Tiampati Ole Kirgoty, 45, looks tired and can hardly support his frail body. He and his two wives are HIV positive. They are supposed to pick up their monthly prescriptions of antiretroviral drugs (ARVs) at the district hospital in Narok, capital of Kenya’s Rift Valley Province, but this presents a dilemma for the Kirgotys who belong to a nomadic Maasai community.
They regularly leave their main home in the village of Olo Lungunga in Narok South District to find better grazing for a herd of cattle that is their main source of livelihood and wealth. At such times, reaching the hospital in Narok to pick up their medication is extremely difficult.
“For me what is really important is to get good grass for my animals because they are the only wealth I know,” Kirgoty said. “They [health workers] tell us to stay around here to always take medicine they give you, but my animals also need food.
“They are the future of these many sons you see here; when I die they will divide [the cattle] amongst themselves.”
Kirgoty has missed a number of visits to the hospital to get his ARVs, but one of his wives, Nampuoyi, a mother of seven children has made the monthly trek a priority, however far the family moves away in search of pasture.
“I cannot miss to go for the medicine because my small child also needs the medicine to survive,” she said. “My husband is valuing the animals more than his life. Even me, if it were not for the child, I would not go when we move far away.”
HIV infection rates amongst the Maasai have reached alarming levels in recent years. The National AIDS Control Council, which coordinates Kenya’s AIDS response, estimates that 30 percent of Maasai are now living with HIV, about four times the rate among the general population.
While cultural practices such as wife sharing have made the Maasai particularly susceptible to HIV, their nomadic lifestyle has hampered the delivery of life-prolonging HIV/AIDS treatment.
Nasela Kiampai, 33, told IRIN/PlusNews that she had lost two children because her husband’s insistence that the family keep moving with their livestock had made it impossible for her to keep them on ARVs.
“We were advised by the doctor to always take the children to the hospital for care after they tested HIV positive together with me, but [my husband] insisted that we move together,” she said. “I pleaded to be left behind but he even beat me up. We just watched as the two children died one after the other.
“Just look at me, the way I am weak, but we still move very far with the animals when there are no rains like now.”
Margaret Lempaka runs the organisation Touch of Love, which uses volunteers to encourage Maasai people living with HIV in Nasok District to adhere to their ARVs.
“Through volunteers we try to reach out to them wherever they move to but it is difficult,” said Lempaka. “The women are willing to get our advice but they fear their husbands who believe that their animals are more important than human life.”
Superintendent of Narok district hospital, Dr Victor Leshore, confirmed that many patients belonging to Maasai communities took their ARV medication sporadically.
“I think we have one of the highest cases of [ARV drug] resistance because of the inconsistency of the patients to take their drugs as scheduled because of the migrations,” he said. “I think the best way to deal with it is to give these people an alternative means of livelihood which will also not be easy.”
Lempaka’s organisation has tried assisting HIV-positive Maasai women to stay in one place, particularly those with children also in need of care, by helping them generate alternative sources of income.
“We give them a small amount of capital to start businesses as an alternative to the nomadic lifestyle,” Lempaka explained. “Widows are more willing but women who are still in marriages are completely controlled by their spouses and we have not been very successful with them.”
Culture versus condoms
Attempts to promote HIV awareness and prevention among the Maasai have come up against cultural taboos and practices such as the sharing of wives and girlfriends by men of the same age-set.
Boys as young as 14 who have been circumcised are also encouraged to demonstrate their maturity and manhood by having unprotected sex with multiple partners.
“Once a man has been circumcised, they are free to engage in sex with girls,” said Mzee Nkaisery, a Maasai man. “To tell them to use a condom, which is a foreign thing, is to abuse culture which is punishable in our community.”
Jack Tande, a social worker with Friends of the Maa, a local NGO promoting HIV awareness among pastoralist communities, said it was difficult to discuss condom use amongst the Maasai because their culture prohibits discussions about sex amongst different age sets.
“We are beginning to see some change,” he said, “but there is still a long way to go, especially in the rural areas where culture is strongly guarded.”