Youth-led responses to HIV and AIDS in Kenya

Proportionally more girls and young women in their teens and early twenties are becoming infected with HIV than any other age group. These are the findings all over Kenya and East Africa.1 The rate for young men is less but still very high. Can anything be done to slow down the rate of infection among young people? Some things are being done. Perhaps not surprisingly, the greatest success in the area of behaviour change is happening when young people themselves become involved in peer group counseling. In the majority of cases these are young people who themselves are infected, who have seen their friends die of AIDS, or who live in an environment where the disease is very prevalent. An excellent little book entitled Youth to youth: HIV prevention and young people in Kenya2 gives information about a number of these youth programmes.

The book describes four programmes which are "among the most innovative and promising 'youth-to'youth' prevention strategies that have been developed." The four organisations are the Mathare Youth Sports Association (MYSA), the Fish Group (a Catholic youth organisation), the Kenya Society for People with AIDS (KESPA) and the Teenage Mothers and Girls Association of Kenya (TEMAK).

The Mathare Youth Sports Association was established in 1987 for two reasons: "to carry out environmental clean-ups, and ... to organise sporting activities in the ten 'villages' that comprise Mathare Valley." The person behind the setting up of MYSA is Bob Munro, a Nairobi-based consultant. MYSA is among the most successful youth groups in Kenya. "It is Africa's largest youth football club, with 410 boys' teams and 170 girls' teams. ... MYSA's senior team, Mathare United is one of the top teams in Kenya's National Super League." MYSA's AIDS awareness programme started when a popular team-mate, Adrian, an orphan and former street boy, died of AIDS when he was only 18.

The strategy chosen was to train all 25 members of the senior squad, consisting largely of 18-20 year-olds, as AIDS peer educators: the focus on the senior team was deliberate. As talented young football players, they were well-known and popular among the many football fans including young womenžin their communities. Their local hero status made them vulnerable to temptation and therefore to AIDS. However, it also meant that they had enormous influence on many other young men and women. If these young men could be trained as peer educators, they could have a positive impact on the attitudes and sexual behaviour of thousands of other young people.

The AIDS programme went through various stages; in the beginning, the effectiveness of the peer educators was hindered by inexperience. But with the help of a local NGO, Friends of Mathare Youth, they were able to progress to where they are today: they are able to be a source of influence "far beyond their immediate circle of friends."

The peer educators work mainly on an informal basis, through the teams they coach, their own team-mates, their friends and family members. They also give short talks on sexual behaviour and AIDS to small groups of young people, at schools and before football matches. The MYSA AIDS programme is estimated to have reached about 20,000 young people between 1994 and 1997. The main emphasis is on abstinence from sex until young people are physically and emotionally mature .... For young people who are sexually active, the emphasis is on staying with one partner and using condoms.

The Fish Group is a Catholic Youth organisation started in 1985 "to promote Christian values and community service, and to organise social and educational activities for young people." It has about 40 branches with around 600 members in and around the city of Kisumu. The Group has "a distinctive, youth-led approach to HIV/AIDS education, known as "education for life' or the 'behaviour change process'. The approach was developed originally by Sister Kay Lawlor and her colleagues at Kitovu Hospital in Uganda and has since spread to other parts of Africa."

The behaviour change approach is particularly suitable for use with groups in areas with high prevalence of HIV infection, and where most young people start sexual activity in their mid-teens. The approach recognises that changing sexual behaviour is not easy, and does not happen simply by giving people information about HIV and AIDS, or employing scare tactics. Rather the individuals in the group are encouraged to go through a three-stage process:

Stage 1: Know and accept the reality of your present risky behaviour.

Stage 2: Choose and commit yourself to a new behaviour which is possible for you.

Stage 3: Act on your choice of new behaviour.

