NATIONAL AIDS CONTROL COUNCIL 1 Women, HIV and AIDS Cultural Challenges and Transformation in Contemporary East Africa – Focus on Kenya Duquesne University

NATIONAL AIDS CONTROL COUNCIL 1

Women, HIV and AIDSWomen, HIV and AIDS

Cultural Challenges and Transformation in Cultural Challenges and Transformation in Contemporary East Africa – Focus on KenyaContemporary East Africa – Focus on Kenya

Duquesne UniversityDuquesne UniversityCentre for African StudiesCentre for African Studies

March 24, 2014March 24, 2014

Prof. Mary N. GetuiProf. Mary N. GetuiChairperson, National AIDS Control Council, KenyaChairperson, National AIDS Control Council, Kenya

Professor, Catholic University of Eastern Africa, Nairobi, KenyaProfessor, Catholic University of Eastern Africa, Nairobi, Kenya

NATIONAL AIDS CONTROL COUNCIL 2

OUTLINEOUTLINE1. Introduction2. Overview on HIV and AIDS in Kenya3. Key Aspects of African Culture4. The Place of Women in Indigenous African Society5. The Place of Women in Contemporary African Society6. The Challenge of HIV and AIDS on African Culture –

Focus on Women7. Women, HIV and AIDS and Cultural Transformation in

Africa8. Conclusion

NATIONAL AIDS CONTROL COUNCIL

1.1. INTRODUCTIONINTRODUCTION HIV and AIDS have dealt a devastating blow to

Africa – socially, economically, politically, spiritually, and on all sectors of African society. Women have borne the heaviest brunt.

The focus of this presentation is the cultural challenges and transformation HIV and AIDS has brought in the way of the African Woman.

HIV and AIDS manifests uniquely in each context. This presentation draws on Kenya; many of the ideas, however, would apply across sub-Saharan Africa.

3


2. OVERVIEW ON HIV AND AIDS IN KENYA

a) HISTORICAL MILESTONES:

1984 - 1st case of HIV infection reported 1997 - Sessional Paper No. 4. of 1997 on AIDS in Kenya

recommended a multisectoral approach in HIV programming coordinated by a body corporate in Office of the President

1998 - 2 million HIV+, over 400,000 had died, 170,000 new infections per year and 100,000 dying yearly; coordination by health sector alone

Early 1999 - AIDS had: -Deepened poverty -Slowed Economic Growth

4


Historical Milestones Contd..Historical Milestones Contd..– Reduced life expectancy from 62 to 46 years – Worsened other infectious diseases – Affected households particularly women and children

1999 - HIV and AIDS declared a national disaster, the NACC established to coordinate multisectoral response

2000 – 2012/13 - Three Strategic Plans developed under NACC leadership

-KNASP I 2000 – 2005 -KNASP II 2005/6 – 2009/10 -KNASP III 2009/10 – 2012/13

5


Historical Milestones Contd..Historical Milestones Contd.. Resources mobilized to support KNASP I – III

– WB - KHADREP 2000 – 2005 USD 50 M – TOWA 2008 – 2013 USD 135 M – GF – Round 2 - USD 107 M (2008)

Round 7 - USD 130.5 M (2016) Round 10 - USD 345 M (2016)

– GOK/USG Partnership Framework (2009 – 2014)

-USD 500 M per year. – As at 2011 – USD 600 M available annually for HIV

programming.

6


Historical Milestones Contd..Historical Milestones Contd..

7

2006 - HIV and AIDS Prevention and Control Act became operational.

2009 - Kenya the only country in the world with an HIV and AIDS Equity Tribunal to fight stigma and discrimination among PLHIV.

Of all cases heard by the HIV and AIDS Equity Tribunal since its commencement of hearing in January 2012, workplace-related discrimination involving PLHIV take the lions share.


