Book Description

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 youth. 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 individuals.