Your daily Selection of IRIN Africa PlusNews reports, 12/5/2005

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CONTENT:

1 - KENYA: Cultural traditions fuel the spread of HIV/AIDS

2 - KENYA: Fish trade aiding the spread of HIV/AIDS

3 - KENYA: HIV/AIDS a major health issue in western province

1 - KENYA: Cultural traditions fuel the spread of HIV/AIDS

BONDO, 30 November (PLUSNEWS) - When Pamela Dola's brother-in-law died in 1995,

the tradition of her Luo ethnic group dictated that her husband " inherit " his

brother's widow, a responsibility he assumed as a matter of course.

Three months after Dola inherited her, his second wife died. He was soon

taken ill and did not last long.

" Before he died in 1997, he tested positive for HIV. So I knew he had died of

AIDS, " said Pamela Dola, who is HIV-positive and takes antiretroviral (ARV)

medications. Despite her illness, she single-handedly shoulders the

responsibility of raising eight children, including the five orphans left behind

by her brother-in-law and his wife.

<b>Traditions</b>

For members of the Luo community who inhabit the Lake region of Nyanza

Province in western Kenya, customs like wife inheritance and widow cleansing

threaten to extinguish a vast majority of the population. Both practices have

been cited as contributing factors to the high HIV/AIDS prevalence rate in the

province.

Nyanza has an average HIV/AIDS infection rate of 14.7 percent, compared with

Kenya's national average of 9 percent. Alarmingly, the rate varies by as much as

30 percent across the province: In Suba district, for example, it is as high as

41 percent, according to Lennah Nyabiega, a health ministry official in charge

of facilitating access to antiretroviral therapy (ART) in the province.

According to Leonard Oloo, chief coordinator of Rural AIDS Prevention and

Development Organisation (RAPADO), an NGO working in Nyanza's Migori district,

wife inheritance is just one manifestation of the importance of sex in Luo

culture.

Custom also dictates that because a widow is " unclean " she is obliged to

undergo a cleansing ritual immediately after her husband's death. Luo women who

refuse to have intercourse with another man are thought to be unlucky or cursed

and are usually ostracised by the community.

Sex is not exclusively linked to death, however. According to Grace Ayieko of

Community AIDS International, an NGO working with AIDS orphans in Bondo district

in Nyanza Province, sex is almost sacred among the Luo.

" A man has to have sex with his wife before cultivating his field. It is a

ritual that has to take place at every stage of the farming process, " she said.

Oloo pointed out that many of life's milestones, like moving to a newly

constructed home, are preceded by sex. " In the Luo society, sex seems to be more

rooted in tradition, " he observed.

The sex act is believed to have protective powers as well. " If your parent dies,

you have to have sex with your wife before you can leave your home. If you

don't, there is a belief that you could die of chira [a curse], " explained

Ayieko.

<b>Identifying risk factors</b>

In addition to harmful cultural practices, the lower status of women, the social

stigma surrounding HIV/AIDS and poverty all conspire against communities in

Nyanza Province. To curb the rampant spread of HIV/AIDS in the region, members

of the Kenyan government and international aid organisations are working

together to address factors that place communities at risk.

Oloo called for a societal review of traditions that may be contributing to the

spread of HIV/AIDS in Nyanza Province.

" We have a situation in which people, especially women, are culturally obliged

to have sex, " he said. " The woman may not like it because she knows that the

partner could be infected, but the cultural hold is so strong on her, she is

unable to say No. "

Bernard Oduor Olayo, a health systems analyst with the Nairobi-based Millenium

Development Goals Centre, previously worked as a doctor in Nyanza. He surmised

that the low status of most Luo women could be linked to the high incidence of

HIV in the community.

" By and large women are still seen as property. Typically, in a rural Luo family

the woman will not even complain when the husband brings another woman home.

They have been inculcated to accept the fact that husbands are going to have

extramarital affairs, " he observed.

" Among polygamous people there is a tendency of men having significant

extramarital affairs. That is what you observe when you live among them.

Polygamy on its own has not been documented in any literature as a risk factor

on its own, but the man has several sexual partners who are not necessarily his

wives, " he added.

Olayo maintained that social stigma and a tendency to deny the problem hindered

efforts to control the spread of the virus.

