Kicoshep

[Guest guest]

Members,

I want to share these two articles about Kicoshep, a project in Kibera, with you.

I’m very worried about my friends

As darkness descends on Kibera, a slum in the Kenyan capital of Nairobi, two groups of boys battle for victory on an unmarked dirt soccer pitch. The light is fading so quickly that the 15-year-old goalkeeper, Kennedy Arinda, has to squint into the gloom to protect his goal, which is framed by two upright twigs. The scores are level at 1-all and, despite the deepening shadows, not one of the young footballers wants to stop playing before he has scored the winning goal.

When the referee finally blows his whistle to signal the end of the game, the exhausted boys groan in unison and head for the sidelines. Now that the fun is over, Arinda and his helpers from the Kibera Community Self-Help Programme (KICOSHEP), a local non-governmental organization supported by UNICEF, are gently corralling everyone together for a serious chat about girls, relationships, sex and AIDS. KICOSHEP, in addition to supporting some 500 Kenyan children orphaned by AIDS, helps young volunteers like Arinda in their efforts to raise awareness about the spread and prevention of HIV, the virus that causes AIDS.

Tonight’s conversation is about safe sex. For Kennedy Arinda, it’s personal.

Arinda’s father died of AIDS in 1995, followed by his mother a year later. After a month of fending for themselves, the young man and his four siblings moved in with their maternal grandmother, 62-year-old Vugutsa, who lost four daughters to AIDS and now receives financial support from KICOSHEP to help her look after her 13 orphaned grandchildren. They all live together in a mud hut measuring 10 feet by 10 feet.

“The biggest problem is ignorance,” said the young man. “If we can just gather them together like this to teach them about HIV and AIDS, then there is a chance they can be saved. Some listen to us. Others don’t — one day they might regret it.”

Courage to change

One fifth of the estimated 2.2 million Kenyans living with HIV live in Kibera where there are at least 50,000 children orphaned by AIDS. “I’m very worried about my friends,” says Arinda. “So many of them have two or three girlfriends on the go at any one time. It is so easy for them to get infected.”

In Kibera, young men are largely uneducated and influenced by a highly promiscuous culture. “Boys here start having sex as young as 10 years old,” explains the young counsellor. Educating boys and young men about HIV and AIDS presents one of the biggest challenges in modern day Africa, home to 70 per cent of the people in the world living with HIV. But activists like Arinda, willing to be scoffed at for breaking with the norms, are slowly making progress with their peers.

Having tired them out on the soccer pitch, the team from KICOSHEP engage their peers in a frank dialogue about sexual health. There is laughter and much boasting. Some of the boys tease Arinda for abstaining from premarital sex, but they sit still long enough to listen to the message.

In addition to organizing these soccer matches, Arinda and other volunteers from KICOSHEP perform songs with AIDS-awareness messages. It isn’t hard to attract an audience. There is very little to do in the slum and few of the adults have jobs.

But it’s the children in the audience who matter most to Arinda and his group. Since only about half of the children here get any formal education, these popular street performances offer the vital information that could quell the spread of AIDS.

As night falls, the young soccer players wend their way home through the crowded streets. The air is filled with the sounds of thumping disco music as streams of men cram into makeshift bars for cheap, home-brewed beer and a chance to flirt with prostitutes. Alcohol and casual sex go hand in hand. But Arinda and his mates from KICOSHEP are ready to wage another battle for victory. This time, the arena isn’t the soccer field — it’s the streets of Kibera and the goal is to save lives.

Family Crisis, Community ResponseWhen AIDS strikes Kenya's breadwinners, community groups help families cope. by Helen Epstein

Summer 2002

Stone/Corbis

Anne Owiti, head of the Kibera Community Self Help Program, with neighborhood youngsters who organized to clean up an open sewer.

