This study examines the role of culture in the adoption of measures and strategies for the prevention of HIV/ AIDS among girls and women in Western Kenya. It focuses on levels of awareness of HIV/AIDS prevention measures and pattern of adoption of five the measures that are currently being promoted in Kenya, i.e.:
(1) the use of condoms;
(2) screening for HIV at Voluntary Counselling and Testing (VCT) Centres;
(3) prevention of mother-to-child transmission (PMTCT);
(4) the use of post-exposure prophylaxis (PEP); and
(5) the prompt treatment of sexually transmitted infections (STIs).
This research is focused on examining the cultural context of HIV/AIDS research and programmes in Western Kenya and aims to reveal how limited has been the critical analysis of culture as a determinant of adoption of these measures despite the stated prioritization of culture as a key factor to consider. An extensive review of literature conducted by this researcher has revealed that there is very little empirical evidence to show the extent to which cultural analysis informs ongoing efforts at promoting HIV/AIDS prevention measures in Kenya and other African countries. The influence of culture is mentioned in a number of documents, and even in some speeches launching campaigns against HIV/AIDS, but its influence has never been given an in-depth critical analysis.
Data used in this report were derived from primary sources and from a review of empirical studies. The field study was conducted in Busia and Siaya districts of Western Kenya. Both quantitative and qualitative data were generated using focus group discussions (FGDs), a survey, in-depth interviews (IDIs) with key respondents and participant observation methods. Thus, this study has made an effort to bridge the perennial divide which unnecessarily polarizes quantitative and qualitative research methods. Nine focus group discussions (FGDs) were conducted to gather information for designing a questionnaire. A total of ninety respondents participated in the FGDs. Each FGD comprised ten respondents drawn from the following groups: employed women, non-employed women, girls in primary school, girls in boarding school, out of school girls, women who live with HIV/AIDS, male youth, married men and men who live with HIV/AIDS. The FGD data were analyzed using the Nudist 6 computer package. A survey questionnaire was then administered to 402 respondents in rural and urban settings in the Busia and Siaya districts. The two settings were targeted with a view to examining whether a variation exists in the adoption of HIV/AIDS prevention measures and strategies. The quantitative data were analyzed using the Statistical Package for Social Sciences (SPSS). The third phase of data collection comprised eighteen IDIs with key respondents to gain greater insight into issues that had not been clarified during the initial two phases of data collection. Content analysis was used to classify the data based on convergence and divergence of ideas on various aspects, followed by an examination of the relationships between these ideas. IDIs were used to clarify issues and assess the validity of the collected data; these formed the basis for case studies that illustrate this report.
The findings show that, in spite of a high level of knowledge concerning the modes of transmission of HIV, the majority of respondents were only familiar with: abstinence, being faithful to one sexual partner, and the consistent and correct use of condoms (ABC) approach to preventing transmission of the epidemic. This scenario could lead to HIV infection, due to ignorance, for example, from mother to child, despite the availability of appropriate interventions to avert such vertical transmissions. Again, the study revealed that knowledge about HIV prevention measures is higher among girls and women than boys and men due to the greater degree of interaction of the former with health-care providers. Furthermore, respondents with a primary-school and above level of education, as well as those below 30 years of age, were more knowledgeable about HIV prevention measures when compared with those with no formal schooling and/or those who were above 30 years of age. However, many respondents did not perceive faithfulness to one sexual partner as being an efficient method for preventing HIV infection because of cultural practices which allow boys and men to have multiple sex partners, thereby rendering girls and women susceptible to infection.
This study has established that more people, especially those below 30 years, have adopted the use of male condoms for vaginal sex and visiting VCT centres before marriage. However, fewer people than expected had adopted other HIV/AIDS prevention measures. Furthermore, the findings reveal that while it is easier for girls to adopt HIV prevention measures when still single, the situation alters upon marriage. This is because, according to cultural tradition in the Abaluhya and Dholuo communities, married women are expected to procreate to perpetuate the lineages of their spouses. Therefore, many married women become susceptible to HIV infections through unprotected sex for the sake of procreation. Other cultural practices rendering girls and women especially vulnerable to HIV infection include: the practice of polygamy, male preference for multiple sexual partners and preference for dry sex that causes abrasions and increases chances for HIV infection.
This study concludes that culture plays a pivotal role with regard to the adoption of HIV prevention measures and strategies. To this end, the worldview of a community needs to be understood by those planning HIV/AIDS interventions and traditions of culture must be integrated with the HIV/AIDS prevention measures and strategy, and related advocacy campaigns, so that these become more efficient and have a greater impact. For example, local terms and, when possible, the vernacular language should be used when referring to HIV and AIDS and when advocating to prevent its transmission. Existing community structures, such as the village councils of elders, should be recognized and made integral parts of campaigns to prevent HIV infection and transmission. The elderly, the traditional custodians of culture, ought to be targeted and enlisted as key spokespersons who have finally understood the dangers in some of their cultural practices which may predispose people to HIV infection. By so doing, it would be possible to change deeply rooted beliefs and practices of Abaluhya and Dholuo communities, to lessen the risks of HIV infection and transmission. If the elders can learn to clearly comprehend HIV/AIDS messages, they would strive to protect the lives of people because life is perceived as sacred in the Abaluhya and Dholuo culture.
In a culturally sensitive HIV prevention campaign, the communal elders could be persuaded to promote cultural practices which prevent HIV infection and reduce transmission, rather than the current practice of fostering it, and to play a leadership role in breaking the silence on traditionally taboo subjects, such as sexuality and illness, again with a view to averting HIV-related deaths. This study, therefore, recognizes a great need to target the elderly in HIV/AIDS advocacy campaigns, in addition to young people, who are already quite knowledgeable about modes of HIV transmission and the corresponding prevention measures and strategies, in comparison with their relatively ignorant elderly counterparts. Redirecting HIV/AIDS campaigns to focus on prevention measures and strategies which target the married and elderly men will enable them protect their spouses and allow a possible reversal of the current tragic trend where marriage is actually heightening the risk of HIV infection among girls and women in the Busia and Siaya districts.
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