FACTORS AFFECTING SAFER SEX STRATEGIES LEADING TO HIGH PREVALENCE OF HIV/AIDS IN KIAMBU TOWNSHIP, KIAMBU DISTRICT


FACTORS AFFECTING SAFER SEX STRATEGIES LEADING TO HIGH PREVALENCE OF HIV/AIDS IN KIAMBU TOWNSHIP, KIAMBU DISTRICT

 

 

 

 

 

 

 

 

 

 

 

A research paper submitted to Premese Africa Development Institute in partial fulfilment for the award of Diploma in Community Health and Development.

 

 

 

 

 

 

 

By

ANN NYAWIRA MAINA

DCHD/SEM-1/FT/004/085/2007

 

 

 

 

 

 


 Declaration

 

This is my original work as a result of independent investigation and has not been presented to any institution for any academic a ward.

 

 

 

RESEARCHER NAME:        ANN NYAWIRA MAINA

 

STUDENT NUMBER:           DCHD/FT/SEM-1/004/085/2007

 

SIGNATURE:

 

 

DATE:

 

 

 

 

Supervisor Declaration

 

I/we acknowledge that this research was conducted by the student under my/our supervision.

 

 

TITLE:            RESEARCH OFFICER

 

NAME:

 

 

DATE:

 

SIGNATURE:

 


DEDICATION

 

This research project is dedicated to my Family Members, for their support, prayers and encouragement. Special dedication to my husband Daniel Eripon, for his financial support and his words that I will make it; to my daughter Heidi Adahpal and my son Bella Eripon for bearing with my absence though young, they gave me strength to continue.

 

ACKNOWLEDGEMENT

 

I wish to extend my thanksgiving to our Almighty God for everything, to all lecturers for their advice, guidance and encouragement; to the entire community of Premese Africa Development Institute for providing a learning environment. Special thanks to Dr. Francis Mulwa for his encouragement. May God bless you all.

Table of Contents

           

Declaration ……..……….….………………….………………….     ii

Dedication ……………………………………………………..      iii Acknowledgement ……………………………………………..     iv

Table of contents ………………………………………………….     v

Abstract ………………………………………………………….      vi

Definition of terms …….…………………………………………     vii

Acronyms …………………………………………………                 viii

Chapter 1

Introduction……………………………………………………………………     1

1.1       Background information ………………………………….     1

1.2       Problem Statement ……………………………….            .    3

1.3       Research Question ………………………………………..     5

1.4       Research Objectives ……………………………………..   6

1.5       Research Hypothesis …………………………………….   7

1.6       Significance of study ……………………………………..  8

1.7       Scope of the study ……………………………………….  8

1.8       Study Limitation …………………………………………  9

Chapter 2         

Literature Review ……………..…………………………………………….     12

Chapter 3         

Research Methodology & Design …………………………………………………..   13

3.1              Study Area ………………..……………………………  15

3.2       Study population/target population ………………………………      16

3.3       Sampling size and procedures……..…………………………………             17

3.4       Data collection instruments …………………………………………  18

3.5       Data analysis and presentation ………………………………………  19

Chapter 4         

Research findings/Results …………………………………………………….  19

Chapter 5         

Conclusions ………..………….………….…………………………….          21

Reference …………..………….………….…………………………….          21

Appendices ………..………….………….…………………………….          21

 


Abstract

Objective:      The study was designed to determine factors affecting the safer sex strategies among the sexually active, commercial sex workers, and Catholic Church Priest in Kiambu Township. The study also sought to answer the following questions: What are the community and religion perceptions and behaviour towards the use of safer sex strategies? What is the role of the church community in combating HIV/AIDS? What is the driving force that has influenced the adolescents more likely to engage in high-risk behaviours, which would lead to high prevalence of HIV/AIDS?

 

Method:          A descriptive cross-sectional employing both qualitative and quantitative methods of data collection was carried out. The study was conducted Kiambu Township. A sample size of 50 respondents (20 youth, 15 CSW, and 15 Priests). Xxx purposively selected focus group discussion was held with in and out of school adolescents.  A scientific calculator was used to carry out analysis of quantitative data.  was selected using simple random sampling. study done by primary and secondary data analysis, the 1991 Population and housing census. The study population were 50 respondents drawn from the Kiambu Township, which forms the target population for questioning on safer sex strategies. The purpose of the study was to assess the level of understand of community towards safer sex strategies.

 

Results:          Evidence suggests that there is greater potential to alter the behaviour and attitudes of younger people with regard to sexuality and HIV/AIDS, because their opinions and behaviour patterns are less well established, so that preventive activities aimed at young people are not only highly necessary but may also be particularly effective.

 

Conclusion/Recommendations:     The study seeks to focus on the assessment of the level of understanding of the community and religion towards safer sex strategies at Kiambu Municipality.


Chapter 1

1.0     Introduction

1.1.   Background information

HIV/AIDS stands for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome. The virus affects human beings resulting into the breakdown of immune system. HIV/AIDS is acknowledged as global health crisis, it emerged in the 1980s as the most terrifying epidemic of modern times. The disease affects all the age groups and it has no cure. It is transmitted through unsafe sex, contaminated blood, and contaminated equipments.

