HIV/AIDS in the Mukuru Slum

Health conditions in a densely populated slum are alarming.  A small outbreak will spread like a wild fire, and thus easily turn into an epidemic.  HIV/AIDS is one of such examples.  Although there is no statistics specific to the Mukuru slum, the HIV prevalence is estimated to be above 10 percent, which is much higher than the prevalence at the national level (6.8%) and in Nairobi (7.9%).  The major risk groups in the slum are sex workers, MSM (men who have sex with men), truck drivers, and IDUs (injecting drug users).

Many social factors are contributing to Mukuru’s high HIV prevalence.  A significant underlying factor is poverty.  Due to their low income level and high income volatility, many women (including widows and single mothers) provide sex for a meal.  Truck drivers who drive in and out of the industrial area where the Mukuru slum is located work in poor conditions and spend many days away from home, thus become tempted to have sex with commercial sex workers along the way.  Unprotected sex and injecting drug use spread the virus across the community, where the web of human interaction is dense.

The first step to treat the disease is to know HIV status.  The Kenyan government is aiming to test 80 percent of the whole population by 2013.  In Nairobi, you can find HIV testing centers in every corner.  People regard HIV testing as part of their health check-ups, and they are not afraid of being seen in a line in front of testing centers.  But this is not what it is in every part of Kenya.  There are some rural areas where stigma continues to rear its ugly face.  One health worker who works in a remote area told me that people ask her to call their mobiles so that they can visit the center when no one is around.  She added that they only use the back door. 

Although stigma against HIV/AIDS is now low in Mukuru, it is not a long time ago when people with HIV in Mukuru were afraid of isolation.  People misunderstood the disease, and the HIV positives were reluctant to disclose their status to their partners.  With counseling and awareness-raising campaigns, people in Mukuru started to correct their misconceptions about HIV/AIDS.  Importantly, those who are living with HIV started to share their stories with others.  Besty (she chose this nickname as it means “best friend”) is one of the HIV positives who have been courageously speaking about their own experience.  I asked her what made her decide to break the silence, which must have required a lot of courage and determination.  She told me that counseling helped her understand that HIV is treatable (although not curable). “And I gradually increased my confidence,” she said.

Stories shared by people like Besty have significant impact on people’s behaviors.  People become more confortable discussing HIV/AIDS in public, and more people visit testing centers.  People become more aware of the necessity of HIV prevention such as condom use.  A real example like Besty is more convincing than plain documents or statistics for people to take action, and interactive programs at community level will be effective.

[This piece is based on interviews with NGO workers, community workers, and dwellers during my visit to the Mukuru slum on June 30th.]