North Eastern

0.9%

Eastern3.5%

Rift Valley3.7%

Nyanza15.1%

Western4.7%

Central3.8%

Nairobi4.9%

Coast4.3%

National Average:

5.6%

HIV Prevalence KAIS 2012

Percentage HIV positive, women and

men age 15-648


b) Programmatic Progress made in the Last Three b) Programmatic Progress made in the Last Three Decades at a GlanceDecades at a Glance

Indicator Baseline Data (2000)

Current Data (2009)

Most Current Data (2012)

HIV Prevalence 15 – 49 Years 15 – 64 Years

14% 6.3%7.1%

5.6%

Incidence 15 – 49 Years 68,457 (2001) 99,324 85,000Number living with HIV 1.5 million 2001) 1.5 million 1.6 MillionAnnual AIDS deaths 107,930 (2003) 73,114 46,000HTC ProgrammeNumber of VCT sitesNumber tested annually

43 (2001)18,151 (2001)

4,9393,471,567

5,4526,350,000

ART ProgrammeAdult ART sitesPediatric ART sitesAdults on ARTChildren on ARTPeople on care

48 (2004)10 (2004)

24,000 (2004)960 ( 2004)

85, 941 (2004)

943385 (2008)308, 61023, 370

621,926 (2008)

18291829

54858855439

981,982

9


Programmatic Progress made in the Last Three Programmatic Progress made in the Last Three Decades at a Glance – Contd..Decades at a Glance – Contd..

Indicator Baseline Data (2000)

Current Data (2009)

Most Current

Data (2012)PMTCT ProgrammeNumber of PMTCT sitesPMTCT (ARV coverage %)PMTCT (Testing coverage %)No. pregnant mothers receiving ARVs% of infants born to HIV + mothers who are infected

76 (2002)38 (2003)55 ( 2003)

14,229 (2003)

36 (2003)

3,000 (2008)6965

59,601

27

67806080

52,180

15

TB/HIV co-infection% TB cases tested for HIVHIV positivity rate among TB patients %

31 (2001)60 (2001)

8844

9439

Condom Distribution Male Condom 92,572,080

(2004)124,523,984 150 million

10


c) SOURCES OF NEW HIV NFECTIONS c) SOURCES OF NEW HIV NFECTIONS (KMOT 2008)(KMOT 2008)

From Kenya Modes of Transmission study (KMoT, 2008); the sources of From Kenya Modes of Transmission study (KMoT, 2008); the sources of new HIV infections were as follows:new HIV infections were as follows: Heterosexual couples within a union/steady Heterosexual couples within a union/steady - - 44.1%44.1%

partnerships partnerships Casual heterosexual sexCasual heterosexual sex - - 20.2%20.2% Men who have sex with men / prison populationsMen who have sex with men / prison populations - -

15.2%15.2% Sex workers and their clientsSex workers and their clients - - 14.2%14.2% Injecting Drug useInjecting Drug use - - 3.8% 3.8% Health facility – related infectionsHealth facility – related infections - - 2.5% 2.5%

Suggesting a need to redesign programme implementation modalities and Suggesting a need to redesign programme implementation modalities and also address systems strengthening issues.also address systems strengthening issues.

11


d) HIV Prevalence by Genderd) HIV Prevalence by Gender

Source:KDHS 2003 & 2009 and KAIS 2007


e) New infection by age – more infection e) New infection by age – more infection among Women occur in age 15-24among Women occur in age 15-24


f) HIV prevalence among MARPs (three to five f) HIV prevalence among MARPs (three to five times higher than general population)times higher than general population)


g) HIV prevalence among women and men g) HIV prevalence among women and men aged 15-64 years, Kenya 2012.aged 15-64 years, Kenya 2012.

15


h) HIV prevalence by age category, h) HIV prevalence by age category, KAIS 2007 and 2012KAIS 2007 and 2012

16


i) HIV prevalence among rural and i) HIV prevalence among rural and urban residents aged 15-64yrs.urban residents aged 15-64yrs.

17


j) Circumcision among men aged 15-j) Circumcision among men aged 15-64 years by province, Kenya 201364 years by province, Kenya 2013

18


k) HIV Prevalence among Couplesk) HIV Prevalence among Couples

Percentage HIV positive, woman and men age 15-64Source: KAIS 2012

19


l) HIV Prevalence among Youthl) HIV Prevalence among Youth

Percentage women and men age 15-24 HIV positive

20


m) New Adult HIV Infections have m) New Adult HIV Infections have reducedreduced

2011 = 91,000


o) Number on ART continue to o) Number on ART continue to increaseincrease


p) Coverage of clients on ART has p) Coverage of clients on ART has increased to over 80%increased to over 80%

