High levels of stigma persist in the north

For the past ten months, health workers at Ijara District Hospital in Kenya's North Eastern Province have been caring for two children, aged six and seven, who were abandoned by their father after he discovered he was HIV-positive. Nurses say the children were weak, malnourished and suffering from tuberculosis when they arrived.

"We have been forced to keep these children; all their relatives have declined to take them, although they are now in good health condition and can enjoy life like other kids," Dr Mohamed Abdikadir Sheikh, Ijara district's medical officer, told IRIN/PlusNews. "Stigma associated with HIV/AIDS is very, very strong here; it is without any doubt responsible for the plight facing these children."

Ijara has 130 registered HIV-positive people, giving it the lowest prevalence in the province, but many residents still associate HIV with evil spirits, curses and witchcraft; most people diagnosed with HIV, he added, sought ritual rather than medical treatment.

"The VCT [voluntary HIV counselling and testing] centre in the district remains idle because the local community believe they cannot contract the disease," Sheikh said. "We need an aggressive awareness campaign in these remote areas."

In Isiolo, a district in the north of Eastern Province, the Isiolo Youths against AIDS and Poverty (IYAP) said spreading awareness in the community was difficult because of the remoteness of the area, the transient nature of its pastoralist population, and cultural taboos.

"This region is vast ... to reach a majority of the youths who are in the remote parts of our region, we need support," said Amina Abdullahi, an IYAP official. The group was limited to conducting their education and information sessions in town, because they lack the resources to travel beyond it.

Group members said they regularly faced personal physical risk while visiting parts of the region prone to conflicts over scarce water and pasture, and had to be careful who they sent to certain areas, or to a specific clan or ethnic community, for fear of reprisals if they sent someone perceived to be from a rival group.

Openly talking about HIV was also problematic because the largely Muslim population frowned on open discussions of sex and sexuality. "As you can see, we have no picture or poster of a condom here - we cannot take the risk ... the landlord cannot allow us to do that," said Ali Boru, another IYAP official.

Cultural norms also hamper awareness-raising efforts, because most of the HIV educators are young people. "It is impossible for me to talk to an elderly woman about HIV/AIDS, my culture does not allow me to advise or discuss any sexual matter with a woman who is older than me," Abdullahi said.

North Eastern Province has the country's lowest HIV prevalence - one percent - but also the lowest literacy rate, another obstacle in the path of HIV education in this remote province.

See also: KENYA: Boy's suicide reveals gaps in HIV education

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