This essay examines the role of rural healthcare centers such as Chulaimbo Hospital in the fight against HIV/AIDS in Kisumu. HIV/AIDS is a major problem throughout Kenya, and the hospital is part of a nationwide initiative to curb the spread of infection and offer treatment to those who have contracted the virus.
Kisumu County has the third highest rate of HIV/AIDS in all of Kenya. According to the International Center for Alleviation of Poverty, Inc., 22-25% of Kisumu’s population is HIV positive. Anti-retroviral medications are unavailable to many of these people. Approximately 33,589 people are under home care for HIV/AIDS in Kisumu, with more than 10,000 new cases annually.
The governments of Kenya and Kisumu County both acknowledge the urgency of the epidemic here. Consequently, both the central and the local county governments have made the issue of HIV/AIDS awareness and prevention in Kisumu of the utmost priority. They have organized many awareness groups, and opened many health centers to help stop the spread of the virus.
One such health center is the Chulaimbo Sub-District Hospital, located in the outskirts of Kisumu just a few miles from Maseno University on the Kisumu-Busia highway. The government of Kenya established it as Chulaimbo Rural Health Center in 1976 to provide basic health services to people of the immediate area. Gradually it also started providing training for medical students on attachment from medical institutions in the region. Although the health center deals with many other health issues, since 2004 it started offering patient-support services for those with HIV/AIDS, and today that is its primary focus. Chulaimbo’s mission is to raise HIV/AIDS awareness, reduce the transmission and spread of the virus, and provide healthcare to those already infected with HIV so that they do not develop AIDS. More than 6,000 people receive antiretroviral drugs from here.
Chulaimbo also runs an awareness program directed at providing access to clean water in order to reduce the threat posed by secondary illnesses to patients. Since breastfeeding mothers can transmit the virus to the child through breast milk, Chuliambo also provides mothers with formula to give to their children to stop HIV transmission from mother to child. The Chulaimbo health center has 60 health workers and 30 nurses–all dedicated to raising awareness about HIV/AIDS, reducing the infection rate, and providing support to those infected with the virus.
Why is Kisumu County one of the most affected by the HIV/AIDS pandemic? Different groups have tried to come up different explanations for the high rate of HIV/AIDS infection in Kisumu County: some credible, others absurd.
Some of the more credible explanations account for the economic climate and cultural traditions in the region. Kisumu is mostly occupied by members of the Luo community. According to one explanation, the reason behind the high rate of infection among the Luo is because the Luo do not practice male circumcision—a study by the World Health Organization finds that circumcision reduces the rate of HIV/AIDs transmission by 60%. Another cultural factor is the practice of wife inheritance among the Luo. This practice, in which a widow marries a male relative of her late husband, could also contribute to the spread of the virus.
Apart from cultural factors, economic factors have also contributed to the high transmission of HIV/AIDs. Most people in Kisumu County live in poverty. This has led to risky sexual behavior by people desperately looking for money to survive. The location of Kisumu town on the shores of Lake Victoria has attracted many people engaged in fishing activities. This has led to the phenomenon of “sex for fish” between the fishermen, fishmongers, and poor women who are in need of fish to feed their families. The prevalence of prostitution in Kisumu directly correlates with the high infection rate.
Many prostitutes are also itinerant and are therefore at an increased risk of contracting HIV/AIDS. It has been estimated that almost 90% of sex workers in the county lack alternative means of survival. Although health organizations have urged sex workers to use protection during sexual encounters with clients, many times they are unable to do so because some of their clients do not want them to use protection. Most sex workers also fear visiting centers for testing for the virus, and can therefore transit the disease without even knowing that they are themselves infected with the virus.
Carolyne Njue, Helene ACM Voeten, and Pieter Remes have conducted an investigation on what they call “Disco Funerals” in Kisumu. They concluded that these parties were contributing to the spread of HIV in Kisumu County. At these disco funerals, many young people engage in risky sexual activities and are vulnerable to sexual assault.
Another reason for the high infection rate in Kisumu is location. Kisumu is located on the main Mombasa-Nairobi-Busia-Kampala highway. Many truck drivers ply the highway transporting goods and services from Mombasa, Kenya, to Kampala, Uganda, and to even Kigali in Rwanda. These truck drivers often make regular stops at different points along the highway, sometimes engaging in unprotected sex. This often leads to the transmission of the disease from place to place along the highway.
But, while some of the theories on the high infection rate of HIV/AIDS in Kisumu seem credible, others are outlandish and ridiculous. One such explanation has been purveyed by the group, Kenya Forum. According to the Kenya Forum, one of the reasons why there has been a high rate of HIV/AIDS infection in the region is infidelity. The Kenya Forum also goes on to mention unheard of practices in the region such as “wife swapping” and “swinging couples” as leading causes of infection in Kisumu, Nairobi, and other cities. Maybe what the Kenya Forum has in mind is the prevalent practice of” wife-inheritance,” already discussed above, but wife inheritance (or what some of us call “levirate marriage”) is not the same thing as “wife swapping and swinging couples.”