Coverage = 81%

Eligibility for treatment changed


q) Number of Children Needing ARTq) Number of Children Needing ART

Eligibility for all HIV+ children under 18 months of age

Coverage = 39%


r) AIDS Deaths Have been Averted by r) AIDS Deaths Have been Averted by ARTART

270,000 deaths averted through 2011


s) Child Infections Averted by PMTCTs) Child Infections Averted by PMTCT

46,000 infections averted through 2011


t) Leading t) Leading CausesCauses of Deaths and Disabilities in of Deaths and Disabilities in Kenya Kenya (Source: WHO 2010 World Health Statistics)(Source: WHO 2010 World Health Statistics)

Rank Cause of Death Proportion (%) of Total Deaths

1 HIV and AIDS 29.3

2 Conditions arising during prenatal period 9.0

3 Lower Respiratory Infections 8.1

4. Tuberculosis 6.3

5. Diarrhoeal Diseases 6.0

6. Malaria 5.8

7. Cerebrovascular Disease 3.3

8. Ischemic Heat Disease 2.8

9. Road Traffic Accidents 1.9

10. Violence 1.6

27


u) Leading Risk Factors and Contribution to u) Leading Risk Factors and Contribution to Mortality and Morbidity in Kenya Mortality and Morbidity in Kenya (Source: WHO 2010 World (Source: WHO 2010 World Health Statistics)Health Statistics)

Rank Risk Factor Proportion (%) Total Deaths

1 Unsafe Sex 29.7

2. Unsafe Water, Sanitation & Hygiene 5.3

3. Suboptimal Breast Feeding 4.1

4. Childhood and Maternal Underweight 3.5

5. Indoor Air Pollution 3.2

6. Alcohol Use 2.6

7. Vitamin A Deficiency 2.1

8. High Blood Glucose 1.8

9. High Blood Pressure 1.6

10. Zinc Deficiency 1.6

28


3. KEY ASPECTS OF AFRICAN CULTURE

29

There are diverse communities but there are some common principles that prevailed in the indigenous setting.– Respect for life hence the emphasis on marriage

and procreation.– Rites of passage that provided communication for

each stage of life and from one stage to another.– Structures and systems that were age and gender

specific.


4. THE PLACE OF WOMEN IN INDIGENOUS AFRICAN SOCIETY

(In East Africa the society was patriarchal and patrilineal)

– At birth, Baby Girl and Baby Boy were accorded respective rituals – those for the boy appearing to be “more”. Of significance is according the baby a name for purposes of identity and belonging.

– Initiation rites hinged on stepping out of childhood to adulthood – the concentration was on imparting context related skills and knowledge in a structured and intense manner.

– The skills and knowledge included: sexuality, relationships, industry, and co-existence.

30


Contd…THE PLACE OF WOMEN IN INDIGENOUS AFRICAN SOCIETY– For the woman, the skills and knowledge

focused on her as homemaker.– The married woman was (expected to be)

mother, nurturer.– The widow was guarded (not inherited), her

property was safeguarded.– The elderly woman served as counsellor,

consultant, and watchman. Advancing/advanced age was regarded as a blessing.

31


5. THE PLACE OF WOMAN IN CONTEMPORARY AFRICAN SOCIETY

The focus on the girl child at the expense of the boy child.

The school is open to both boys and girls but girls have higher drop out rate.

The school curriculum has generally no gender bias, but there are subtle inferences on the inferior woman.

Through formal education and job opportunity, she is no longer just home maker, she is a career woman.

32


Contd...THE PLACE OF WOMAN IN CONTEMPORARY AFRICAN SOCIETY

Even without formal education she is not confined to the domestic front – she is a factory worker, she is a trader, she has moved to the urban centre in search of greener pastures.

For various reasons, there is an increase of single mothers.

She is not confined to cultural expectations – the enlightened widow can choose not to be guarded or inherited.

It ought to be noted however, that the cultural expectations and obligations still linger, much more in the rural area.

33


6. THE CHALLENGE OF HIV AND AIDS ON AFRICAN CULTURE – FOCUS ON THE

WOMAN Virginity of the woman (at marriage) was a blessing but

with HIV and AIDS, it is a curse – “to sleep with a virgin is cure” a contributing factor to rape, of babies, children and young women.

