GENDER RELATED DYNAMICS IN THE FIGHT AGAINST HIVAIDS PREVALENCE IN KASIPUL DIVISION, HOMABAY COUNTY
GENDER RELATED DYNAMICS IN THE FIGHT AGAINST HIV/AIDS PREVALENCE IN KASIPUL DIVISION, HOMABAY COUNTY
REG: C50/CE/22720/2010
A Research Project Proposal Submitted in Partial Fulfillment of the Requirement for the Award of A Degree of Master of Gender and Development Studies, Kenyatta University.
April, 2013
DECLARATIONI, the undersigned, declare that to the best of my knowledge this is my original work except where references has been made in the acknowledgements and has not been submitted to any academic institutions for examination purpose.
Signed……………………………………….Date……………………
Name: KENYATTAJANET ATIENOREG. No.: C50/CE/22720/2010
This research thesis proposal has been submitted with my approval as the University supervisor.
Signed………………………………………Date………………………
Name: DR. GRACE WAMUE NGARE
Department of Gender and Development Studies
This research thesis proposal has been submitted with my approval as the University supervisor.
Signed………………………………………Date………………………
Name: DR. MILDRED LODIAGA
Department of Gender and Development Studies AbstractThe patriarchal nature of African societies continues to shape women’s sexual behavior in the region. This in turn accounts for the high prevalence of HIV/AIDS among women in sub-Saharan Africa. Of the several factors implicated in the unequal prevalence of the disease among women in Africa, economic dependency/feminization of poverty, unequal distribution of sexual power (sexual violence and coercion), limited educational opportunities and lack of political will, continue to dominate the literature (Robinson, 2004; Dunkle, et al., 2004; Martin and Curtis, 2004; Eaton, et al., 2003; Mill and Anarfi, 2002). While programmatic and financial initiatives have increased significantly in the third decade of the epidemic, the international community must do more to reverse the trend of the epidemic in sub-Saharan Africa. Leaders of sub-Saharan nations must show a new determination to coordinate available HIV/AIDS related programs so that afflicted individuals voluntarily participate. Culturally relevant (gender biased) public health education in the region is implied.
Keywords: sub-Saharan Africa, culture, socioeconomics, HIV/AIDS, coercion, inequality
TABLE OF CONTENTS
Declaration …………………………………………………………………………………….…ii
Abstract ………………………………………………………………………………………….iii
CHAPTER ONE
Introduction ……………………………………………………………………………………..1
1.1 Back ground to the study ……………………………………………………………..……..1
1.2 Statement of the problem ……………………………………………………………….…..3
1.3 Purpose of the study …………………………………………………………….…………..4
1.4 Objectives of the research …………………………………………………………………..5
1.5 Research Questions …………………………………………………………….……………5
1.6 Significance of the study …………………………………………………………………….5
1.7 Limitation and Delimitations ………………………………………………………………..6
1.8 Research Assumptions ……………………………………………………………………….6
1.9 Definitions of operational terms …………………………………………………………….6
CHAPTER TWO: LITERATURE REVIEW………………………………..………………..8
2.0 Introduction …………………………………………………………………….……………8
2.1 Key Gender Concepts ……………………………….………………………………………..8
2.2 Gender and HIV/AIDS ………………………………………………………………………..9
2.3 Cultural Practices and Gender Roles.……..………………………………………………11
2.4 Patriarchy and HIV/AIDS……………………………………………………………………13
2.5 Female Poverty, Economic Dependency and HIV/AIDS ………………………………..13
2.6 Gender and Healthcare Seeking Behavior ……………………………………………….14
2.7 Sexual Violence and Coercion ……………………………………………………..….…..16
2.8 Governance and Political Will……………………………………………………………..17
2.9 Conceptual Framework ………………………………………………………………..…..19
CHAPTER THREE
Introduction ……………………………………………………………………….………..20
3.1 Research Design ……………………………………………………………………………..20
3.2 Location of the study ……………………………………………………………………….20
3.3 Target Population ……………………………………………………………………….…21
3.4 Sampling Techniques ………………………………………………………………….……21
3.5 Research instruments ………………………………………………………………….…..22
3.6 Pilot Study …………………………………………………………………………….……23
3.7 Data Collection Techniques ………………………………………………….……………23
3.8 Data Analysis Plan ………………………………………………………………………….23
