“Yes, I get the ARVs, but I cannot afford to put a simple meal on the table,” says Wa Kimani*.
“This is why I had to register at two treatment sites, so that I could get ARVs [anti-retroviral drugs] twice: utilise one set from one site, then sell the other batch from the second site, so that I can get something small to put in my stomach.”
Wa Kimani sat outside one of the centres where he receives treatment, awaiting the client who buys medication from him. The stigma that continues to surround Aids in Kenya has apparently made the client wary of obtaining ARVs through official channels — something he fears may lead to his HIV-positive status being made public.
Wa Kimani, who is unemployed, began selling the drugs last year. He charges his client just less than $7 for a month’s worth of medication.
“This is not much, but at least it helps me purchase some basic food so that I do not take the medicine on an empty stomach. It can be dangerous, you know,” Wa Kimani says.
“I remember once, before I thought of the trade, I would take the medicine without any food — just porridge alone. I nearly died. I got so weak, I developed ulcers which have not healed well until now.”
Until the beginning of this month, government facilities had been charging about $1,4 for the same amount of ARVs. However, the fee was waived from the beginning of this month. About two million people are living with HIV/Aids in Kenya — more than 200 000 of whom require ARVs. Wa Kimani’s case does not seem to be unique.
Patricia Asero, a member of the Kenya Treatment Access Movement, says she has heard of six other people receiving ARVs from more than one centre. “I got interested and investigated the matter further because these people belong to the same support group as me. I found out that they had registered in more than one treatment centre so that they could get extra drugs to sell and buy food to take with medication,” she said.
In some cases, patients who only have one source of drugs will also sell their ARVs to buy food, added Asero.
“They will tell you that their medication got lost; others claim that their bags were snatched by thieves. But when you interrogate them keenly, you get to know the truth,” she noted.
With official figures indicating that about 56% of the population lives below the poverty line, the temptation HIV-positive Kenyans face to sell their medication is huge. “The fight against HIV/Aids must be coupled with the fight against poverty. If not, we are wasting our time,” says Omu Anzala, a senior lecturer in the department of medical microbiology at Nairobi University’s School of Medicine.
The Kenyan government claims to have steadily increased the number of people receiving ARV medication in recent years: 39 000 patients were treated in 2005, up from 24 000 in 2004.
“The government should get away from giving us numbers. It should be concerned about the quality and sustainability of the service. These numbers mean nothing when the majority of the patients are skipping or selling drugs,” says Anzala.
The alleged sale of ARVs by some patients, and the erratic way in which others take the medicine, has raised fears of drug-resistant strains of HIV in Kenya.
“When we talk about comprehensive care in HIV/Aids, nutrition is part of it. But the government has neglected it; it only provides nutritional counselling and that is it,” notes Asero.
“Some treatment centres may only give a packet of ujimix [porridge flour] per month. This is nothing.”
* Not his real name