Archive for July 26th, 2008

More Education Equals Less Teen Pregnancy and HIV

Posted on 26 July 2008. Filed under: Education, Public Health |

Photo: Julius Mwelu/IRIN
Girls who stay in school are less likely to contract HIV

NAIROBI, 25 July 2008 (PlusNews) – Keeping Kenyan girls in school and ensuring they have access to HIV and sex education has a dramatic effect on lowering future levels of HIV, according to experts.

“Young people do not have the information they need, and the dropout rate, particularly for girls, is still too high,” said Rosemarie Muganda-Onyando, executive director of the Centre for the Study of Adolescence (CSA), which conducts research into teen behaviour and implements programmes for them.

“Dropping out of school ensures a life of poverty for these girls, and many of them also wind up HIV-positive because the male-female power dynamics become even more slanted against them.”

Although the government introduced free primary school education in 2003, an estimated one million children of school-going age are not attending school. Up to 13,000 Kenyan girls drop out of school every year as a result of pregnancy, and around 17 percent of girls have had sex before they turn 15. HIV prevalence in Kenyan women aged between 15 and 24 is about 5 percent, compared with just one percent for their male counterparts.

The Kenya Demographic and Health Survey of 2004 found that better educated girls were less likely to marry early, more likely to practice family planning, and that their children had a higher survival rate.

According to the United Nations Children’s Fund, uneducated girls are also more likely to contract HIV/AIDS, which spreads twice as quickly among them than among girls who have had even some schooling.

The Ministry of Education has an HIV/AIDS prevention and sex education curriculum that focuses on upper-primary and secondary school, but no specific time is set aside for this, leaving teachers and school heads to fit in the subject at their discretion.

“I would like to see compulsory comprehensive HIV and sex education – and not just the bare bones, but something that goes further and teaches kids to become responsible for their actions and take greater control of their future,” Muganda-Onyando said. “Not enough teachers have been trained for this type of education, so children are leaving school with academic qualifications and not many life skills.”

These were not the only obstacles: the strong influence of fundamentalist Christians in HIV funding to Kenya had also played a part in preventing sex education from being taught in schools; and “There is also resistance from parents, many of whom feel school is not the place to learn about sex,” she said.

This lack of information meant girls were not practising safe sex; a 2003 government survey noted that just 25 percent of women aged 15 to 24 reported using a condom the last time they had sex with a non-marital, non-cohabiting partner.

Schools ill-equipped for sex education

Schools in remote, rural areas and deprived urban areas are often ill-prepared to handle sex education; many have not seen the government’s curriculum.
“We don’t have sex education or HIV education; the government hasn’t given us any materials or training so we don’t know where to start,” said Christopher Barassa, principal of Genesis Joy Primary and Secondary School in Mathare, Nairobi’s second-largest slum.

Although registered with the Ministry of Education and the Nairobi City Council, the school is considered as ‘non-formal’ because of its location and lack of facilities; it has no playing ground or toilets, so the school is surrounded by ‘flying toilets’ – faecal matter wrapped in plastic bags and thrown away – and garbage. All the students are from the slum, and Barassa says keeping them in school can be difficult.

''When we investigate the pregnancies, it is almost always an older man … over twenty and sometimes over thirty. We work with the local police to prosecute them.''

“Our drop-out rate is not very high, but teen pregnancy is a real problem,” he told IRIN/PlusNews. The school’s policy is to encourage girls to return to school after they give birth, but many felt too stigmatised or had no help to look after their children and therefore stayed away.

“When we investigate the pregnancies, it is almost always an older man … over twenty and sometimes over thirty,” he said. “We work with the local police to prosecute them – we recently had a 31-year-old man arrested for marrying one of our students who was just 15.”

He noted that many parents in the slum had inadequate control because work kept them away from their children, sometimes for days. As a result, children learnt about sex from the wrong sources, such as the numerous video halls that allowed children to view pornographic films.

“The girls also have to live in one room with their parents until they are mature, and many of them witness their parents having sex, so they learn about it early,” Barassa said. “Sometimes they get a man when they are still young in order to get out of that situation.”

