Wednesday, July 8, 2009

The Apparent Irrelevance of Current HIV Prevention Campaigns

It seems extraordinary that after many years of campaigns to get people to use condoms and take precautions against HIV, other sexually transmitted infections and unplanned pregnancies, university students, the (supposedly) best educated people in Kenya, do not consistently use condoms. Many of them do use condoms, or say they do. But usage has to be consistent and only 15.8% say they use them all the time. Most (77%) do sometimes, or have done on some occasions.

My aim is not to criticize Kenyan university students here, though they really should take note of their vulnerabilities. My aim is to question the country's overall strategy to reduce transmission of HIV. For a start, most money that has been spent on HIV has gone to those who are already infected, on treatment and care programmes. That's fine, as far as it goes. But doesn't the Kenyan government want to cut the number of new transmissions so they can afford to continue to treat and care for those already infected?
But even the money that has been spent on HIV prevention doesn't seem to have been spent on effective programmes. Ok, we hear so much about condom social marketing and various programmes that involve slogans and celebrities and sports and various ‘feelgood’ factors. But which of these programmes have been effective? Well, all of them, if you ask their proponents. But why, then, is HIV transmission still so high?

Well, of course, I don't know the answer to that. But I do know that in Kenya many people do not get enough basic education and that many do not have access to basic health care or other social services. Sex education requires recipients to have some basic educational background for it to mean anything. And sexual health requires a good level of general health. So, dealing with education and health in general would probably help specific HIV related health and education programmes to be more effective.

But that doesn't answer the question of why the people who receive enough education to reach university are also not responding to HIV prevention programmes. Well, sex is just not a popular topic for many people; politicians, church leaders, teachers and parents, for example. Even well educated people have very mixed ideas (some true, some confused) about sex and HIV transmission. It's almost as if their sexual behaviour, then, remains completely independent of and unaffected by the various HIV prevention programmes going around.

I would suggest that the exceptionalisation of HIV has not helped in this respect. HIV is presented to people as something separate from their overall health, as something unprecedented, something that requires emergency measures. But HIV it is not exceptional in the sense that it infects more people or kills more people than other diseases. It is a virus, one of many, that happens to be spread sexually (mainly). Given that most young people have sex, many of them are vulnerable. HIV is not a short term emergency, it is an endemic condition in Kenya and many other developing countries in the world. It is not something that can be eradicated in a short period of time.

And it will certainly not be eradicated by separating this one virus from every other health issue. On the contrary, this is one of the things that can lead to people viewing HIV as something 'other', something that affects people who have been 'bad'. Sex is not bad, it is part of human behaviour, always has been and always will be. Yes, people can take precautions and make sure they only indulge in ‘safe sex’. But they don’t seem to be responding very well to the finger wagging, moralising and frankly medieval prevention campaigns that can be found in Kenya. And that’s hardly surprising.

I was in a London HIV clinic yesterday and people all looked furtive, as if they were going someplace they shouldn't be going. Even in a country that likes to think of itself as permissive and liberal, where sex and sexuality are easier to discuss than they are in East Africa, HIV and other sexually transmitted infections are still treated differently. But at least here in the UK, people have better access to education and information pertaining to health. Health services of any kind, particularly sexual health services, can be pretty remote from the day to day lives of most Kenyans.

I think many people just ignore the messages they hear. Their sex life is their business and they consider themselves to be careful and in control. Try telling most car drivers that they are doing something wrong; they see themselves as being in control and if something does go wrong it's got to be someone else's fault. HIV has been too much associated with things that people feel are not relevant to them, such as commercial sex work, men having sex with men, intravenous drug use, etc. Perhaps HIV programmes are not working very well because they have this 'undesirability' factor built in to them.

Sex plays a big part in the lives of most people. Therefore, HIV is just one issue that relates to sex and just one negative issue, for that matter. Sexual health is as much a part of people’s overall health as nutrition, say. HIV needs to be put in a context where it can be seen as relevant to the lives of ordinary people in Kenya, whether they are well educated and comfortably off or less well educated and poor.

The religious and political posturing, that seems to be so influential when it comes to HIV programming, is killing people. Just as sex is a part of people’s lives, sexual health needs to be seen as a part of their overall health.


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