HIV and AIDS: The Global Inter-Connection

POSITIVE DIALOGUES

Margaret Mwangola and Rose Mulama
Interviewed by George Orick

Margaret Mwangola is a liberator. She founded the Kenya Water for Health Organization (KWAHO) over ten years ago, and she has liberated approximately one million women from the time-consuming, mind numbing work of carrying water daily from rivers and ponds to their villages. Given clean water, the prerequisite of good health, and released to redirect their time and energy, these village women have created an ecosystem of development. Schools rise, gardens thrive, water-borne diseases diminish, longevity increases, and profit from new small enterprises organized by the women is invested in community projects. Says Margaret Mwangola, "The African woman who does not go to the river gives birth to a new woman."

This interview took place during a two week visit to KWAHO villages in western and southern Kenya. For three days of that tour Margaret was accompanied by Rose Mulama, the KWAHO programme manager for the Lake Victoria region. Rose, a sociologist and single woman, brought a different generational perspective to the discussion the two women shared about HIV. They spoke of a growing awareness of the epidemic among the women of KWAHO villages, citing in particular the village of Kakamega, near the Kenya-Uganda border.

ROSE: HIV is a reality now. It's in our midst. As we see our own relatives dying, we have begun to accept that we must take preventive action, and also provide care for those of us living with this disease. Statistically it's difficult for me to say where it's more prevalent. It's very difficult to determine whether it's a town or a rural problem. Within our African setting, when people are infected, they normally go back to their rural communities to die. So, even if they got infected in the urban areas, the impression is that there are more cases in the rural areas. This is why, over a year ago, the women in the village of Kakamega decided to organize themselves to do something about HIV. They decided to come together to talk about how HIV is spread and what they can do to prevent it by working together with their husbands ware that if people were more faithful each other, and could stick to one partner, then we would be able to reduce this epidemic. It is a good thing also that polygamy is actually dying because of the economic situation. Men cannot afford to have two, three wives anymore. One wife is more than enough.

MARGARET: In your generation, my darling. Someone died last week in my church, and they didn't know he was a polygamist. We cannot deal with the present and not deal with the past.

ROSE: It's so difficult to actually guarantee that a man is not still going to go out with other women. This is our problem.

MARGARET: He will go. That's the problem.

ROSE: The issue is not polygamy anymore. It's the issue of people accepting that HIV comes about by not having some self-control. If people can appreciate that aspect, then I think it will help.

MARGARET: I agree, but in Africa it will never happen because of the upbringing of our men. They're led to believe they are kings for the women. So we must also deal with the root problems.

I come from the coast where polygamy is not strong, but some of my people are Muslims. My sisters-in-law think I'm very lucky because my husband has never thought of it. Maybe I'm too much of a handful and will not allow polygamy to take place in my house. That doesn't stop me from feeling for my sisters-in-law who are in this situation. If you are lucky, you can control your husband, but you control him within your house, within your bedroom. It is the society that controls the man, and therefore we have this conflict.

ROSE: In the past maybe some women were content with the fact that they had no control over their men. He owns the house and he owns the bedroom. But this was as long as the woman didn't want the headaches of chasing him around to find out what he was up to. Then HIV came in and now people are nervous. It's not an issue of control anymore, it's an issue of when he returns, you are also going to be a victim of something you have not actually participated in. This is what is making people like the women in this community of Kakamega start to address what can be done about it.

MARGARET: I couldn't agree with you more. If I may speak for the married women, they are now more worried than the single women. If you are unlucky, you may have a stubborn husband who is ready to die from HIV anyway so he will go with anybody he wants. Yet you as a married woman are trying to be very careful, trying not to have another partner in your married life. Because of your husband's attitude, though, you can die. It's a very frightening experience.

And in our marriages, you do not necessarily stay with your husband every day. The husband can be in Mombassa, the wife can be in Kakamega or Machekos. And chances are that the men have plural marriage affairs. So the woman is in a very difficult position.

I would recommend this: if any education about HIV is to be done, it must be addressed to men first. We women want to care for our families, our brothers and sisters, and the people around us, but our lives can be cut short by someone who is careless. Someone who claims to get drunk and not know what he's done afterward. And you, the wife, are in a very helpless situation. Even as much as women in the northern countries are controlling their men, there is also this plural arrangement of having mistresses. So I do not think the women in the developed world are as powerful as they want us to believe. There is something we share: unless a husband is completely faithful to you, I think we are all singing the same tune. It doesn't matter what age, the husband can bring it home.

If my husband wanted to be a polygamist today, I don't have one traditional power to stop him from doing so. In modern Kenya I could stop it because I want him for myself, for my children, and for our home. At the same time, if he would keep me and still keep mistresses, one in Mombassa, one in Kisuma, and another in Nairobi. In that case I'd be very happy if he officially became a polygamist. At least then I would know who the other woman is.