3.9 Ethical consideration …………………………………………………………………….…24
REFERENCES …………………………………………………………………………….…..26
Appendix A: Introductory Letter ……………………………………………………………….30
Appendix B: Questionnaires ………………………………………………………………..…31
Appendix C: Study time table …………………………………………………………..…….34
Appendix D: Budget ………………………………………………….………………….…….34
CHAPTER ONE
INTRODUCTION
Background to the Study
The spread of HIV/AIDS remains a global public health challenge. Admittedly, this pandemic is equally widespread in Sub-Saharan Africa, with an estimated 30 million Africans now living with the disease. Although Africa is home to about 14.5% of the world’s population, it is estimated to be home to 69% of all people living with HIV and to 72% of all AIDS deaths in 2009(UNAIDS 2003). Kenya is home to one of the world’s harshest HYPERLINK “http://www.avert.org/hiv.htm” HIV and HYPERLINK “http://www.avert.org/aids.htm” AIDS epidemics. An estimated 1.6 million people are living with HIV, around 1.1 million children have been orphaned by AIDS and in 2011 nearly 62,000 people died from AIDS-related illnesses. Women bear a disproportionate burden of the infected as they constitute 58% of the disease cluster in the region (UNAIDS 2003). Locally, this pandemic is widely felt at Kasipul Division, in Homa-Bay County where the infection rate rests at about 12.4% (National AIDS Control Council (Kenya), & National AIDS and STDs Control Programme {Kenya}, 2011).
Of the several factors implicated in the unequal prevalence of the disease among women in Africa, economic dependency/feminization of poverty, unequal distribution of sexual power (sexual violence and coercion), limited educational opportunities and lack of political will, continue to dominate the literature (Robinson, 2004; Dunkle, et al., 2004; Martin and Curtis, 2004; Eaton, et al., 2003; Mill and Anarfi, 2002). The extent to which these factors fuel the spread of the disease in Sub-Saharan Africa must continue to dominate public discourse. Also, although it can be argued that the third decade of this pandemic has witnessed an increase in programmatic, socioeconomic and policy initiatives among African nations and donor countries, some basic questions would appear pertinent at this time. Is the international community doing enough to reverse the spread of this contagion in Sub-Saharan Africa? How determined are African leaders to coordinate available national and international resources in the battle against HIV/AIDS in the region? Most importantly, what strategies can African leaders formulate in order to effectively address the disproportionate prevalence of the disease among women and men? These issues constitute the major thrust of this research paper.
HIV/AIDS does not respect social boundaries: children, youth, women and men are all susceptible to infection and potentially exposed to risk, especially when they lack the power to protect themselves. Because individuals may be both vulnerable and at risk related on their age and sex, a gender-sensitive approach to HIV/AIDS policy making, programming, and implementation should focus on vulnerable and at-risk populations. A common perception is that such an approach requires separate, “stand-alone” projects dealing specifically with women’s issues or, occasionally, with men’s issues. Another common perception is that such an approach requires a complicated, time-consuming and therefore costly process. However, experience shows that neither perception is correct (Wodi, 2011).
Cultural practices and values that discriminate against women or use women are also factors in the spread of the disease. The common African practice of marrying a widow to the deceased husband’s brother also spreads the disease when the husband has died of HIV/AIDS and the wife is infected (Mill, 2002). The belief in Africa and Asia that sleeping with a virgin will act as a cure for an infected man is a cause of infection in many young girls (Wodi, 2011). Sexual initiation practices with prostitutes for young boys still persist in some Asian countries, as well as elsewhere, and result in the infection of young boys. In Africa, women’s chances of contracting HIV/AIDS are about double that of men’s.