 

Sub-Sahara Africa is now home to nearly 30 million of the World’s 42 million people living with HIV/AIDS. Approximately 3.5 million new infections occurred in 2002 (2.4 in 2006 with a prevalence of 6% over 1% worldwide); while the epidemic claimed lives of an estimate of 2.4 million Africans in the past year which represent 72% of global deaths. Ten million young people (aged 15-24) and almost 3 million children under 15 are living with HIV. For every 10 adult men living with HIV, there are about 14 adult women who are infected with the virus. Across all age groups, 59% of people living with HIV in sub-Saharan Africa in 2006 were women. AIDS experts attribute Africa’s AIDS epidemic to a variety of economic and social factors, but place primary blame on the region’s poverty, which has deprived Africa of effective systems of health information, health education, and health care. As a result, Africans suffer from high rates of untreated sexually-transmitted infections other than AIDS, increasing their susceptibility to HIV. (UNAIDS/07.19E / JC1306E, June 2007)

 

In Kenya, AIDS is a tragedy of devastating magnitude 700 people die every day from the disease and, since the epidemic started, 1.5 million Kenyans have died of AIDS. Most AIDS deaths occur between ages (15-49) in men and (20-30) in women. Thus, most infections occur in teenage (15-19) and early 20s. The country is faced with 2.5 million living with HIV/AIDS and 51% of the beds in government hospitals are occupied by people with AIDS. National HIV prevalence rose from 5.3% in 1990 to 13.1% in 1999. (Kenya National HIV/AIDS strategic plan, 2000). The trend from 1990 to 2000 suggests that adult HIV prevalence in Kenya will increase to about 14% by the year 2005 and then stabilize at that level and the number of infected people in the population will have increased from about 2.2 million people in 2000 to 2.6 million by 2005 and to 2.9 million by 2010. (WHO, 2004)

 

In Kiambu, the HIV/AIDS pandemic is radically affecting the lives of adolescents (15-25) and has a prevalence rate of 7% above the national rate of 5.5% (1999). Estimated 10,000 children have been left orphans by the devastating disease and as a result 60% including young girls below age 15 have resorted to child labour, school drop-out, and commercial sex workers as a way of meeting some of the   basic needs. (Kiambu PLWHA, CBO)

Given the rapid spread of the disease (HIV/AIDS), there is need to continually reassess transmission mechanisms and the behavioural factors which increases the likelihood of a rapid spread of HIV infection and its prevention especially in the case of Kiambu Township.

 

Evidence suggests that there is greater potential to alter the behaviour and attitudes of younger people with regard to sexuality and HIV/AIDS, because their opinions and behaviour patterns are less well established, so that preventive activities aimed at young people are not only highly necessary but may also be particularly effective.

 

 


1.2.   Problem Statement

In Kiambu, the HIV/AIDS pandemic is radically affecting the lives of adolescents (15-25) and has a prevalence rate of 7% above the national rate of 5.5%. Estimated 10,000 children have been left orphans by the devastating disease and as a result 60% including young girls below age 15 have resorted to child labour, school drop-out, and commercial sex workers which  are extremely very high in the town, as a way of meeting some of the   basic needs. Although Kiambu is rated number one in terms of wealth distribution in households, the disease has continued causing poverty and very negative social economic consequences. (Kiambu PLWHA, CBO)

 

Sexuality and sexual behaviour covers huge area of human nature and behaviour. However, in most African societies, these issues are usually not a matter of open discussions. Hundreds of thousands of women and children have contracted the HIV virus despite living lives of moral faithfulness. For example, in Kikuyu culture a woman’s highest risk factor is to be faithfully and submissively married to a husband. In many places it is unacceptable for a woman to negotiate safe sex; to ask her husband to be sexually faithful; to insist he uses a condom if he isn’t faithful; to refuse sex if she suspects he is infected; or to leave him if she feels her life is at risk. Rape and sexual abuse are always more common in such cultures (and subcultures).

 

Jesus endorsed sexual union and faithfulness within committed, monogamous heterosexual relationship as “good”, as being part of God’s intention for humanity. But the Church in general has handled the subject of sex with embarrassment and discomfort. This lack of frank discussion fuels the HIV/AIDS crisis by failing to offer forum for discussion, clear guidelines, role models or accountability for those exploring their sexuality, instead attributing it.

 

Many factors including social and economic have influenced the spread of HIV/AIDS; The HIV/AIDS strategy of the government of Kenya emphasizes an evidence-based approach rooted in Abstinence, Being faithful, and the Correct and Consistent use of Condoms; the researcher intents to explore factors affecting the safer sex strategies (ABC) in Kiambu Township.


1.3.   Research Questions

  1. What are the factors affecting safer sex strategies?
  2.  Is there a relationship between poverty and low use of safer sex strategies?
  3. What are the community and religion perceptions towards safer sex strategies?
  4. What influences adolescents to engage in high-risk behaviours?

 

1.4.   Research Objectives

  1. To assess factors affecting safer sex strategies (abstinence, being faithful and use of condoms).
  2. To find out if poverty contributes towards low use of safer sex strategies.
  3. To asses the community and religion perception towards the use of safer sex strategies.
  4. To asses factors influencing high risk behaviour among the youth.

 

1.5.   Research Hypothesis

  1. There is a strong relationship between poverty and low use of safer sex strategies.
  2. Peer pressure is an influence of low safer sex strategies among the youth.
  3. Level of education is a major factor causing effect of safer sex strategies.
  4. Religion still stands against the use of safer sex strategies (especially condoms).

 

1.6.   Significance of Study

The findings of study will initiate a dialogue to create awareness and educate people on various aspects of sexual health, HIV/AIDS and to promote safe sex practices, including use of condom.

