Scientists widen hunt for elusive Aids cure

The AJS building on Keekorok road in Nairobi, which houses the Sex Workers Outreach Programme or SWOP clinic. Photo/Courtesy UoN

What you need to know:

  • Scholars now target popular CBD spots in the continuing search for solution

Efforts to establish why the famous Majengo prostitutes continue to defy the Aids causing virus have now been intensified to include women operating in the central business district.

For almost two decades, some of the best scientists in the world, using state of the art facilities, have been trying to find out why these women are not infected with HIV despite constant exposure.

While the first attempt to design a candidate vaccine around this theory failed three years ago, scientists at the universities of Nairobi and Manitoba, Canada have mounted a new and more comprehensive assault on the problem using the same women.

Bars and brothels

Previous efforts were manly restricted to Majengo areas of Nairobi, but now the researchers have cast their net much wider with their teams recruiting volunteers right inside the City in such popular drinking places like Good Hope, Modern Green, Karumaido (Sabina Joy), Three Aden and Simmers.

The move to include prostitutes working in the CBD started 12 months ago, according to Dr Joshua Kimani, the programme’s clinical director. The first phase involved mobilising these women from their working stations -- bars and brothels and educating them on safe sex, HIV and other sexually transmitted diseases.

Those willing to be tested for HIV, or treated for other venereal diseases, were referred to a clinic in Majengo.

“However, this did not work well because only about a quarter of those mobilised went for services at the Majengo clinic with the rest citing distance, lack of bus fare and time as some of the obstacles. Consequently there was need to bring the services closer to the clients,” Dr Kimani said in Nairobi last week.

So in August, a classy and chic clinic was opened at the AJS building along Keekorok Road, opposite the famous strip joint called Liddos.

“It was important to open a facility with an attractive face because most of our clients are young, flashy and fashionable,” says Dr Kimani.

So far the facility has screened and treated some 500 prostitutes and reached another 1,500 with safe sex education.

Another similar facility; Family Care Centre, operates at Ribeiro House, next to Ramogi Studio on Luthuli Avenue, Nairobi.

However, this facility is run by an NGO called Family Health Options Kenya and also caters for other publics.

Free condoms

Dr Kimani was categorical that no research is carried out at the Keekrok Road clinic called Sex Workers Outreach Programme or SWOP.

“This clinic acts as a drop-in centre where this marginalised group can access free condoms, quality health information and care in a safe haven,” says Dr Kimani.

However, those prostitutes who volunteer to participate in research are referred to the Majengo clinic.

Other areas in Nairobi where various Aids research related vaccine activities are going on include Kangemi, Korogocho, Pumwani, Kibera and Majengo.

With all these activities going on, all kind of rumours are in the air. Interviews by Nation at several recruitment zones brought out a lot of conflicting information.

Zoni, not real name, a tall attractive girl of 24 dressed in a tight fitting jeans trouser and a low cut blouse is all bubbly about the subject. We are sitting strategically at a corner where she can easily spot a prospective catch.

In fluent English, the mother of one says she has participated in some of the projects awareness activities and even been treated at the Swop clinic at no cost. However, she says she has heard of women who are asked to donate blood, a lot of blood, which is used for some mysterious research.

At this point, she hurriedly jumps up to accost what she says is a regular customer who had promised to ‘M-Pesa’ money for services he had got on credit, but had defaulted. Their exchange becomes violent and the bar management sides with the man and our source is thrown out.

Fortunately for us, other prostitutes sitting at the next table jump into the topic and it becomes a free for all with all unsubstantiated claims flying around.

Some are outrightly outrageous, like being asked to donate three bottles of blood per sitting; but others quite plausible, like the amount of money being paid out. The Sh200 they are paid for a visit and blood donation, they say, is too little.

Like many other Kenyans, they are surprised that anyone can offer a prostitute (much stigmatised in society) free medical services and at a very classy clinic, better than those attended by other publics.

“There must be something they are not telling us,” says one of the prostitutes.

“The claims have no basis at all; however in a new programme of this nature, such teething problems are expected but as we progress things will become clear,” says Dr Kimani as he went ahead to table documentary evidence proving that the project was operating above board.

“We know the issue of compensation, sometimes called motivation, is sensitive and I am just from South Africa attending a conference on the same issue.”

Compensating research volunteers is a hot debate in scientific circles with some groups in favour of meeting the direct costs spent by the participants such as bus fare. Others offer more and have been criticised for what is called undue inducement.

Rising inflation

In the Majengo study, says Dr Kimani, they compensate participants for travel expenses, time lost and a little for opportunity forgone, all which they calculate at Sh200 per visit.

"However, due to the rising inflation and high cost of travel, we have recently doubled this,” says Dr Kimani. He is categorical that those attending the City Centre clinic are not compensated because they are not on a research programme.

Peer leaders, those who bring in new recruits in the programme, are now being paid Sh4,000 per month. However, this is pegged on a performance contract which requires one to recruit 20 new prostitutes per month and teach another 20 on the proper use of a condom.

It now emerges that, while the Majengo prostitute may find Sh200 adequate and not grumble because on average this could translate to almost four sexual acts, this is bound to be looked down upon by those operating in the City since they charge more for their services.

“The other questions we were debating in South Africa is what if some gene is responsible for these women’s resistance. How do you compensate them in case such knowledge leads to a successful vaccine,” says Dr Kimani.

The project’s other partners include the City Council of Nairobi, Ministry of Health, National Aids and STDs Control Programme with funding from two US bodies, the President’s Emergency Plan for AIDS Relief (PEPFAR) and Centres for Disease Control and Prevention (CDC). The Gates Foundation is also a major donor to the research programme.

As displayed by Dr Kimani, the project has been vetted and approved by the Kenyatta National Hospital’s Ethics Board and for every person participating in the study, they do so after every aspect of the research is explained to them. After this, they sign a consent form which is written in both English and Kiswahili and each gets a copy to take home with them.

While the Majengo clinic takes blood for research, Kimani says it is nowhere near the amount those women are talking about but only collects 20mls- 30mls for the key studies, maximum four times in a year. After this blood and sometimes urine samples are collected, they are delivered to the project headquarters at Kenyatta National Hospital where a high security Biosafety Level 3 laboratory is being put up by the Canadians.

This lab is able to handle some of the words hottest organisms like ebola, marburg and anthrax though some aspects would still have to be investigated abroad in a Biosafety Level 4 lab.

A further reason, Dr Kimani advocates offering SWOP services is because there has been a shift in Aids control programmes with more emphasis being laid on high risk groups who act as an infection bridge to the rest of the population.

A new issue that is emerging is the rising number of male prostitutes, who Dr Kimani and other social researchers prefer to call men who have sex with men. Some statistics indicate there are about 500 such prostitutes in the CBD.

It is claimed that men who buy sex from men pay a premioun price. This comes with all the attendant health risks associated with anal sex.

Alarmingly high

Surprisingly, says Dr Kimani, contrary to popular belief that prostitutes are masters in the usage of condoms, facts on the ground reflect otherwise.

“Women reporting condom breakage at the Swop clinic are alarmingly high and it is mainly because of poor usage.”

An emergent trend, he says, is to use two or more condoms expecting to get double or triple protection, or even more couples are using both the female and male condoms in the same act, but this only increases friction and the chances of breakage.

“For safety, use one condom at a time,” says Dr Kimani.

The other reason for the high rates of condom breakage in commercial sex, says Dr Kimani, could be because the nature of the environment is characterised with need for money and not pleasure and also the high number of sexual acts in a short period could all lead to virginal dryness.