Factors influencing planning and implementation of male circumcision in HIV Prevention in Nyando District, Kenya

Abstract

approximately 3,000,000 people (CBS, 2006). Compared to other ethnic groups in Kenya, the Luo community has the highest prevalence of 21%; 18% for males and 26% for female (Montana et al., 2007). Rural areas of Nyando, Migori and Suba districts lead in HIVprevalence in the province (NACC 2007). There appear to be several reasons for high HIV prevalence in Nyanza province, in it and among its Luo-inhabited districts such as Nyando. First, Nyanza is a major overland trade route, with several truck-stops on the interstate highway feeding Uganda, Rwanda, Burundi and Congo. The trade route cuts through Nyando district, with a busy stop-over in the district's headquarters at Awasi Town. Commercial and unprotected sex with truck-drivers at these stopovers has been. blamed for the relatively high mv prevalence among communities living along the highway (Adari, 2004). As a result, HIV gradually migrated along sexual dyads which link urban and rural networks, leading to rapid increases in HIV/AIDS in rural areas (Luke, 2002). Secondly, IPAR (2004) identified poverty as another causal (as well as consequent) factor for high HIV infections in the region. It is the leading predisposing factor to casual sex and promiscuity. Furthermore, poverty is perpetuated by the high cost of taking care of the medical and nutritional needs of the infected, funeral expenses, . increased dependency from the swelling number of orphans, reduced number of hours spent in economic activities to take care of the ill and lack of will and hopelessness. Thirdly, the relatively high HIV prevalence among the dominant Luo ethnic group has been associated with risky cultural practices such as ter (widow inheritance), polygamy, and other practices that include sex before ceremonies like harvesting, opening of new house or home, and or marriage of sons (Agot et al., 2007; Caldwell & Caldwell, 1994; Luke, 2002; IPAR, 2004). Luke (2002), however, observed that wife inheritance factor should be considered within the context of other socio-cultural factors 3 since there are some other ethnic groups in Kenya, like the Maasai, that practice womensharing, but have low HIV prevalence. Fourthly, high sexual risk behaviors along the shores of Lake Victoria such as sex-for-fish (joboya) and carefree lifestyles of the beach community, have also been associated with high HIV infections in the region (IPAR, 2004). Beach culture is conducive to casual and commercial sexual practices, hence playing a major role in the spread of the scourge, not only among the Luo but in the Lake Victoria gulf in East Africa. The peculiar characteristics of the beach community are that men have sex at random and can change partners at leisure; and each woman at the beach must have a husband at anyone time, to be assured of fish supplies and other favours; and in addition condom use is low. The consequences of the beach culture are felt not only among the immediate community but also in many neighboring hinterlands. This is because as the beach people move to the hinterlands to visit spouses and relatives, they can)' the virus along with them (IPAR, 2004). Lack of circumcision has also been considered a risk factor for HIV infection among the Luo. Unlike the great majority of others in Kenya, the Luo do not practice traditional Me (Agot et al., 2004). Several prior studies in Kenya have shown a significant relationship between Me and HIV risk (Auvert et al., 2001). KDHS (2003) found that in Nyanza Province, 21 percent of men who were uncircumcised were HIV infected, compared with 2 percent of those who were circumcised. Moreover, KAIS (2007) reported that 13 percent of men who were uncircumcised were HIV infected, compared with 3 percent of those who were circumcised. These evidences make an urgent case to explore how projects to promote Me can be designed and implemented among the Luo community. Approximately 30% of adult men worldwide are circumcised. In SSA, about twothirds of men are circumcised (WHO&UNAIDS, 2007a). Me is practiced by many 4 communities in Kenya, largely for religious and cultural reasons (NASCOP, 2008). Approximately 84% of Kenyan men are circumcised (KDHS, 2003). More than 90% of men are circumcised in North Eastern, Eastern, Coast, and Central Provinces; more than 80 percent in Nairobi, Rift Valley and Western Provinces. In Nyanza, MC prevalence overall is 46%, although there is wide variation within districts ranging from 17% to 99% (NASCOP, 2008). Approximately 90% of Luo men are not circumcised (Buve et al., l 2000). In Luo-inhabited districts of Nyanza province, the few cases of MC have generally resulted from clinical indications and religious reasons, especially among Nomiya Church, which requires its male members to circumcise (Matson et al., 2005).