The Star (Nairobi)

Kenya: War Against HIV/Aids Stepped Up

The great philosopher Albert Einstein once said you cannot do same things over and over again and expect different results.

It's for this reason those leading the war against HIV/Aids are reinventing the wheel, noticing the ABC strategy is becoming fast obsolete in turning back the scourge.

Until recently, the Abstain, Be Faithful and Condom Use (ABC) were the pillars on which prevention approaches were pegged. But two decades on, some countries, local medical experts, government officials, religious leaders and NGOs are questioning its effectiveness. They are now stressing the need for urgent comprehensive prevention strategies that tackles all the facets of the epidemic.

Unlike the ABC that previously received massive resistance from various faiths because it was advocating for what was perceived as 'methods that are contrary to religious teachings' - it bred stigma and prejudices that hampered efficient intervention - SAVE is becoming fast acceptable mode that its proponents believe will have massive societal and religious shift on how the scourge can be dealt with.

"SAVE is an acronym for safer practices (S), access to treatment (A), voluntary counselling and testing (V) and empowerment (E), a strategy which was developed in 2003 by the African Network of Religious Leaders Living with or personally Affected by HIV to address the shortcomings of ABC and build on its strengths and since then we have seen its successes so far in those countries that have adopted it fully," Jane Ng'ang'a, Inerala co-ordinator Kenya Chapter says.

"SAVE is comprehensive and cuts across all life situations unlike the ABC approach which mainly concentrates on morality and sexuality," Major Rose Mbula from Salvation Army explains. She says the wide approach has made SAVE more acceptable across religious faiths which traditionally showed laxity to join the fight against HIV/Aids as some aspects of ABC like condom use was seen as contrary to religious teachings that outlaws sex out of marriage.

"Even though its effects was being felt across our altars, most of us, religious leaders, felt it didn't concern us and therefore saw no need to join the war against HIV/Aids. We have put our heads in the sand for too long and our children, relatives, our faithful and even ourselves have continued to die, but now we have an all inclusive approach in SAVE which can save lives by stemming new infections, re-infections and taking care of those already infected," Mbula adds.

Dr Mohamed Karama, a health researcher, says SAVE is more holistic and loops everyone in the fight against the scourge and not limiting as ABC. He says ABC approach was biased towards men with women left with no power to negotiate on sex. "It is acceptable in society unlike ABC which pushed towards promiscuity by permitting sex out of wedlock by advocating for condom use which didn't go down well with clerics," he says.

According to a 2008-2012 Regional Plan For HIV and Aids and Implementation Plan, Kenya tops the HIV prevalence rate standing with a prevalence rate of 7.4, followed by Tanzania at 6.2, Uganda with 5.4, Rwanda at 2.8 and Burundi with the lowest at 2.0. The statistics for Kenya show that young women are the worst affected. Lobbyists blame it on ABC which they fault for having an approach that left out women in the fight by giving men an upper hand on sexual matters. The campaigners say if well mainstreamed in all institutional policies and programmes, SAVE will see HIV prevalence rate halved within five years, as it is multi-sectoral and all incorporating everyone in the fight.

ABC was introduced in 1992, with many countries across the globe adapting and promoting it within their national prevention strategies. The approach is generally seen to respond to the HIV/Aids epidemic as a 'moral' and sexual issue, while following a similar line to the prevention. Its cornerstones being abstinence outside marriage and maintaining of single long-term sex partner. It also encourages individuals to eliminate casual sex partners and be faithfulness within their marriages and other sexual relationship. Its third emphasis is 'correct and consistent' use of condoms if individuals are unable to maintain a single long-term partner or abstain.

"In its approach ABC concludes that HIV and immorality are linked and that the people who are HIV positive failed to abstain or be faithful; this a wrong assumption that only fuels stigma among people living with HIV/Aids since it portrays them as immoral. ABC also leaves out other important incentives in prevention such as testing, care and treatment for infected people and empowerment of various groups against the epidemic," Ng'ang'a says.