Nairobi, Kenya--The bright afternoon sun shines off rivers of sludge between narrow passageways in a section of the Kibera slum accessible only by foot. Only two roads in this precinct of tiny shacks and mud houses are wide enough for a car to pass through. Milicent Ovwanda, a nurse on her way to visit one of her patients, stops, not sure how to cross the mud. An old woman with an enormous bundle on her head and a chicken nestled in her arm shows her how--by hopping stone to stone. It is November, when it rains every morning in Nairobi. Ovwanda, who provides home-based nursing care for the Kibera Community Self Help Program, knows that her patient, , like many poor Kenyans with AIDS, has no other source of care. Lying in bed in her dark shack, is too weak to sit up when the nurse arrives. Ovwanda can offer several forms of assistance, including food, antibiotics, herbal remedies, aspirin and emotional support. But when she asks how is feeling, does not want to talk about her health. She is worried about what will happen to her children when she dies. Will they be able to stay in school? Who will take care of them? "Don't worry about the children," Ovwanda says. "You just worry about your health for now. We will figure out something for the children." Much of the debate over what to do about AIDS in Africa has centered on medical issues, especially access to antiretroviral drugs. Some day these drugs--now used only in small, experimental treatment programs--may be available to extend the lives of people like . But Kenyan activists are not waiting idly for that day to come. Armed with vision and determination, they are taking steps to break the cycle of desperation and disease that puts one generation after another at risk of getting AIDS. Their efforts are demonstrating that local action can play an important role in caring for people with AIDS and ultimately slowing the epidemic. In Kenya, one in every seven adults carries H.I.V., the virus that causes AIDS. Unlike tropical diseases that mainly kill young children and the elderly, AIDS strikes the young men and women who earn the money and grow the food that supports their families. When these breadwinners become sick or die, children are forced to drop out of school, and grandparents struggle to find some way of supporting them. Land pressures and political tensions have compounded this situation by driving huge numbers of young people to urban slums (see box below). The dismal economy leaves them few options, and many desperate youth resort to prostitution and drug abuse, putting themselves at greater risk of contracting the virus.

Stone/Corbis

A Nairobi woman with grandchildren she is raising because both their parents died of AIDS.

More than one million people live in Kibera, an area that measures roughly one square mile. Most of them have no electricity, no running water and no sanitation. The streets seem more crowded in contrast to the expansive green fairways of a golf course that abuts the slum. Many residents rightly attribute this deprivation to government corruption and skewed policies. Ovwanda's pledge to do something for 's children might have been an empty promise if not for Anne Owiti, a fellow nurse known for her hope, vision and endless stamina. After opening a health clinic in Kibera in 1987, Owiti saw how AIDS not only ravaged many of her patients but also devastated their families. She began taking in AIDS orphans, cajoling community leaders to help fight the epidemic and creating opportunities for young people to construct a more hopeful future. In 1991, noting her clinic's broadened mission, Owiti reconstituted it as the Kibera Community Self Help Program, known as KICOSHEP. Today its compound of several clay and mud buildings buzzes with activity. On a given day one might find children playing outside and a group of teenagers listening to a young volunteer talk about how to avoid H.I.V. Inside, Owiti and her nurses attend to patients, monitoring the progress of one woman's pregnancy and treating others for symptoms of AIDS. Other clients visit KICOSHEP's social workers who counsel them on problems ranging from coping with the stigma associated with H.I.V. to putting food on the table. KICOSHEP offers free and confidential testing and counseling through six other sites in Kibera.

Kenyan activists are taking steps to break the cycle of desperation and disease that puts one generation after another at risk of getting AIDS.

In searching for affordable and effective ways to treat her patients, Owiti has found reason to believe that herbal remedies may help. Eighty percent of Africans use traditional medicines and many of Owiti's AIDS patients rely on such therapies to alleviate diarrhea and fever, curb opportunistic infections and boost immune systems. Owiti has also been managing the participation of 40 KICOSHEP clients in an observational study of the clinical benefits of a Chinese herbal compound made in part with herbs grown in Kenya. According to Owiti, preliminary results show improved health among many participants. In a district where there are no public squares and few places for youth to congregate, KICOSHEP often serves as a community center, particularly for adolescents. In Kibera, fewer than half of the youth attend school--usually because they can't afford the fees. KICOSHEP offers several responses. For children whose parents are sick or who have died from AIDS, it runs a small orphanage and a school for 450 children. It provides food, clothing and school fees for 600 others and coordinates sports and social activities that give young people an alternative to hanging out in the streets. KICOSHEP volunteers, some of them AIDS orphans themselves, engage other young people in efforts to promote AIDS awareness and prevention, including the use of condoms. Peer counselors help youth deal with such issues as domestic violence, drug abuse and the shock of receiving a positive H.I.V. test. Finally, KICOSHEP provides skills training and small loans to help young people generate income.

Stone/Corbis

A Nairobi sex worker (right) with her mother and daughter in 2001. She died a week after the photo was taken.

