In a rural town three hours from Nairobi, Makueni District Hospital provides HIV-AIDS health care to 339 patients enrolled in its antiretroviral therapy program.
For infected patients, the antiretroviral drugs improve their overall quality of life by preventing the virus from replicating inside the bloodstream.
Yet, the road to diagnosis and therapy is mired with challenges.
For many patients diagnosed with HIV at Makueni District Hospital, the discovery of the disease is oftentimes by accident.
According to the hospital's district AIDS coordinator, Dr. Albanus Mutismo, "Many patients I see come to the hospital thinking they have bad luck because they have been sick from malaria or tuberculosis multiple times [in a year]."
Since the disease attacks white blood cells that fight infection (lymphocytes), HIV-positive patients have increased susceptibility to illnesses. Many return regularly to Mutimo's office without knowing they have HIV.
If the patient's history indicates a weak immune system, doctors prescribe a blood test and a liver-functioning test.
According to Mutismo, most patients visiting his office don't have the 200 Kenyan shillings, equivalent of $2.85, to pay for testing. Instead of refusing them care, Mutismo submits a government request to subsidize the fees. The referral adds an extra layer of bureaucracy, but patients receive the free help they require.
It wasn't until 28-year-old Kathei Usingi developed blindness from advanced complications of HIV that she sought testing. Usingi refuses to disclose her illness to her closest family members, including the father of her second child. Fear of abandonment by her estranged husband may have prevented her from seeking testing earlier.
"Stigma is a huge reason couples don't disclose their status [to each other]. They are afraid of how their partner will react," Mutismo says.
It wasn't until 32-year-old Ruth Syombute's husband died of AIDS complications that she was tested. Diagnosed in 2005, Syombute says the results didn't translate to a death sentence.
"I felt nothing inside but turned to God to save me," she says.
As the mother of two young children, the single parent's outlook on life is surprisingly upbeat. The former housemaid depends on donations from well-wishers, her church and local government. The community provides for her because she is a widow -- not because she has HIV. Asked if her neighbors, friends and children know she is ill, she says no.
"Fear is the main obstacle that prevents discussion. Many are sick but afraid to know their status," Mutismo says.
Syombute isn't entirely secretive about her HIV status. Each month she attends an HIV support group sponsored by the African Medical and Research Foundation, an African NGO. Syombute is one of its 27 members.
"One day, I hope to have the strength to be open," Syombute says, but for the moment she finds contentment in her privacy.