Inter Press Service - June 2, 2006
Joyce Mulama

"This is why I had to register at two treatment sites, so that I could get ARVs (anti-retroviral drugs) twice: utilise one set from one site, then sell the other batch from the second site, so that I can get something small to put in my stomach."

Wa Kimani spoke to IPS outside one of the centres where he obtains treatment, his face perspiring in the hot sun as he sat on a stone, awaiting the client who buys medication from him. The stigma that continues to surround AIDS in Kenya has apparently made the client wary of obtaining ARVs through official channels -- something he fears may lead to his HIV-positive status being made public.

Wa Kimani, who is unemployed, began selling the drugs last year. He charges his client just under seven dollars for a month's worth of medication.

"This is not much, but at least it helps me purchase some basic food so that I do not take the medicine on an empty stomach. It can be dangerous, you know," wa Kimani says.

"I remember once, before I thought of the trade, I would take the medicine without any food -- just porridge alone. I nearly died. I got so weak, I developed ulcers which have not healed well until now."

Until the beginning of this month, government facilities had been charging about 1.4 dollars for the same amount of ARVs; however, the fee was waived from Jun. 1. About two million people are living with HIV/AIDS in Kenya -- more than 200,000 of whom require ARVs.

Wa Kimani's case does not seem to be unique.

Patricia Asero, a member of the Kenya Treatment Access Movement, heard of six other people receiving ARVs from more than one centre last year.

"I got interested and investigated the matter further because these people belong to the same support group as me. I found out that they had registered in more than one treatment centre so that they could get extra drugs to sell and buy food to take with medication," she told IPS.

In some cases, patients who only have one source of drugs will also sell their ARVs to buy food, added Asero. However, they present a different tale to staff at their treatment centres.

"They will tell you that their medication got lost; others claim that their bags were snatched by thieves. But when you interrogate them keenly, you get to know the truth," she noted. Asero is also an HIV/AIDS counselor at a government hospital.

Other patients who live long distances from ARV sites and who are too weak to walk to there -- also too poor to afford transport -- simply skip treatment, using what money they have to buy food.

With official figures indicating that about 56 percent of the population lives below the poverty line, the temptation that certain HIV- positive Kenyans face to sell their medication is unlikely to diminish in the near future.

"The fight against HIV/AIDS must be coupled with the fight against poverty. If not, we are wasting our time," says Omu Anzala, a senior lecturer in the Department of Medical Microbiology at Nairobi University's School of Medicine. Nairobi is the Kenyan capital.

The government claims to have steadily increased the number of persons who are receiving ARV medication in recent years: 39,000 patients were treated in 2005, up from 24,000 in 2004. The aim was to have 95,000 people on the drugs by the start of 2006.

But, says Anzala, "The government should get away from giving us numbers. It should be concerned about the quality and sustainability of the service. These numbers mean nothing when the majority of the patients are skipping or selling drugs."

The alleged sale of ARVs by some patients, and the erratic way in which others are said to take the medicine, has raised fears of drug- resistant strains of HIV in Kenya.

At present, there are only about 24 ARVs on the market -- and at any one time, a patient must be on three. If present trends continue, says Anzala, "we may not have any ARVs to talk about, since people will be resistant on all of them."

"There is a need to monitor people and to see if they are taking their medication as required, as well as monitor resistant strains of the disease."

Others claim that these problems would be circumvented if more attention was given to the matter of nutrition.

"When we talk about comprehensive care in HIV/AIDS, nutrition is part of it. But the government has neglected it; it only provides nutritional counseling and that is it," notes Asero.

"Some treatment centres may only give a packet of ujimix (porridge flour) per month. This is nothing."

A report issued last month by the International Treatment Preparedness Coalition, a grouping of AIDS organisations from across the world, also cites lack of nutrition as a major obstacle in the war against HIV/AIDS in Kenya.

"Nutritional support is still minimal except for nutritional education," says the document, titled 'Missing the Target -- Off Target for 2010: How to Avoid Breaking the Promise of Universal Access'.

The report was released last week ahead of the United Nations General Assembly Special Session on HIV/AIDS, which opened May 31 in New York.

Health officials say they are trying to improve nutrition amongst AIDS patients.

"There are activities going on to provide this service. Most of the hospitals are implementing it," David Mwaniki, head of the Technical Support Department in the National AIDS Control Council, told IPS.

"But, we need to work further to strengthen it."

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