"All my life I wanted to be a barber," says one young man. "I used to watch my uncle do it when I lived in my village." Now he runs a popular barber stall under a tree in Kibera. Others work as carpenters, hairdressers, grocers and cooks. They are the lucky ones. Experts say there are more than 600,000 AIDS orphans in Kenya. Owiti estimates there are 50,000 in Kibera alone. Despite the scale of the problem, local and national officials have been slow to respond. Owiti knows the only way to help that many people is to raise public awareness and change public policy. Lately KICOSHEP has scored important gains on both counts. To counter the stigma associated with AIDS, Owiti and her staff have conducted educational seminars for influential church and community leaders. Many now recognize the powerful role they can play by publicly accepting people with H.I.V./AIDS and by educating churchgoers about H.I.V. A minister who once complained about condom posters, for example, now displays them in his church. He also lets KICOSHEP hold regular health screenings on church property. Other religious leaders now see AIDS counseling as an important part of their ministry. "We have learned to get church leaders to interact with us," says Owiti. Such progress helps her envision a day when "we'll have a very different picture of AIDS in Kibera." ActionAid, a development group based in London, credits KICOSHEP with getting Nairobi officials to take some responsibility for providing basic health services to Kibera residents. After negotiations with Owiti, health authorities agreed to provide some resources, including land, to KICOSHEP. And they agreed to see that patients referred by KICOSHEP get prompt treatment at the district hospital instead of waiting six hours, the typical time it takes to see a doctor. Owiti also arranged for a doctor from the hospital to see patients at her clinic once a week. Owiti acknowledges that the work of getting the government to address the problem has just begun. But she has made a start. "We simply couldn't allow the authorities to ignore the problem," Owiti says. "We had to act and we've managed to come up with one solution that works." When Lucy Mathai first came to Nairobi's Pumwani slum seven years ago, she, too, was looking for solutions. A former journalist then serving as a representative of a Christian aid organization, Mathai saw a link between high rates of unemployment and H.I.V. infection among youth. "Too many young people were idling around with little or nothing to do," she recalls. Wondering what might happen if they had a constructive alternative, she began to seek out youths who were open to exploring how they could bring positive change to Pumwani. Inspired by her message, several young people wrote a kind of manifesto titled "Sauti ya Pumwani," or "Voice of Pumwani," articulating their concerns and aspirations. As it circulated through the community, other youth joined their budding movement. In 1997 the group--then numbering about 40 young people--adopted the name SIDAREC, an acronym for Slums Information Development Resources Center. Today it is one of the largest youth organizations in Kenya and was cited by United Nations Habitat as a model for other such groups. Mathai serves as coordinator. SIDAREC youth are becoming more vocal about the world they live in and more active in shaping their future. For instance, in a recent issue of their magazine, Slum News, Omondi, a SIDAREC member, calls on the government to extend services and land ownership rights to slum residents. With candor and conviction, the magazine is helping mobilize the community to fight for better sanitation, health services and an end to land-grabbing, in which outsiders seize open space held in common or in government trust. "Around here, one problem gives birth to another," says Mathai. But each new challenge seems to offer SIDAREC youth another opportunity to demonstrate their flexibility. When the group held community meetings, for example, people were most concerned about the city's failure to collect garbage in the slum and the hazard this poses to public health. Now its young members gather and dispose of refuse, repair sewage systems and public toilets and clean children's playgrounds. One problem may lead to another, but Mathai also maintains that success leads to more success. Investing in the potential of some youths, she says, attracts others. Before long, a pool of skill and talent emerges. SIDAREC members also stage plays and puppet shows in schools and other places to debunk myths about AIDS and provide accurate information about it. Several youths are trained to counsel their peers about such issues as living with H.I.V./AIDS, overcoming drug abuse and escaping prostitution. Others lead sports clubs, organize tournaments or host forums in which youth and elders have been able to bridge their differences. The local youths who manage SIDAREC's computer center have trained more than 2,000 young people in information technology, and SIDAREC's new cyber café has become a popular hangout where young people can access the Internet and send and receive e-mail.

Not long ago, got up the courage to have an H.I.V. test. 'I found I was negative,' she says. 'I will never return to prostitution.'

"SIDAREC has made the impossible happen in the slums," says Onyango, a trainer in information technology. "Some have been able to land jobs; others are thinking of starting their own cyber cafés. We have learned that young people can do wonders if given the chance to succeed in life." As Judy Waihuini walks along a road where sex workers often ply their trade in the Nairobi neighborhood of Majengo, she talks about the brothel she used to run. "I told the young women how to be prostitutes," she says. Now she spends her days convincing women to leave sex work and gives them the tools do so. She is an organizer for the Kenya Voluntary Women Rehabilitation Centre, known as K-VOWRC. The organization was founded in 1992 by Dr. Ngugi, a community health professor at the University of Nairobi, who set out to help the city's prostitutes protect themselves from H.I.V. At first, she distributed condoms and information about where to find treatment for sexually transmitted diseases. But many women told Ngugi that they would leave sex work altogether if they had other ways to earn money. To help women set up informal businesses she began to offer small loans and lessons in bookkeeping.

