The Star (Nairobi)

20 December 2012

Kenya: No Sex, No Fish

Photo: Wendy Stone/IRIN
HIV test being carried out (file photo).

The HIV/Aids prevalence rate in Mbita district currently stands at 26 per cent against the country's seven per cent. Habil Onyango explains why this is the case and the efforts to stem new infections.

Wycliffe Odhiambo* has been a fisherman at Rombo beach within Mbita district for the last eight years after spending over a decade in the neighbouring Remba Island. Odhiambo, 32, a father of six, barely visits his family back in Ugenya. Reason? He gets everything he wants at the beaches.

"Why should I keep on going home every now and then while all the stuff I may need are readily available at the beach?" Odhiambo asks. Odhiambo, whose work begins at 6pm and ends between 8 and 9am, has been in the business for 20 years.

Due to his busy schedule, Odhiambo barely get time to go to hospital for voluntary counselling and testing and whenever he gets time, the queue at various health facilities drive him away. "The last time I tried to go for VCT, I found a very long queue which made me to return home without testing."

Odhiambo is just one of the fishermen who have neglected their families at their rural homes and engaged in risky sexual behaviour at their places of work.

According to Nicholas Ouma*, who is a fisherman at Rombo beach, going for VCT takes a lot of their time. "We always come from the lake at around 8am. At that time we need to sell and preserve the remaining catches, and we hardly get anytime to attend to other issues," he said.

"At the same time, we must catch a little nap in readiness for the night job, and we rarely get enough time to attend to go for testing."

Ouma, who revealed that he has been involved in unprotected sex with numerous sex workers, says he has never checked his HIV status. "I have never gone for any testing; queues are always long and I cannot waste my time waiting," he said.

The father of four, who left his family at Kawabwai in Ndhiwa, disclosed that even his wife has never been tested yet he sees her once or twice a month.

Ronald Ochieng, 28, a fisherman who tested HIV positive two years ago has since defaulted taking the prescribed ARVs and his health keeps on deteriorating day by day.

Ochieng, who is based at the neighbouring Ngodhe Island, says the long distance to the nearest health facility and his busy schedule made him discontinue his medication. "Sometimes back I went for the drugs but I was discouraged by the large number of patients. I had to wait for several hours in Mbita before I could get back to the island which made me lose hope," he said.

There are only two major hospitals, based in Mbita and Rusinga, which serve the population living in over 100 beaches and several islands.

However, the situation might change after the commissioning of a drop-in centre for the fisherfolk at Tom Mboya Health Centre within Rusinga Island.

The centre is tailored-made for the fisher community where its members get tested, counselled and receive drugs within the workplace.

The facility, which has been sponsored by the Ministry of Public health, DEVLINK-AFRICA, an International NGO, and the local community, will serve the fishing community and their families

It has been initiated due to the need for effective tackling of the disease among fisher folks, a group considered most at risk of HIV/Aids infection.

The facility will provide services such as VCT, VMMC, TB testing, guidance and counselling and will distribute ARV drugs. Esther Soti, the NGO's director, said the facility will help reduce the HIV prevalence rate in the region.

She says they came up with the integrated HIV prevention strategy which includes biomedical, behavioral and structural approach to help minimise the gaps that lead to new infections among the fisher folks.

"A fisherman goes to the lake at night, comes back in the morning; he needs to prepare the catch, sleep, sell the fish, when he goes to the hospital for treatment or testing he finds a long queue, finally he loses hope," Soti said.

The facility will be independently operated and fishermen will voluntarily visit for peer support, treatment, testing and counselling services.

"The fisher folks have their peer educators who know their colleagues and whenever any feels like visiting the facility, he will be issued with a referral letter which will not include whatever he is suffering from," she said.

Soti said the patient will be tested and treated free of charge and in case they cannot handle the complication, they will refer him or her to their partners who deal with the relevant condition.

The project was initiated after a case study in two locations in Mbita district within Homa Bay county. "The survey helped us to get the data on the characteristics, sexual behaviour, other risk factors and estimates of population sizes of the fisher folk within the beaches of Rusinga Island," Soti said.

"This will guide the development and implementation of the effective intervention measures and address the critical information gaps that are contributing to the new HIV infections," she added.

According to the District Aids and STIs Coordinator Joseph Onyango, the HIV/Aids prevalence rate in Mbita district currently stands at 26 per cent against the country's seven per cent. He says the care-free lifestyle and the 'floating' money are the major causes of the rising cases of HIV/Aids infections in the area. "Fishermen engage in unsafe sex without considering the dangers they are putting themselves in," Onyango said.

He says with their tight schedules, very few get the time to go for VCT and even those who have already tested positive never return for the drugs.

Onyango said with the introduction of the drop-in centre, the second one in the district, they expect more fishermen to get access to various services. "The services will always be readily available to the fishermen and their families; they will be accessing it any time," Onyango added.

Mbita Health ministry's Mathew Ajwala said they have already attached two trained nurses to the centre. He says depending on the number of clients, they will consider increasing the number of nurses.

Ajwala said the "fish for sex" trade is fuelling the new infections in the region. "Due to the high demand for fish within Homa Bay County due to the water hyacinth which has covered parts of the lake, some fishmongers are forced to exchange fish for sex. Sadly very few use protection," he said.

Asca Anyango*, a fishmonger who transports the catch to Nairobi, says they are sometimes forced to give in to sex in order to get the fish.

"For one to maintain the high demand for fish, we must create 'concrete' relationship with the fishermen which automatically leads to sex," Anyamgo said.

*Not real names.

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