LIVING ON PENNIES / PART 6

A life measured in ounces

As AIDS ravages Africa, the struggle for survival imposes unforgiving discipline.

By Davan Maharaj

Los Angeles Times Staff Writer

July 22, 2004

A bottle of Dark and Lovely hair gel in hand, Kassim Issa pushes his withered body down a dirt path through Nairobi's biggest slum, peddling a few ounces at Mama Washington's and other tumbledown salons.

For Issa, Dark and Lovely is life. The 20-cent profit from one bottle can pay for an injection to dull the chronic pain of AIDS. Two bottles can pay for a hospital visit. And selling 10 means he can afford a chest X-ray.

"I am fighting every day to stay alive," Issa said. "Every day I live, I win."

Winning means another day of difficult choices — a dinner of bitter greens or medication. Issa can buy one or the other, but usually not both. Without the right food and drugs, it's hard to find a better job. On top of that, drugs that make him stronger also make him hungry for food he can't afford.

In sub-Saharan Africa, where half the people survive on less than a dollar a day, life is a struggle for food, clothing and shelter. Issa and 28 million other Africans stricken with HIV and AIDS face the extra burden of finding and paying for treatment.

Nearly 7% of Kenya's 32 million people are living with the human immunodeficiency virus, which causes AIDS. The epidemic claims the lives of 700 Kenyans each day. Across the continent, 3 million people died of AIDS-related illnesses last year. The U.N. reported last week that life expectancy has dropped as low as 33 years in some African countries, largely due to AIDS.

The disease has decimated the ranks of teachers and shuttered schools. It has wiped out subsistence farmers, slashing food production. It has taken mothers and fathers, creating millions of orphans.

Years ago, when Issa was healthy, he brought home about $100 a month from his job selling Dark and Lovely shampoos, gels and hair straighteners.

The salesman also brought home HIV. Three generations have suffered because of it. His wife is dead. Because he cannot care for his 6-year-old son and 4-year-old daughter, the children live with their grandmother in a distant village.

For Issa, the disease created its own twisted logic of survival. To qualify for free doses of the most important medication — antiretroviral drugs — from the aid group Doctors Without Borders, Issa needed his immune system cell count to drop to dangerous levels.

He prayed to get sicker. In a few weeks, he lost 40 pounds from his slender 6-foot-2 frame. His cell count plummeted. His prayers were answered.

"I could live a little longer," he said.

Once in a while, Issa gets a letter from his mother-in-law, Adelaide Maraga, who is caring for his children in Chavakali, a village in western Kenya near Lake Victoria.

Maraga loathes Issa because he never paid a dowry for her daughter, Khadija. Then he gave her the disease.

Now he has saddled Maraga with his children.

"I am completely not happy with you," Maraga wrote in one letter. "The children you've left with me, did I produce them with you? Come pay dowry and get your children. Don't tell me you are sick. You've killed my child. Then you leave me with the children. How stupid are you?"

He can't argue with her. He knows that he brought disaster on his family, even if he didn't mean to.

"Sometimes I feel responsible for what happened, but then I tell myself that things come and go," he said. "I didn't do it intentionally. I tend to think that this is the fate that befell us."

He believes that he contracted the disease from one of the women who frequent the bars here in the Kibera slum.

"I had a line of them," Issa said.

He would pay the women about $1.25 for sex. When he was broke, the women would settle for a drink of changaa, a potent homemade brew of fermented corn.

Issa suspects that a woman named Rose gave him the virus. He still sees her near the bar. Issa has noticed that she appears ill. She has sores, like his, on her body. He has never urged her to get tested for HIV "because I don't want the situation reversed on me. She might tell me that I gave it to her. I don't want to be like the hunter getting hunted."

Issa lives in a one-room shack made of mud and rusty metal sheets in a neighborhood known as Mashimoni, which means "in a hole." The hovel sits at the bottom of a dirt path that turns into a small swamp when it rains. A bare wall is covered with green plastic to keep crumbling mud from falling into the living area. He pay $10 a month in rent.

He is reluctant to venture outside. Even though AIDS is rampant, he can hear neighbors whisper. They shun him as jimmi, a dog.

"It used to be worse," Issa said, his reddened eyes widening. "They would want to beat you. But because so many people have relatives with HIV, they realize it's not a laughing matter anymore."

He shared the shack with Khadija and the children until she died in 2000. She was buried in her home village. Issa dared not attend the funeral.

"I have friends and other people who come back from such funerals with one leg and one eye," he said. "Their in-laws say: 'You've killed our daughter, and now you've come to mock her. You are a killer.' "

Issa's mother-in-law haunts him.

"You are there in the city, and you're working," she berated him in another letter. "You can't send 50 shillings to pay for your children's food and pay their school fees? You think I'm your mother who has given birth to you? You are a very lazy man. I do not want to see your face."

The letters give him headaches, but he can't throw them away. He is incredulous that his mother-in-law thinks he has money to spare. Even the healthy suffer in Kibera. For the sick, staying alive is a full-time job.

"Because I live in the city, she thinks I'm a very rich man," Issa said, burying his head in his hands. "She doesn't know that I have nothing, that I am trying to keep from falling down."

Issa's antiretroviral pills sit beside a copy of Barbara Taylor Bradford's pulp novel "The Women in His Life." Issa escapes with Bradford's billionaire tycoon as he seduces women and dabbles in gourmet food, fancy clothing and opulent furniture while jet-setting to London, Paris and Venice.