More sex education, less sex

The CSA runs projects aimed at lowering the drop-out rate for girls and teaching them about sexual and reproductive health, including HIV. “The projects train teachers to impart life skills, create safe spaces in schools where girls can freely discuss the issues they are facing, and foster mentor-protégé relationships between older and younger students, so the younger ones have somewhere to turn,” CSA’s Muganda-Onyando said.

“One of the big problems has been the breakdown of our traditional African systems, where an aunt or grandmother was responsible for sex education … people say discussions about sex are taboo in Africa, but this is not true,” she said. “We lost those systems through colonisation and modernisation, and they haven’t been replaced; these projects are trying to give children back that support system.”

The CSA also establishes ties with the community, encouraging parents to take an active role in teaching their children about sex, and to behave more responsibly themselves.

The initiative, which is being implemented in more than 100 schools around the country, has had positive results so far: participating schools have noted a significant drop in teen pregnancy, higher retention and completion rates of school education, and improved self-esteem and confidence among girls, which in turn has led to higher scores in exams.

“Girls also need to be supported with uniforms, books, and other material necessities for school,” said Principal Barassa. “If a girl has everything she needs for school, she can stay in school and concentrate on her studies, and she will not look for an older man to buy them for her in exchange for sex.”

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PMTCT Services not Reaching Rural Women in Kenya

Posted on 26 July 2008. Filed under: Affirmative Action, Public Health |

Photo: Manoocher Deghati/IRIN
Many of the women are unaware of their status

ISIOLO, 24 July 2008 (PlusNews) – The government’s campaign to prevent HIV transmission from mother to child is failing pregnant HIV-positive women in Kenya’s remote rural areas.

A shortage of testing sites and trained medical staff in rural areas means many of these women are unaware of their status and that their babies are at risk of contracting the virus.

“You have been blessed with a baby; as part of the Government’s free child health care, take your child for HIV testing six weeks after birth,” reads a poster at the Isiolo district hospital in Kenya’s Eastern Province. “If found positive, your child will receive free care and treatment. Children are a blessing – nurture their health.”

These public service messages, strategically placed in government hospitals, are meant to encourage women to use prevention of mother-to-child HIV transmission (PMTCT) services. But the messages and the services they advertise are only useful to women who live close to district hospitals.

“Women attending antenatal care services are never tested for HIV in remote areas of Samburu district [in the northwest]. The services are only available at the district and some few divisional health centres … many children are contracting the virus from their parents,” Margaret Leshore of the local NGO, the Samburu East Women’s Empowerment Programme, told IRIN/PlusNews.

“We know that HIV transmission to the unborn can be prevented; transmission while breastfeeding can also be avoided, but we are lacking all these services,” she added.

Heavily pregnant Julie Leresh, the mother of four young children, attends the antenatal clinic at Samburu’s Lerata dispensary but does not know her HIV status and does not perceive herself or her children to be at risk of infection.

More information and awareness needed

“I have no reason to be tested for HIV. I have heard a lot about it … I don’t stay in town – it affects those who reside in town and it is all because of what they eat and their behaviour,” she told IRIN/PlusNews.

Many rural women in the area have views similar to those of Leresh, and health workers have pointed out that unless information about the pandemic is brought to grassroots communities, HIV will continue to spread unchecked. In Samburu, where ignorance about HIV is widespread, prevalence is 6.1 percent, compared to the national average of about 5 percent.

''I have no reason to be tested for HIV. I have heard a lot about it … I don’t stay in town it affects those who reside in town and it is all because of what they eat and their behaviour''

In areas where services are present, health workers say they should be culturally sensitive if they are to have the intended impact. “Women who are strict Muslims can never allow to be attended by a man,” said Ali Boru of the NGO, Isiolo Youth against AIDS and Poverty.

“Also, some of the locals are reluctant to be tested by local health personnel, because some cases of those who were found to be HIV positive are said to have been leaked to the community – it is the worst fear for many.”

Boru said the problem was compounded by a severe shortage of qualified medical personnel and counsellors in the region.

The Kenya Red Cross and the government recently drew up a five-year plan to combat the spread of HIV by equipping existing health centres in rural areas with voluntary counselling and testing (VCT) services and using mobile VCT centres.

Dr Robert Ayisi, PMTCT coordinator at the National AIDS and STI (sexually transmitted infections) Control Programme, acknowledged that women in rural areas were worse off.

