Poverty, inadequate diet main reasons for not taking drugs

“Nyinyi pia mmekuja kutupa? (Have you also come to dump  the stuff?), a man whom we will call Joshua asks the DN2 staff at a dumpsite as he empties the contents of a black plastic paper bag.”

We ask him what he is doing but, perhaps after realising that we are not from the area, he does not answer.

However, after we introduce ourselves, he opens up, although he does not appear completely at ease.

“This is where most people dump the vidonge (tablets),” he says.

We ask what kind of tablets and why he’s dumping them, and he replies that they are antiretroviral drugs (ARVs). But why dump the life-sustaining drugs, we ask, surprised.

His response is even more surprising: “Because they make my life “miserable,” he says.

“I feel very weak and drowsy whenever I take them. They are so powerful that if you don’t eat well, you cannot even get out of bed,” he offers.

Joshua, who tested HIV-positive a year ago, says he takes only a small fraction of the drugs he collects from the Homa Bay Referral Hospital and throws away the rest with the container.

The 36-year-old, who seems uncomfortable about what he  does, however, offers to introduce us to his friends who have been doing the same at the somewhat peculiarly named Shauri Yako slum, barely a kilometre away.

The slum, comprising hovels made of corrugated iron sheets, is densely populated, but has no pit latrines. It is here that we meet Jackson (he gave only one name), an-HIV patient living the county’s largest slum.

He welcomes us to his single-room house next to a dumpsite with an overwhelming stench.

GOOD PATIENTS

“Let’s talk quickly before my wife comes back. She has gone to buy fish on the shores of Lake Victoria,” he whispers loudly.

“She goes to the lake very early in the morning and buys fish and then heads straight to the market to fry and sell them. It is not easy for her to know that I’m on anti-retroviral therapy,” says Jackson.

His wife does not know that he is on ARVs, and he is not about to reveal the fact to her.

He religiously throws away the drugs on Friday evenings before she returns as he cannot risk having them in the small house for fear that that the mother of their two children might stumble on them.

 “I have told you my story, now please leave before you mess up my marriage,” he says as he hurriedly ushers us out.

“I know many other women who do not know their partners are taking ARVs. Their partners are among those who dump the drugs where you found me or hide them at their places of work in order to save their marriages,” Jackson says, as he leads us to his neighbour’s house.

The neighbour’s door is locked, so Joshua calls him.  The neighbour says that he is in the queue at the Homa Bay Referral Hospital waiting to pick up his anti-retroviral drugs.

We head there but when we meet him, he is reluctant to tell us his name. However, he readily  admits that he occasionally throws away the drugs even though he goes to the hospital to collect them every three months.

So why go to the trouble of picking up the drugs only to throw them away?

Jackson and his friend say they do not want to land into trouble with the hospital authorities and the police for “defaulting”.

“All the HIV patients have medical cards indicating the dates on which they should collect the drugs from the hospital. The nurses are very keen and if you fail to pick up the drugs, they trace you to your home and everyone will know that you are on anti-retroviral therapy,” the friend says.

The nurses alert the police if you fail to go for the drugs.

“I do want my name to appear on the list of defaulters. I throw them for fear of being ridiculed by my neighbours. I once heard some of my next-door neighbours saying, “Huyu mtu wa ukimwi siku hizi amenona” (This man with Aids has put on weight),” says the youthful man.

In what must be a major setback to the war on HIV/Aids, a considerable number of patients are not using the critical drugs as required.

Many of  the patients DN2 spoke to said they feared taking the drugs home for fear of being ridiculed by their families, or ruining their marriages if their spouses discovered their status.

Theirs is an unfortunate mix of ignorance, pain, fear, deceit and despair.

Most blamed poverty and joblessness for their desperate action. Physically drained by their situation, the mostly young men and women seek solace in alcohol and cigarettes, which only puts more strain on their health and families. 

NORMAL DUMPING

Some patients say the throw away the drugs because they cannot afford to eat well consistently, adding that to survive on the drugs, one must eat well.

Ms Zahra Hassan, the programme co-ordinator for the non-governmental organisation Women Fighting Aids in Kenya, says the “ARV dumpsites” have been in existence for four years.

The most popular one is barely 300 metres from the Homa Bay Referral Hospital. The others are in Salama, Kaburini (cemetery) and  Shauri Yako slums.

At the Salama dumpsite, we see a variety of drugs and packets strewn all over. We count count a total of  almost 200 packs and containers at the dumpsites.

Most of them are manufactured in Germany or India and supplied by the USAid/Kenya Pharma with the inscription “Not for resale” in bold on the packets.

A close look at the drugs shows that they have not expired.

The practice is so common that the residents find it normal to see the  drugs dumped at garbage sites or along the roads.

Mr Wycliffe Otieno, who lives in Shauri Yako, says most patients have lost hope and calls for more education on the management of HIV.