 

This study seeks to encourage the church to be leading the way in discussing and celebrating the matters of sex among the youth, rather than attributing it to ethical cause or blame.

 

The results of the study may be used by NASCOP, NGOs, and CBOs for intervention purposes and scholars as a reference.

 

The study will serve as a learning tool to researcher in order to develop improved skilled in research studies and finally for the partial fulfilment for the award of Diploma in Community Health and Development.

 

1.7.   Scope of Study

The researcher seeks to assess factors affecting safer sex strategies among the youth (15-25) who are sexually active and commercial sex workers (CSW). The Catholic Church priests are the target of the study as they influence thoughts, actions and ways of living. Kiambu Township is densely populated and it may not be possible to have a large sample size, the researcher carefully considering many factors (i.e. time, resources) was restricted to a sample size of 50 respondents.

 

1.8.   Limitation

The respondents may be reluctant to disclose information about their social activities, especially when issues such as sexual activity, HIV/AIDS, condom use and possible illegal activities are involved.

 

 


Chapter 2

2.0              Literature Review

This chapter opens by shedding light on understanding, identification and use of safer sex strategies – Abstinence, being faithful and consistence use of condoms. The researcher will then examine literature on factors affecting the safer sex strategies leading to high prevalence of HIV/AIDS.

 

Practising safer sex through correct and consistent use of condoms is among the recommended HIV risk reduction strategies. Sex is any activity that one engages in for pleasure or reproduction, but safer sex is where you choose a behaviour that makes it less likely for you to get an infection; whereas unsafe Sex is where one is at a high risk of getting an infection.

The HIV/AIDS strategy of the government of Kenya emphasizes an evidence-based approach rooted in “ABC: ” Abstain, Be faithful, and the Correct and Consistent use of Condoms. The Kenyan health ministry estimates that HIV prevalence has dropped markedly from 1998 to 2003. National adult HIV prevalence fell from 10% in the late 1990s to about 7% in 2003 (Ministry of Health Kenya, 2005) and just over 6% [5.2–7.0%] in 2005 (UNAIDS, 2006). As a result of Kenya major HIV prevention effort, there is and evidence that more people have been delaying their sexual debuts, that condom use rates have increased and that a smaller percentage of adults has multiple sex partners. (Cheluget, Marum, Stover, 2006). Similarly, a study published in 2006 in the journal Science reported sharp declines in HIV prevalence in eastern Zimbabwe, associated with striking changes in sexual behavior. As Dr. Peter Piot, head of UNAIDS, remarked, “The declines in HIV rates have been due to changes in behavior, including increased use of condoms, people delaying the first time they have sexual intercourse, and people having fewer sexual partners.” With that knowledge, if one chooses risky behavior, condoms must be made available to that person. (Ibrahim M, et al, ABC of Kenya’s War on AIDS, August 2006).

Today, the World Health Organisation, and indeed most health agencies involved in the HIV/AIDS crisis, promotes the A, B, and C strategy. The A and B emphases are more to do with behaviour change, and the C with harm reduction (or damage limitation). Behaviour change strategies focus on increasing commitment to and the practice of abstinence (before marriage) and faithfulness (when married). Clearly, this strategy is completely compatible with Biblical theology. The Bible, continually calls us to conversion and transformation (Luke 15:1-7; Romans 12:1-2; 1 Corinthians 5:17). The effectiveness of this moral behaviour change approach is frequently credited for bringing about declines in HIV infection rates (although condom promotion has also played a part).

 

Research Objectives

Wthat are the factors affecting safer sex strategies? To assess factors affecting safer sex strategies (abstinence, being faithful and use of condoms).

Is there a relationship between poverty and low use of safer sex strategies? To find out if poverty contributes towards low use of safer sex strategies.

What are the community and religion perceptions towards safer sex strategies? To asses the community and religion perception towards the use of safer sex strategies.

What influences adolescents to engage in high-risk behaviours? To asses factors influencing high risk behaviour among the youth.

 

National adult HIV prevalence fell from 10% in the late 1990s to about 7% in 2003 (Ministry of Health Kenya, 2005) and just over 6% [5.2–7.0%] in 2005 (UNAIDS, 2006). Major HIV prevention efforts were mounted in Kenya from 2000 onwards, and there is evidence that more people have been delaying their sexual debuts, that condom use rates have increased and that a smaller percentage of adults has multiple sex partners. (Cheluget, Marum, Stover, 2006). It is to be hoped that the recently observed changes in behavior will maintain the declining trend. A new concern, however, is the emergence of injecting drug use as a factor in Kenya’s epidemic. Among injecting drug users in Mombassa, for example, 50% were found to be HIV-infected in a 2004 study (Ndetei, 2004), while a study in Nairobi found 53% of injecting drug users were HIV-positive (Odek-Ogunde, 2004). (UNAIDS, 2006)

 

Social and economic factors

Thambo Mbeki’s views on addressing the enormous HIV problem, emphasizes on need to pay more serious attention to the social and economic causes of AIDS and not just a small tiny virus. Many researchers and policy makers agree with President Mbeki that the presence of the virus alone is not sufficient to explain the explosive HIV spread in Sub-Sahara Africa. The role of immigrant labour, social and economic disempowerment of women, pervasive poverty, illiteracy etc have fuelled the spread of the virus. In addition, poverty has further increased the impact of HIV/AIDS in Africa as individuals and governments lack resources needed to manage and cope with disaster of this magnitude. Muraah & Kiarie (2001:128-129).

