Young people between fifteen and twenty-four years of age account for more than half of the over five million new HIV infections worldwide each year; an estimated six thousand youth become infected each day across the globe.1 In Kenya, HIV-prevalence in this age bracket—particularly among females—is extremely high. Kenyan women are at greatest risk of infection between the ages of twenty and twenty-four, with eighteen percent being infected within two years of sexual initiation.
Included within this high-risk group are the majority of university students. By the time Kenyan youth walk into their university hostels for the first time, a large proportion of them have already had sexual intercourse.2 The new-found autonomy of university life—away from the watchful eyes of parents, high school teachers and church youth leaders—leads many additional students to experiment with a wide range of risky behaviours. The Kenya National AIDS Strategic Plan (KNASP) 2005–2009/10 has therefore identified university students as a high-risk group for contracting an HIV infection.
Thus, although university students as a whole are viewed as key to the future of the nation, individually they are at enormous risk of contracting HIV and other sexually transmitted infections (STIs). It is with this in mind that the Commission for Higher Education, together with I Choose Life—Africa, has made it a priority to implement HIV/AIDS interventions in Kenyan universities.
I Choose Life—Africa
I Choose Life—Africa is the leading behaviour change communication program in institutions of higher learning in Kenya. The program was launched in 2002 by the Ministry of Health and later recommended to all universities by the Commission for Higher Education. To date, we have set up programs at the University of Nairobi, Kenyatta, Daystar, Maseno, Moi and Egerton, as well as the Cooperative College of Kenya. The program is poised to include more universities and colleges in the near future. The vision of I Choose Life—Africa is to have an AIDS-free country. The mission is to create a movement of caring communities among students that make responsible and informed choices with regard to life and HIV/AIDS through prevention, care and support as well as mitigation of social economic impact.
There are at least six objectives of I Choose Life—Africa:
- To improve the level of knowledge, attitude and practices regarding HIV/AIDS.
- To reduce risky sexual behavior.
- To increase Voluntary Counseling and Training (VCT) uptake.
- To strengthen Behaviour Change Communication Groups (BCCGs) and their support structures.
- To campaign against negative perceptions toward PLWHIV (Persons Living With HIV).
- To contribute to the development and implementation of HIV/AIDS policies within the institutions.
Training of Peer Educators
I Choose Life—Africa recruits students in the various institutions of higher learning to participate in the 32-hour Peer Education Training. The HIV/AIDS training incorporates interactive teaching methods, including audiovisual learning techniques, case studies, drama, games and small group interaction. Some topics covered in the training include: STIs; sexual responsibility; living with and managing HIV; culture and sexuality; and consistent and correct use of condoms.
After this training, peer educators are taken through a course on life skills to increase their effectiveness as peer educators. The life skills training includes communication, counseling, facilitation and negotiation and leadership skills.
Behaviour Change Communications Groups (BCCGs)
After training, peer educators who have now acquired various skills form groups with other peers with whom they have similar interests (e.g. sports, performing arts, gender, etc.). These groups are known as Behaviour Change Communications Groups (BCCGs); the peer educators use these interests as avenues to pass HIV/AIDS information to the wider community.
Voluntary Counseling and Training (VCT)
I Choose Life has been on the frontline in mobilizing students to know their HIV status. Mobile VCT sites are set up during the training period in each of the campuses. Peer educators taught the importance of VCT, and are encouraged to motivate their peers to go for testing.
Students who have gone for VCT are encouraged to form Post Test Clubs. Some of the clubs’ objectives are to encourage fellow students to know their status, reduce stigma and carry out advocacy campaigns.
Greater Involvement of People Living with AIDS (GIPLA)
Peer educators interact with People Living with HIV (PLHIV) regularly. During the training sessions, PLHIV are invited to share their experiences as well as how to live with and manage HIV/AIDS. In addition, peer educators take part in home-based care visits with PLHIV and their families. The visits target PLHIV living in less privileged areas such as slums.
Care and Support
Psycho-social services, counseling, post test clubs, nutrition programs for PLHIV, referrals and other treatment services are among the care and support activities of I Choose Life—Africa.
In nearly five years of operation, I Choose Life—Africa has trained forty-five staff and 4,011 peer educators. The peer educators have reached over forty thousand students and formed over forty-two BCCGs. Over seventy thousand pieces of information, education and communication (IEC) materials have been distributed.