“We are working hard with our partners in remote areas to ensure that all women, be they rural or urban, have access to PMTCT services,” he told IRIN/PlusNews.

According to the government, an estimated 19,000 babies contracted HIV during pregnancy, childbirth or breastfeeding in 2006.

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No Substitute for Support When Taking ARVs

Posted on 26 July 2008. Filed under: Public Health |

Photo: Waweru Mugo/IRIN
“They know where the shoe pinches most”

MERU, 16 July 2008 (PlusNews) – “We [people living with HIV] must eat well, must keep off stress – it is not good for you … if you can, please walk out on anything annoying and go and watch Vitimbi [a popular TV sitcom] or sing your favourite song … be happy and positive.”

This is part of a message Dorothy Kendi* gives her ‘class’ of HIV-positive people at Meru district hospital in eastern Kenya. Her students listen eagerly, interrupting her dialogue every now and then with questions about diet, adhering to an antiretroviral (ARV) drug regimen and other lifestyle issues.

Kendi has lived with the virus for the past 23 years, during which time she has gathered a wealth of knowledge. She has also become a valued asset of Zingatia Maisha (ZM) (Swahili for focus on life), a project started in 2006 and supported by pharmaceutical giant GlaxoSmithKline through the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), as well as the African Medical and Research Foundation and the Ministry of Health, among others.

The project empowers communities to participate in HIV care and treatment, with a focus on encouraging people living with HIV/AIDS to take a more active role in the fight against HIV.

“Zingatia Maisha came here to help those of us who are infected. Those on ARVs have been trained to stick to drug prescriptions to the letter, and we have been taught good nutrition habits and positive living,” she told IRIN/PlusNews.

Rogers Simiyu, programme officer for EGPAF, said: “The number of people testing HIV-positive was overwhelming health facilities and health workers, so we decided to go into the community to get support for the programmes.”

He added that the project was particularly useful on the issue of adherence, because while so much focus had gone on increasing the numbers of people on ARVs, there was not enough on keeping them on the drugs.

“HIV-positive people usually visit the clinic once a month, but they live in the community for the other 29 days. It’s important for them to have support systems within their social networks.”

Support groups a “safety net”

The ZM initiative fosters adult, paediatric and youth support groups. Group leaders assist with client referrals and ARV defaulter tracing, while HIV-positive youth and adult members pair up as ‘treatment buddies’ to check on one another’s health and general welfare. Groups also engage in income-generating activities to improve the socio-economic welfare of members.

Kendi, a leader of Meru’s Mwiteria support group, is among the many volunteers who train visitors to the hospital’s comprehensive care centre. For example, every Monday morning, when infected children gather with parents or guardians on their clinic days, she discusses ARV adherence, paediatric psychosocial support and stigma.

“Using HIV-positive people to pass on these messages is really useful – I have often heard them say they know where the shoe pinches most,” EGPAF’s Simiyu said. “They understand exactly what people are going through and can deal with them on the same level.”

He said the support groups had provided a crucial ‘safety net’ for newly diagnosed HIV-positive people, because stigma and discrimination were still high in Kenya and the groups acted as a good buffer against society’s negative attitude.

“In our talks at the centre, and during community outreaches, we also emphasise the importance of forming or strengthening [HIV/AIDS] support groups, disclosure, behaviour change and healthy eating, and discuss opportunistic infections,” said Zablon Kithinji*, an official of Meru’s Kagendo support group.

Local health workers said the ZM project and its involvement in the community had had a significant impact on the care and treatment of people living with HIV in the region.

“The support groups system has encouraged people to freely discuss AIDS, there is widespread knowledge dissemination at the community level and, interestingly, more people are now keen to know their [HIV] status,” said Meru’s Medical Officer of Health, Dr James Gitonga.

Simiyu said the Meru hospital had noticed shorter counselling times, as many patients came to the centre equipped with knowledge gained from the community outreach projects run by the support groups.

Kenya has lost more than 3,000 nurses in the past five years, with most leaving for jobs in Europe and the United States. In an effort to bolster HIV programmes, lay people are increasingly being involved in the less technical aspects of care.

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    A blog created to cover environmental and political information in Kenya with a view to promoting POVERTY ALLEVIATION through creating awareness of the Millennium Development Goals


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