From July to September, 2002 I spent ten weeks in Kenya conducting full-time research on the macroeconomic impact of HIV/AIDS and community action towards combating the epidemic in locations dominated by members of the Luo tribe in Nyanza Province, Kenya. Gathering data from both the Ministry of Health and non-governmental organizations, I sought to identify the causations and impact of the HIV/AIDS epidemic from a holistic framework. Serving as a pilot study for future research and program evaluation, my research primarily focused on four community-based organizations (CBOs) and Ministry of Health offices located in Kisumu, Nyando, Rachuonyo, and Migori Districts. My research objectives were to explore the cultural and economic variables related to the spread of the HIV/AIDS epidemic, identify which sectors of society were negatively impacted by the epidemic, record community action in response to these impacts, investigate obstacles related to implementation of such interventions, and share research and recommendations with the Ministry of Health and CBOs in Nyanza Province in a way that was meaningful and useful to them. Several qualitative and ethnographic methods were utilized. Participant observation was the principal method used and consisted of a wide range of activities. Additionally, I conducted sixteen formal semi-structured interviews, approximately thirty informal unstructured interviews, and one focus group discussion with nine youth. I found that community-based organizations and the Ministry of Health engaged in a wide variety of activities in response to the HIV/AIDS epidemic including providing Home Based Care to the sick and dying through trained community health workers; training individuals in income-generating activities to provide support for the organizations, the infected and affected, and as a means of prevention of new infections; and providing education to the communities at large. The Ministry of Health and non-governmental organizations also engaged in a significant level of collaborative work to assist each other with their programs and ensure there was no duplication of services. Despite considerable organizational efforts by both the governmental and non-profit sectors, these groups faced a number of different obstacles in their mobilization efforts including limited funding, transportation obstacles in visiting HIV/AIDS clients, and difficulties in convincing individuals to change their behaviors. Individuals interviewed cited a number of factors related to the spread of HIV/AIDS including wife inheritance, wife cleansing, poverty, commercial sex work, and distance marriages. Limited access to voluntary counseling and testing (VCT) services was also an obstacle in a number of communities. Additionally, I found a positive association between access to VCT services, perceptions of people living with HIV/AIDS, and social support for the infected. Based on my findings I concluded that individuals' behavior resulting in the transmission of HIV/AIDS is not solely related to lack of knowledge. Circumstances, especially related to poverty, lead to actions such as exchanging sex for money, distance marriages, early marriages for females, and wife inheritance. In order for HIV/AIDS prevalence to be reduced in Kenya, there must be active participation at all levels and from all sectors of society, including from community members themselves, community-based organizations, the Government of Kenya, and international governmental and non-governmental assistance organizations. Among my recommendations I propose the expansion of voluntary counseling and testing services to make it easier for individuals in rural areas to know their HIV status. I also advocate for a holistic and multisectoral response to HIV/AIDS prevention and support for the infected and affected, including through Home Based Care and social support for the infected, support for AIDS orphans, prevention of mother-to-child transmission, effective HIV/AIDS education, reducing poverty through income-generating activities, making school educations accessible for all children, and improving the overall state of health and access to health facilities for all individuals. / Graduation date: 2004

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The focus of this thesis is an AIDS education programme targeting prostitutes in the industrial town of Thika, Kenya. The thesis challenges three key assumptions underlying the programme, namely: (1) prostitutes in Kenya form a readily identifiable, homogenous social category; (2) medically, they are a source of HIV-infection, and a risk group due to their sexual activity; (3) once provided with knowledge about AIDS transmission and prevention, they have the incentive, and the means to modify their risk behaviour. The notions of "prostitution", "risk", and "responsibility", as assumed in the medical discourse of the programme, are contrasted with those found in the narratives of local health workers and the women involved in the programme. The incongruences in these sets of understandings have implications for the interpretation of epidemiological findings and the planning of AIDS prevention programmes in general. By lending an overall priority ranking to the risk factor of sexual behaviour, the epidemiological paradigm informing the programme masks social and economic co-factors placing women at risk, as well as the role of men in transmission of the HIV-virus. Further, the paradigm ignores important factors in the motivation of health behaviour, namely, the relative significance that women attribute to the risk of AIDS, as well as their envisaged control over health.