Poverty forces large numbers of African men (majority of these are young people) to migrate long distances in search of work; Isolated from mainstream society and with limited knowledge and life skills, they are at higher risk of acquiring HIV as a result of unprotected casual sex; while away from home they may have multiple sex partners, increasing their risk of infection. Some of these partners may be women who engage in commercial sex because of poverty, and they are also highly vulnerable to infection. Migrant workers may carry the infection back to their wives when they return home. Long distance truck and public transport drivers are also seen as key agents in the spread of HIV. MoH/CBH Zambia, September 1999.

 

Among various factors that account for the increasing HIV trends, are political and cultural factors, these include war and civil disturbances, social non-acceptance of condoms, cultural and ethnic practices, and women’s status and inability to influence their partner’s behavior. There are also social and economic factors like low literacy rates, poverty, increasing urbanization, economic migration and separation of families. Away from their community and their regular sexual partners, men are more likely to become clients in commercial sex. The involvement of girls and women in sex work often results from coercion and/or the need to provide a source of economic survival for themselves and their families. Violence against women has also been a problem in some places.  WHO, African Health Monitor, December 2000.

 

Unfortunately, however, cities and towns are often the driving force behind the spread of disease as well as economic and social growth. This is due to high population density; the presence of transportation hubs and the existence of large groups of vulnerable persons (e.g. sex workers, unemployed youth, migrant labor, drug users). UrbanAIDS@worldbank.org

World Bank, Published September 2003 A Handbook to support local government authorities in addressing HIV/AIDS at the municipal level

 

Gender roles

Women who are financially, materially or socially dependent on men may have limited power to exercise control in relationships, such as negotiating the use of condoms during sex. Social expectations about how women should behave can place women in subordinate roles and increase their risk of being sexually assaulted. In Zanzibar, unmarried women are denied contraceptives from health professionals, while in Botswana and Senegal married women are restricted from using contraceptives without the permission of their husbands. Generally, women lack complete control over their lives and are taught from early childhood to be obedient and submissive to males, particularly males who command power such as a father, uncle, elder brother or guardian. In sexual relations, a woman is expected to please her male partner, even at the expense of her own pleasure or well-being. Dominance of male interests and lack of self-assertiveness on the part of women puts them at risk. Women are taught never to refuse having sex with their husbands, regardless of the number of partners he may have or his non-willingness to use condoms, even if he is suspected of having HIV or another STD. — MoH/CBH, Zambia, September 1999

Peer Pressure

As remarked by Rusty Wright at a university in California, “Apart from the obvious physical power of one’s sex drive, there are other equally powerful emotional factors that can make it difficult to wait. A longing to be close to someone or a yearning to express love can generate intense desires for physical intimacy. Many singles today want to wait but lack the inner strength or self-esteem They want to be loved—as we all do— and may fear losing love if they postpone sex. They are frustrated when unable to control their sexual drives or when relationships prove unfulfilling. Often sex brings emptiness rather than the wholeness people seek through it”. Peer pressure may be increasing the HIV trends.

Religion

Dr. Juan Flavier, the Philippine Health Secretary, is a fighter. As he goes around the country teaching safe sex, Flavier has emerged as the most serious foe of the Philippine Roman Catholic Church. His teaching is based on the ABC’s of safe sex: “A for abstinence. If you can’t abstain, B for be faithful and, if you can’t be faithful, then use C for condoms.”  The Catholic bishops did not find this funny. In a series of reactions, they accused Dr. Flavier of peddling “promiscuity and permissiveness” along with condoms and diaphragms and warned that his population control program would lead to “the breakdown of families, the encouragement of pre-marital sex and the increased incidence of sexually transmitted disease.”  Clift S, Davidson E, Wilkins J. Int Conf AIDS. July 1992: 19

The Church in general has continued to handle the subject of sex with embarrassment and discomfort. This lack of frank discussion fuels the AIDS crisis by failing to offer forum for discussion, clear guidelines, role models or accountability for those (particularly the youth) exploring their sexuality, instead attributing it . The Catholic Church worldwide on its war against safer sex strategies has remained firm.

 

Archbishop Orlando Antonini, the apostolic nuncio to Zambia, defends the church’s ban on condoms and asserts that the “use of condoms still constitutes a false solution” to preventing the spread of HIV/AIDS. Chansa Kabwela, Post (Zambia), May 5, 2005. In response to a proposal to sanction condom use, the Southern African Catholic Bishops Conference releases a statement saying that widespread promotion of condom use is “an immoral and misguided weapon in our battle against HIV/AIDS.” Reading from the statement, Cardinal Wilfrid Napier says, “Condoms may even be one of the main reasons for the spread of HIV/AIDS. Apart from the possibility of condoms being faulty or wrongly used, they contribute to the breaking down of self-control and mutual respect.” Australian, August 1, 2001. While Cardinal Emmanuel Wamala of Uganda says condoms were originally made for prostitutes and “if we want to promote immorality then we shall continue advocating artificial methods like condoms.” Africa News, “Condoms promote immorality,” September 29, 2003.

 

In an interview with the Sunday Times, Perth archbishop Barry Hickey condemned those who promote condoms as a means for safe sex saying, “Society only gives false assurances to young people” and says the answer is self-control and chastity.” Paul Lampathakis,” Sunday Times (Perth, Australia), November 13, 2006. The Croatian Bishops Conference maintains its opposition to condoms, noting that abstinence and fidelity are the most effective methods of prevention against HIV. Denis Barnett, Agence France Presse, January 19, 2005.

