Pastoralist communities in Turkana face rising HIV rate

Turkana in northern Kenya is the largest district in the country but poor services and low literacy have led to a high HIV prevalence rate among its pastoralist communities.

Yakish Eyapan, the District AIDS and Sexually Transmitted Infections Coordinator, reported a rate of 11.4 percent in the area, compared to the national prevalence rate of 6.7 percent estimated by UNAIDS.

"The problem with Turkana is that it has many neglected issues that are more important to people than HIV. It has priority problems like food insecurity, water, education and poverty. If they have no water and are hungry how can you talk to them about HIV?" asked Eyapan. It is also one of the most insecure regions in Kenya.

Ruth Eripete, a nurse counsellor with the mobile voluntary counselling and testing (VCT) team of Merlin, a UK-based healthcare nongovernmental organisation (NGO), told PlusNews that "cultural factors like polygamy and wife inheritance [a widow has to marry a male relative of her deceased spouse], we believe, increase the prevalence rate".

Daniela Stein, field medical coordinator for Merlin told PlusNews that "there is also a major truck route to Juba, [in southern] Sudan".

A lack of education and poverty forced many young girls to "use their bodies to get food or money", Eyapan added.

Eripete said the pastoralist community, constantly moving to find grazing for their livestock, was also fuelling the epidemic, "as many meet new sex partners".

Condoms are not widely used in Turkana for reasons of access and culture. Eripete had heard men say that "they cannot eat a sweet while the wrapper is still on. Many also say that their penises are too long for condoms; they have yet to believe that they fit any size."

Clementina Imona, a Turkana woman who lives 15km from Lodwar, the main town in the region, said she had seen a "condom in a packet at a health talk. I do not know what they look like out [of the wrapper] and I do not know where to buy one."

Even when offered condoms at the VCT centres, many refused, Eripete reported.

Building HIV awareness in Turkana is difficult - there is no access to radio or print media and illiteracy is high. "The area is so huge that many of the pastoralists have yet to be reached," Eyapan commented.

Staffing shortages are also a problem. Although the local population were at first suspicious of Merlin - the only NGO in Turkana providing mobile VCT testing - because they felt HIV was something that didn't happen to them, "they are now more open and willing to come for testing," Stein said.

One of the benefits of mobile VCT centres is that more women are being tested. At clinics run by the ministry of health more men than women report for testing. "The women have to seek permission from their husbands to be tested and they have many tasks to complete, and so don't often have the time to travel to the clinic," said Eyapan.

Merlin tests about 600 people per month, while the health ministry tests 500 people per month at their centres.

Antiretrovirals are available in Turkana at the hospital in Lodwar, but the supply is not constant and it is still difficult to obtain the drugs.