1.2 Statement of the Problem
The HIV/AIDS epidemic is driven by a complex mix of factors, including poverty, cultural norms, sexual norms, violence, legal frameworks and physiological factors (Wodi, 2011). In a given context, different groups may be more or less vulnerable or at risk than others. Many HIV/AIDS programs target “vulnerable and at-risk groups,” often without necessarily differentiating between males and females within such groups. In determining what gender-sensitive policies and strategies to adopt and which interventions to implement, it is important to pinpoint exactly which risk or vulnerability factors are at play and for which group of men or women.
Over the past decade, several policies and initiatives have been made in Kenya generally and in Kasipul division with an aim of combating and preventing this menace. These policies by agencies like NACC and action plan by private and governmental support institutions like VCTs have targeted reduction in prevalence rates for both males and females in this area. Despite these efforts, the problem of HIV/AIDS still persists. Even with the support of stakeholder involvement, the infection and prevalence rates have not decreased substantially in Kasipul division (NACC, 2010). The number of new infections despite campaigns likes male circumcision and awareness among the females is still a serious cause of alarm. Even with access to HIV and AIDS education and other reproductive health services, more males and females in this area have become more vulnerable to HIV/AIDS infection (NACC, 2010). There have been elaborate government plans that aim at scaling up interventions to promote social inclusion and to reduce infections in affected areas (NACC, 2010). In spite of all these interventions, policies, actions and programs, this problem of infection has not been tackled in this area.
1.3 Purpose of the Study
This proposed research study will contribute to a better understanding of how gender influences the risk of HIV infection through sexual behaviors and of how HIV risks rooted in gendered expectations and behaviors may be best reduced. The research is aimed at establishing the role of gender dynamics in the spread and fight against HIV/AIDS particularly in Kasipul Division, Homa-Bay County.
1.4 Objectives of the Study
To determine the extent to which cultural and traditional conservativeness impact on the fight against HIV/AIDS.
To establish the role of gender and social inequality in the fight against HIV/AIDS in Kasipul Division.
To find out the contribution of the stakeholders in the fight against HIV/AIDS in Kasipul Division.
1.5 Research Questions
The study will be guided by the following questions;
What are the role of culture and tradition in the fight against HIV/AIDS?
Is gender and socio-economic inequality having a significance role to the fight against HIV/AIDS particularly in Kasipul Division, Homa-Bay County?
How effective is the participation of the stakeholders with regard to policy formation in fighting HIV/AIDS?
1.6 Significance of the Study
The study will be of use to the Ministry of Gender and Social Services and the Administrative team, policy makers, teachers, students and other relevant stake holders in the education sector. The study is also of importance in creating awareness to the general population concerning gender related concerns that enhance the spread and prevalence of this pandemic. Besides, this research findings will be significant and prove worthy for other learners who are interested in investigating the same topic.
1.7 Limitations and Delimitations
The study will only be conducted in selected institutions in Kasipul Division, Homa-Bay County. Therefore, this study will not be exhaustive of all the possible cases with a bigger geographical location. Besides, the entire study population will not be involved in the study but will be sampled, hence generalization of the findings. Secondly, the research will heavily rely on the primary sources collected from the respondents. However, some of the respondents would not be honest in their opinions and thereby limiting the reliability of the findings.
1.8 Research assumptions
This proposed study will assume that all the respondents will be drawn from the desired population. The research further assumes that all the administered questionnaires will be returned back. Finally, the views and opinions of the respondents will be assumed as the opinion or position of the entire population of the study.
1.9 Definitions of operational terms
Gender: Gender refers to the expectations people have from someone because they are female or male. Gender attitudes and behaviours are learned and the concept may change over time.
Sex: Sex is the physical, biological difference between women and men. It refers to whether people are born female or male.
HIV/AIDS: Human immunodeficiency virus infection / acquired immunodeficiency syndrome (HIV/AIDS) is a HYPERLINK “https://en.wikipedia.org/wiki/Disease” o “Disease” disease of the human HYPERLINK “https://en.wikipedia.org/wiki/Immune_system” o “Immune system” immune system caused by infection with HYPERLINK “https://en.wikipedia.org/wiki/HIV” o “HIV” human immunodeficiency virus (HIV).
