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Education key to ARV adherence among refugees

[Kenya] ARV drugs stored in basic conditions, Kakuma. [Date picture taken: 09/11/2006] Sarah Mace/IRIN
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Anti-AIDS drugs are available to a small group of HIV-positive patients in northern Kenya's remote Kakuma refugee camp, but access is only part of the challenge: ignorance about the virus is widespread.

Many of the 95,000 refugees are from poor, rural, low-HIV prevalence areas and had never heard of AIDS until coming into contact with awareness programmes in the camp.

Kakuma is home to refugees who fled neighbouring Sudan, Somalia and Ethiopia. Its comprehensive care centre (CCC) has been active for a year, providing refugees and the local population with access to testing, counselling and antiretroviral (ARV) drugs, which help prolong the lives of HIV-positive people.

"Many of the patients that I see do not know of ARVs and what they are used for. Only those who have interacted with some of the more educated ones do," said Monika Ashikanda, the adherence counsellor at the CCC.

The HIV infection rate in Kakuma is a relatively low two percent. The CCC provides antiretrovirals to 85 patients, 60 percent of whom are refugees, while the rest are from the host Turkana population.

"It is key that they understand that these are drugs for the rest of your life. This is a very difficult concept for many," said Ashikanda, who gives patients a small oral test to ensure they have understood that adherence is critical. They are counselled about the importance of healthy eating and treatment discipline each time they collect their drugs.

New lease on life

To help ensure that ARVs are taken at the same time each day, Ashikanda encourages her patients to use visual aids, such as their toothbrush, so pills are swallowed when teeth are brushed.

"I remember by setting the alarm on my cellphone. I always have battery [power], as I work on the generators in the Ethiopian area of camp. Through this I earn 3,000 shillings [US$40] a month and use this to buy extra food," said Abraham Tesfaye, 29, who has been in the camp for 15 years and was first diagnosed HIV-positive five years ago.

The ARVs have allowed Tesfaye, an Eritrean refugee, to continue with his job: "Before I was often sick, now I feel good, I have gained 15kg. I ensure I eat twice a day, I feel like my normal self, I go running and do push-ups."

John Deng [not his real name], 21, from southern Sudan, has been in the camp since 1999 and has been taking ARVs for five months. He has only disclosed his status to health workers and is so afraid of stigma that he tells his friends he has tuberculosis.

Anti-AIDS drugs increase a patient's appetite and in remote Kakuma food is not always readily available, so Deng relies on regular visits by home-based carers for nutritional help. "I don't want the carers to stop coming, they remind me of my appointments when I feel weak, and bring me vouchers for more food. I get two cups of rice and three cups of beans extra each 15 days."

Reluctant to return home

A peace agreement in January 2005 ended Sudan's 21-year civil war, bringing long-awaited peace to the south, but the region remains desperately poor, lacking even the most basic services, and some southern Sudanese are reluctant to return home.

"ARVs are my life - how can I return to Sudan? I have to be close to where they [the drugs] are. I am willing to stay here for as long as God wishes," Deng said.

Tesfaye also feels he is tied to the camp. "The drugs encourage me to stay in the camp, as I won't get them in other places for free."

This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information:

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