Harsh living conditions and the onset of the cold rainy season in Kenya are making it increasingly difficult for HIV-positive people displaced in the recent post-election violence to stay healthy, according to health workers in the camps.
"The main difficulty is getting a good balanced diet," said Ancilla Kemunto, a government community healthcare worker at the largest camp for internally displaced people [IDPs] in the Rift Valley town of Nakuru. "Although, like other IDPs, they [HIV-positive people] get the WFP [United Nations World Food Programme] rations, they are not nutritious or large enough to keep them healthy."
The situation is all the more worrying, given Kenya's looming food crisis after a poor rainy season between October and December, and the impact of the post-election crisis on agriculture, in which tens of thousands of farmers, casual labourers and food traders were displaced.
The post-election violence started in early January 2008 after presidential elections were held on 27 December 2007, and continued until an agreement was signed on 28 February, usually the peak of the agricultural season.
The resulting high food prices have reduced government stocks and affected WFP's ability to buy maize locally. The UN body says this could ultimately mean ration cuts for beneficiaries.
"We occasionally get donors, such as the Girl Child Network (GCN), to give us fruits, vegetables, milk and supplementary cereals, but for the past two weeks we have had nothing apart from WFP rations, which are mainly maize, beans and cooking oil," Kemunto said.
She added that as the second rainy season sets in, from April to mid-May, many IDPs living in tarpaulin tents are sleeping under thin blankets on reed mats, putting those with HIV in particular danger of contracting pneumonia.
"We need basic necessities like soap; we get regular skin infections without it," said Loyce Wambui, speaking on behalf of a group of HIV-positive IDPs in Nakuru. "Many of us get frequent diarrhoea and have no toilet tissue. As for children, it is much harder to keep them healthy in the cold and rain."
According to Kemunto, camp organisation is not what it should be. People known to be infected with tuberculosis [TB] continue to share overcrowded tents with their families - GCN has identified at least 32 TB patients at the Nakuru camp.
"The risk of infecting others in the same family is so high because it is usually one five-person family per tent; TB patients need to be isolated, but this issue has not been addressed yet," she added.
New location, new stigma
HIV-positive people in the camp are also dealing with the dilemmas of adjusting to unfamiliar healthcare providers, and whether to disclose their status to a whole new community.
"When they go to the national hospital here in Nakuru, the treatment they get is not good - the staff there tell HIV-positive people to form a line, where they can easily be recognised," said Henry Mwiterere, a health worker attached to the Academic Model for the Prevention and Treatment of HIV (AMPATH), a research institution linked to Moi University in western Kenya's Rift Valley.
|They tell us they have nowhere to hide their drugs, since the tents have no drawers or lockable cupboards|
"At our centre they are treated with consideration for confidentiality, but at the government centres it is not as easy for them," Mwiterere added.
He said adherence was difficult for HIV-positive IDPs living in close quarters with people they preferred not to disclose their status to. "They tell us they have nowhere to hide their drugs, since the tents have no drawers or lockable cupboards, and some days they might miss their drugs because they have no privacy to take [them]."
Adding to the stress is the uncertainty under which the IDPs are living: it is unclear when they will be able to return home. "The AMPATH programme is here but we don't know for how long," Mwiterere said.
"Usually our service is comprehensive, providing nutritional support, helping our clients create an income and providing drugs. At the moment we can only provide drugs in the camp - it is not a sustainable way of looking after these people."
The Kenya Red Cross Society and its partners are trying to ensure that all IDPs are provided with ground sheeting, insecticide-treated nets and mattresses, but staff said additional food for HIV-positive IDPs would depend on donors stepping up to provide it.
Kenya's National AIDS Control Council estimates that at least 15,000 HIV-positive people were displaced by the post-election violence.