I got fired for testing HIV-positive

When Peter Odonyo underwent his annual medical checkup as part of his job one Tuesday morning in 1996, his life turned upside down. He was handed a termination letter after his employer found that he had tested positive for HIV.

“I had no idea that the company I worked for in the hospitality industry had decided to screen us for HIV during the medical examination. Twelve of us were laid off. We were told that we needed to go for further medical check-up, and the first thing that clicked in my mind was HIV,” he says.

Losing his job and finding out about his HIV status threw him off kilter. He doubted the initial results, and thus sought the help of his brother, who used to work at the Kenya Medical Research Institute (Kemri), for a second opinion.

"There were no VCTs then and so after I left my blood samples, I would have to wait for a month before I got the results,” he says.

The wait was arduous, and it tortured him mentally.

When the results finally came out, Peter was in shock. He found it hard to tell his wife about his HIV status.

He started falling ill often, and to avoid facing his wife with the reality, he drowned his sorrows in alcohol.

“Being intoxicated meant that I could not have any serious conversation with those around me. That is how I was coping.”

But a few months down the line, he gathered courage after counselling and disclosed his status to his wife, who also tested positive.

The couple was not started on antiretroviral (ARVs) immediately because the drugs were not available in the country.

They only got Septrin to protect them from opportunistic infections. Peter and his wife started taking ARVs in 2005, when they became available for free to people living with HIV.

“I remember being trained on HIV Treatment Literacy by MSF Belgium, where we were taught about disclosure and self-acceptance. From that day, I knew why I was taking the drugs, and why I needed to stick to treatment regime.”

Peter says that to date, a majority of men are still reluctant to adhere to their antiretroviral treatment.

Statistics from the National Syndemic Diseases Control Council show that men have been experiencing a higher mortality rate from advanced HIV disease.

“Apart from men being socialised to be providers at home, there’s a certain pride that comes with being a man. Here in Africa, we do not want to be seen as a weakling, and this has cost many men their health and lives,” says Peter.

The World Health Organization defines advanced HIV disease (AHD) as someone with a CD4 cell count below 200; HIV-positive people with HIV disease stage three/ four, which includes TB, and Cryptococcal meningitis among other opportunistic infections in adults and adolescents. This includes both individuals who are on antiretroviral therapy (ART) for the first time and those returning to care after interrupted treatment.

All children younger than five years of age are considered to have advanced HIV disease.

Dr Rachel Kiuna, who leads the National Aids and STI Control Program at the Nakuru County Department of Health, notes that due to men and boys having poor health-seeking behaviour, the 2024 World Aids Day theme is targeted at this group of people who are adversely affected by AHD.

“Our data shows that men come with a late diagnosis, while others come for the first time with advanced HIV disease. Mortalities associated with this AHD are more among men than in women,”she says.

In 2022, Kenya updated its HIV Prevention and Treatment Guidelines to include the management of advanced HIV disease in order to reduce HIV/Aids-related morbidity and mortality.

Dr Kiuna notes that Nakuru County is a pioneer in training its health workers on advanced HIV disease.

“We have trained a total of 118 among them consultants, nurses, clinicians and lab technicians, so they can easily screen, diagnose, and even treat advanced HIV disease as fast as possible to save lives.”

Data from the National AIDS & STI Control Programme shows that as of June 2024, 1,080 men in in Nakuru County got enrolled on Antiretroviral treatment, while women who got enlisted were 1,877.  Some 191 men had a CD4 count of below 200, while 183 women fell in the same category. The demographics of those diagnosed with advanced HIV disease were 259 males while the females were 244.   On opportunistic infections like tuberculosis, 79 men tested positive, and 31 women.  Four men suffered from cryptococcal meningitis, with only two women testing positive for the same.

Dr Kiuna explains why men are highly likely to be diagnosed with advanced HIV disease compared to women, saying:  “Men do not go to the hospital immediately they notice something is wrong with their health. Further, many men work in congested work environments like the transport industry and quarries. They visit congested drinking joints.  Men are poor with their nutrition and there is the self-stigma that comes especially after a man has tested positive for HIV,”

Nakuru now has four centers of excellence for advanced HIV disease namely Nakuru County Teaching and Referral Hospital, Naivasha Sub--county Hospital, Molo Sub-county and Bahati Sub-county Hospital. They act as hubs or points of reference for lower level facilities and the community, taking into account the concept of Primary Health Care.

AHD is also classified as a Neglected Tropical Disease, which kills more than 600,000 people annually across the world, according to the Drugs for Neglected Diseases initiative.

Cryptococcal meningitis, which is the second leading cause of Aid-related mortality after tuberculosis, is currently being treated using liposomal amphotericin B and flucytosine as prescribed by the World Health Organization, but these medications are still not available in most Sub-Saharan countries.

DNDi began developing a sustained-release formulation of flucytosine in 2020, aiming to deliver a simpler, easier-to-administer formulation of the drug that is affordable and accessible to more people.

Peter notes that getting men, especially those living with HIV, to board the ship of acceptance and adherence to treatment would need the society to shake up the perceived gender roles that prevent men from being vulnerable.

“I am one of the men who are championing men's health-seeking behavioUr. This means developing programmes targeted to them and with a focus on counselling just like we have seen programmes targeted to empower women. When we do this, especially on the HIV and Aids warfront, we shall create health champions and adherence warriors,” he concludes.