Gender Inequality: refers to unequal treatment or perceptions of individuals related on their HYPERLINK “http://en.wikipedia.org/wiki/Gender” o “Gender” gender. It arises from differences in socially constructed HYPERLINK “http://en.wikipedia.org/wiki/Gender_role” o “Gender role” gender roles as well as biologically through chromosomes, brain structure, and hormonal differences.
CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
The study will examine the role of gender dynamics in the fight against HIV/AIDS. In the literature review, the proposed study will depend on secondary sources of literature that discusses the effects of cultural norms, socio-economic variables, traditional, gender inequality in the fight against HIV/AIDS.
2.1 Key Gender Concepts
Gender Approach: This refers to the attempts made to give equal opportunity to men and women, where men are made to share the burden and recognize women as equal partners.
Gender Awareness: This is used to describe the situation where people are sensitive to the needs and interests of men and women in the implementation of an activity.
Gender Role: This refers to the duties and responsibilities attached to the positions occupied by males and females in society. Roles can change according to the geographical, social, economic and political environment. Gender roles refer to expectations regarding the proper behaviour, attitudes and activities of males and females.
Sexual Division of Labour: The way work is allocated and valued according to whether it is performed by women or men. Globally, feminists argue that in the world economy women are the most exploited workers as a result of the sexual division of labour.
Socialization: Socialization refers to how people are taught to accept and perform the roles and functions that society gives to them. Men and women are socialized into accepting different gender roles from birth. Establishing different roles and expectations for men and women is a key feature of socialization in most societies.
Stereotyping: It is based on prejudices and fears about certain social groupings usually seen as inferior to the dominant group. Individuals are then judged according to their group identity. In other words, the belief that all people that belong to a certain group – gender, age, or tribe do, or should, act alike.
Gender Sensitivity: It refers to awareness that there are both biological and gender differences between women and men. Also that women and men in different parts of the world have been gendered in different ways. Gender sensitivity also means building a critical edge to counter the gender oppression that we have been socialized into.
2.2 The Role of the National Aids Control Council
The National AIDS Control Commission, abbreviated as NACC, was found under Section 3 of the State Corporations Act Cap 446 through the National AIDS Control Council Order, and was published on 1999 vide Legal Notice No. 170 of 1999. NACC is a non-commercial entity and its mission is to “Provide policy and a strategic framework for mobilizing and coordinating resources for the prevention of HIV transmission and provision of care and support to the infected people in Kenya”.
Just like many other organizations, NACC has a devolved system for enhancing decentralizing services to the Kenyan people. These decentralized structures comprise nine offices based in Central, Coast, Eastern, Nairobi, North Eastern, North Rift, Nyanza, South Rift and Western region. The core purpose of this body is to combat spread of HIV/AIDS in the country through various strategies. This assignment will look at these strategies and analyze various challenges towards this.
Both social and pharmaceutical interventions are undertaken towards prevention of HIV. Some commonly considered pharmaceutical interventions for the prevention of HIV include the use of the following: microbicides for sexually transmitted diseases, pre-exposure prophylaxis, post-exposure prophylaxis, HIV vaccines, circumcision, antiretroviral drugs to reduce viral load in the infected and condoms. Out of these strategies, the only medically proven method for preventing the spread of HIV during sexual intercourse is the use of condoms.
Various strategies like male circumcision have been put in place to help in curbing this pandemic. According to Denniston (1999), circumcision male reduces the chances of HIV infection to a larger degree. In this context, uncircumcised men in Kasipul division are thus considered as vulnerable to infection due to the health concerns that are brought about by the foreskin. Various stakeholders and local agencies have thus stepped up campaigns to reduce and eradicate this diseases encouraging youths (males) to accept this practice. Despite this efforts, very little progress have been realized due to poor attitude and cultural limitations that often bar this practice from taking shape (Denniston,1999).