 

After a bishop announces at the Spanish Bishops Conference’s support for condom use as part of a global HIV prevention strategy, Pope John Paul II reiterates his ban on condoms: “Considers that it is necessary above all to combat this disease in a responsible way by increasing prevention, notably through education about respect of the sacred value of life and formation about the correct practice of sexuality, which presupposes chastity and fidelity.” Associated Press, January 20, 2005. In his written message for the XIII World Day of the Sick to take place in Cameroon in February 2005, Pope John Paul II states, “As regards the drama of AIDS, I have already had occasion in other circumstances to emphasize that AIDS is also a ‘pathology of the spirit.’  In order to fight AIDS in a responsible way, its prevention should be increased through education in respect for the sacred value of life and through formation in the correct practice of sexuality.” Zenit, Vatican, November 24, 2004.

 

 

 


Chapter 3

Methodology

3.0              Research design

This was a descriptive cross-sectional study, which was carried out to determine factors affecting safer sex strategies leading to high prevalence of HIV/AIDS in Kiambu Township. The criteria for choosing these place was based on their regional representation, service delivery, security, accessibility, expected level of coverage and presence of diverse activities. The criteria to determine the sample size was derived from a number of factors: The population coverage, prevalence of HIV/AIDS, which forms the target population for questioning on safer sex strategies.

 

3.1              Study Area

Kiambu District covers an area of approximately 1,324 km2. Bordering in the South is the Nairobi and Kajiado Districts, to the East and West by Nyandarua and Nakuru Districts respectively. The district has seven administrative divisions which are subdivided into locations. Kiambu Municipality is the district administrative headquarters.

 

The district is divided into four broad topographical regions i.e. the Upper and Lower highlands and Upper and Lower midland respectively. The upper highland is found in Lari location and is an extension of Aberdare ranges. It lies at an attitude of 1,800M above the sea level. The lower highlands are mostly found in Limuru, part of Kikuyu and Githunguri divisions. It’s characterised by hills, plateaus and high level structural plains which make it fairly easy for construction of road network.

 

The upper midland which is below 1,500M above the sea level covers parts of all the divisions in the district except Lari. The landscape comprises of dry plains. Attitude is the single most important factor influencing climate in Kiambu. The rainfall regime bimodal and reliable rains occur between April and May while the short rains fall from October to November. The mean temperature in the district is 26oC; average temperature ranges from 20.4oC in the upper highlands to 34oC in the lower midlands of Karai in Kikuyu divisions.

 

Although the district hosts different ethnic groups, the majority of the people here are Kikuyu who are engaged in agriculture. The agriculture and rural development sector have earned the district a lot of income both at the household and industrial levels. The district is rated number one in terms of wealth distribution in households.

 

The District has a total population of 802,625 people, and 189,706 households with a density of 1,375. Kiambu Township sub location, in Kiambaa settled area location; in Kiambu Municipality division where the study was conducted covers an area of 2.3 km2 with a population of 5,498 persons, and 1,651 households with a density of 2,390. The population data was obtained from the District Commissioner’s Office of Kiambu based on census done in 1999, January 2001 publication.

 

With 137,635 pupils enrolled in Primary School, there is an indication that the district has a participation rate of 89%. However, there are many school dropouts after the Primary level of education due to the high cost of education and the limited number of place in secondary school. About 50% of the children in this age end up in the labour market, youth polytechnic and the informal sector.

 

The district has accessible and fairly well distributed health facilities; it has 203 clinics, 37 dispensaries, 22 health centres and 11 hospitals whereas Kiambu Municipality has 16 private clinics, 3 dispensaries, 2 health centres, and 2 hospitals. The health providers are either the government or non-government organization. Beside other common diseases in the district like Respiratory Tract Infections, Malaria, STIs, there is a high prevalence of HIV/AIDS in the township.

 

3.2              Study population/target population

Kiambu Township sub location covers an area of 2.3 km2 with a population of 5,498 persons, and 1,651 households with a density of 2,390. The focus population here are the youth (15-25) who are sexually active, commercial sex workers and the Catholic Church priests.

 

3.3              Sampling size and procedures

Non probability sampling method was chosen to determine the number of CSW through purposive sampling in which units are chosen as per the intention of the researcher and a sample size of 15 were chosen. Non probability sampling method was again applied for the priests using snow ball sampling where the researcher identified characteristic key to the study and a sample size of 5 was chosen; the priest will then direct the researcher to another priest. The youth were randomly selected using systematic random sampling where the research intends to issue identification number in an institute and hence a sample size of 30 was chosen.

 

3.4              Data collection instruments

The main instrument for the exercise was in-depth interviews (face to face). The data was collected using structured and semi-structured interviews (primary data), to gather information on social demographic, knowledge, attitude and practice and on the understanding of safer sex strategies. Literature reviews was as well examined as a source of secondary data on the research topic.

 

3.5               Data analysis and presentation

The quantitative and qualitative analysis was done and the results is presented in figures, tables, percentages, bar and pie charts.


Chapter 4

4.0              Research Findings and Discussions

 

The study was carried out between September and November 2007, and a total of 50 persons from Kiambu Township were interviewed. The findings and discussion is based on the research objectives that includes assessing factors affecting safer sex strategies, if poverty contributes towards low use of safer sex strategies, to assess community and religion perception towards safer sex strategies and to assess factors influencing high risk behaviour among youth.