Training sessions are enlivened by the use of role plays and songs. In one role play, the workshop facilitators toss a glass around casually until it drops and smashes. The surprised and rather upset members of the audience are then asked to interpret the exercise. Anne Amimo [one of the founder members of the club] explains:

"What we are trying to get across is that life is precious and fragile, and you have to handle it carefully. If you don't, it will smash into pieces. But even if things do go wrong, you can still pick up the pieces of your life and make something worthwhile of it - just like the pieces of broken glass can be recycled and used again."

The Fish Group also uses a greatly shortened adaptation of the behaviour change approach in presentations at secondary schools and with local churches and community groups. A highlight of these presentations is the personal testimony of Christine, a 19 year-old Fish Group member who was diagnosed HIV-positive at age of 16. (See below on Christine)

The Kenya Society for People with AIDS (KESPA) was founded in Nairobi by Edwin Odera in late 1992. Edwin later went to Western Kenya, his province of birth where he was instrumental in getting a girls' school (Bishop Okoth Girls' Mbaga Secondary School) to start an Anti-AIDS club. The Club had the following objectives:

1. Creating AIDS awareness among students and adults in schools and the surrounding communities.

2. Creating AIDS awareness back home.

3. Visiting the sick.

4. Spiritual support for the affected and infected, and for scientists' struggle to get a remedy for the disease.

The club members started several activities to promote these objectives and committed themselves to abstain from sex until marriage as well as to abstain from activities which could lead to risky sexual behaviour.

Outside the school, groups of students from the Club spoke and performed at churches, other schools, chiefs' barazas (community meetings), and special events such as the Annual Show and the Independence Day celebrations on December 12 each year. They spoke not only of about AIDS and sexual behaviour, but also about the dangers of traditional customs such as widow inheritance and the 'cleansing' of widows through sexual intercourse after the death of their husbands. They also spoke out against the rejection of people with HIV or AIDS by family, friends and work mates....

Meanwhile the local District health authorities had heard about the Anti-AIDS Club at Mbaga Girls' Secondary School, and decided that similar clubs should be promoted in all local secondary schools throughout the District. In 1994 the District authorities organised two HIV/AIDS seminars, in which KESPA participated, for 70 teachers from all over the District....

Over the next 12 months Edwin Odera, travelling by public transport, visited all 36 secondary schools in the District, where he spoke movingly and inspirationally about the threat of HIV/AIDS to young people's lives: "I spoke about the fact that young people with AIDS often die before they get a job. All the sacrifices their parents made to give them a good education are wasted. And they may die even before they have a family of their own.." The latter subject is especially poignant for Edwin, who was married in 1992. He and his wife decided, however, not to have children because of the risk of passing HIV onto their unborn child during pregnancy.

KESPA has done a lot in a short period of time. At least 5,000 boys and girls between the ages of 15 and 19 are members of Anti-AIDS clubs in 25 schools in Siaya District. They have spread their message about ways of avoiding HIV infection to many others. Girls are learning that it is all right to say "no" to sexual advances from boys and young people in general are learning to accept that friendship between boys and girls is possible without sex.

The main factor in KESPA's achievements has been their co-founder and Programme Co-ordinator, Edwin Odera. The reason for his involvement was simple. He says: I was infected while I was still young do I wanted to do something to help young people. I wish I'd been given information about AIDS while I was still at secondary school. If I had been, I would have never become infected with HIV."

Edwin Odera died of AIDS on the 6th of June 1997

The Teenage Mothers and Girls Association of Kenya This association was started by a young couple, Philomena Othatcher and her husband, Joab, graduates from the Jomo Kenyatta University of Agriculture in Nairobi. They started the association as a result of Philomena's experience of seeing the suffering of her two older sisters who became pregnant while still in school. As Philomena explains:

"They had to drop out of school and my parents wouldn't let them return and finish their schooling. There was no-one to care for their children or to assure them that life goes on, even for unmarried mothers. Today, they're both leading miserable lives."