Sex was for procreation; she was the “recipient” – how does that augur with condom use? She is the “suspect” – could lead to sexual violence.

Vacuum on sex/sexuality education – initiation has weakened, school focuses on academic matters – how can a youth mitigate against HIV infection through sex when she is ignorant?

34


Contd…THE CHALLENGE OF HIV AND AIDS ON AFRICAN CULTURE – FOCUS ON THE

WOMAN When she has no formal education to guarantee a

steady job, what prevents her from sex work and the consequent vulnerability to HIV infection? More so if she is an AIDS orphan who is also head of a family; can she even resist widow inheritance for the sake of her children and assets?

Pregnancy is no longer a private matter – she should be tested for HIV in line with PMTCT.

Breastfeeding was a pinnacle of motherhood – if she is infected, does she or does she not breastfeed?

35


Contd…THE CHALLENGE OF HIV AND AIDS ON AFRICAN CULTURE – FOCUS ON THE

WOMAN If her children have succumbed to HIV and AIDS, what is

the option other than to become grandmother mum? Women (older) are not comfortable with male service

providers. HIV and AIDS regarded as a female issue so male support

lacking, a blame game on the woman. The infected or affected woman is bound and open to stigma

and discrimination - what has she been up to? more so in discordancy.

Africa suffers constant turmoil/conflict – women and children bear “the fruits” – rape, displacement – prone to infection, adherence hampered.

36


7. WOMEN, HIV AND AIDS AND CULTURAL TRANSFORMATION IN AFRICA

Generally, it is women who have emerged stronger than men with regard to testing, adherence to treatment, public declaration/confession, to joining social support groups and to being care – givers. Some examples:

Women Fighting AIDS in Kenya (WOFAK)– Founded by Dorothy Onyango who discovered her sero – positive

status in 1990.– Is a countrywide organization that provides basic needs, but also

nurtures and grows women to become transformative leaders.– In the book “Beyond Public Confessions”, Dorothy and eight other

women share their inspiring stories of struggle, betrayal, acceptance and triumph.

– Dorothy serves as an Advisory Board Member, Pan African Positive Women Coalition.

37


Contd…WOMEN, HIV AND AIDS AND CULTURAL TRANSFORMATION IN AFRICA

Kenya Network of Women with AIDS (KENWA)– Founded by Asunta Wagura– When she was diagnosed HIV positive in 1989 she was

given six (6) months to live.– Asunta has defied all odds, she is the proud mother of five

(5) children – a testimony that motherhood is possible even with HIV.

Social Support Groups There are thousands of Social Support Groups across Kenya

headed by women who are infected or affected by HIV and AIDS. Often, they are supported by local or international partners for nurture of capacity building of skills or for Income Generating Projects. More importantly is the support they derive from each other.

38


7. WOMEN, HIV AND AIDS AND CULTURAL TRANSFORMATION IN AFRICA

Beyond Zero – The First Lady’s Campaign – Margaret Kenyatta, the First Lady, Kenya, has initiated the

Beyond Zero Campaign that aims at preventing women and children deaths and giving a new impetus to HIV.

– One of the drives is the First Lady’s Half Marathon – March 9, 2014 that attracted over 30,000 participants which will culminate in the London Marathon in April 2014.

– The First Lady intends to support various activities that will enhance maternal new born and children’s health.

– Beyond Zero resonates with getting to zero – new infections, discrimination and HIV related deaths.

39


8. CONCLUSION The involvement and contribution of women in the HIV and AIDS

response is critical.– They constitute 52% of the population.– They are more vulnerable to infection due to their anatomy and cultural

expectations, hence the need for specific and deliberate focus on the woman by key arms such as the health sector, religious institutions and the academy.

– They suffer more from stigma and discrimination– While being HIV positive is a threat to motherhood, many of those

infected desire to be mothers and have been able to do so.– The unique position of the African Woman who is expected to abide by

culture and/but at the same time driven to question, ignore or abandon this culture due to the contemporary reality – has ignited in her a drive to transform society, not just for her good but for the good of the wider society.

40


THANK YOU

41

Documents

NATIONAL AIDS CONTROL COUNCIL 1 Women, HIV and AIDS Cultural Challenges and Transformation in Contemporary East Africa – Focus on Kenya Duquesne University