Kenya: Why HIV Does Not Kill Anymore

Diana Wangari, CNS Correspondent, Kenya
(First published in The Star, Kenya)
When it comes to HIV, it is not the virus that kills you; it is everything else. Your body's immunity is weakened and some simple curable disease is what often gets you. The thought amongst many is that taking anti-retrovirals (ARVs) is all that one needs. But the struggle with HIV requires comprehensive treatment, including prevention of infection and psychological counseling. Therefore, the burden often lies in dealing with co-infections and, of these, TB is of great concern.

This is one such story of what it truly means to be HIV positive and infected with TB. Lying in the hospital bed, Joshua stared at the ceiling lost in thought. The hospital had been his home for the past three months and as the rest of the patients prepared to see their friends and relatives once it was12.30pm (visiting time for visitors), Joshua remained in his recumbent position.

No one would be coming to visit him; no one had visited him for the past two months. He had remained hopeful during the first few weeks, but as days passed reality dawned on him--they had all given up on him. But who could blame them? They all had their lives to be lived, plans to be made and goals to be achieved.

They did not need to be burdened by the likes of him whose luck seemed to be getting worse with every passing month or as some people in the village said, “a man who was cursed.” Joshua had tested HIV positive one year ago. He had been careless that one time and now the consequence would forever haunt him. The bar maid denied being the source and when he suggested that she get tested, she retaliated by spreading the word throughout the village that he was positive.

In a small community such as his, words spread fast, and soon everyone started avoiding him. People would whisper whenever he passed by and no one wanted to be seen walking with him. It was as if they were afraid the virus could be transmitted through contact.

Yes, so small and remote was his village that such myths reigned supreme. He was forced to close down his shop, as his loyal customers weren’t so loyal after all. However the biggest blow came when his wife left him. There was just so much she could endure and nothing more. Between the costs of ARVs and having to support both her husband and child on her meager earnings, something had snapped-- having to starve proved too much!

So she packed her bags and headed back to her parent’s home taking her child with her. This is what drove Joshua to Nairobi, the big city where a man could always find something to do even if it was cleaning toilets. Thus began his career as a ‘hustler’ as they are referred to in Kenya. He would do any job as long as it paid him and at night he would go back to the one-roomed shack, which he shared with two other men-- all hustlers.

So when the cough began he assumed it was a cold and when the nausea came he took it as a sign of exhaustion. When he collapsed on the streets, the few good Samaritans passing by rushed him to the hospital where after several tests he was diagnosed with TB.

He would have to be admitted. He had contacted his two surviving brothers who had come to visit him during the first few weeks. The pill burden of both TB and HIV started getting to him and he constantly kept a bucket beneath him when the nausea hit. The drugs had drained him of all strength, so much so that at times he never made it to the bathroom and often wet his pants.

But what really troubled him was the growing hospital bill and when he sought his brothers’ help, they disappeared. Joshua could not blame them, they were hustlers like him and he was a man with TB and HIV. And these were the struggles of living with HIV and TB co-infection.

Dr Anthony Harries, Senior Advisor, International Union Against Tuberculosis and Lung Disease says that: "HIV-associated TB can be controlled by better scaling up and implementation of tools that are currently available. We need to get more HIV infected people earlier on to antiretroviral therapy (ART) as this is an important way of preventing TB. We need to test all patients with TB for HIV and those who are positive need to start on ART and co trimoxazole preventive therapy as soon as possible. We have made good progress over the years but only by attaining universal coverage will we achieve victory."

It is thus imperative to have a strong coordination between TB and HIV programmes and integration of collaborative TB-HIV services into the general health services to deliver high-quality integrated TB and HIV care to thousands of patients like Joshua and also to remove misconceptions about the two diseases that are still there in communities.

  • 35.3 Million people were living with HIV in 2012 and approximately 1/3 had latent TB infection. HIV being a strong risk factor of developing active Tb disease.
  • Despite the fact that TB is curable and HIV is treatable, 320 000 people co infected with the two diseases died in 2012.
  • An estimated 1.1 million people needed simultaneous treatment for both diseases in 2012- 75% of them in the African region.
  • Of the TB patients found to be HIV+ in 2012, 57% were enrolled on antiretroviral therapy. 80% received co-trimoxazole preventive therapy as needed.
Source: WHO TB-WHO Factsheet 2012-13

Diana Wangari, Citizen News Service - CNS  
7 July 2014