When originally established, TEMAK set itself eight broad aims ... . Although HIV/AIDS is not mentioned explicitly in these aims, the HIV epidemic is now an issue of major concern for TEMAK. The turning point came in 1995. Over a period of several months, 125 young women from TEMAK agreed, after counselling, to be tested free of charge for HIV at Rapha Christian Mission Hospital. To the consternation of TEMAK staff, 45 young women tested positive for HIV. In the following year, at least six TEMAK girls died of HIV-related causes, causing great grief among TEMAK members, staff and volunteers. The project is now acutely aware of the need to integrate HIV prevention into all its activities:

"All our projects now" says Philomena Othatcher, " stress how teenage mothers and girls who drop out of school can avoid getting infected with HIV. These young women and girls are at really high risk of getting HIV. So everything we do whether it's training or income generation of health carežit all has to include HIV and AIDS as well."

TEMAK works through a network of community volunteers, who are organised into four committee members in and around Kisumu. Most committee members are mature women, who are well respected locally and know all the families in the neighbourhoods and villages. The committee members identify pregnant teenagers and young single mothers in their neighbourhood and recommend them to TEMAK for assistance....

HIV/AIDS information is given through individual counselling and through workshops with small groups. The controversial use of condoms is handled sensitively by the Othatchers who are devout Christians. Joab Othatcher explains:

Being Christians and talking about condoms is not easy. But every day we see young people who are involved in sex, and putting themselves at risk of HIV. We want to lead them to Christ, but how long will that take, when they are already having sex and HIV is out there? It might take a girl two years to stop selling sex but by then she might have got infected with HIV. So in that time the only way she can protect herself is to use a condom. "Our conscience is very clear about it now. People might say we are promoting promiscuity, but the idea is to prevent HIV and then look for other options for these girls, so in the end they won't need a condom ....

TEMAK has not yet carried out an evaluation of the impact of its programme on the lives of the young women and girls it is trying to assist. However, TEMAK staff and volunteers are in close contact with the young women and girls involved in the programme, and believe that several important changes in their attitudes and behaviour have taken place.

Notes

2. London: ACTIONAID; Nairobi: Kenya AIDS NGOs Consortium, 1997..- 57 p. : ill. (Strategies for hope ; no. 13). In order not to clutter up the text with references, individual references to page numbers have been omitted from the footnotes.

"One night I was just dozing off and I overheard a conversation between two student nurses. One of them said to the other ' Just imagine, the young girl in this bed is HIV-positive'. I opened my eyes and asked her to repeat what she'd just said, and she told me 'Don't you know you're going to die of AIDS soon?' I was so shocked, I lay awake all night, thinking about suicide.

"Next day I asked the hospital matron and she told me it was true that I had HIV. Soon afterwards I was discharged and I went to live with a Catholic Sister who had been visiting me in hospital. My father had visited me a couple of times in hospital, but had stopped. I stayed with the Sister for a year, and I met people at an AIDS support organisation who were very good to me and counselled me a lot. After about a year I came to Kisumu and met another AIDS counsellor, who found me a job in a hospital pharmacy."

Christine had taken to the streets at the age of 12, after being mistreated at home. She was rehabilitated by the Undugu Society and managed to finish primary school. At the age of 13, however, she was back on the streets, living in a gang with a boyfriend who was the only gang member allowed to have sex with her. He would also send her out to sell sex to other men. She had to give her boyfriend all the money she earned in this way. Since coming to Kisumu, Christine has joined the Fish Group and often speaks about AIDS to groups of young people at schools and churches. She is open about being HIV-positive herself, and receives many letters from young people who have been moved by her testimony to change their behaviour:

"I tell people that being HIV-positive doesn't make me any different from them. Many of them could also have the virus. The only difference between us is that I've been tested for HIV and they haven't, that's all."

A year ago Christine had a recurrence of TB and was hospitalised for three months. Since being discharged she has been using her monthly salary to repay the hospital. Friends from the Fish Group pay her house rent, and also buy her food and clothes. Now aged 19, Christine has a positive approach to life:

"I feel healthy now and I don't want to get involved in anything risky ever again. I still have a long time to live. I do miss my family, and I wish they would accept me again. But I have plenty of friends. I enjoy their company and they support me so much."

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