Friday, September 18, 2009
Still trying to familiarize myself with the area around Nakuru, the towns, villages and rural areas. More importantly, I'm trying to get a picture of the organisations and initiatives that I hope to work with, their members, leaders, qualities, interests and levels of activity.
Some are very active and productive, with keen participants and strong projects. I couldn't help agreeing with the home based care worker I met yesterday who said he thought leadership is the key. I don't believe for a moment he was talking about himself as he is a very modest man. But in Salgaa, he gives excellent leadership and gets excellent results. Leadership does appear to have a vital bearing on the success or failure of support groups and their activities.
Peter knows all of the people in his two community support groups very well because he lives near many and pays regular visits to others, travelling many kilometers every week on his bike, on a hired motorbike or on public transport. There is no substitute for covering as much of this large area as possible, as often as possible.
But the results of his work include regular meetings, high levels of support given to and given by participants; Peter and others working in the area can tell you all about each participant and they know when someone is sick or in trouble. Not everyone takes an equally active part, of course, but compared to some other support groups that don't even meet most of the time, Salgaa has a very healthy community.
Most importantly, people there who are on antiretroviral therapy (ART) are taking their medication as they should. This means they gradually become as healthy as they were before they were affected by the opportunistic infections that appear in people in advanced stages of HIV. This is one of the primary aims of the support groups and in that respect, they are doing very well.
As for HIV prevention, the area has not been so lucky. The Kenya National Aids Control Council has never really spent much time, effort or money on HIV prevention. They talk about it a lot but neither Kenya, nor any country in the world, have really implemented programmes that demonstrably reduce HIV transmission. Calling their programmes, such as they are, 'evidence based', does not mean they have had any effect.
And some organisations never learn. After many years of bleating about sexual abstinence and how it reduces transmission, even though it clearly does not, many of those involved in HIV prevention are still coming out with the same tripe.
Yes, young people need to know they can refuse those who try to persuade them to have sex. And those who are in a position to refuse either don't have sex or they only have sex under circumstances they choose. That's great for people who have freedom of choice but fails to address those who, for many reasons, don't have the choice or don't have much choice.
Children (and adults) need to know the reality of sex and choice and many other things. Abstinence campaigns, even ones that include partner reduction and condom use, do not have a history of teaching realities. There are still many adults who believe all sorts of rubbish about condoms, circumcision, reproduction and other vital matters. And there are still people who use the word 'abstain' all the time and have very little useful knowledge about what they are supposed to be abstaining from. It's sex, it's a big subject and it goes far beyond a few over used slogans.
These bogus HIV prevention campaigns demonstrate something else, besides leadership, that is missing from initiatives that fail: reality. There is plenty of money and therefore plenty of 'leadership' behind abstinence and the related sanctimonious parphenalia. But because they are not rooted in the realities of people's lives, they have little or no impact on their lives.
In Salgaa, the support groups don't just have good leadership. The groups arose from the realities of living with HIV/Aids. People need to get on with their lives, facing the same realities that may well have resulted in their becoming infected. They don't survive by refusing to accept the realities, rather, those who refuse to accept the realities become sick and die.