FEMINIZATION OF HIV IN THE KENYAN CONTEXT

 

                              FEMINIZATION OF HIV IN THE Kenyan CONTEXT

                                                                                                              By Peter K’ouma

 HIV and AIDS operate as an epidemic of signification concentrating more on the gendered and sexualized body of the Kenyan woman as its subject rather than the structural determinants of risk to infection.  This was my stand on a pedestrian argument I had with three learned University comrades from the College of Health Sciences (CHS) - University of Nairobi. Ndambuki, Lovy and Jairus are medical students and I kept wondering what kind of an argument they will have with a student of College of Education. They ended up concluding that I must have been a student of philosophy professors and my Literature gurus.

Jane lost her parents at age fifteen, while her younger siblings were between 5 and 13. Compelled to drop out of school to find a life for her minors, she moved with them to Kibera slums a year later. The same year she moved to the shanties, Jane was raped by a man of her late father's age and contracted the HIV virus. With no job or book knowledge to rely on, she turned to the streets of Nairobi as a commercial sex worker at seventeen. To her, this was a way of fending for her siblings as well as a way of punish the world that infected her with the virus. Unfortunately, Jane died late 2014.

Ndambuki moved in to dilute my true story with another. One of the sitting African presidents married a young lady in a colourful royal ceremony three years ago as dictated by his community’s custom.  He bedded her the very night, and later on, it turned up that the royal queen was HIV positive. The president was screened severally for any infection and he emerged negative. This is also a true story, just as that of Jane. Why is it that the president is alive and free of virus, yet Jane is dead? Was it the biological/ physiological structure of Jane (woman) that exposed her to the virus? Was it the physiological nature of the President (man) that saw him safe?  This is the key question that created tension among us for more than three hours. The interventions that are supposed to be used to combat the HIV menace are directly proportional to our understanding of the context through which this infection operates.

Going with statistics, The Kenya HIV Estimates Report 2014 released by the Ministry of Health in June 2014 provides several insights into this. Kenya’s HIV epidemic is geographically diverse, ranging from a prevalence of 25.7 % in Homa Bay County in Nyanza region to approximately 0.2 % in Wajir County in North Eastern region. Prevalence remains higher among women at 7.6 % compared to men at 5.6 %. In descending order, counties with highest adult HIV prevalence in 2013 included Homa Bay 25.7%; Siaya 23.7%; Kisumu 19.3%; Migori 14.7%; Kisii 8%; Nairobi 8%; Turkana 7.6% and Mombasa 7.4%. HIV prevalence among young females aged 15-24 was higher than that of males in the same age group at 2.7% and 1.7% respectively. Notably young women in this age group account for 21% of all new HIV infections in Kenya, a clear incidence marker.  There were approximately 88,620 new infections that occurred among adults and 12,940 among children in 2013, with the first five counties contributing about 50% of the total new infections.

The key question is
still looming here. The statistics clearly indicate that females are at higher risk of contracting the virus compared to their male counterparts. Why? My learned colleagues based their arguments on the biological structure of a woman and insisted that it is on this that the HIV interventions should be stuffed; the bio-medical interventions.

I agree with the medics that a man’s semen has more viral load compared to that in the vaginal secretions. This means that there are higher chances of a woman (whom the semen is deposited) to contract the HIV virus than men. Men go in and out, while women remain with the deposit, hence a longer time for virus to get into their system.  Lovy commented that if  a woman contract sexually transmitted infections, it naturally takes a longer time to be detected making interventions almost ineffective, unlike men who only need 2-3 days  for it to be detected , hence rendering them aversive to the immediate responses. Jairus almost made me rethink of my stand when he punched in that it is globally confirmed that circumcising men reduces chances of contracting the virus and that it has been proved in Nyanza among the Luo men. I agree this is biological still. Lovy summarized their stand by insisting that it is all about the biological structure of a woman that makes her to be at risk and so biological interventions should be embraced. They mentioned flooding the community with condoms, having enough pre-exposure prolificacy (PREP), microbicides, and having enough ARTs; in order to reduce the high prevalence of HIV among women.

