by Fumnanya Ekhator
“You need it to be hard, because otherwise you could get hurt while the men are pushing on you.” These are the words of Agnes Munyiva, a 50-year-old woman in the Majengo slums of Nairobi, Kenya. She is describing the hard lumpy mattress in the small rented room she uses for work. On the other side of Majengo, she rents another room, slightly larger, where she lives with the three youngest of her five children. Her children have never seen her other room. Though she never discusses her work with them, she is sure they know. Agnes Munyiva is one of Kenya’s numerous sex workers.
Her twelve-hour workday day begins at 6 a.m. everyday and ends before sunset. She begins with a wink and a sly smile, seated on a low three-legged stool in the alley outside her rented room. “Karibu,” she says, Kiswahili for “welcome.” If a potential customer stops, she invites him in to negotiate the prices; it is usually set between 50 and 100 shillings. The transaction is silent and swift; there are families in the neighboring rooms. When it is over and her client leaves, she cleans up with a cloth and a pitcher of water before returning to her stool. A dozen men later, she returns home with about 500 shillings (enough for food), and sets some aside for the children’s tuition and other expenses.
Agnes recalls painful memories of losing her friends in the business to a strange disease she had once called “plastic,” named for the wrapping the city workers would cover the bodies with once the women had passed away. Beginning in the early 80s, some women began to grow thin and weak “with sharp coughs and white fur that coated their mouths and throats.” At the time, most scientists were still unconvinced women were susceptible to HIV or that the virus could even be transmitted through heterosexual intercourse. Year after year, Agnes continues to test negative for HIV, though she has fallen ill to other (more common) venereal diseases. She is one of the five percent of women believed to have protection against the world’s deadliest virus.
About 30 years ago, Agnes and a group of 40 other Kenyan women unlocked a world of possibilities in the realm of research. These women were found to be “immune” to HIV. Despite consistent exposure to the virus due to their line of work, the women repeatedly tested negative for the virus.
Scientists believed these women had HIV-specific immune responses in their genital tract that could protect against HIV infection. It also appeared that their killer T-cells were more effective at identifying and eliminating the HIV virus as soon as it entered the system.
While a single exposure often does not constitute infection, scientists have ruled out all possibility of chance; many of these women have had “500-2000 sexual exposures to infected men when they weren’t using a condom.”
Interestingly, researchers found that in instances when women took breaks from their work and later returned, they fell susceptible to the disease; continuous exposure was necessary to maintain immunity. Almost seventeen years later in 2009, scientists in Thailand developed and tested a vaccine based on research gathered from these immune Kenyan women. The vaccine displayed an impressive 30 percent reduced risk of HIV contraction. The vaccine was a combination of two earlier versions and was administered to 16,000 people, making it the largest trial for a vaccine of its kind. The participants were regularly tested for infection every six months for three years. Results showed the chances of contracting HIV were 31.2 percent less for those who had been given the vaccine. Seventy-four people who received the placebo became infected, while only fifty-one people who received the vaccine became infected.
Thirty years after the study, Agnes is not much better off than when she first arrived in Nairobi. She is reimbursed with free health care for the occasional STD she contracts on the job and treatment for respiratory problems that result from air pollution in the slum. Other than that, her life is unchanged; she continues to turn about eight tricks a day so she can feed her family. Have researchers no obligation to better the lives of those they literally use?
The ethics of science today require that these women receive counseling and condoms: an education that tells them that what they are doing is dangerous and unhealthy. Yet rather than being helped to pursue higher levels of education or training in another trade, these women are merely given condoms to make their occupation “less detrimental.” As a result, these women continue to live lives of shame in a desperate attempt to provide for their children.
Ninety percent of Kenya’s poorest prostitutes find themselves infected with HIV. Simultaneously, 33 million people in the world suffer from HIV worldwide. Researchers face one of the greatest ethical dilemmas of all time: sacrifice the lives and well-being of some in the hopes of a preventative vaccine, or even a cure, for countless others. Should we ignore the suffering allowed, and in some ways encouraged, by a research community that gives so little for the well-being of those studied? Is it permissible to employ human beings as lab rats for the overarching cause of a cure? Is it even that simple?
A cure or a vaccine would be a world-changing discovery that could save millions of lives. But even today when we find ourselves with an effective tuberculosis vaccine, the disease still plagues developing countries where the governments cannot afford the medical technology needed to control and eradicate the bacilli. As of 2007, 2 billion people—a third of the world’s population—were infected with tuberculosis. Since 1990, the number of TB infections has increased four-fold in countries that are heavily affected by HIV. Ultimately, it is likely that a vaccine for HIV, once developed, would not be readily available to those in the poorer countries; the very people without which there would be no cure in the first place.
1. Nolan, Stephanie. “Staying Alive: The Women Who are Immune to AIDS.” The Observer: 27 May 2007. Guardian News and Media. 4 May 2010. <http://www.guardian.co.uk/world/2007/may/27/aids.features/print>
2. ibid. p 13.
3. ibid. p 3.
4. ibid. p 5.
5. ibid. p 8.
6. “HIV Vaccine ‘Reduces Infection.’” BBC News: 24 September 2009. <http://news.bbc.co.uk/2/hi/8272113.stm>
7. Nolan, Stephanie. “Staying Alive: The Women Who are Immune to AIDS.” The Observer: 27 May 2007. Guardian News and Media. 4 May 2010, page 5.//8. Purvis, Andrew. “Cursed Yet Blessed.” Time: 6 December 1993. Time Incorporated. 4 May 2010 <http://www.time.com/time/magazine/article/0,9171,979763,00.html>
9. As of 2007. CIA. “TB and HIV/AIDS| Factsheet.” Centers for Disease Control and Prevention. January 2008. < http://cdc.gov/hiv/resources/factsheets/hivtb.htm>.
10. CIA. “TB and HIV/AIDS| Factsheet.” Centers for Disease Control and Prevention. January 2008. <http://cdc.gov/hiv/resources/factsheets hivtb.htm>
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