" There is a big number of number of people who do not want to go through VCT

[voluntary counselling and testing centres], who do not utilise the

antiretroviral programmes that are already in place in Nyanza. In fact, they do

not want even to know what killed people, " he said.

" People continue interacting sexually with these women even after their husbands

have died of HIV/AIDS, " Olayo observed. " Alternative explanations are given for

every death. It is either a neighbour's witchcraft, or chira, or something

else. "

Extreme poverty also played a role in the rapid spread of HIV/AIDS.

The findings of a government survey released in early November showed that 65

percent of the inhabitants of Nyanza Province lived below the poverty line,

which was calculated at 1,239 Kenyan shillings (US $17) per month in rural areas

and 2,648 shillings ($35) in towns.

" Poverty has a causal relationship to HIV/AIDS, " explained Olayo. " In poorer

areas women start having sex much earlier. They do not have good education.

Women who do not go to school have been studied and found to have higher HIV

prevalence than their counterparts who do go to school. "

The poor were also more likely to have sex for money or marry at a younger age.

They lacked access to good nutrition, healthcare and other services available to

other HIV/AIDS-affected people.

" The poor also carry a bigger burden - like deaths from HIV/AIDS - and were more

likely to engage in sex as a source of income, " Olayo said. " Even young men -

there are women who have been widowed by HIV/AIDS and tend to migrate to

fish-trading areas. These women generally give young boys money and keep them as

sex partners. "

The fact that the Luo as a community do not practise circumcision is also

considered a factor in the high incidence of HIV/AIDS in Nyanza.

According to a study carried out in Gauteng Province in South Africa and whose

results were presented at the 3rd International AIDS Society Conference on HIV

Pathogenesis and Treatment in Brazil in July 2005, male circumcision showed

promising results in reducing HIV acquisition.

The Joint United Nations Programme on HIV/AIDS (UNAIDS), however, cautioned that

more research was needed to confirm the findings of the study in South Africa.

" If you look at the Luo community as a whole - even those living away from the

lake - it has been observed that they tend to have a relatively higher HIV

prevalence, " Olayo said. " One key feature of the Luo culture that has been

studied and documented is the lack of circumcision. Lack of circumcision is a

significant risk factor for contracting HIV/AIDS. "

<b>Working towards change</b>

Oloo said that people in Nyanza province were conscious of HIV/AIDS, but they

" are not changing their sexual behaviour despite the HIV pandemic. "

Awareness campaigns by groups like RAPADO were beginning to bear fruit, however.

" People are now open. They can speak out, " observed Oloo. " More and more people

are coming to our mobile VCT, saying they want to know their [HIV] status. Last

year alone we received 844 people. "

The government had also set up its own VCTs and made ARV medications available

in the main hospitals and health centres in the area. Oloo, however, criticised

the administration for its initial slow response to the pandemic.

Lazarus Ouma, a community volunteer health worker in Bondo district, said people

were beginning to realise that some of their cultural traditions were outmoded

and potentially deadly within the context of HIV/AIDS.

" There are some people who criticise when we discourage wife inheritance. They

will say, 'You are cheating people. Death has always been there [death predates

HIV/AIDS].' But generally people are beginning to understand [that HIV/AIDS is a

reality], " said Ouma.

In the Wawai village of Bondo district, women who have been widowed by AIDS and

rejected wife inheritance have established a support group.

" Wife inheritance is bad. It is because of it that I am now HIV-positive. Were

it not for it, I still would be a healthy person, " said Felista Aluoch, 37, who

believed she was infected by her late husband, who took his sister-in-law as his

second wife after his brother died.

Aluoch said she was " deserted " by her brothers-in-law after she refused to be

inherited. She now raises seven children on her own, despite the fact that she

relies on free ARVs provided by a government clinic in Bondo town, 58 km away.

Aluoch, who ekes out an income fetching water for neighbours, selling firewood

and raising a few chickens, said she sometimes lacks the 300 Kenya shillings

($4) in bus fare to travel to Bondo town to pick up a month's supply of ARVs.

The National AIDS Control Council, a government agency, has in its strategic

plan acknowledged that although HIV/AIDS awareness in the country was high,

people have been slow in changing their behaviour where sexuality was closely

linked to traditional beliefs and cultural practices.