Traditions that could be useful in this area should be looked into. At my age I'm trapped in between. I cannot be the modern woman. I must address both worlds. When I go home, my aunt who never went to school, still goes to the river a mile away to fetch water. I must walk with her, and I must carry the heavier calabash of water while she carries the lighter one. We return home talking. Instead of being an executive officer in Nairobi, I'm now a real African woman, serving my aunt. The international community expects me to behave like an executive. An executive of what? When I go back home I must be my traditional self.

ROSE: When we work with these communities and their water, it brings them together as a group with a common goal. One of the issues that we address is to reduce the burdens they face as women in terms of water collection: the time they spend, the distance travelled, and the risks involved in drawing water. Once they can be relieved of these problems, they then have time to sit and look at other serious problems that are affecting them and to see what they can do about them as a group.

MARGARET: The major emphasis of our programme has been on the health between the tap and the mouth; the container we bring water in; the boiling of water at home; the use of sand filtration; or what can we do to prevent water borne diseases within the village. Through this process we bring more awareness about HIV. I don't want it to be a subject that will supersede all other health issues, but I agree that it's a very important thing.

ROSE: AIDS takes time before it really germinates; we all may look healthy, so we don't even know if we have the virus. We do not have drastic numbers of deaths, one after the other, but the women can see that it is happening elsewhere. They want to take precautions.

That was very big step for them as a community. They're trying, in spite of their not being fully informed about the disease. You can hear some of them saying: "It may be coming out of use of dirty water, use of latrines, and so forth," which is not true. In spite of that, they're still making efforts to educate one another. I think that is the major first step. From a village point of view, they have really made a big step ahead.

MARGARET: Extension workers have also supported the villagers with health education material. They are urging doctors and health visitors to hold listening forums and discussions, and calling for seminars and workshops to go into more detail regarding how the community can protect itself from HIV. Not all organizations in Kenya are involved in these activities; there are specific ones such as the Red Cross, Family Planning Association, and health sector non-governmental organizations, that are mandated by Ministry of Health to do this. We in the KWAHO office, for example, can only draw upon them to come and discuss the disease in the evenings and show films, but we do not carry out the HIV prevention program as such. I've seen that the Ministry of Health seminars include men. So it isn't only the women that break the news about HIV in the villages. We hope that this approach has improved the dialogues within homes and families.

With more people becoming educated and aware now, and more exposure taking place among families, women are traveling to the cities to attend seminars and conferences. We find positive dialogues, even where some husbands and wives do not have effective communication at home. HIV has brought about discussion. Everybody's afraid for their lives. Now it's very fashionable to hear someone talk about the disease, what is going on, and how the people are dying. However, very few of us really understand what's going on.

In most African countries, issues related to sexuality and childbearing, issues that are sensitive on those lines, have never been a subject of easy reference in any home. This is a very private cultural matter. It embarrasses everybody. Family planning was impossible to introduce in Kenya because many years ago there were tribes that wouldn't talk about controlling births. So you have to face cultural difficulties.

Rose, you are in the age group of my daughter. In Africa, I do not discuss with my daughter issues related to sexuality. My husband's sister or my sister discussed that with her. But in modern Kenya, I can do it. My sisters will not come to Nairobi to talk to my children. I can't find the time to go to my sisters' houses and discuss these things with their children. And my aunt is too old and too busy to come to the city.

So, we parents of today are left with no option but to be friendly to our children, to discuss their personal secrets with them and to try to help them. I have teenage sons. Each time they want to enjoy themselves I tell them, "You have to be careful because it is no longer safe nowadays." Traditionally, I would never do that; I would have no business telling my sons to be careful. But if they go out and become infected with HIV or my daughter does, who is the loser? Is it not me? So I have said to hell with the traditions, I must tell my children.

ROSE: I support that very strongly. People cannot handle HIV as a secret thing anymore.

MARGARET: The women talk. I do not imagine that they have the factual knowledge to carry out serious discussion of this subject because many of them don't understand Kiswahili or English. But the information process, as disorganized as it may be, I would not dismiss altogether. I think the word is spreading: "There is this disease. Look after your daughters. Look after your sons. Be careful of your husband if he persistently comes home late. Maybe it's good to talk to him."

This is now going to bring in the use of condoms. Eventually, the old myth about men not getting their satisfaction with condoms will be overturned. Lives will be saved, if condoms do save lives, because satisfaction and sexuality are just at the back of your brain.

I want to believe what doctors and nurses are telling people; that the chances of saving one from HIV is greater if there is a practice of using condoms. But you don't just come into a village and begin to discuss issues related to sexuality. HIV will not give women the mandate to control their husbands. Maybe insights and ideas on how to approach the subject quietly with their husbands would help.

