Traditional Culture Impedes the Fight against HIV in Kenya

By Julie Bowen

The battle against HIV/ADS in Kenya is also a battle against entrenched traditions and taboos. In the rural villages, its existence is either denied or spoken of in whispers. To these people, AIDS is not real: this is Chira, a deadly wasting disease caused by a curse that strikes down anyone who transgresses society’s norms, which can be treated only by the village medicine men. This plays into the hands of opportunists, such as the rogue herbalists who see only profit in suffering, or the vested interests of those who persist in the stigmatisation of AIDS victims – seen not least in the rigid short-sightedness of the Catholic Bishops of Kenya, who only exacerbate the problem with their hard-line pronouncements against the use of contraceptives.

Women and poverty

Throughout Kenya, women are at a disadvantage in all things. In the communities of Nyanza Province for example, the twin social stigmas of poverty and HIV/AIDS, plus the lower status of women, polygamy and the practice widow inheritance, make women particularly at risk of HIV infection. The rate of infection in the province stands at 14.7% compared to the national average of 9%. However, rates vary enormously within the province, with the Suba district showing a rate as high as 41%. Average infection rates for women in the whole of Kenya are 6.9%, compared to men at 4.4% and children at 0.9%.

Pamela Dola is a member of the Luo community in the Lake Victoria region. When her brother-in-law died of AIDS, custom dictated that his widow was then inherited by Pamela’s husband as a second wife. Three months later, the second wife died. Shortly afterwards, Pamela’s husband was taken ill and died, leaving Pamela to single-handedly raise her three children as well as the five children of the dead wife and brother-in-law. This story contains all the ingredients that make HIV/AIDS infection a high risk in such communities, where women lack the freedom to control their own lives, and sex is of prime importance in every aspect of the culture.

By custom, a widow is unclean and has to endure a ritual cleansing immediately after the death of her husband. A widow who refuses to have sex with another man is considered cursed or at least unlucky and are usually ostracised. Similarly, many of life’s important milestones such as moving house, or even the routine stages in cultivating the land are marked by ritual sex, which also has protective powers: for example, if a parent dies, a man must have sex with his wife before leaving home or be cursed. Women are seen as property and are expected not to complain when another wife comes into the house or the husband has extramarital affairs. In such a society, where a man may have sex with several women, where HIV is rife, where even its existence is denied and every death is explained away, and where education is poor and poverty drives many women into prostitution or early marriage, we see a perfect recipe for the spread of the HIV, where the heaviest burden is carried by women.

Fighting the epidemic

The Kenyan Ministry of Health has tracked the spread of HIV since 1990 through annual sentinel surveys in antenatal clinics. The turning point came around the end of the decade, when rates of adult infection peaked at 14% and the government recognised that the burden of high mortality and ill health on both the rural and urban population was eroding family ties and social cohesion. A national emergency was declared and the newly created National Aids Control Council (NACC) led the response to the epidemic with the launch of the Total War on AIDS (TOWA) campaign. More than a decade later, the UNAIDS Global Report on the AIDS epidemic for the years 2003 to 2008 shows a decline in infection rates and risk behaviour alongside increased knowledge of HIV prevention and treatment. However, death rates and numbers of new infections remain high. NACC estimates the number of Kenyans living with the disease at more than 1.1 million; and after more than a decade of decline, infection figures are again beginning to rise. While improvements in medical science and services help to control the problem, entrenched cultural practices still act as a brake on progress.          

The herbalist

With the spread of HIV, the herbalists thrive. Nobody wants the stigma of being HIV positive, so secrecy is common. Amidst fear and suspicion, the herbalists see an untapped potential for profit, but fill it only with more sorrow for the unfortunate victim. Herbal medicine is not regulated by law and there is no code of ethics among herbalists. The Kenya Medical Research Institute has established a requirement for safety assessments to be made on all drugs including traditional herbal medicines, but there is no control mechanism to ensure they are implemented. 

People like Jesse Ng’ang’a, from Gilgil in the Rift Valley region, who kept his HIV positive status a secret from his wife, family and neighbours and was looking for a release from his daily dose of antiretroviral drugs, was easy pickings. The herbalist first interrogated him about his life and the history of his disease, and then told him that through his healing powers he had cured ninety-eight cases of AIDS and had become famous and influential. An hour long consultation followed that included prayers and invocations to the supernatural. He then explained that the fee would be KSh. 4,000 ($45), with a further KSh. 10,000 ($112) for the 60 day course of treatment. Jesse then had to sign a memorandum of understanding that bound him to make the full payment for the treatment after completion or he would forfeit the title deed to his land. He was given a concoction of herbs that made him feel drunk for several days. After this he came to his senses and went back on his antiretroviral drugs. He told his wife about his infection and she encouraged him to go to the Kikopey Diatomite Community Based Organisation, a home based self help group that was able to offer him support.

Determined resistance by such individuals and organisations to the pressure by society on the HIV-positive to be ashamed and secretive about their status can help turn the tide of the epidemic. HIV/AIDS has profoundly challenged Kenyan society, putting a burden on its healthcare system. Only by the breaking down of some of society’s barriers, its prejudices and traditions, will the war against HIV eventually be won.

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