 

Socio Demographic information

 

The level of awareness of HIV/AIDS was 40 percent among men and 60 percent among women. Of the total respondents interviewed 80 percent were reportedly aware that HIV/AIDS can be transmitted through sexual contact whereas 20 percent appeared to have no knowledge about HIV/AIDS.

 

Most of the respondents seemed to have knowledge about HIV/AIDS and most of them appeared to have a limited knowledge on transmission and prevention of HIV/AIDS. However, a higher proportion was willing to learn more on the disease.

Have you ever heard of an illness called HIV/AIDS? Yes =(15), No =(0)

Where did you hear about HIV/AIDS? Church=(1), Family=(1), Health Workers=(11), Don’t know=(0), Other Specify ___ Media=(1)

 

Doughnut: 1 Respondents knowledge towards HIV/AIDS (n = 50)

 

 

 

When asked what they feel about HIV/AIDS, 90% of the respondents said it was dangerous and it kills. 10% of the respondents did not believe and therefore indicated HIV/AIDS is not there.

How is HIV/AIDS transmitted? Sex=(10), Body fluids/blood=(11), Mosquitoes=(0), Sharp objects=(8), Don’t know=(0)

 

Bar Chart: 1 Knowledge on HIV/AIDS transmission (n = 50)

 

 

Asked how HIV/AIDS is transmitted, 100% of the respondents mentioned only sex as the route of transmission.

Is there anything a person can do to avoid getting HIV/AIDS? Yes=(12), No=(0), if yes mention them… Abstinence=(8), Faithfulness=(9), Condoms=(11), other (specify) __ = 7. If yes, do you practice them? Yes=(1), No=(2); if no why not? ____

 

Pie Chart: 1 Understanding preventive measures of HIV/AIDS (n=30)

Nearly all the respondents mentioned at least one method of HIV/AIDS prevention. However, the majority of the respondents 83% mentioned the use of condom as one method of prevention. 10% indicated Abstinence while 7% said faithfulness. Most of those who mentioned faithfulness were married couple.

Have you heard of condoms? Yes=(14), No=(0); if yes, do you use them? Yes=(9), No=(5) and if not, why not? ___ what do you feel about them? Bad=(0), Good=(7), Embarrassing =(3), Don’t know=(6)

 

Bar Chart: 2 Respondents understanding of condoms (n = 30)

 

 

It was evident that 100% of respondents knew about condoms. However, it was very discouraging to find that, most of the respondents did not use condoms. Some of the responses were: “you can not chew a sealed sweet otherwise you can never know the sweetness” also “it is a murder, as indicated in the Bible”.

 

Pie Chart: 2 Respondents Attitude towards condoms (n = 50)

 

 

Asked what they feel about condoms, 67% of the respondents said they are good. 30% of the respondents indicated the condoms were very embarrassing while 3% said the condoms are bad.

 

Table: 1 Reasons for not using condoms (n = 50)

 

Reasons

Frequency

Percentage

Not available

25

83

Fears/traditional beliefs

5

17

Religion

0

0

Total

30

100

 

When asked for reasons why they did not use the condoms, a high proportion (83%) of the respondents said they were not available. 17% indicated it interferes with the sexual desire.

 

Pie chart: 3 Religion attitude towards HIV/AIDS and use of condoms (n = 30)

 

 

Asked whether religion talk about HIV/AIDS and the use of condoms, it was evident that 90% of the respondents said the church do not talk about AIDS and condoms, whereas 7% indicated the church do talk about it and 3% did not know what role do the church play towards HIV/AIDS.

 


Analysis:

Table: 1 Respondents sex (n = 50)

Response

Frequency

Percentage

Male

22

44

Female

28

56

Total

50

100

 

When asked what they feel about HIV/AIDS, 90% of the respondents said it was dangerous and it kills. 10% of the respondents did not believe and therefore indicated HIV/AIDS is not there.

Table: 2 Respondents Age (n = 50)

Response

Frequency

Percentage

15-25

30

60

26-35

15

30

36+

5

10

Total

50

100

 

Table: 3 Respondents marital status (n = 50)

Response

Frequency

Percentage

Single

22

44

Married

15

30

Separated

12

24

Widow/Widower

1

2

Total

50

100

Table: 4 Respondents education (n = 50)

Response

Frequency

Percentage

Primary

23

46

Secondary

19

38

University/College

8

16

Total

50

100

 

Table: 5 Respondents occupation (n = 50)

Response

Frequency

Percentage

Employed

11

22

Unemployed

22

44

Farmer

5

10

Business

12

24

Total

50

100

 

Table: 6 Respondents Religion (n = 50)

Response

Frequency

Percentage

Christian

50

100

Total

50

100

 

Table: 7 Respondents understanding of HIV/AIDS (n = 50)

Response

Frequency

Percentage

Yes

44

88

No

6

12

Total

50

100

Church

8

16

Health workers/Hospital

10

20

Media

19

38

Public address/School/PLWA

13

26

Total

50

100

 


Table: 8 Knowledge on HIV/AIDS transmission (n = 50) multiple response

Response

Frequency

Percentage

Blood/Fluids

11

16

Sharp Objects

1

1

Sex

56

80

Breast Milk

2

3

Total

70

100

 

Asked how HIV/AIDS is transmitted, 100% of the respondents mentioned only sex as the route of transmission.