[<a href= " http://www.plusnews.org/AIDSreport.asp?ReportID=5500 " >HIV/AIDS a major

health issue in western region</a>]

[ENDS]

2 - KENYA: Fish trade aiding the spread of HIV/AIDS

BONDO, 5 December (PLUSNEWS) - Isaya Onyango, a 47-year-old fisherman, lives in

Liunda village near the shores of Lake in western Kenya. He spends most

of his nights in a dugout canoe, fishing the lake. His wife and children, who he

visits occasionally, live far away in another village.

Onyango says loneliness compelled him to start living with a female fishmonger

he befriended on the beach, where most of the fish trade is carried out.

" I felt the need for companionship, so we started living together, " explained

Onyango, who added that affairs between fishermen and women fish traders were

commonplace.

Lake is the world's second largest freshwater lake and renown for its

rich harvests of tilapia and Nile perch. Sadly, the region has also gained a

reputation for having the highest HIV-prevalence rate in Kenya.

The average HIV-infection rate in Nyanza Province, which falls within the lake

basin, is 15 percent, compared with the national prevalence rate of 7 percent.

In the villages along the shores of Lake and on the isles that dot its

surface, HIV/AIDS has taken a heavy toll.

Experts have indicated that the lifestyle of people involved in the fish trade

increases their likelihood of engaging in risky sexual behaviour and could be

one of the reasons for the high prevalence rates in the region.

Women fish traders regularly buy fish from specific fishermen, and in the

process they develop relationships. " It is something they call jaboya [a

customer who is also a lover] in the Luo language, " said Bernard Oduor Olayo, a

doctor who has worked in hospitals in Nyanza and a member of the Luo community.

" So that kind of unsafe sexual practice is one thing which I think contributes

to the high HIV prevalence among people along the lake, " he said. " If you look

at the communities living around the lake in Kenya, Tanzanian and Uganda, those

communities have a very high HIV prevalence. "

The sexual relationships between fishermen and women fish mongers in most cases

happen because the catch is not always bountiful, according to Grace Ayieko, who

works in Nyanza with Community AIDS International, a grassroots NGO funded by

the US Agency for International Development (USAID).

" Most fish buyers are women. Whenever fish are scarce, fishermen prefer to sell

to the women, who often become lovers of the fishermen - kind of giving sexual

favours to ensure a consistent supply of fish for their trade, " said Ayieko.

" Many of these women, the majority of whom have either been widowed or

separated, then become jaboya. If they are infected, the men - some of whom have

multiple jaboya - then infect their wives, " she added.

The fact that fishing is often a nocturnal activity also makes them vulnerable

to risky sexual behaviour, according to Olayo.

" One pertinent feature of lake culture is that these people work at night -

people have to be away from home, just like truck drivers. Couples traditionally

have sex at night, but fishermen are never there at night when they should

interact with their wives and families, " he explained.

Most men enter the fish trade when they are very young, as apprentices to their

fathers, and receive little or no schooling. Lack of education and financial

know-how makes members of the fishing communities more likely to mismanage the

money they earn, according to Olayo.

" They have money but no investment knowledge, " he said. " They don't bank

[money], so they use it for those kinds of risky sexual behaviours. "

Ayieko said HIV/AIDS awareness campaigns and treatment opportunities were rarely

available to the fisher folk, most of whom live and work in the islands and

along the beaches of Lake .

" Most of the NGOs are concentrated in the mainland, leaving people in the fish

trade isolated in terms of awareness creation and treatment, " she said.

She lamented that little had been done to address the issue of HIV/AIDS in

relation to the Luo culture, saying traditions such as the jaboya sexual

relationships between fishermen and women fishmongers had become the norm among

members of the ethnic group, which inhabits most of the lake basin.

" HIV/AIDS has not been looked at in relation to culture in this region, " she

said.

[<a href= " http://www.plusnews.org/AIDSreport.asp?ReportID=5500 " >HIV/AIDS a major

health issue in western region</a>][ENDS]

3 - KENYA: HIV/AIDS a major health issue in western province

NAIROBI, 5 December (PLUSNEWS) - HIV/AIDS remains a major health concern in

Kenya despite the fact that a recent study showed a drop in the national

prevalence rate. According to the Joint United Nations Programme on HIV/AIDS

(UNAIDS), the overall adult infection rate reduced from 10 percent in the late

1990s to 7 percent in 2003.