There are approximately 100,000 new infections in Kenya every year. 60,000 of them are women. I don’t think it is the physiological structure of a woman. I have a different literature on this. My argument is based on the gendered and sexualised body of the Kenyan woman.

There is gender ratial in Kenya, just as in most African countries. Women don't have equal rights as men. To address the HIV and AIDS and why it's got a higher prevalence in women, we need to understand the cultural, political, religious, economic, and social factors that surround the Kenyan woman. In my argument, it is the society and its structure that made the president safe while Jane died. The president has access to all medical screenings and all sorts of post-sex care, but Jane, being a young woman, battered by poverty, forced to having sex with a man twice her age, couldn't have survived it. Jane is an African woman, who is supposed to submit fully to a man without questions, as dictated by African beliefs and customs.

I agree with my friends that the use of condoms, microbicides and all that, are means of going through this. However, we can buy all the PREPS and condoms in the world, but at the end of the day, they will all work within a social-cultural setting. They will only work when the conditions are favourable. A woman can buy the condoms from the shop, but can only use when her man agrees and accepts.

In my opinion, we went the wrong way- bringing condoms first before we could make the conditions favourable for their usage. We all agree that the most common way of contracting HIV and AIDS is through sex. Sexual behaviour is within the socio-cultural context. The socio-cultural issues explain how, where, why and when to have sex. Look at for example the difference in the meaning of sex between the Luo and Mijikenda communities. To a Luo, sex has got a deeper meaning. For instance, the Luo culture demands sex on the eve of land preparation, the eve of planting, weed control, the eve of harvesting the eve of making a new home......sex is on a ritual context to the Luos. This is not the case among the Mijikendas. If we can manage to change this set of societal setting then we are going to make an impact.

Again, if we have to argue on the context of male circumcision, then I think we are blinded. A study led by Chris Richard Kenyon of Belgium reveals that the prevalence of HIV is nine times higher among the Luhyas than the Somalis despite similar circumcision rates. Among the Luhyas, the study says almost two-thirds of women believe it is alright for a man to have extra-marital affairs, something which aids the spread of HIV. It is from this context that I strongly believe that the more amorous a community is, the higher the HIV infection.

When we talk of rescuing the society, we need to go further than individual. We change the laws, norms and practices; such that when we talk of ‘me’ as a changed person, then behind me are friends, family, clan and community at large. We need to focus on structural and economic issues within our borders.  HIV is a global issue, but still, there is still a large difference between an African woman and a Western woman; literacy level, employment rate, level of poverty, access to information and level of exposure. All these could explain why in America, people don’t die of HIV and AIDs but live with HIV and AIDS. This is what i will baptize as preparing the land (society) before we could think of preparing seeds (condoms). There is no sense in preparing the seeds, yet you have no hope on where you will plant them. Change the norms governing the society first then bring the condoms, microbicides, PREPS and ARVs.

HIV virus was first detected in both Thailand and Philippines in 1982. Ten years later, both countries devised various interventions to the menace. Thailand took money and invested in condoms. They flooded markets, bathrooms, school and roads with condom sachets and boxes. Philippines on the other hand, started advocacy on promoting virginity. The year 2002, a survey report revealed that the HIV prevalence was 40% less in Philippines compared to Thailand.

It is on these facts that I still believe in, and not even my medicine comrades will change my school of thought. It is in the society first. I believed the director of National Aids Control Council, Mr. John Orago, when he said that we need to tackle the fundamental drivers of the epidemic, particularly gender inequality, poverty, stigma and discrimination in family and health service settings. Mr. Orago, we are not taking off our feet from the pedal until we get the vaccine, move to zero discrimination, zero HIV transmissions and zero HIV and AIDS related deaths.