 

Table: 9 Understanding preventive measures of HIV/AIDS (n = 50) multiple responses

Response

Frequency

Percentage

Yes

47

No

3

Total

50

100

Abstinence

13

Faithfulness

9

Condoms

8

Don’t know

3

Total

50+

100

 

Nearly all the respondents mentioned at least one method of HIV/AIDS prevention. However, the majority of the respondents 83% mentioned the use of condom as one method of prevention. 10% indicated Abstinence while 7% said faithfulness. Most of those who mentioned faithfulness were married couple.

 

Table: 10 Respondents understanding of condoms (n = 50)

Response

Frequency

Percentage

Knew

Don’t know

Total

50

100

 

It was evident that 100% of respondents knew about condoms. However, it was very discouraging to find that, most of the respondents did not use condoms. Some of the responses were: “you can not chew a sealed sweet otherwise you can never know the sweetness” also “it is a murder, as indicated in the Bible”.

Asked what they feel about condoms, 67% of the respondents said they are good. 30% of the respondents indicated the condoms were very embarrassing while 3% said the condoms are bad.

When asked for reasons why they did not use the condoms, a high proportion (83%) of the respondents said they were not available. 17% indicated it interferes with the sexual desire.

 

Table: 11 Respondents bad experience – abuse (n = 25)

Response

Frequency

Percentage

Yes

No

Total

50

100

 

Negotiate sex, sexual partners

 

Table: 12 Receiving money (goods) in exchange sex (n = 15)

Response

Frequency

Percentage

Yes

No

Total

15

100

Poverty

 

Total

15

100

Table: 13 Respondents HIV status (n = 50)

 

Reasons

Frequency

Percentage

Yes

No

Total

50

100

 

CSW – regular check up

 

Table: 14 Religion attitude towards use of condoms (n = 5)

 

Reasons

Frequency

Percentage

 

 

 

Total

30

100

 

Chapter 5

5.0              Conclusions/Recommendations

 

HIV/AIDS was perceived as a deadly disease for which no treatment was available. All the respondents seemed to have knowledge about HIV/AIDS and most of them appeared to have a limited knowledge on transmission and prevention of HIV/AIDS. However, a higher proportion was willing to learn more on the disease.

 

Although major campaigns on awareness and prevention on HIV/AIDS has been operational for many years, no significant change in the knowledge and behaviour of the people has been realised. There is need to explore people’s behaviour and culture beliefs, as this might explain why they have not been open to change.

The fact that, 83% of the respondents did not have access to condoms clearly indicates the need to increase availability and accessibility of good quality condoms at prices every one can afford.

Behaviour change strategies in the past have proved to be the most effective long term solutions to the HIV/AIDS crisis, both for individuals and societies. There is need to create an enabling environment and to empower the community of Kiambu Township to adopt the safe sex strategies.

 

The fact that religions often argue against condoms distribution, they do not want to approve or facilitate this particular behaviour.  The fact that 2% of the respondents mentioned use of condoms as act of murder as the Bible indicates, this clearly indicates lack of knowledge among the religions. Religions should be pursuing and promoting behaviour change at the deepest and most profound levels, change that touches people at the core of their values, beliefs, hopes, motivation and understanding of reality.

 

Knowledge of preventive measures of AIDS, particularly use of condom was very limited. There were several misconceptions about the sources of the spread of AIDS.

It was evident that the majority of the respondents had inadequate knowledge on the use of condoms. There is need for Kiambu Township residents to have thorough knowledge about condom use. This includes how to store condoms, check expiry dates, open packets without damaging condoms, roll the condom onto the penis at the best possible time, and remove and dispose of condoms.

 Sex of the respondent: M=(1,20), F=(12, 3)

Age of the respondent: 15-28=(7), 29-44=(5), 45+=(2)

Marital status of the respondent: Single=(12), Married=(2), Widow=(0), Widower=(0), Separated=(3), Divorced=(0)

Education level: Primary=(36), High School=(12), University=(2), None=(0)

What do you do for a living? Employed=(3), Unemployed=(1), Farmer=(2), Business=(5), Other specify _______ (CSW)=(3), Student=(1)

What is your religion? Christian=(14), Muslim=(0), None=(3), Other specify___ =4

Have you ever heard of an illness called HIV/AIDS? Yes =(15), No =(0)

Where did you hear about HIV/AIDS? Church=(1), Family=(1), Health Workers=(11), Don’t know=(0), Other Specify ___ Media=(1)

How is HIV/AIDS transmitted? Sex=(10), Body fluids/blood=(11), Mosquitoes=(0), Sharp objects=(8), Don’t know=(0)

Is there anything a person can do to avoid getting HIV/AIDS? Yes=(12), No=(0), if yes mention them… Abstinence=(8), Faithfulness=(9), Condoms=(11), other (specify) __ = 7. If yes, do you practice them? Yes=(1), No=(2); if no why not? ____

Have you heard of condoms? Yes=(14), No=(0); if yes, do you use them? Yes=(9), No=(5) and if not, why not? ___ what do you feel about them? Bad=(0), Good=(7), Embarrassing =(3), Don’t know=(6)

Have you ever been forced to sex? Yes=(3), No=(12); if yes, what did you do? ____

How many sexual partners do you have? 0=(5), 1-4=(10), 5-10=(0), 11+=(0)

Do you negotiate sex? Yes=(3), No=(12); if not why not? _______=3

Have you ever received money or goods in exchange for sexual services? Yes=(0), No=(0)

Reasons why you decided to do so? Poverty=(0), Lifestyle=(0), Other specify ____=(0)

Do you negotiate sex before doing it? Yes=(0), No=(0)

How many sexual partners do you have per day? 1-3=(0), 4-7=(0), 8+=(0)

Do you go for regular health check-up? Yes=(0), No=(0)

Reference

The researcher will gain time to research on the topic in various books, research papers, and documentaries.