The deliberate political marginalization of members of the Luo community by the successive governments of the first and the second presidents of Kenya cannot be ignored in explaining the high rate of HIV/AIDS infection among the Luo. This contributed to a shortage of healthcare personnel, facilities, and resources. Hospitals and health centers in the region were forced to operate without even the most basic medical things like gloves, syringes, hot water, and first-aid equipment. Doctors, nurses, and other medical staff in the region were regularly forced to use the same syringe on patients without cleaning them adequately, thereby leading to the transmission of the HIV infection from one patient to another.
Due in part to these factors, the HIV/AIDS pandemic in Kenya had become so high that the government of Kenya was forced to intervene. In 1999, the President of the Republic of Kenya, Daniel Toroitich arap Moi, declared HIV/AIDS a national disaster. The National AIDS Control Council (NACC) was formed under the office of the president to control HIV/AIDS in the country. The NACC, in conjunction with World Health Organization (WHO), sponsored a group of health workers to go to South Africa to get training on HIV/AIDS. Upon their return these health workers were absorbed into health centers across the country where they established specialized units to deal with the virus. They were charged with monitoring these units as well as training others to start a grassroots movement.
The health workers identified Kisumu County, in particular, as among the most affected areas in the country, and gave it special attention. Indeed, even today, Kisumu County ranks number three behind Homa Bay and Nairobi counties as one of the counties most affected by the HIV/AIDS pandemic. In 2013, the Kenya Forum reported that a total of 1.45 million people in Kenya were living with the infection. Many of those people were in Kisumu County. Kisumu’s HIV/AIDS prevalence is twice the average infection rate in Kenya.
For this reason the Kisumu County government has taken extra measures to deal with HIV/AIDS in Kisumu County. Medical practitioners, scholars, HIV/AIDS activists, local elders, and other community leaders have begun working together to try and control the spread of the disease in the Kisumu County. The Kisumu County Governor Jack Ranguma has recently said that his government has allocated 30% of its budget on health to fight the HIV/AIDS problem. The Kisumu Deputy Governor Ruth Odinga has also dedicated herself to fighting against the spread of HIV/AIDS in Kisumu. Florence Atera, the Kisumu County Officer has asked Kisumu youth to abstain or practice safe sex. Joseph Okello, the Kisumu County Youth’s representative, has publicized the need for the youth to receive more sex education to raise awareness about the HIV/AIDS pandemic.
This is why the role of Chulaimbo in raising awareness about the HIV/AIDS virus, stopping the transmission of the virus, and providing support to those already infected and living with the virus in the County is very important. It is a health center that is well known for providing healthcare to those dealing with HIV/AIDS. Governor Ranguma has recently said that, although fighting the HIV/AIDS pandemic in Kisumu is going to be a long process, there has already been some success.
This success is in no small measure due to the role of Chulaimbo Sub-District Hospital. The road ahead for the people dealing with the HIV/AIDS pandemic in Kisumu County is still going to be a long one, but with health centers like Chulaimbo playing their part in raising awareness about the virus and reducing infection rates, controlling the impact of the disease could become a reality.
Sign Marking the Chulaimbo Sub-District Hospital: The prevalence of HIV/AIDS in Kisumu is two times higher than the national average. With such a high infection rate, Chulaimbo's treatment and awareness programs are crucial to fighting the pandemic. ~ Leonard Odhiambo Obiero
Voluntary Counseling and Testing Room: The Chulaimbo health center has 60 health workers and 30 nurses on staff dedicated to treating HIV positive patients and public outreach. ~ Leonard Odhiambo Obiero
A Hospital Ward: Chulaimbo’s mission is to raiseHIV/AIDS awareness, reduce the transmission and spread of the virus, and provide healthcare support to those already infected with the HIV virus so that they do not develop AIDS. ~ Leonard Odhiambo Obiero
The HIV/AIDS Clinic at Chulaimbo: Chulaimbo currently treats over 6,000 patients with antiretroviral drugs. ~ Leonard Odhiambo Obiero
Informational Signs Outside the Health Center: The large billboard above proclaims Chulaimbo’s mission as a leading health provider and points out that drugs for the treatment of tuberculosis, HIV/AIDS, malaria, and other epidemics are free. ~ Leonard Odhiambo Obiero
Walkway Between Wards: The walkway above leads to various in-patient and out-patient wards, including the ward for HIV-infected patients. ~ Leonard Odhiambo Obiero
The Main Gate to Chulaimbo Health Center: With HIV and AIDS afflicting 22-25% of the Kisumu population, many people rely on places like Chulaimbo Health Center for healthcare services. ~ Leonard Odhiambo Obiero
HIV/AIDS Prevention Message: This message urges care in preventing the transmission of HIV/AIDS from mother to child. “Kata Shauri, Tulinde Kizazi” is a campaign launched in November 2012 by the Kenya Ministry of Health and UNICEF to eliminate mother-to-child transmission. The slogan, in Kswahili, means “Make the decision and protect generations.” ~ Leonard Odhiambo Obiero