Despite the reduction, which was mainly due to awareness-creation programmes,

UNAIDS estimated that some 1.2 million Kenyans were living with the virus, of

whom 100,000 are children. Some 650,000 children have been orphaned as a result

of the disease.

To contain the epidemic, Kenya has set up national institutions and local

committees in communities and is working on a new strategic five-year plan for

its fight against HIV/AIDS.

" HIV/AIDS continues to pose a great threat to our society. [...] The virus is

destroying the gains made over the years attesting to the fact that the disease

has impacted negatively on our country's economy " said Orege, director

of the National AIDS Control Council (NACC), in a statement.

According to the NACC 2000-2005 work plan, the disease increasingly affects the

poor and people with low levels of formal education.

" The profile of HIV-infected people has been changing and is becoming a disease

of the poor with educated people in a position to respond to information

available - and adopting safer sexual practices, meaning that the share of new

infections is rising among low income and less educated people " NACC noted.

" Substantial reduction in poverty levels is key to subsequent lowering of HIV

prevalence rates " the agency maintained.

Gender is also a factor in HIV/AIDS infection. HIV/AIDS prevalence among women

aged 15-49 in Kenya is nearly 9 percent, compared to less than 5 percent for men

in the 15-54 age group, according to a 2003 demographic and health survey. "

" This female-to-male ratio of 1.9:1 is higher than found in most

population-based studies in Africa and implies that young women are particularly

vulnerable to HIV infection compared with young men " , the report noted.

The national HIV/AIDS strategic plan acknowledged that women are more vulnerable

to HIV infection than men - largely as a result of women's lower position in the

hierarchy of traditional societies, powerlessness and lack of adequate

information about the disease.

The " majority of women have little control over their own sexual behaviour, and

less over the sexual behaviour of their husbands or partners " , the NACC

observed.

" In addition women have biological factors that increase their risk of HIV

infection. As a strategy to fight HIV/AIDS women should be empowered to enforce

faithfulness within relationships, " it noted.

The government estimated that by 2003 the level of public HIV/AIDS awareness had

risen to more than 90 percent across the country. It noted, however, that

information, education and communication campaigns (IEC) were being undermined

by custom and a lack of trained personnel at the community level.

As a result of increased awareness, condom use has risen. " There has been a

change in sexual behaviour among Kenyans " observed Arungah, permanent

secretary for special programmes, in a statement. " Use of condoms [has risen]

from 15 percent in 1998 to 24 percent among the women in 2004 and from 42.5

percent in 1998 to 47 percent in 2003 among men. "

Similarly, the proportion of men and women with more than one sexual partner

reduced by more than half between 1993 and 2003. Over the same period, more

adolescents delayed the onset of sexual activity.

According to the government, awareness raising, scaling up VCT centres and other

strategies are part of efforts to realise the March 2003 declaration of " Total

War Against HIV/AIDS " .

According to Miriam Were, NACC chairwoman, the government anticipates " further

reduction in new HIV infections through stepped up behaviour change

communication, especially targeting young women and other groups with greater

vulnerability to the virus. "

NACC noted in its 2000-2005 HIV/AIDS strategic plan, however, " Successful IEC

interventions for behaviour change are complicated by the fact that matters of

human sexuality are closely tied to traditional beliefs and cultural practices.

In no other place in Kenya, perhaps, is this demonstrated as strongly as in

Nyanza province in western region.

While the national picture indicates some progress in the fight against the

disease, the situation in Nyanza province is completely different.

The province - with an average HIV/AIDS infection rate of 14.7 percent -

continues to face a crisis and offers a lesson in the role culture and tradition

play in the transmission of the HIV virus.

Traditions such as wife inheritance and widow cleansing, a fish trade in which

women often fall prey to sexual exploitation, a tribal culture that views sexual

intercourse as a harbinger of good fortune, and the lack of male circumcision

have been cited as factors that contribute to high HIV/AIDS infection rates.

In this special report, IRIN explores the HIV/AIDS crisis in Nyanza province's

Bondo, Homa Bay, Kisumu, Migori and Suba districts.

In villages surrounding Kenya's Lake , the pandemic continues to wreak

havoc, awareness levels remain relatively low, traditions that facilitate the

transmission of HIV persist, and medical facilities are too far away for many of

those desperate for help.

[ENDS]

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