Arvind Singhal, Everett M. Rogers, Compacting AIDS: Communication Strategies,

Deborah J. Terry, et al (1993)             The Theory of Reasoned Action: It’s Application to AIDS-Preventive Behaviour, Health & Fitness – 1993 – 326 pages

Gill Gordon with Alice Welbourn “Stepping stones,” life skills and sexual well-being: a desk-based review, August 2001

Hermans I, et al Int Conf AIDS. (1998); BADC/NASCOP, Nairobi, Kenya

Muraah W.M., Kiarie W.N: (2001), HIV/AIDS, Facts that could change your life; Nairobi, English Press Limited.

Ministry of Health/Central Board of Health, “HIV/AIDS in Zambia: Background, projections, Impacts, Interventions,” September 1999.

World Bank, Published September 2003 A Handbook to support local government authorities in addressing HIV/AIDS at the municipal level

Written by Rusty Wright ese remarks at a university in California, The Catholic Bishops and Condoms: Statements and Actions Opposing Condom Use as Part of an HIV Prevention Strategy

Catholic Information Service for Africa,”Kenya: Catholics Reaffirm Stand Against Condoms in Fighting HIV/AIDS,” Africa News, June 26, 2007.

Clift S, Davidson E, Wilkins J. Int Conf AIDS. 1992 Jul 19-24; 8: D446 (abstract no. PoD 5355). Published: August 4, 1993

Ben Padley, “Drugs Better than Condoms in AIDS Fight, Says Cardinal,” Press Association, December 3, 2006.

The Nation (Nairobi, Kenya), “Stop Giving Free Condoms, Say Clerics,” November 29, 2006.

Paul Lampathakis, “Calls for Modest Dress, Less Sex,” Sunday Times (Perth, Australia), November 13, 2006.

Africa News, “Catholic bishops reject school syllabus over condoms,” January 13, 2006.

Maureen Gerawa, “Bishop Slam’s new condom campaign,” PNG Post-Courier (Papua New Guinea), August 3, 2005.

Associated Press, “Pope promotes abstinence to fight AIDS,” June 10, 2005.

Chansa Kabwela, “Use of condoms is a false solution to HIV/AIDS–Nuncio Antonini,” Post (Zambia), May 5, 2005.

Daily Mail (UK), “Bishops defy the Vatican over backing for condoms,” January 20, 2005.

Denis Barnett, “Vatican holds its ground over Spanish bishops’ condom stance,” Agence France Presse, January 19, 2005.

Associated Press, “Spain’s Catholic church reverses statement in support of condom use to prevent AIDS,” January 20, 2005.

Zenit, “Vatican Message for World AIDS Day, Dedicated This Year to Women,” November 24, 2004.

Panorama, “Condoms at Carnival,” British Broadcasting Corporation, June 27, 2004, and Special Assignment: BBC Panorama,“Can Condoms Kill?” British Broadcasting Corporation, November 16, 2004.

Panorama, “Can Condoms Kill?” British Broadcasting Corporation, June 27, 2004.

” Agence France-Presse,”After yoga and Sunday shopping, Croatia’s Catholic Church targets condoms,” February 15, 2004.

Associated Press, March 16, 2004.

Africa News, “Condoms promote immorality,” September 29, 2003.

Australian, “Bishops attack use of condoms in AIDS war,” August 1, 2001.

Appendix: 2 Interview Questions:

General information for all respondents

  1. Sex: M    F
  2. Age: 12-1415-18 19-25 26+
  3. Marital status of the respondent: Single Married Widow Widower Separated Divorced
  4. Education level: Primary High School University None
  5. What do you do for a living? Employed Unemployed Farmer Business Other specify __________
  6. What is your religion? Christian Muslim None
  7. Have you ever heard of an illness called HIV/AIDS? Yes No, if yes, where did you hear about HIV/AIDS? ______
  8. How is HIV/AIDS transmitted? ______
  9. Is there anything a person can do to avoid getting HIV/AIDS? Yes            No if yes, how? ____________ Do you actually practice? Yes No if no why not? ______
  10. Have you heard of condoms? Yes No if yes, do you use them? Yes No and if not, why not? ________________

Youth 15-25 & CSW

  1. Have you ever been forced to sex? Yes, No; if yes, what did you do? ___________
  2. Do you negotiate sex? Yes No; if not why not? ____________
  3. How many sexual partners do you have? ___
  4.  Do you know your status? Yes  No    if no, why not ____________?

 

Commercial Sex Workers (CSW)

  1. Have you ever received money or goods in exchange for sexual services? Yes No if yes, what influenced you to do so? __________
  2. How many sexual partners do you have per day? ________
  3. Do you go for regular health check-up? Yes No

Church Priests

  1. Have you heard of condoms? Yes No if yes, do you encourage the church to use them? Yes No and if not, why not? ___________
  2. HIV/AIDS is rampant among the youth, what is the church doing to prevent the spread of HIV? ___________
  3. Does the church discuss matters about sex? Yes No If no, why not? ___________
  4. HIV/AIDS strategy for the government of Kenya is based on “ABC” approach: does the church support this? Yes No if not, why not? __________

 

 

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