. We have also met with several clinics, hospitals, and VCT (Voluntary Counseling and Testing) centers in our attempt to create a database of the current providers of services for people in the area seeking information and testing for HIV.

The Devastating Realities of HIV/AIDS

We are finding that in this area, HIV is an extremely pressing issue; girls between the ages 14-19 have an infection rate of 40%!  Every single person we have talked to knows someone in their immediate family or a close friend who has HIV/AIDS and about 80% of the clients we have interviewed are taking care of multiple children orphaned by a family member.  In addition to their own expenses to survive, the extra burden of taking care of additional children is thrust upon them in the midst of their grieving including impossibly large school fees that are in addition to the cost of having to feed the children.

It is becoming increasing clear how HIV/AIDS is very much associated with poverty; many women we find turn to sex as their fall back option.  Young girls are tempted with free gifts and money to have sex with older men and it is not uncommon for a woman to come home from work and be forced to have sex in order to put food on the table.  As I saw in South Africa, shantytowns are everywhere.  We have done home visits in many slum areas where up to 13 people sleep in one room with mostly grandparents who are left to take care of orphaned children due to the wide spread loss of almost an entire generation due to HIV/AIDS.  The unfortunate part is that most women do their 'business' in their homes...the majority of the time in front of the children, forcing kids literally to grow up knowing nothing but sex in their lives, which leads to them experimenting with sex at a very young age since they’re so desensitized.  

It’s also incredible the amount of child prostitution there is here in Kenya, especially in Kisumu.  We sat in on a sex talk with 12-13 year old girls and most of them didn’t know what rape was or that there was a difference between consensual sex and rape. In the Kenyan culture, women do not have the right to refuse sex, even it is from someone they do not know. One 13-year-old girl had said that if a father rapes his daughter it must have been the daughter’s fault as she must have invited the sexual advances by not wearing enough clothing around her father.  The young girl saw no problems with the idea of rape.  Ironically, in the Kisumu area, a woman is much more likely to contract HIV if she is married than if she is sexually active and unmarried.  It is seen that if a woman refuses sex or demands condom use with a boyfriend and he does not listen, she can easily leave him and find another man, but if she is married, she has no ability to decide if she has sex or not as it is completely at the will of her husband. 

Another thing that we have learned from talking to clients is that women are pretty much paralyzed in the business world if they don’t have financial support.  You see women turning to sex to pay for school fees and especially with the fish mongers. In order to buy fish at a competitive price, women are forced to sleep with the fishermen.  This is one of the main reasons why Kisumu has one of the highest HIV infection rates in all of East Africa.  In the more rural areas of western Kenya, it seems that most people know of the services provided by VCT centers (Voluntary Counseling and Testing) but many lack the education to understand how HIV is spread or even what it means to get tested.  A great thing is that all testing services and ARV (HIV drugs) are completely free but unfortunately not everyone knows that.  

The largest deterrent to getting tested for HIV is people's fear that the test will only lead to death, unaware that with the proper diet and drugs one can live a very long and relatively healthy life.  We spent at least an hour yesterday providing extremely basic HIV education to a group of about 20 female rice millers who knew almost nothing about HIV.  We even did a mock role play of suggested ways they can tell their husbands they should be using a condom.  In the Lou (pronounced Lu-O) tribe, polygamy is practiced, and it was not uncommon to hear women talking about their husbands’ multiple wives and the uncertainty they had about how safe their relationship was.

Client Interviews

When we interviewed clients in the Kisumu city area (as compared with the Rural areas), we found that the amount of education of the clients was much higher in the city and so was the awareness of the virus. Many of the women commented that normally in the Kenyan culture, the man was the sole breadwinner for the family, placing the wife completely under the command of the husband. Speaking to women who were coming into the office applying for a loan, they said that they did not have the ability to demand condom use or insure that their husband was being faithful for if they questioned the man, they could be thrown out of the house or denied resources.  Interestingly, when I spoke with women who were either finishing their first loan cycle or currently on their multiple loan cycle, they reported the various impacts that the loans were having on their lives in addition to the increase in their personal income.  When I asked them the question about their ability to demand condom use (either for HIV protection or family planning) manyreported that since they were taking an active role in supporting the family and paying for resources, they had gained much more control over these type of decisions, including control over their own bodies.  The women were no longer frightened with threats of abandonment by condom-weary husbands and could more easily implement the HIV education they had received.  “Empowerment,” one woman claimed, “is the most powerful impact the loan had provided me, especially with my ability to stand up for myself against my husband and demand he remains faithful and wears a condom.”

We are definitely looking to find ways that OI can provide ways to support its clients by linking up with external organizations that do HIV education; most of the clients simply don’t have the knowledge.  Our initial idea of getting a list of available VCT clinics would be helpful as a form of non-verbal motivation and encouragement, but I don’t think it would be enough for the clients, especially since almost everyone is impacted by the disease.

After all of this advocating for testing and stressing the importance of knowing one’s status, Chelsea and I are going to get tested for HIV tomorrow to understand the process better so we can help ease the fear a lot of our clients have expressed surrounding testing. 
(Side note: Barack Obama’s father is from Kisumu and when he came to Kenya he got tested for HIV. The person doing the testing is my Kenyan host father!)

The encounters I have had so far are truly amazing. I am learning more everyday and experiencing so many new things, I cannot believe that we have only been here a week!
First Impressions
Friday, July 13, 2007