When the sun goes down on fishing islands like Remba and Ringiti, fisherman back form a hard day of work resort to the nightly activities of drinking and sex. If the catch is big, the local bar is roaring with drunks and the hotel rooms are all full. Reading and being told about the practices that lead to the spread of HIV in these areas is one thing, hearing it bang against the tin wall alongside your bed is another.
For the past few weeks, we have been living the lives of migrant fisherman, traveling island to island. We have been eating what the fisherfolk eat, bathing where the fisherfolk bathe, and sleeping where fisherfolk sleep. Our lodging has been in the tin "hotels" that are the center of the prostitution practices on the islands. (The last we stayed in was called the "Usisime Guest House", translated "Don't-talk-about-it Guest House".) The rooms are little more than a tin box with a bed, and come with one candle, the source of light that lasts as long as most of the activities undertaken in these rooms. Rates are ~75-100KSh/ night (a little over 1 dollar), or they can be rented out for the "short-term" in hourly intervals. Each night, nearly all of the rooms surrounding ours are filled with fisherman and the women that are exchanging sex for fish with them, or prostitutes from the bar. Walking out of our room after one of our first nights in one of these hotels, we were torn between being disgusted by the used condom left in the hallway, and being pleased that at least one was used.
Our clinics providing sexually transmitted disease treatment and anti-retroviral therapy are often held in the same location that the disease was likely transmitted in the first place. We rent either the hotel rooms described above or partition the local bar into patient rooms and treatment areas. After seeing a steady flow of patients all day, we are often left no other option (as there is none available in town), but to sleep in the same room that we have been seeing patients all day. Picture your doctor treating ill patients all day on the same table, then deciding to curl up on that table and sleep for the night-- that will give you a good idea of how we've been living.
The islands have no source of clean water, leaving most to drink water straight from the lake (although we rely on bottled water). As there are no public latrines, you must walk to the end of the island away from homes to relieve yourself. When the rains come and wash the rocky island clean, cholera and waterbourne diseases run rampant as this waste trickles down to the source of drinking water. This also makes bathing tricky, as the water you are to bathe in is likely dirtier than you are in the first place. We have been forced to do our best to find a "clean" point of the island, scrub up, and swim out into Lake Victoria. Food is severd in one "restaurant" in town, which often has a long menu posted upon the wall. However, after ordering you quickly learn that the only available options are fried fish, boiled fish, or fish stew.
The experience of eating, sleeping, drinking, and bathing as migrant fisherfolk for the past few weeks has allowed us to enter into the lives of the population we have been working with. We have seen and heard firsthand the practices that contribute to HIV in these areas. Most of all, the undeniable link between poverty and the spread of disease has been cemented into our consciousness.