Generating Self Reliance

Sometimes I get carried away when I'm blogging and I write something quite different from what I set out to write. The other day I wrote about how food insufficiency could affect people's likelihood of transmitting or becoming infected with HIV. That's fine, but my intention was also to say why I ended up working for a community based organisation that aims to help people become more self reliant, to produce food or goods that they can sell, or to identify ways of cutting their day to day costs. But now I think the answer should be clear.

Ribbon of Hope Self Help Group, Nakuru, are working on a number of projects involving both HIV positive and HIV negative people in poor communities. Those projects range from growing food crops and keeping livestock to making things for sale here and abroad, providing various services and spreading intermediate technologies, such as solar cooking. The main thing is that we find income generation activities that are easy for people to do, even if they have very little money and training. If people are able to make or save some money, they will be more self reliant and better able to cope with the many stresses of life.

Today was a great day for solar cooking. The location was ideal, about one kilometer from the Equator, and the sun was hot. We got there in time to set things up, not that that takes very long, and then started to answer the numerous questions people had. We were in a conspicuous area, so groups of people would form and disperse throughout the morning. I have no idea how many people came to see food being cooked using bits of reflective cardboard and pots that were painted black and stuck in a bag. But when the food was cooked, there were around thirty people willing to taste the rice, boiled maize meal and cabbage. If I'd known so many people were coming I would have prepared something more appetizing. But there will be plenty of opportunities to go back and demonstrate again!

Will this prevent HIV from spreading? Not on its own, no. But there are many intermediate technologies that can provide people with cheap or free energy, solar cookers are just one example. We will be demonstrating others when we have the equipment. There are also many ways people can make money. We are researching the ones which will be most suitable for this particular context, poor, rural, isolated, etc. We want each person or family to take on more than one way of making or saving money, in fact, as many as possible each. The Scottish say 'many a mickle makes a muckle', here in East Africa they say 'haba na haba hujaza kibaba' (little by little fills the pot).

Those who collect HIV data are probably not going to note a drop in HIV transmission in this area next year, or perhaps even several years from now. HIV is going to continue to spread in an area where the disease is endemic, where people are poor and lack health facilities, where a good level of education is rare, where basic things like food and water are in scarce supply, where infrastructure is falling apart and where most people don't work.

But Ribbon of Hope aims to reduce poverty to the extent that some people will be able to send their kids to school, pay for their health care and provide them with adequate nutrition and clean water. And when those children leave school, they will have a better chance of being able to find work, being better educated and healthier than the generation before them. They may even have developed some entrepreneurial skills and know good ways to make enough money to do the same for their children.

Most HIV money is spent on very expensive projects that target one disease and only one aspect of that disease, sexual behaviour. As long as the contexts in which this sexual behaviour takes place are ignored, most of the money is being wasted. Health, nutrition, food security, education, infrastructure and many other things are crying out for money but unless sexual behaviour is somehow involved, they will not be funded. This approach has not worked. HIV rates have waxed and waned in certain areas and in certain demographic groups. But rates are still high and the levels of sexual practices said to spread HIV have remained relatively unaffected by the hundreds of millions of dollars that have been thrown at the problem for over two decades.

People's sexual behaviour is at least partly determined by the conditions in which they live and work (in addition to physiological conditions, hormonal levels, etc). But their health seeking behaviour, their diet, the way they raise their children and their attitude towards education are also constrained by these same conditions. If you want to influence people's sexual behaviour, and especially their attitude towards sexual health and risk, you need to look beyond their sexual behaviour in isolation. This sexual behaviour is likely to be pretty much the same all over the world. But the conditions in which people live and work are very different in Kenya than they are in, say, Ireland.

There are exceptions, but most people I have met who are HIV positive spend their days getting on with the same things as people who are HIV negative, and worrying about the same things, too. They need to earn money, pay bills, raise their children, support their dependents, get by and perhaps even think about the future, if there is any money or energy left over for that. That's why I think a community based organisation that helps people achieve these goals is doing more to reduce the spread of HIV than all the expensive HIV prevention programmes that UNAIDS can think up.