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This dissertation brings into perspective the plight of AIDS widows in Kisumu. Often widowhood in general focuses on the older women, while AIDS has created a generation of young widows. A high percentage of these widows are immediately pushed into poverty by the death of husbands. AIDS widows' poverty and vulnerability to external shocks and stresses increases dramatically, while the delicate process of juggling competing needs and pressures becomes a far greater challenge. The range of forces against which widows in Kisumu must struggle is formidable: low self-esteem, complex family relationships, hostile or indifferent communities, systemic gender discrimination and harassment, property loss, unemployment or underemployment, lack of education and a daily grind that leaves widows with scant energy to contemplate the possibility of transforming and regaining their dignity/condition. For these reasons this dissertation contends that the church has an obligation to strategise a holistic intervention to care for these widows who are part of the church and society. This dissertation manifests an on going struggle and quest for adequate instruments to understand AIDS widows in the light of God's promise of the fullness of life to all. AIDS leads to severe social, psychological and financial consequences for the affected families, hence the challenging question how the widows can move from deprivation to begin self-reliant sustainable livelihood is addressed. Since widows' lives are complex and constantly changing, their livelihoods wholly depend on their identifying and building their own various strengths, assets and capabilities. In this way the dissertation suggests that the following areas should be secured overtime. Supportive relationships, networks and environments, that is relatives, the church and church organization, government and other agencies should pool and pull together with the widows. Long-term earning power and financial security is badly needed. That means that their property should be secured and their land be on their hands for continuous utilization, contrast to the current state where they are ejected and driven away of their homes. Up-to-date skills, knowledge, self-esteem, motivation, self-confidence and spiritual well being. In this area it is suggested that capacity building would play a major role in moulding their current and future life. Finally the church is challenged to cultivate an alternative theology to address the ever-growing problem of marginalization and violence against widows. That is to say all forms of prejudice, for example stereotyping, isolation and condemnation must be strongly rejected and urgent need for justice, reason and deep faith be employed. As a result the widows would be integrated and feel valued in the society and the church. / Thesis (M.Th.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

Caring for a family member who is ill can be a draining experience (Cooper et al., 2006; Daire, 2002; Zarit et al, 1980). Providing care for a family member that is living with HIV/AIDS is potentially even more stressful because of social meanings associated with HIV/AIDS infection (Stajduhar, 1998) and the contagious nature of the HIV virus (Powell-Cope & Brown, 1992). Research indicates that most caregivers are female (Bunting, 2001; Songwathana, 2000). In Africa women bear the brunt of the burden of providing care for family members who are living with HIV/AIDS (Mushonga, 2001; Olenja, 1999). This study examined coping factors and caregiver burden among female caregivers (N=116) of a family member living with HIV/AIDS in Kenya. Coping factors were derived from a principal components factor analysis of the fourteen scales on the Brief Cope (Carver, 1997). Caregiver burden was measured using the Zarit Caregiver Burden Inventory. Multiple regression analysis was used to investigate the relationships between caregiver burden and coping factors. Post–hoc multiple regression analyses further investigated the relationship between caregiver burden and caregiver demographic characteristics. The relationship between caregiver burden and care recipient characteristics was also investigated. The principle components factor analysis of the Brief Cope yielded five coping factors that were labeled: Social support, Hope, Acceptance, Planning, and Disposition. The regression analysis that was conducted to investigate the relationships between these five coping factors and caregiver burden indicated a significant inverse relationship between Hope and caregiver burden. The post-hoc analyses investigating the relationship between various caregiver and care recipient characteristics indicated a significant relationship between the caregiver's age and caregiver burden, and education level and caregiver burden. An increase in age correlated with a decrease in caregiver burden. An increase in education level correlated with reduced caregiver burden. Implications of the findings for research and practice are discussed.

The purpose of the study was to describe the determinants and practice of HIV self-testing among health care workers (HCWs) in Nyeri provincial hospital, Kenya. A descriptive cross-sectional study was conducted to determine the rate of HIV self-testing, explore the factors influencing the practice and describe access to HIV psychosocial support, care and treatment. The study was guided by the concepts of the protection motivation theory. Data was collected from 348 HCWs and analysed by means of logistic regression. Results showed that 65.8% of the HCWs had practiced HIV self-testing among themselves. Age, self efficacy and response efficacy were found to be significant predictors of HIV self-testing. Willingness to access HIV psychosocial support (71.3%) and care and treatment (73.9%) was high. Self-testing is highly practiced by HCWs. / HIV self-testing among health care workers at Nyeri Provincial Hospital in Kenya / HIV self-testing among health care workers / Public Health / M.A. (Public Health)

The purpose of the study was to describe the determinants and practice of HIV self-testing among health care workers (HCWs) in Nyeri provincial hospital, Kenya. A descriptive cross-sectional study was conducted to determine the rate of HIV self-testing, explore the factors influencing the practice and describe access to HIV psychosocial support, care and treatment. The study was guided by the concepts of the protection motivation theory. Data was collected from 348 HCWs and analysed by means of logistic regression. Results showed that 65.8% of the HCWs had practiced HIV self-testing among themselves. Age, self efficacy and response efficacy were found to be significant predictors of HIV self-testing. Willingness to access HIV psychosocial support (71.3%) and care and treatment (73.9%) was high. Self-testing is highly practiced by HCWs. / Public Health / M.A. (Public Health)