ROSE: I think influencing the husbands is one thing, but controlling them is another. The approach with which we share the problem with them and sensitize them to the seriousness of its effect on us and the family is more important than trying to seize control of their habits. They're human beings, they have a capacity to listen. They are also being affected.

MARGARET: Then there is the issue of the people who have someone sick at home. This is very hard: the moment you announce Margaret Mwangola has become infected with HIV, because of the way it has been perceived, the people run away. The person living with HIV becomes a severely isolated, medically feared person, whom nobody wants to be near. Then the agony the family goes through, let alone the sick person, is unbearable. Something ought to be done to bring positive education to everyone.

ROSE: The major problem would be in terms of how we can help those of us who are living with the disease. We all know how difficult it is to provide care and counselling, especially in a rural setting where there are other illnesses like diarrhea and dysentery.

I would appeal for some kind of assistance to give that kind of support and to try and create more awareness of prevention in the rest of the rural communities, particularly for those of us who are not yet affected and for the younger generation.

MARGARET: I can tell you quite frankly, I'm so afraid of this disease. I don't stay with my husband, and I don't have the ability to check his movements; so, like the village women, I am afraid too. And because I am dreading it, it must affect my relationship with my partner.

I can assure you that AIDS information, the way it has been mishandled, has created more separations and divorces than ever before. People are full of distrust. They're full of fear and they're not enjoying themselves because they're waiting to be told that they are positive. It used to be syphilis, now you've got a killer disease. And who is going to be responsible for these broken marriages? It's bad enough, without the AIDS component, that a lot of husbands and wives are not talking.

How do you expect widows to manage their lives without one or two boyfriends? How do you expect women who are frustrated in their marriages to manage their sexuality without a boyfriend somewhere? How do you expect a man who is a widower, or a man who can't get along with his wife, or a man who has a medical problem with his wife not to have a partner?

If I was told my sister had AIDS, my immediate reaction would be, "Oh, poor Mercy, what will she do?" All the neighbors would run away from her. Her husband would also run away from her, and maybe her children would leave. Who is going to help her? If I touch her, am I also going to get it?

Why all these negative feelings? For goodness sake, whoever discovered HIV, please discover another method of also putting across hope for the future.

Until now the whole approach on this issue has been completely wrong. Instead of making us all aware and careful, people have been instilled with fear. People are afraid of one another, afraid of those living with HIV, and afraid of getting the disease from their husbands and wives. If fear were dispelled, it would lead to positive education and prevention which would be much more effective.

ROSE: I don't think the issue of where HIV came from is very important. If the white man or the European continent is so disturbed about the deaths caused in Africa by this epidemic, what are they doing about it?

MARGARET: It's no use sitting in New York, Paris, or Copenhagen and assuming that anybody who is a community leader, or in an executive position, is knowledgeable about AIDS. Maybe there should be a major campaign of basic preventatives, basic information kits that can even be given out in churches, schools, youth clubs, the scout movement, non-governmental organizations such as KWAHO, and government ministries. A package that tells you how you can deal with it, whom you should go to first, and how you can prevent spreading it.

ROSE: It's the hopelessness we all feel about what we can do that makes people just say, "Okay, let me tackle it sort of individually." Then, in the final analysis, we realize this is a very slow and defeatist approach because you do not live in isolation. In a case where you're married, you cannot guarantee one hundred per cent that your partner won't cheat on you. So it is helplessness and hopelessness that makes people now shrink back and not get involved. This has created more ignorance amongst us.

How do we help one another to accept that the disease is here; that it is happening because of a, b, c, or d? We need to share and accept this as the world's problem, and march together to find a solution to it. If it means more research on how to cure the disease, if it means support in terms of strengthening the preventive measures, then this is what we are calling for.

We are asking, "What's the outlook?" The United Nations Development Programme, for example, is concerned about this problem. What kind of support can it come up with? How do we support those who are already living with HIV? How can we address ourselves to the present before we think of the future, especially when everyone is fearing that the entire human race is going to be extinct, or that by the year so-and-so half the population or the younger generation will be wiped out?

MARGARET: Even if they can gather millions and billions for AIDS programmes, unless they implement them with full participation from the recipients, they are wasting their time. They can keep their millions.

In Kenya we have taken positive steps to curb the spread of the virus. The Ministry of Health is spending millions of shillings on education every week. Everybody's being encouraged to help educate people, create awareness, and become volunteers.

I must see to it that KWAHO as an agency, and community leaders within KWAHO, will play a substantial role in community awareness, community health education, and HIV prevention. Through our unified action, it may not take long before we reach a point where we can triumph over this disease. There will be no wiping away of the world.

Biographical note

George Orick is a writer and editor for many American newspapers and magazines. For thirteen years he was a writer, producer and news editor for several ABC network news shows in New York, including The ABC Evening News and 20/20. Mr. Orick lives in France.