While the physical impact of HIV/Aids continues to devastate Africa, healthcare professionals in Kenya are making progress in addressing the psychological and emotional effects of this killer disease, writes Morag Prunty
Kenya is a testament to successful PR. With tourism as its second biggest industry after agriculture, one would be forgiven for thinking that this popular holiday destination was the "developed" face of Africa. Travelling from the capital Nairobi by safari bus the biggest slum in Africa, Kibera, is barely visible. This vast poverty-stricken area houses one out of every five people in Nairobi, yet it is cartographically invisible.
As too are the estimated two million people who are living - and dying - with HIV/Aids in Kenya. The stigma of the disease was such that in many African countries people preferred not to know their status. In some cases communities left those infected to die in isolation and families feared they would be contaminated themselves by dealing with such people. But things are slowly changing in Kenya.
Liverpool Voluntary Counselling and Testing (LVCT) is an non-government organisation set up in 1998 by a PhD student called Miriam Taegtmayei who worked with world Aids expert Dr Elizabeth Marum to provide a set of workable guidelines to test people for HIV/Aids. Since its inception, LVCT has partnered with the Kenyan government to help scale up quality- assured counselling and testing services throughout Kenya. They have trained most of the counsellors working across some 800 testing centres in the country.
Its headquarters are in Nairobi, although one is reminded everywhere one goes in the leafy, lush suburbs of the city that violent crime is rampant. With few exceptions, every middle class home or office building is surrounded with electric fencing; aggressive coils of barbed wire rim every wall. Carjacking is random, frequent and often fatal.
In a place where life is so tenuous, there is a perception that life is cheap. It's an unfair one that belittles the impact Aids has on the individual and their families. Dr Ernest Nyamato, a specialist in infectious diseases and LVCT's director of services, is a quietly spoken, large man.
"Usually by the time people come to us they are often presenting symptoms. They don't want to admit that there is a problem, but they have already taken a big step in coming here. We talk them through the test, and reassure them of the treatment and help available should they be positive - then we sit with them and watch as the test results come through.
"The results are instant - there is no waiting. If they are negative, we talk to them about prevention. If they are positive, we talk them through their treatment options and refer them on. The whole counselling and testing session takes 40 minutes per client," Nyamato explains.
All clients testing positive receive follow-up counselling appointments.
The Kenyan government has recently adopted LVCT techniques as official government mandated Aids testing. Three years ago, the government provided free antiretroviral drugs (ARVs) for all those living with HIV/Aids.
While these are positive moves, they appear to make little impact around the slums of Nakuru in the Rift Valley region, where Belfast-born Sr Patricia Speight at the Love and Hope Foundation finds that fear of diagnosis is one of the most challenging elements of her job.
"It is very hard for people to face up to having Aids," she says.
"Many of them are in a very bad physical state before they come to us. They are afraid of the stigma - of being rejected by their own families."
While Sr Patricia and her team of counsellors and nurses provide home care, nutritional and nursing support for more than 400 people living with Aids in the area, by far their greatest impact seems to be in the area of providing emotional and psychological support.
"We run support groups where our clients can come and talk to each other about the problems they experience around living with Aids. This is a huge part of our job, providing people with the tools and the language to tell their families. It takes a lot of courage to open up."
One of the newest initiatives in the area of emotional recovery from Aids has been memory group training that originated in Uganda in 1997. A programme designed to help children who are faced with the prospect of losing their HIV-positive parents, it is being used all over the sub-Saharan region as a useful tool in not only helping people come to terms with their status, but in bringing whole families closer in accepting the person's impending death.
One of the more heart-rending aspects of these workshops are memory books, where parents are invited to write stories and take photographs of themselves so that their children will have a record of their lives after they die.
Despite this, there are smiling faces at the Love and Hope Centre in Hekima as clients and counsellors suddenly start singing in the afternoon sun. In Aids-ridden Africa, it seems a little hope goes a long way.
Morag Prunty travelled to Kenya to visit Trócaire-funded projects.