KENYA: HIV prevention for married adolescents
MT ELGON, 15 October 2010 (PlusNews) - Doris Chebet has never had a say in her life; married off at 14, she has always taken orders, first from her own family, and now from her husband's.
When Chebet, now 18 and living in the western Kenyan region of Mt Elgon, fell pregnant at 15, her mother-in-law made sure she gave birth at home with a traditional birth attendant, in keeping with her culture.
"I almost died because I bled a lot; it is God's love that the child survived," Chebet told IRIN/PlusNews. "I was never tested for HIV and [nor was] the child. If I had HIV, from what I know today, my child would have been infected."
Chebet's knowledge of HIV was gained through a programme for married adolescent girls aged 14-24, run by the NGO, Programme for Appropriate Technology in Health (PATH). The programme provides HIV/AIDS, reproductive health and family planning information and services to adolescent girls who are often left out of traditional HIV programming.
High risk
"Married adolescents are at greater risk of HIV infection because many of them are not only naïve but face sexual violence; many are in polygamous unions and they are never able to negotiate safe sex, because they don't have the skills to do it and... are married to people who are much older than they are, which prohibits partner communication," said Pamela Odolo, a programme officer at the AIDS, Population and Health Integrated Assistance II, APHIA II, a partner to PATH in western Kenya.
According to Judith Bruce, author of a 2007 paper on adolescent girls' vulnerability to HIV, married adolescents tend to have little contact with their peers, have restricted social mobility, low levels of education and limited access to media and health messages.
The PATH programme, which has reached more than 45,000 married adolescent girls in western Kenya, aims to provide them with couples' HIV counselling and testing, reproductive health services, such as contraception, and income-generating activities that can give them economic independence.
Mentors
To get the girl's in-laws on side, "mentors" - usually well-respected women from the local community - are used to persuade her husband and the family to allow her to attend peer sessions.
"As a mentor, I ensure my mentee goes to the clinic, and for the expectant ones, that they not only attend clinic on time but also that when the time comes to give birth, she goes to the hospital," said Alice Wanyonyi. "Some of these girls even fear going to the hospital because they might fear the nurse; it is up to me to escort or to convince the husband of the need for them to go to the clinic together.
"Many men now realize that when they accompany their wives to the health facility, they get services such as STI [sexually transmitted infections] screening, testing for HIV and they learn together how to take care of their baby," she added. "If you don't involve men, then even things like exclusive breastfeeding [for HIV-positive mothers], becomes difficult to enforce."
The mentors are trained in couple communication skills and counselling, and because they are normally trusted by the mentees, they help in delicate situations such as HIV status disclosure.
Progress
But families are not always receptive to change. "Because the people targeted have a culture that promotes having many children, there is resistance to family planning, but it is the reason we have roped in mothers-in-law because in most instances, they are the ones that [insist on] cultural issues like having many children," said Odolo.
"So we create awareness among them and many of them are appreciating what we do, albeit slowly," she added.
According to Odolo, the programme has noticeably increased uptake of family planning services, couples' HIV counselling and testing and health worker-assisted deliveries.
"All the girls in the programme and their partners have been tested, they have learned lessons on infant feeding and they have embraced family planning," she said. "Increased cases of health institution deliveries promote prevention of mother-to-child HIV transmission efforts tremendously."
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Theme(s): (PLUSNEWS) Children, (PLUSNEWS) Education, (PLUSNEWS) Gender Issues, (PLUSNEWS) HIV/AIDS (PlusNews), (PLUSNEWS) Prevention - PlusNews
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