- From July to September, 2002 I spent ten weeks in Kenya conducting full-time
research on the macroeconomic impact of HIV/AIDS and community action towards
combating the epidemic in locations dominated by members of the Luo tribe in
Nyanza Province, Kenya. Gathering data from both the Ministry of Health and non-governmental
organizations, I sought to identify the causations and impact of the
HIV/AIDS epidemic from a holistic framework.
Serving as a pilot study for future research and program evaluation, my
research primarily focused on four community-based organizations (CBOs) and
Ministry of Health offices located in Kisumu, Nyando, Rachuonyo, and Migori
Districts. My research objectives were to explore the cultural and economic variables
related to the spread of the HIV/AIDS epidemic, identify which sectors of society
were negatively impacted by the epidemic, record community action in response to
these impacts, investigate obstacles related to implementation of such interventions,
and share research and recommendations with the Ministry of Health and CBOs in
Nyanza Province in a way that was meaningful and useful to them.
Several qualitative and ethnographic methods were utilized. Participant
observation was the principal method used and consisted of a wide range of activities.
Additionally, I conducted sixteen formal semi-structured interviews, approximately
thirty informal unstructured interviews, and one focus group discussion with nine
I found that community-based organizations and the Ministry of Health
engaged in a wide variety of activities in response to the HIV/AIDS epidemic
including providing Home Based Care to the sick and dying through trained
community health workers; training individuals in income-generating activities to
provide support for the organizations, the infected and affected, and as a means of
prevention of new infections; and providing education to the communities at large.
The Ministry of Health and non-governmental organizations also engaged in a
significant level of collaborative work to assist each other with their programs and
ensure there was no duplication of services.
Despite considerable organizational efforts by both the governmental and non-profit
sectors, these groups faced a number of different obstacles in their mobilization
efforts including limited funding, transportation obstacles in visiting HIV/AIDS
clients, and difficulties in convincing individuals to change their behaviors.
Individuals interviewed cited a number of factors related to the spread of HIV/AIDS
including wife inheritance, wife cleansing, poverty, commercial sex work, and
distance marriages. Limited access to voluntary counseling and testing (VCT)
services was also an obstacle in a number of communities. Additionally, I found a
positive association between access to VCT services, perceptions of people living with
HIV/AIDS, and social support for the infected.
Based on my findings I concluded that individuals' behavior resulting in the
transmission of HIV/AIDS is not solely related to lack of knowledge. Circumstances,
especially related to poverty, lead to actions such as exchanging sex for money,
distance marriages, early marriages for females, and wife inheritance. In order for
HIV/AIDS prevalence to be reduced in Kenya, there must be active participation at all
levels and from all sectors of society, including from community members
themselves, community-based organizations, the Government of Kenya, and
international governmental and non-governmental assistance organizations.
Among my recommendations I propose the expansion of voluntary counseling
and testing services to make it easier for individuals in rural areas to know their HIV
status. I also advocate for a holistic and multisectoral response to HIV/AIDS
prevention and support for the infected and affected, including through Home Based
Care and social support for the infected, support for AIDS orphans, prevention of
mother-to-child transmission, effective HIV/AIDS education, reducing poverty
through income-generating activities, making school educations accessible for all
children, and improving the overall state of health and access to health facilities for all