SAVE, according to sector players, corrects the presumption that HIV/Aids is purely a 'moral issue' by integrating all the principles of ABC and addresses the gaps in the strategy through tackling the structural factors that drive the epidemic. The approach also outlines prevention and control measures for expectant mothers, youth, women, children men and partners in general before and after infection. It further advises on appropriate support programmes for those infected or affected by HIV/Aids with provisions for those living with HIV to get a chance to participate in prevention.

In addition, the SAVE approach, Ng'anga says, involves an analysis of underlying factors that hinder access to service namely stigma, shame, denial, discrimination, inaction and misaction (wrong actions), which are summarised as SSDDIM. "These are the six evils that continue to fuel stigma and discrimination and drive the epidemic underground. That is why we are seeking to reduce SSDDIM which are largely associated with ABC and embrace SAVE," she adds.

For safer practises, use of condoms, being faithful to one partner, practising sexual abstinence, use of sterile injection equipment and ensuring that all blood transfusions are tested for HIV, prevention of parent-to-child transmission and circumcision are advocated. Ng'ang'a further says that safer practises also cater for pre-and post prophylaxis, use of standard hygiene precautions such as gloves and clean needles for all patients and adherence to treatment.

Access to treatment, Ng'ang'a days, entails giving everyone who is HIV positive his or her right to access medication and treatment, which should not only be provision of anti-retroviral treatment, but a combination of drugs to fight HIV as well as treatment for illness that particularly affect people with HIV such as tuberculosis. They must also get good nutrition and clean water. "Nutrition plays a major role in the ability of the immune system to respond to infection. The nutrients that our bodies obtain from food keep the immune system strong, therefore SAVE advocates and insists on maintaining a healthy lifestyles for those infected to keep opportunistic infections at bay," Ng'anga says.

For voluntary counselling and testing, the lobbyists argue that it should be free, routine, stigma-free and confidential for all. To make informed decisions about HIV and sexual behaviour, injecting drug users, children, the youth, elderly women, sex workers, homosexuals, people with HIV/Aids need to be empowered which should be followed with defending the rights of women and other marginalised groups, the approach advocates under the E initial. "To make people take control on their lives, education, economic security, promoting equity, ensuring the voice of PLHIV and most vulnerable populations are heard and by tackling other determinants of poverty such as intolerance are key to stemming the spread of HIV. Empowerment involves looking beyond individual behaviour change and engaging the wider community," SAVE guide by Christian Aid reads in part.

Since its introduction, SAVE has received significant support from some governments and organisations in more than 15 countries. In 2005, Christian Aid adopted the approach as its organisational strategy to HIV prevention, treatment, care and support. The approach has since been adopted by other international development agencies, government partners, and community based organisations and faith-based organisations including the Tearfund and Swedish International Development Cooperation Agency.

In Sierra Leone, advocates including religious, influential personalities, and local government agencies in 2009 lobbied for inclusion of SAVE in the national strategic plan. The strategy is about to be adapted in Malawi, while it has been adapted in the Democratic Republic of Congo.

In Rwanda, the RWANARELA+ initiative has managed to cut prevalence rate drastically.

In Kenya, though not yet in official strategic or policy books, policymakers and key players are warm about the approach, saying it will give an impetus to already prevailing efforts in the fight against HIV/Aids. "ABC has not failed though it has some gaps, but acknowledging that no single approach is efficient in fighting this scourge, we will adopt both the strategies. Looking at SAVE strategy we see it giving us a holistic non-judgemental approach to prevention and with the religious leaders backing it we are confident we will have the fight stepped up to over 75 per cent and this is our pleasure," National Aids Control Council director Prof Alloys Orago says.

He says though ABC has had gaps, it can't be discarded all together. He says ABC effectiveness has not been felt because many organisations working around HIV/Aids agenda failed to implement it fully and their approach tried to portray HIV fight as a moral question and not looking at it holistically.

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