Stone/Corbis

Second from right, a woman who supported herself as a sex worker until a small business loan allowed her to open a beauty parlor.

Further down the street Waihuini passes a condom poster that reads "Trust for Maximum Protection." Cultivating trust is the first step in trying to convince sex workers to join K-VOWRC, she says. "If I know you are a prostitute, I will find a way to be your friend but I won't tell you where I work right away. Later, I'll talk about the dangers of prostitution and the many women that I helped." One such woman is Wanjiku Njuya, whose parents died of AIDS when she was in high school, leaving her in charge of two siblings. She turned to prostitution to support them. "Someone told me about Judy so I went to see her and she was moved by my story," she says. Soon after Njuya joined K-VOWRC, the staff offered her a loan to sell vegetables and fruit and some training to help her new business succeed. Sitting on an overturned bucket in the bright sun, Njuya breaks off the outer leaves of a crisp head of lettuce. Her fruit and vegetables are spread out before her on a clean cloth by the road. "The day I got my loan I was so excited," she says. "I'd never seen so much money in my life and I knew my life was going to change. Because of the training I received my business is going smoothly. I thought it would be hard but customers have been coming." She cuts an orange into sections for a customer. "I'd like to start selling other kinds of food so that next year I may get a stall." Although the loan repayment rate has climbed to 90 percent, not all of the businesses supported by K-VOWRC are doing as well as Njuya's. In some cases, that is due to illness--many of the women are H.I.V. positive and as they get sicker, business slows to a halt. During those times, K-VOWRC members often lend a hand, visiting an ailing member with a meal or seeing that she gets health care. K-VOWRC helps keep members connected by organizing group meetings to discuss nutrition, health and business development. Importantly, research carried out by the University of Nairobi shows that the K-VOWRC program has achieved significant results in terms of boosting women's income and changing risky behavior, an outcome that is often elusive in H.I.V. prevention efforts. Findings include an increase in safer sex practices among borrowers as well as a decline in their drug and alcohol consumption and, among their dependents, improved rates of school attendance. Not long ago, got up the courage to have an H.I.V. test. "I found I was negative," she says. "I will never return to prostitution."

'A Community Problem'

Stone/Corbis

Lucy Nkya at an orphanage in Morogoro, Tanzania.

Dr. Lucy Nkya, a medical doctor, got her start in H.I.V. prevention more than 10 years ago, when she went to the slums of Morogoro, Tanzania, pushing a wheelbarrow full of condoms. On Saturday mornings she would distribute them to sex workers she had discovered sharing condoms--when they could find them at all. Today, Dr. Nkya is a member of Tanzania's parliament and advises health workers and nongovernmental organizations around the country about how to run effective AIDS care and prevention programs. Tanzania is one of the poorest countries in the world, but Nkya's organization, the Faraja Trust, has shown just how much can be achieved with dedicated volunteers, a comprehensive strategy that is sensitive to local needs and support from local institutions, including religious groups and government officials. Faraja has 63 volunteer counselors, nurses, teachers and community activists who bring food and medicine to people with AIDS and their families. Faraja also runs a school for orphans and gives small loans and business advice to former sex workers and other unemployed young people so that they can start small enterprises such as handicraft shops and hairdressing salons. Early on Nkya learned how this work can produce results. In 1992 she began helping 450 sex workers from the country's largest brothel find alternative work through small loans and training. Two years later, 20 women remained and the brothel has since been demolished. Creating jobs and expanding education, especially for girls, is crucial, says Nkya. "Economic opportunity will reduce the transmission of AIDS among youth." It is too soon to measure the effect of Faraja's programs on H.I.V. incidence in Morogoro, which, at 20 percent, is twice the national average. But the organization has greatly increased awareness about the disease and reduced the suffering and hunger of many AIDS-affected families. Nkya works through existing community structures to reach large numbers of people, an effort that is aided by Tanzania's decentralized system of government. Nkya trained government officials in Morogoro's 19 wards, each of which formed its own AIDS committee. These committees conduct awareness campaigns, recruit youth volunteers and refer hundreds of people to Faraja's services. Nkya has also encouraged religious leaders, both Christian and Muslim, to take initiative. "Islam has its own strategy for community mobilization," says Ayoub Muinge, who chairs an AIDS committee of 24 imams from Morogoro. "From Faraja they learned that H.I.V. is sexually transmitted. Before that they didn't know. They kept hearing 'AIDS, AIDS!' in the streets, but the proper truth about AIDS they got from Faraja," he says. The imams do not condone condom use, but evidence from successful H.I.V. prevention programs in Uganda suggests that encouraging young people to delay sexual activity and to have fewer sexual partners can cause H.I.V. rates to fall. Moreover, says Nkya, the imams have helped break the silence around AIDS. "They are talking about it in mosques, at mulids [religious festivals], and even at burials," says Nkya. The value of reducing the stigma associated with AIDS cannot be underestimated, she says. More people feel free to come in for H.I.V. testing and counseling. "People with AIDS are now able to speak openly and assist us in raising awareness," she says. "It's very effective when this happens." Still, discrimination against people with AIDS persists. For example, many widows in Morogoro who have lost husbands to AIDS have had their property and even children taken away by in-laws who blame the widows for the husbands' deaths. Faraja's lawyer has defended many of these women, and even though Tanzania's courts can be corrupt, Nkya says, Faraja has never lost a case. She attributes that to Faraja's strong support in local government and legal circles. Increased demand for Faraja's services prompted Nkya to form the School Without Walls, a program to train other organizations to mobilize their communities to meet the challenges posed by AIDS. Currently Faraja staff members are training 34 organizations from the 10 regions that make up Tanzania's mainland. But even with this kind of reach, Tanzania faces a lack of resources and widespread poverty that will continue to impair efforts to fight AIDS. Nkya is concerned that too many people still view the epidemic in Africa as simply a medical problem. "We've over-medicalized what is really a community problem," she says. -H.E.

