Liz Akoth* is 18 years old. She is currently attending a local secondary school within Shauri Yako, Homa Bay County, Kenya. She fervently dreams of becoming a nurse, one day. Will she realize her dream? Is a question that bothers her almost every morning she wakes up and night when she retires to bed.
Sadly, the young ambitious girl will be forced to drop out of school because of her pregnancy. Her HIV status also makes her anemic. Her jaundiced eyes tell it all. “Please adhere to medication and follow the diet I gave you,” advised her nurse during her recent antenatal Care visit.
Liz was impregnated by her 30-year-old boyfriend who lives in Rongo, an adjacent town. He not only made her pregnant but also infected her with HIV. When she shared the news about the pregnancy with the boyfriend, he told her to stop bothering him for he had already married another woman. She later learned about her HIV status during her first clinic visit to Family Health Options Kenya (FHOK), Homa Bay Centre. She again shared the news with the now ex-boyfriend. He insulted her and accused her of having ‘brought’ him a disease. He threatened to harm her if he ever came across her again. Her parents evicted her from their home for the embarrassment she had caused them. She is currently living with her brother, though she mentioned that life there is not easy.
She appears quite strong on the outside but one would never know what goes on inside. But hers is a life of optimism and resilience. She hopes to give birth and re-enroll back to school in February 2019. She however said that if she had learned earlier about contraceptives, especially condoms, she would never have had sex without one. “If I knew the importance of condoms, I would not be pregnant and HIV positive. I would have used one.”
HIV prevalence is high in Homa Bay County, Kenya. With a prevalence of 36%, it is one of the highest rates in Kenya according to the National Aids Control Council (NACC). According to the latest Kenya Demographic Health Survey (KDHS) report, teenage pregnancy in Homa Bay County stands at 33% and national prevalence at 18%.
Dinah Odoyo, Nurse at FHOK residing in Homa Bay attributed the high prevalence facts to the following factors:
- Non-adherence to antiretroviral therapy (ART) - Many residents living with HIV enroll and collect ART, but they do not take the drugs. They throw them away instead. This is because they do not want friends or family to know their HIV status.
- Sex for Fish - Homa Bay has a large share of Lake Victoria compared to other counties around the Lake. Many residents fish for a living. Shortage of fish forces businesswomen to have sex with fishermen to acquire whatever they have caught. The women enter sexual deals with particular fishermen for assurance of regular fish supply. The high HIV prevalence among fisher folk is due to the unprotected sexual interactions.
- Traditional birth attendants (TBAs) - Many expectant women give birth with the help of traditional birth attendants. More than 60 per cent of women in Shauri Yako, Misita and Sofia estates in Homa Bay Town deliver children their at the homes of TBAs instead of hospitals.
- Poverty and Orphanage - Many homesteads lack either or both parents, leaving children to fend for themselves. Many children engage in sexual activities to get money for food and shelter.
- Other key drivers of high HIV prevalence, according to the Homa Bay Multisectoral AIDS Strategic Plan, are boda boda (motorcycle) riders and wife inheritance cultures.
Sospeter Aloka, guidance and counseling teacher at Ogande Mixed Seconady school said that top disciplinary cases he struggles to manage are boy-girl relationships, teenage pregnancy and gender-based violence. He is however unable to manage out of school relationships where men, mostly bicycle riders and traders prey on the school girls.
He confirmed that in 2015 alone, 6 girls in their first year of secondary school got pregnant and dropped out of school. He also confirmed that the school was aware of 5 girls who disclosed their HIV status and that he has made it his responsibility to closely monitor their adherence to ART.
He said, as teachers they realize that the students are sexually active. In Homa Bay County, most of the adolescents have sexual debut as early as at 13 years of age. He therefore advises those who cannot abstain to practice safe sex. He concluded by saying; “To win this war will require collective responsibility; teachers, parents and churches both need to talk to the adolescents and lead them to the right path” Said Sospeter.
Roselyne Atieno, FHOK trained Social worker works within Aruja Community in Homabay. She serves about 530 households and visits a minimum of 20 households every day. She also coordinates 10 Community Health Volunteers (CHVs) who operate within her jurisdiction. Their main roles include; data collection, community education and sensitization, counselling for teenage mothers, psychosocial support, referral, follow-ups and creating linkages.
She said that community sensitization is key. “Young people are sexually active, but their parents do not want to talk to them, they too do not have knowledge about the risks that they face. We reach out to all these groups and provide not only appropriate information, but also necessary services” said Roseline
Dinah Odoyo, who doubles up as the Facility in Charge said that FHOK focuses a lot on young people and adolescents and their reproductive health. “In fact, the clinic is quite youth friendly. It is a Youth Centre. Young people trickle in to learn more about how their sexuality and how they can practice safe sex” Said Dinah.
Interestingly, a condom dispenser is hooked at the gate. “The condom dispenser at the gate supplies young people and the community around with condoms. It is refilled twice a week” Said Dinah
She believes that young people are their own change agents. She has trained 20 youth volunteers- three quarter of whom are HIV positive-to speak to their peers within the community. “Young people prefer getting information from their friends and tend to do what their friends tell them. These trained lot speak to their friends about how to protect themselves from unplanned pregnancies and STI’s and advise those who are infected to adhere to medication” She added.
Dinah also holds outreaches to reach the entire community with messages around contraceptives, cancer awareness, HIV-Aids among other STI’s.
“I work with community leaders, religious leaders, teachers from the guidance and counselling department, parents, young people through a Social Behavior Change Communication (SBCC) program. Our main aim is to make these people understand the changes that adolescents undergo (puberty) for the guardians to know how to handle them and for the adolescents to understand how to handle themselves. We make them understand that these changes are normal and not a trigger to engage in sex, and if they do, they risk getting unplanned/unintended pregnancies and STI’s” She said.
She concluded by saying that their main aim is to reduce risky sexual behaviors. “When we reduce risky sexual behaviors, there will be less unplanned/unintended pregnancies and decline in unsafe abortion as well as reduced incidences of sexually transmitted infections” said Dinah.
Laws and Policies on Adolescent SRH
Article 43 (1) of the Constitution of Kenya (2010) states that ‘every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care’.
The National Adolescent Sexual and Reproductive Health Policy, 2015, shall support access to and provision of high quality and affordable adolescent-friendly SRH services at all levels of health service provision.