“These are all ARVs that have been freshly dumped. People have lost hope in life, especially the youth.  The fact that you are likely to die even after being put on life prolonging drugs is very disheartening,” says the 28-year-old Otieno, who tested HIV-positive five years ago.

Health officials cite stigma as one of the biggest challenges in the war against HIV. 

ALCOHOL PROBLEM

Otieno says he became the laughing stock of the neighbourhood and sought solace in alcohol.  But after counselling, he accepted his status and was finally put on ARVs.

He even promised the health workers at the then Homa Bay District Hospital, where he collects the drugs, that he would take them as instructed.

However, in December last year, he stopped due to excessive drinking and smoking. 

“I would drink a lot and forget to take my medication,” says Otieno, who collects garbage for a living. “Sometimes I would remember to take them after two or three days. This started after my mother died in September 2014. I think I became frustrated and lost hope,” says the Form Four leaver.

But Otieno still collects the  drugs from the hospital and dumps them at one of the spots in the town.

Another patient, Oliver,  29, -told DN2 he dumps the drugs at a local cemetery  because every time he takes them without eating a proper meal he becomes weak and ends up bed-ridden for weeks.

I take only two doses and throw away the rest. I’m jobless so I do not have money to buy food. I depend on well-wishers to give me food.”

Oliver’s wife of two years abandoned him as soon as she realised he was on ARVs.

“I am in a big dilemma. When you are sick, you cannot perform your duties well and getting a job in such a state is very tricky,” Oliver, a Form Three drop-out says.

He claims that most youths in the Shauri Yako slums are infected with HIV, and goes on to say, “I have 25 friends who are infected. They are aged between 24 and 28, and due to the many challenges, we do not take our drugs as directed,” he says.

Dr James Abwao, the acting medical superintendent at the Homa Bay Referral Hospital, says the drugs are issued to patients depending on their health status.

But Dr Lawrence Oteng’, the County Executive Member for health in Homa Bay, blames the unfortunate trend on the stigmatisation of HIV patients. However, he claims that the patients  throw away only  the packets and containers but not the drugs.

“Stigma is quite bad. They would rather throw away the containers and keep the drugs in their pockets rather than be seen carrying them,” Dr Oteng’ says.

Meanwhile, Ms Hassan cites food insecurity and poverty as the major reasons the HIV patients are not using ARVs.

JOBLESS YOUTH

Youths account for 80 per cent of the  people infected with the virus, and most of them are jobless, according to the Women Fighting Aids in Kenya report.

“Most of these people are languishing in poverty; they don’t have jobs and resort to prostitution to make ends meet,” says Ms Hassan.

To address the matter, young people, especially those infected with the virus, should be linked to microfinance institutions where they can access loans to improve their livelihood.

The network has registered 4,000 people living with HIV in Homa Bay County. It runs a programme, Food Basket, through which it supplies assorted items including maize, sugar, cooking fat, beans, salt and soap to registered patients who adhere to treatment and medication every month

In addition, the network provides seeds and fertilisers to farmers every planting season.

Ms Regina Ombam, head of strategic development at the National Aids Control Council (Nacc) describes the trend among HIV patients as worrying.

“We should look at the bigger picture, which could be a social issue here. For instance, what is driving young people into sex? Sex is being used for every transaction, be it food, jobs or education,” Ms Ombam says.

She calls for more education on the use of ARVs.

“It is evident that most patients do not take their health seriously, and that is why they are talking about lack of food.  HIV patients  are given supplements to give them energy when they visit the  hospital  so lack of  food cannot be an excuse,” she says.

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LIFE SENTENCE

Counselling patients helps them to take medicine

MR JOEL ODONDI, a researcher at the Kenya Medical Research Institute (Kemri) based in Kisumu County, says it is important to counsel HIV patients thoroughly before they are put on anti-retroviral therapy.

Mr Odondi notes that counselling offers them hope and makes them realise that contracting HIV is not a life sentence.

That way, he says, they quickly accept their status and start taking their medication. 

“When you disclose your status to your family, they tend to accept you and offer moral support. Disclosing one’s status helps reduce stigmatisation and discrimination against HIV patients and increases their willingness to adhere to medication and reduce behavioural problems,” he says.

The researcher says that ARVs should be taken continuously because they help suppress viral loads.

“A person on ARVs cannot infect another because he or she has a low viral load as opposed to a patient who has stopped taking the medication. They also prolong life and prevent opportunistic infections. For these drugs to be effective, the prescription must be adhered to,” Mr Odondi, who also counsels HIV patients, says.

Other advantages of taking the anti-retroviral drugs are that they improve the patients’ quality of life and prevent mother-to-child transmission.

It is notable that almost 90 per cent of the anti-retroviral drugs used in the country are donated by foreign agencies.