By Mikhail Alexeev, of Russia's Medportal online service, who attended a Reporting HIV AIDS course in Nairobi in November.

The situation with HIV/AIDS in Kenya looks relatively stable in comparison with other African countries.

One of the fastest growing economies in Africa, Kenya gets lavish financial support for fighting the deadly virus, and international sponsors acknowledge the huge progress in fighting HIV in the country.

However the daily life of Kenyan medics on the streets of the capital city Nairobi may reveal a different picture.

Pumwani Maternity Hospital, one of the medical facilities, where inhabitants of Nairobi can get HIV testing and treating, is located in the east of Nairobi. Every day several HIV-positive women give birth in the gynaecological department of Pumwani. Furthermore, medical staff at the centre provide free HIV testing for everyone in need, women and men.

“We tested nearly 110 people yesterday,” Project Nurse Serah Njuguna told visiting reporters. The centre provides free anti=retroviral therapy (ART) for nearly 3,000 patients. This work is done by a small team of four clinicians and 15 nurses, Njuguna said.

Most visitors to the Pumwani HIV centre are women, most of them married, many pregnant or breast-feeding. Their husbands are much more reluctant to take a HIV test; HIV-associated prejudice is much stronger among men than women in Kenya. Women generally have more opportunities to get proper HIV counseling when visiting medical facilities when pregnant or when bringing in sick children. And every mother-to-be gets a mandatory HIV-test in Kenya.

One of the new patients at Pumwani, Jacqueline, 31, tested positive for HIV a month ago. She is still frightened and fights to keep back her tears. "My son is ten years old, what shall I do now?” she asks.

Jacqueline received anti-retroviral therapy immediately after her HIV test due to her low CD4+ cell count - a measure of the destruction of the immune system. “I was afraid to take these drugs. People say that by taking them you might lose good looks,” she says.

Virginia, a young woman with an exhausted face, holds a three-months-old baby in her arms. Two of her other children died and she does not know why; medics think they probably got HIV from their mother via breast-feeding. During her last pregnancy Virginia was taking ART. It is still unclear whether the surviving child has acquired HIV from his mother. Within several months, when it will be possible to detect HIV antibodies in the child’s blood, medics will perform tests.

The head of the Pumwani centre, Dr. Francis Nyamiobo, said: “The number of HIV patients is constantly increasing. Up to 60 per cent of Kenyan virus carriers don’t know their status.”

According to official figures,between 1.5 and two million out of Kenya's 38 million population have tested positive for HIV.

Besides counseling, testing and providing ART therapy for HIV patients, local medics are carrying out several clinical studies. One of them is dedicated to evaluating the effectiveness of SMS (text message) reminders which alert patients when they have to take their drugs or visit a clinic for further testing. First results of the trial are encouraging.

Majengo slum

The best-known research at Pumwani centre is the continuous monitoring of several dozen prostitutes in Nairobi's Majengo slum, who seem to have developed immunity against HIV infection. Despite constant exposure to HIV, these women have stayed free from infection for years and decades.

First reports of these cases of unexplained resistance date back to the 1980s, and the study is still going on. Dr. Nyamiobo believes that finding the cause of this phenomenon could lead to new drugs and vaccines against HIV.

Although prostitution is illegal in Kenya, many brothels operate in the poor outskirts of Nairobi. Targeted counseling and treatment of sex workers is conducted in a small medical centre located in the midst of Majengo spontaneous market – a huge gathering of hawkers and customers around piles of shoes, cloth and other commodities. Locals come here to get tested for HIV, other STDs (sexually transmitted sieases) and for free condoms.

Looking healthy

But it seems that free condoms and counseling won’t solve the problem. Clients of local prostitutes almost always object to having safe sex. Margaret Hangui, who has worked as a prostitute for nearly 20 years, says: "If you propose to a man to use a condom he will not go with you. Sometimes they beat you for refusing having sex without condoms, they may rape you.” Margaret tested positive for HIV several years ago and now she is on anti-retroviral therapy.

Fatuma Wangui, 27, at first claimed she was HIV-negative despite working as a prostitute since she was 18. “I am trying to be careful and I always use condoms,” she said. However, a few minutes later she acknowledged that she does have HIV and has been taking ART for nearly four years. Fatuma is reluctant to reveal her status to strangers even in the hospital – she can lose her clients, her only source of income. All HIV infected prostitutes conceal their status from relatives, friends and fellow sex workers.

Another sex worker, Hidai Wanjim, said she was arrested and raped by policemen in jail. “I told them that I have HIV, but they didn’t believe me, because I’m looking healthy”. she said.

Senior project nurse/counselor Elizabeth Bwibo said: “Sometimes you feel desperate when you work with these women, many of them don’t take their medications or refuse testing because they can’t stop working. You have to keep your moral beliefs to yourself while trying to help, they cannot change their lives...”

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