Migration fans spread of AIDS epidemic in Africa

NAIROBI, 30 July (The Nation) — As 13,000 people dispersed at the close of the 12th World Aids Conference in Geneva, Switzerland, it was clear to Kenyans participating in the meeting that too little has been done at home. "You hardly hear about aids at home," says researcher Dr Ruth Nduati. "Yet in some areas, it is as high as 30 per cent. People are dying."

Although much has been achieved in creating awareness about the disease, the experiences of others show that much more remains to be done by the government, NGOs, media, people living with aids and wananchi (countrymen).

Most African countries were represented with their delegates calling for drugs to be made available to their people at reduced rates, enlightenment on state-of-the-art methods in HIV/aids care and treatment and sharing of ideas in policy and funding.

Senior high court judges discussed the dilemmas HIV posed in legislation. South African Justice Cameron in his presentation spoke of the need to ensure an essential rights-based approach to dealing with the epidemic which has seen some of the worst human rights abuses perpetrated in recent times.

Cameron questioned the persistent thinking that it is necessary to curtail individual human rights in order to safeguard public health including such practices as ostracising and deportation of people with HIV/aids. "Social deprivation and human rights abuses lead to vulnerability and the aids epidemic has shown that respect for human rights is an essential part of containment and prevention," said Cameron.

In the modern world where up to one third of the people are moving from their homes in search of employment, fleeing war or simply in search of leisure, migration emerged as an important issue that has to be thoroughly dealt within the context of aids.

Researcher Dr Josef Decosas, who works with ProAction in Accra Ghana linked the spread of the epidemic in West and Southern Africa to the strong economies presented by South Africa and Cote d’Ivoire and the history of migrant labour from neighbouring countries which serve them. "These migration patterns result in gender unbalanced communities both at the source of the labour and also in the target areas," Decosas told the participants.

In addition to the dysfunctional social organisations, migrant labourers also have to deal with disruption of their social support structures and deprived living conditions with poor provision for health needs leading to vulnerability to sexual behaviour and practices that spread Aids.

The use of criminal law to arrest the spread of HIV/aids generated widespread debate during the meeting which coincided with the deportation order made on a Congolese man by the Swiss Government after he was released from a three year jail term for infecting his girlfriend with HIV.

Joshua Odongo from Kenya who works as a health promotion advisor with African communities in London, stressed "HIV is not a crime," as he joined activists lobbying the Swiss Government to change its decision.

The diversity of representation at the meeting - researchers, people- living-with HIV/aids PLWHA, policy makers, doctors, private sector interests, NGOs - showed clearly an understanding that this is a multi- sectoral problem requiring concerted action.

Although Kenya was well represented at the meeting by the non- governmental sector, it was clear that there is little dialogue or co-ordination between them.

Roselyn Ngugi, a nurse and community health worker reported on work being done by the Kenya Medical Research Institute in collaboration with the Catholic Church to provide affordable health care for HIV/aids patients for the control of opportunistic infections in slum areas.

She said the church and KEMRI were producing cheap drugs to help in the control of respiratory infections, diarrhoea and skin infections.

The drugs include such novelties as the extract of a particular type of Frangipani tree which eliminated neurological pain and enhances the healing of blisters associated with herpes zooster when applied to skin infections.

Topical steroids creams have not been found to be as effective as a compound labelled KAD 94 which controls itchy and pseudomonas and other preparations for oral thrush were also mentioned.

Lecturer Gilly Arthur, of the University of Nairobi’s School of Medicine, presented research findings that Kenyatta National Hospital has become more efficient in the face of the epidemic. "There were fewer cases of advanced HIV/aids being admitted in 1997 and fewer deaths from aids," said Arthur suggesting that patients were being treated better and were better informed on how to care for themselves away from the hospital.

This was despite the fact that there was no increase in staff during the period and the increase in the incidence of people who tested HIV positive.

Award winning research came from Kenya’s Ephantus Njagi of the University of Nairobi who demonstrated that peer intervention strategies can lead to a sustained increased in condom use by commercial sex workers. The programme dramatically reduced the incidence of sexually transmitted infections.

Also awarded was Rupert Kaul also of the University of Nairobi for his research on the role of mucosal immune factors in HIV - susceptibility. His work involved the study of virus specific IgA in a group of highly exposed, HIV-1 seronegative commercial sex workers in the Pumwani slum of Nairobi.