The following is a true story on the impact of AIDS and the need for a program such as I Choose Life—Africa:
I am twenty-three years old and I go to one of the public universities. I discovered my HIV status when I was completing my first year. I thought life had come to an end. I would not have tested for HIV if it were not for the mobile VCT service that was brought to campus by I Choose Life—Africa (ICL), and the convincing of a friend who was a peer educator with ICL. My friend used a blitz card, which had the VCT information, to convince me of the importance of knowing my status. Because I wanted my friend to stop bothering me, I eventually went. I never thought I would be HIV positive. I was.
Not knowing what to do, I stayed in my room for some days after testing. I then decided it was all a big mistake and pretended it had not happened. I pushed it to the back of my mind.
Three months later, I developed a bad skin rash and began to lose weight. I went to the university student clinic. When the doctor saw the rash, she asked if I had tested for HIV. I told her I had tested, but that I doubted the results. She asked if I minded taking a second test. The worst was confirmed.
She asked to introduce me to a counselor at ICL. She explained they had support groups which included other students. Out of curiosity and confusion, I agreed. Doubting whether anybody would be willing to spend his or her time on a student like me—who had not taken care of herself to prevent HIV—I did not go immediately.
After I finished the treatment the doctor had given me, I developed other ailments, which I later learned were opportunistic infections that affect people with low body immunity. I was weak and did not have consistent meals due to financial constraints. I finally went to ICL where I talked to the counselor.
The receptionist was so welcoming that I felt like some of my problems had been lifted. The woman talked to me and introduced me to the nurse, who helped me do my CD4 (cluster of differentiation 4, a glycoprotein) test. At several appointments, I was counseled on positive living and received a medical check up. The nurse explained my symptoms clearly. I was also introduced to a support group which had students like me. I now take a nutrition supplement twice a day and am able to concentrate on my studies.
When I told the people at ICL I did not want to go to the university health clinic for fear that someone would discover I was HIV positive, they referred me to a care clinic. At this center, I receive medical management and antiretroviral therapy (ARV). I’ve been on ARVs for seven months, and today I don’t think much about it. I have had tuberculosis and other infections. The ICL counselor and nurse have kept a close watch on me; they are my treatment buddies and I feel life is worth living now.
Although living with HIV is difficult, especially the road to a stable immune system, I thank God I have received overwhelming support. There were days when finances were not there and I had no food, and I would eat the porridge I got from ICL for breakfast, lunch and dinner. The people at ICL have ensured I get a constant supply of food for the whole semester and money to pay for my room. I would not have managed without this extra support.
I had lost twenty-five kilograms when I started care and my CD4 count was less than twenty. I have now added eight kilograms and although I have not done another CD4 count, I am sure it is higher. The opportunistic infections have reduced and I am now attending classes full time. I am forever grateful to the care and support program at ICL. I wish all HIV positive students would know the depth of help available there. My prayer is that people would not condemn those of us who are positive, and that we would be free to live in society without fear of being stigmatized.
Spiritual Journey of the Students
I came to know the Lord through The Navigators while I attended the University of Nairobi. I graduated with an engineering degree and started working for the government doing road design and construction. Then the Lord called me to full-time ministry with The Navigators.
It was while discipling university students that it became clear to me that the gospel was about more than just meeting spiritual needs. I did a survey to find out what issues were important to students. Three came up: HIV/AIDS, music and finances. At that time, the infection rate among the youth was about seventeen percent. We decided that if the gospel was relevant to the whole of life, then it needed to address the issues above. We began “I Choose Life.”
Spiritual growth is a key element in I Choose Life’s program. On the one hand, we endeavour to be a professional HIV prevention, care and support organization that seeks to increase knowledge and change attitudes and practices with a view toward risk reduction. However, we also let students know that there is a spiritual component to risk elimination. We therefore have some Navigator-trained students in the small groups who are available to discuss spiritual matters with those who are interested. If they would like to explore more about their spiritual journey, the students are invited to a weekly forum called “The Journey” that meets every Friday. During these forums, over eight hundred students meet for worship and Bible study.
1. The Joint United Nations Programme on HIV/AIDS. UNAIDS. 2004