Social strategies do not require any drug or object to be effective, but rather require individuals to change their behavior so as to gain protection from HIV. These strategies include the following: sex education. This involves educating the general public on the reality about HIV AIDS and possible measures to combat it. Another strategy is the needle- exchange programs which involve combating HIV/AIDS transmission by adhering to rules of safe use of needles.
Another strategy is the safe injection sites. This has to do with availing sites that don’t tolerate infection of HIV. Safe sex is yet another strategy that is indented to create awareness for people to eliminate transmission through unsafe sex (Akande, 1994). Safe sex means having sexual intercourse with a partner by making use of condom. The council also employs a strategy of sexual abstinence. This is meant to mitigate transmission of HIV/AIDS through informing the society and championing for stoppage of conducting sexual intercourse as a way of combating HIV/AIDS, especially considering that most of infection occurs through sexual intercourse. The last social strategy is that of immigration regulation. This strategy puts into understanding that transmissions occur during movement of citizens especially cattle keepers (Fassin, 2010).
According to Helman (2010), these strategies have widely varying levels of efficacy, social acceptance, and acceptance in the scientific and medical communities. In the execution of these strategies, various challenges have been experienced. It is heavily argued by many scholars that the Risk- Reduction Model applied by the council is American based and can not work effectively in African states. It has been difficult for Western donor agencies and consulting firms involved in AIDS prevention to accept evidence that suggests what they have been doing may not have been very effective in Africa.
Challenges of financial resources have been experienced in the administration of the strategies by the council, among many other issues. A number of strategies have been implemented towards combating HIV/AIDS, and fruits are already manifesting. However, there are underlying challenges which need to be sorted out for the effectiveness of NACC.
2.3 Gender and HIV/AIDS/STIs – The Problem
The first official report of the disease now known as AIDS (Acquired Human Deficiency Syndrome) was published on 5 June 1981. The one-paragraph report by the US Centre for Disease Control catalogued five cases. That was about 21 years ago. The epidemic has since spread to every corner of the world. Reports indicate that almost 22 million people have lost their lives to the disease and over 36 million people are today living with the Human Immune Virus (HIV), the virus that causes AIDS (Martin, 2012). It is a known fact that the majority of People Living with AIDS (PLWAs) can be found in Africa south of the Sahara. Failure to significantly contain rising rates of the global AIDS pandemic has led to the rethinking of earlier response strategies to the infection.
It is generally accepted that 80% or more of all HIV/AIDS infections can be traced to unprotected sexual intercourse (Fleck, 2004). There is a need for a gender-related response that will focus on how the different social expectations, roles, status and economic power of men and women affect and are affected by the epidemic. The above implies that it is these relationships, together with physiological differences, that determine to a great extent women’s and men’s risk of infection, their ability to protect themselves effectively and their respective shares of the burden of the epidemic.
It has been argued that HIV prevention is a gender issue since seroprevalence rates tend to be much higher amongst certain groups of young women. Furthermore, the responsibilities of care for AIDS patients often fall on women, and the role of women in child care means that their health is especially important in ensuring continued reductions in child mortality and reducing the number of orphaned children (Martin, 2012). There is therefore a need to place special emphasis on the education of girls and women about risk patterns and safe practices, alongside efforts to encourage men to be better informed and adopt patterns of behaviour that reduce the spread of HIV. By promoting a culture of rights and gender equality, responsibility and choice in relation to HIV/AIDS, adult educators can play a meaningful role in ending women’s overwhelming biological, social and economic susceptibility to HIV and can affirm the right of all people to life and dignity (Martin, 2012).
2.3.1 Physiological Vulnerability of Women and Men
Evidence from research suggests that women’s risk of HIV infection from unprotected sex is at least twice that of men (Helman, 2012). A woman’s body has the ability to retain a high concentration of semen in the vaginal canal. Similarly, women are exposed to infection because of the extensive surface area of mucous membrane in the vagina and on the cervix through which the virus may pass. Uncircumcised men are also at risk because the delicate area under the foreskin may expose them to infection if they have unprotected sex. Young women are at a greater risk because of abrasions they may have during unprotected sex since they tend to have a thin vaginal lining.