Each day, Issa takes from eight to 11 pills in two doses. One is so big he calls it a horse pill. The medicine makes him among the lucky AIDS patients in Africa. Across the continent, only a tiny fraction of the people in need of AIDS treatment receive it. The treatments might cost only a couple of dollars a day, but they are too expensive for individuals. Governments and aid agencies are overwhelmed by the number of victims. Many people seek out potions from traditional healers. Thousands die a slow death, never realizing that they have AIDS.

On most days, Issa's breakfast is mandazi, or fried sweet bread, and some chai that he buys for about 8 cents from a neighborhood stall. He eats kale and grits when he can.

Several months ago, he treated himself to half a pound of beef, using the 50-cent profit from two bottles of Dark and Lovely. It was his first taste of meat in months.

Issa's strategy is to skip meals. Sometimes he goes without breakfast, takes lunch, skips supper and then has breakfast. But the medicine makes him hungry.

"The only problem with the ARV is it wants me to eat," he said. "I can finish two plates of food if I have it."

Once a week, Issa walks four miles to an outpatient clinic at Mbagathi Hospital to pick up his free medicine. The key to the treatment is sticking to a schedule for taking the pills, and Issa said the threat of death has imposed discipline on him.

"I've become more in control and responsible for my own life," he said. "If I don't take the tablets, I die."

Issa is guaranteed free pills for five years. But he needs ointments for his rashes, and painkillers and checkups. And the cash-strapped Mbagathi Hospital, where 80% of the 200 beds are occupied by AIDS patients, demands payment for these.

For $1.25, Issa gets an outpatient card that he must show to a social worker before he can obtain other services. A doctor's exam costs $7.50, but if he is feeling gravely ill, Issa begs the social worker to waive the fee.

He exults when the social worker is absent or reassigned to another department. Then Issa can beg new favors from the replacement.

But he can do nothing for his children.

His 6-year-old son, Isa Gazemba, is fine. Issa says his daughter, Mwanaidi, has tested negative for HIV but that she has the same rashes and coughs he had before he was diagnosed.

He hasn't seen the children in almost two years and won't visit them in the countryside because there are no clinics and the trip would interrupt his treatments.

"Medical help is what is keeping me alive," he said.

Issa worries about Mwanaidi, but says he has nothing to offer her now.

"I feel sorry for my daughter because she has a dark future, with nothing to cling on," Issa said. "She will have dark memories."

'I have sent you two other letters, but you haven't replied … why?" his mother-in-law wrote in a third letter. "Your daughter is always sick, you don't care. I completely don't like your attitude. You don't even send a piece of cloth. What do you think they wear?"

He is trying to earn more money. If he succeeds, he might be able to pay his wife's dowry — a cow, which would cost about $125, plus 2,000 shillings, or $25. After that, maybe he could afford to support his children.

"I want to be around for my children," he said. "I don't want to live a meaningless life."

Sometimes when he feels well, Issa walks five miles to Nairobi's Industrial Area to look for work.

The guards at the gate usually tell him that there is none. When he is lucky, they let him through. But once the bosses glimpse his body sores and blistered lips, they tell him to move on.

"They know HIV when they see it," he said. "Everybody is an expert."

If he had a job, he might have the $6 to buy ointment that could heal his lips or the money for reading glasses to compensate for his failing eyesight. But he can't do either on what he makes selling Dark and Lovely ounce by ounce.

Issa's mother-in-law has no time for such excuses.

"Be warned young man. Come let us settle, you collect your children as soon as possible," she wrote. "I'm not writing another letter after this one. If you have ears, you hear."

A few months later, she showed up at Issa's shack with his daughter. They had taken the nine-hour bus ride from Chavakali to Nairobi. Issa was elated. He had not seen Mwanaidi since she was an infant. His mother-in-law stood icily in the room and told the girl that this was her father.

Issa watched Mwanaidi for some sign.

She had no idea who he was. In a few hours, she was back on the bus with her grandmother.

Soon, Issa was back on his rounds.

As a hard rain pounded on Kibera's tin roofs, Issa stepped into a pair of pink pants, a faded blue denim jacket and rubber boots. He put a few bottles of Dark and Lovely into a gym bag and set out to collect on old sales and to make some new ones. He had many stops to make: Ladies Choice Hair Salon, Powerful Hair Kuts, Mama Anyango Hair Salon.

But rain kept most of the customers away, and when they have no customers, salon owners won't buy.

He found one of the salons completely empty. A tailor who runs the shop next door said that the owner had died of AIDS.

She owed Issa about 75 cents, money he needed for food and medication.

"I can't ask the family to pay this money," he said. "They have their own grief."

About this series

The number of people in sub-Saharan Africa living in dire poverty has nearly doubled in the last two decades. Times staff writer Davan Maharaj and photographer Francine Orr traveled the continent over nearly two years to chronicle the continual struggle to survive on less than a dollar a day. The six articles in the series:

PART 1: July 11 -- Eking out an income.

PART 2: July 12 -- Staving off hunger.

PART 3: July14 -- Settling for castoff clothes.

PART 4: July 16 -- Living in 100 square feet.

PART 5: Tuesday -- Locked out of school.

PART 6: Today -- Surviving AIDS.

On the Web:

More photos, narrated reports by the reporter and photographer, previous articles in the series and information on how to help can be found on the Times website at: latimes.com/pennies.