THE FUTURE OF HIV / AIDS MANAGEMENT AMONG THE POOR IN KENYAN SLUMS AREAS

When i heard the story on the NTV station about sisters of death, i was so curious to get to understand better. I was very eager to hear the real story.I followed the broad cast and at the time of sharing the findings of Jane Ngoiri and her colleague......i was left shocked and speechless.this was the shock of my life.

while seated on the couch in the house,several questions were very clear on my mind:-where are the research findings that tell us that the combination of formalin, molasses and anti-retroviral drugs(ARVs) make a healthy brew? Where was the study on use of formalin in alcoholic drinks for living bodies done? who scientifically carried out research on the number 2 use of ARVs- that is use in alcoholic drinks? this is abusive,selfish, criminal, morally incorrect and misleading.
several people as we read the summary of the article below have given their opinions on the story. As i read and hear the story, the following themes remind me of the existential realities of poor vulnerable slum dwellers in the capital of Nairobi;

-poverty
-gender
-free market economy-role of black markets
-corruption
-misinformation
-HIV management.

All theses thematic areas are going to seriously affect the current and future of HIV/AIDS management among the poor people in urban slum areas, and more so on HIV prevention strategies. The impact will be felt by many people. facilities that render health care services to kenyan citizens will need to rethink on a system that will assist in tracking ARV users and treatment supporters-but especially those on the ART.At the same time, cost implication for the government especially on the resistance of ARV. Some innocent and deserving people will end up not accessing the free ARV medication if rules will be changed. Mortality and morbidity will increase. As we face the future, we need to re-think again how we can b effective in HIV/AIDS care, prevention and management among poverty stricken and vulnerable communities.

Let us follow the the story as it is told below;

The dangers illicit traders are exposing thousands to by using HIV drugs and formalin to brew alcohol. Photo/NATION
By JANE NGOIRI jngoiri@ke.nationmedia.com And AGGREY MUTAMBO amutambo@ke.nationmedia.com
Posted Wednesday, August 29 2012 at 01:00

In Summary
• The dangers illicit traders are exposing thousands to by using HIV drugs and formalin to brew alcohol
They pounded and mixed. They brewed. They distilled. Then they shipped it to the black market, hoping against hope that a few hundreds of the thousands of social butterflies ensnared by cheap liquor would find their concoctions fulfilling.
With Kenya ranked by the World Health Organisation as the most drunk nation in East Africa, these merchants of illicit booze knew they had a ready and willing market. Nothing could go wrong.
But as the Nation team found out last week while deep in the dense slums of Korogocho, Nairobi, although there was an ever ready market for this most bizarre of boozes, something was not right in the way it was made.
Not that the ingredients mattered to the consumers. Here, all that mattered was how fast your Sh50 could send you to an artificial high.
Still, how do you explain that freaky ingredient called Anti-Retroviral Drugs that will never find its way onto the label on the bottle?
During the filming of the NTV investigative news report aptly titled Sisters of Death, two women who ‘starred’ in the piece told us that they initially just wanted to ‘experiment’ on the effect of the drugs on the potency of their brews.
Then they learnt that patrons liked the new strength. So they kept increasing the number of tablets.
By the time they agreed to speak to us, they were putting nine ARV tablets into every five litres of the spirit they brewed.
And their patrons seemed to like the new potency that the ARVs added to their intriguing product.
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It all started from a conversation overheard by one of the women, whom we shall call Mary to protect her real identity, and who had been on ARVs since 2009.
“I would take the medicine at 9pm and, by noon the next day, I would still be feeling tipsy,” she told us. “Then I heard some women say that the ARVs could be a source of income.
I asked them how, and they told me I could make a fortune by selling the tablets... so long as I kept it ‘top secret’.”
HIV patients are normally given 60 tablets per month, but Mary and her peers have discovered that they don’t have to go through the daily ritual of swallowing two tablets every day, and so they sell them at Sh35 per tablet to illicit brewers in Nairobi slums.
The buyers then pound the tablets into a fine dust, mix the powder with molasses and formalin (a preservative used in mortuaries), then distil the mixture in the dark of the night. After four hours, the vapour from the concoction is bottled as an alcoholic spirit and distributed to Nairobi joints.
Mary and her friends have mastered the art of sustaining the ARV supply. Some have either registered — and got prescription cards — at several government clinics, or simply go back claiming they lost the tablets.
Dr Mohamed Ibrahim, the Head of the National Aids and Sexually Transmitted Infections Control Programme (Nascop), says the thousands who unwittingly consume this concoction are putting themselves in a very scary position
“If you take ARVs when you are healthy, the drug would not work on you when you get infected because you would have had an optimal dose, meaning you would have developed resistance to the drugs,” he says.
We could not establish whether the effects of this abuse of prescription drugs have started taking root, but Dr Ibrahim’s warning means that there are possibly thousands of people who have developed resistance to ARV medication, and who would therefore face the full wrath of HIV should they get infected.

Cotu Secretary-General Francis Atwoli is livid. “The government should comprehensively investigate this incident,” he says. “This is what happens when you give ARVs to people who are poor and cannot afford to buy the food to accompany the drugs. What else do you expect?”
The biggest danger lies in the way the three ingredients of ARVs, formalin and molasses are concocted together without any consistent formula. Most ARVs, for instance, combine Lamivudine, Nevirapine, and Zidovidine at the ratio of 150mg, 200mg and 300mg per tablet.
The US Food and Drug Agency (FDA) says that the drugs, which sell under various brand names, belong to a class of prescription medicine used as HIV inhibitors. They work by blocking the release of enzymes that help the Human Immune-deficiency Virus to replicate their DNA so that the virus keeps multiplying in the human body.
Users of these drugs, therefore, do not eliminate the virus from their bodies, but restrict its multiplication. Sometimes though, each of these components is taken alone, depending on the stage at which the virus has spread.
Dizziness, confusion, headache, and general lack of appetite are some of the side-effects associated with the drugs. Coincidentally, these are also the feelings you get when you take safe, conventional alcohol.
That means the men and women who drink the illicit brews of Korogocho and other dens will never know what they are ingesting until it is too late.
Most are duped into thinking that all they are taking are distilled molasses, the refined product of that thick, brown substance that resembles honey which is a by-product of the process of making sugar.
It is enjoyed as a sweetener in many countries, especially in bakeries. Its weird use, though, must have begun long time ago. In Charles Dickens’ Nicholas Nieckleby, starving students of Mr Wackford Squeers’ school used to take molasses to reduce their appetite for porridge.
Then, in the US, people started using it to make rum. In Kenya, most makers of illicit brews like chang’aa add it to cereal solutions (in place of sugar), ferment it and distill.

As for formalin, the US National Cancer Institute would be horrified to learn that unscrupulous brewers have found this interesting use for it. Formalin — or formaldehyde when in solid form — is a flammable, strong-smelling chemical often used as an industrial fungicide or disinfectant. It has also been used as an embalming agent in mortuaries, although many countries in the West have banned its use.
The Institute warns that the chemical can cause cancer “after high or prolonged exposure”. All that short-term exposure would do is cause your eyes to water, besides the coughing and burning sensation in the places it comes into contact with.
When these three ingredients are combined in one concoction, there can only be one outcome; disaster. Little wonder, then, that the slums of Nairobi and other informal settlements have the highest fatality rates occasioned by alcohol.
The government says it is going to investigate this illegal business, but before it extends its arms there, Mary and her colleagues are likely to have found another way to dupe the system and, by extension, their customers.