Abra Pollock

WASHINGTON, Feb 8 2008 (IPS) – In what has been labeled an emergency within an emergency , thousands of people living with HIV/AIDS who have been displaced by Kenya s recent political violence are struggling to access their life-saving antiretroviral drugs, reported the World AIDS Campaign this week.
United Nations agencies estimate that up to 250,000 people have either left or been forced from their homes since the violence broke out following Kenya s contested elections in December 2007.

Of these displaced persons, approximately 21,000 are living with HIV/AIDS, according to the United Civil Society Coalition for AIDS, TB, and Malaria (UCCATM), a Kenyan public health advocacy group.

Many of those living with HIV/AIDS have been forced to discontinue their daily antiretroviral regimen either because they cannot access clinics due to the violence, or because of forced location, the World AIDS Campaign said. In some cases, people fled their homes without the medical documents that show their status and entitle them to treatment. In other cases, their homes and documents were burned.

Advocates and experts worry that not only will the lack of access to drugs have devastating effects on the health of these vulnerable people, but that the conditions within the camps including reported outbreaks of sexual violence will result in countless new HIV infections.

We are going to lose everything we ve been fighting so hard for, said Elizabeth Akinyi Osewe, a Kenya programme officer for the International Community of Women Living with HIV/AIDS.
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In 1999, approximately 14 percent of adults in Kenya were living with HIV/AIDS, according to the United States Agency for International Development (USAID). But over the past five years, that number had dropped to five percent.

Kenya was making some very real progress in terms of reducing the prevalence rate and bringing their rates of infection down, said Stephen Lewis, who served as U.N. secretary-general s special envoy for HIV/AIDS in Africa from 2001 to 2006, and now directs AIDS-Free World, an international AIDS advocacy organisation. This is a terrible setback in human terms.

Compounding the problem is the persistent stigma surrounding the disease, which inhibits people living with HIV/AIDS from seeking out treatment in the camps or at their temporary lodgings.

Those in the camps fear they will be marginalised and discriminated against in an environment where resources are already scarce, said Allan Ragi, the executive director of the Kenya AIDS NGOs Consortium (KANCO).

In addition, Osewe said, some of the displaced persons living with HIV/AIDS are being housed by relatives who are unaware of their positive status and to reveal their status would only add distress on top of the trauma they have already experienced.

It is difficult for them to tell their families, You know, I am on drugs,’ she said. How do we ensure that they still keep their pride?

According to Lewis, this is a critical moment for the U.N. to provide emergency medical assistance perhaps by setting up medical shelters within the camps that do not advertise themselves as HIV/AIDS treatment centres, but rather offer a range of services.

The World Health Organisation (WHO) reported last week that teams in Nakuru, Eldoret, and Naivasha were coordinating medical activities and visiting camps and hospitals to assess the health conditions, but that for security reasons, health workers in several other areas have been unable to report for duty.

This is why advocates such as Ragi and Osewe argue that another key function of the U.N. should be to support the efforts of Kenya s HIV/AIDS grassroots organisations, which already have access to the population and have built relationships of trust with them.

One group, Women Fighting AIDS in Kenya (WOFAK), which has been in operation since 1993, has started to hold support group meetings for displaced persons at their offices in recent weeks yet this additional programming has forced the organisation to exceed its budget, Osewe said.

The problem is that [grassroots groups] don t have the capacity, and they are trying to do more work than before, according to Ragi. The role that the U.N. can do is prepare civil society to do their work well.

In addition to WOFAK, several NGOs and grassroots organisations within Kenya are now collaborating to identify areas where their services currently overlap and to strategise how they can best work together to address the crisis.

KANCO has been coordinating groups like NEPHAK, the National Empowerment Network of People Living with HIV/AIDS in Kenya and KENWA, the Kenya Network of Women Living with AIDS. Critical next steps for these groups include looking at the health system and health centres currently available, working on press releases, and finding other ways to increase the scope of psychosocial counseling, Osewe said.

In the meantime, another key aspect of their clients needs in the midst of the political crisis that Ragi and others hope to address is the legal ramifications of displacement and property loss. This will mean more than just a short term response and will require a longer effort than temporary aid teams from multilateral organisations can provide, Ragi said.

He described plans among his NGO network to incorporate discussions around people s legal rights into the group therapy sessions over the upcoming weeks and months.

People may have lost documents, people may have lost property birth certificates, school certificates, title deeds There s going to be more than we know, Ragi said. The first thing is that these people need to feel safe in order for them to feel comfortable talking.