The Economics of AIDS

comes from a rural village in Kenya's Central Province; she moved to Nairobi at the age of 22 because of what she calls "problems." "She means poverty," explains Milicent Ovwanda, a nurse, translating 's Swahili into English. already had four children, and her family did not have enough land to support them. Soon after she arrived in Nairobi, she met a man who helped her set up a small business selling vegetables. For a time she made enough money to send some back home to her children and the rest of her family. But now she has AIDS, is too sick to work, and is worried because she has had two more children here in Nairobi. Leaving 's house, Ovwanda says that had not, in fact, come to Nairobi to sell vegetables, but to work as a prostitute, and that was how she had earned the money she sent home to her children. 's situation is not unusual and her story, in some ways, is the story of Nairobi itself. Until the 1890's, much of Kenya was open grassland, where Maasai herdsmen grazed their cattle. At the turn of the 19th century, the British established a railway town--Nairobi--which eventually became one of the largest cities in Africa. Early on, the British recruited native labor to build the town along with the railways that crisscrossed the territory, but they did not want to bring in and settle entire native families. To force men to leave their villages alone, the British imposed a "hut tax" on rural families, which had to be paid in cash. That meant men had to find wage-paying jobs in the cities or on the railway lines, but the jobs did not pay the men enough to support their families and pay their taxes. They still needed additional income from their farms, which were tended mainly by their wives and daughters. By 1911 there were six men for every woman in Kenya's cities. In the late 19th century, when a rinderpest epidemic killed off cattle throughout East Africa, young farm women had to find other ways to supplement their families' incomes. Around this time prostitution emerged along the railroad lines and in the growing cities of Nairobi and Mombasa. During the past 20 years, Kenya's rural economy has again faced a series of crises, prompting mass migration to the cities. Most of the best land in colonial Kenya had been appropriated by white settlers, who established large commercial farms. Since independence in 1963, the Kenyan government has failed to make good on its promises to redistribute land fairly. And when Kenya's baby boom generation reached its twenties in the 1980's and 1990's, land became even scarcer. Today most of the large farms, and the best land, are in the hands of politicians and businessmen with close ties to the ruling KANU party. Meanwhile, since their inception in the 1970's, Kenya's rural development programs, which aimed to relieve rural poverty through the construction of roads, irrigation systems, fish ponds, schools and health facilities, have been hobbled by corruption and mismanagement. Under the influence of the World Bank and International Monetary Fund, Kenya embraced the free market in 1993, but the terms of trade for agricultural products are very poor, making it extremely difficult to make a living as a small farmer. After Kenya's Western donors insisted that the nation hold multiparty presidential elections in the early 1990's, corrupt KANU politicians instigated tribal clashes in some rural areas as a way of intimidating the opposition in the run up to the 1992 elections. More than 300,000 rural people were displaced, mainly to urban slums like Kibera. The clashes also hurt the tourist industry, which further contributed to rural poverty. All these factors drove huge numbers of unemployed migrants into Nairobi and other Kenyan cities in the 1990's, making them some of the fastest growing in the world. In Kibera alone, the population swelled from 250,000 in 1988 to nearly 1.5 million today. Health care, social welfare assistance and job training and opportunities, inadequate to begin with, were no match for the increase in people. Among the inexorable results has been Kenya's rising incidence of H.I.V. and AIDS. -H.E.