2.3.2 Sexually Transmitted Infections (STIs)
STIs in women tend to be asymptomatic (they go unnoticed because they are internal). Unlike men, women may experience no pain initially and are thus less likely to seek prompt medical treatment. The situation is often compounded by the stigma attached to STIs, inaccessibility to clinics, lack of money, negative attitudes of health workers to infected women and women’s own preoccupation with too many domestic responsibilities (Cohen, 2010). The World Health Organization (WHO) estimates that at any point in time there are as many as 330 million curable STIs worldwide. This calls for much concern, considering the fact that the condition predisposes infected individuals to HIV/AIDS.
2.4.0 Cultural Practices and Gender Roles
Some cultural practices aggravate women’s physiological risk of HIV infection. Examples are men’s preference for “dry sex” (often with the active connivance of women), “rough sex” which may lead to sores in the mucous membrane, and female genital mutilation, which could lead to extensive tearing and bleeding during sex (Helman,2010). The practice of widow inheritance has also contributed significantly to the increasing rates of infection.
Culture as a set of guidelines acquired from infancy tells the individual how to think, feel, perceive and act either as a male or female. Helman (2010) notes, “The division of human society into two gender cultures is one of the basic elements of social structure, and an important part of the symbolic system of any particular society.” (p. 110). This would illustrate the culturally accepted double standards in patterns of behavior between the genders in many cultures. Women are expected to maintain their purity and not bring shame on their husband and family. A man’s honor in some societies may well lie on how well the women in his life conduct themselves. For example, among the Muslim Swahilis in Mombasa, Kenya, women are expected to be dependent on men. It is the responsibility of men in this society to provide for and therefore control women and children. Similar pattern of male domination has been reported in Mediterranean societies where premarital/extramarital affairs define masculinity (Ibid, p.110). In South Africa, cultural influences in the spread of HIV/AIDS among women include the fact that “young men claim ownership of their sexual partners” (Eaton, et al. 2003). These men feel justified to have sex on demand including the use of force in a romantic relationship. Thus the patterns of behavior rooted in gender cultures especially in less industrialized societies become significant in the high prevalence of sexually transmitted diseases among women. These societies would be considered patriarchal and understanding their role in the spread of HIV/AIDS is important in any effective intervention program.
2.5 Patriarchy and HIV/AIDS
The relationship between patriarchy and gender roles has been widely discussed in the literature (Parish, 2001; Tabi and Fripong, 2003; Martin and Sandra, 2004). African societies are patriarchal (Airhihenbuwa, 1995), with some ethnic traditions requiring female pre-marital chastity while others require women to prove premarital virility by having babies (Schoepf, 1991). Girls are therefore socialized from very young ages to play subordinate roles. Girls that are socialized this way would then grow up as desirable women for marriage. They could be rewarded by their families for enhancing family honor and image. Thus years of “hand-me-down” conditioning of women have accounted for gender inequality in the region. In the era of HIV/AIDS, this power imbalance between the sexes carries a new sense of urgency. Women have become especially susceptible to the disease as a result of their limited power in sexual encounters. In one estimate, 6 – 11% of young women aged 15 – 24 years were HIV positive compared to 3 – 6% of their male counterparts (Tabi and Frimpong, 2003). Any intervention program designed to reduce the high incidence of HIV/AIDS among women in the region must first address socioeconomic and cultural issues in addition to political will. The role of the international community in poverty alleviation programs as well as HIV/AIDS control in the region is also pertinent.
2.6 Female Poverty, Economic Dependency and HIV/AIDS
Several social, economic, cultural and political factors account for African women’s dependence on men and their consequent vulnerability to HIV/AIDS. In African societies, the desire by men to have many children and women to validate their marriage through multiparity (having borne more than one child), have been implicated in the spread of this contagion (Moyo and Mbizvo, 2004). In these societies, marital fidelity is questionable since the relationships are usually not mutually monogamous. Moyo and colleague reiterate the fact that “… in Zimbabwe, women may be under pressure from their spouses or sex partners not only to reproduce, but to also achieve a desired number of surviving childr
