On HIV/AIDS, religion, and public health

Over the years I have lost many to HIV/AIDS: family and friends. I can’t tell you how many, though. I stopped counting a while back. However, I can tell you that, because of the impact of HIV/AIDS on my life, I know what stigma is. I know what it is like to watch people sink into depression, lose hope and die because those who matter most to them have rejected them. 

HIV/AIDS as we have experienced it in the East African context has struck the family as a whole: men and women in their prime and young children have been the typical victims. Our AIDS story has had much to do with heterosexuality. So one can’t simply label HIV/ AIDS a “gay disease” as has tended to happen in the US. Our governments have had to address AIDS as a national crisis because it has stricken the mainstream.

In nations such as the US, where the tendency has been to associate the disease with sexual and ethnic minorities, I get the distinct sense that little mainstream urgency has been attached to the fight against AIDS. There are certainly men, women, and youth who have devoted their lives to fighting this apathy. But, unfortunately, there are also others who tend to view HIV/AIDS as a form of punishment for “breaking God’s laws” on sex and sexuality. Of course, this is not a uniquely American view. I have also encountered it among some people of faith in the East African context.

My interactions with those who have expressed these troubling views have led me to think about just how limited this particular religious approach to human problems is. I’m talking about a specific interpretation of the Christian teachings on sex and sexuality. The idea is that, if everybody limits themselves to following these teachings and only engages in sex within the context of heterosexual marriage then sexually transmitted infections (STIs) such as HIV/AIDS will cease to be a problem. In other words, the only way to curb the spread of HIV/AIDS is to be a “true” Christian.

That is all well and good, except that never in the history of humankind have all members of a given community adhered strictly to its religious teachings: A “true” Christian can get infected with HIV/AIDS even if he or she is firmly heterosexual, married, and faithful. For one, there is such a thing as a cheating spouse. Secondly, infection can be transmitted through rape. Yet another situation that facilitates the spread of infection is transfusion with infected blood and blood products. Yet another is the use of unsterilized medical equipment. The list goes on and on.

Those who persist in seeing HIV/AIDS as a form of divine punishment conveniently forget how closely interconnected we all are. As a result of these interconnections, HIV/AIDS does not discriminate. When you are exposed to the HIV virus, it does not ask whether you are “saved,” pray regularly, give alms to the poor, fast, or obey God’s law. If your defenses are weak, it penetrates them and infects your body whether you are rich or poor, young or old, “innocent” or not, devout or otherwise.

Keeping all of this in mind, how useful is it that a significant number of religious leaders have a simplistic approach to dealing with HIV/AIDS? How useful is it that they condemn it as a sinners’ disease, oppose the use of condoms under all circumstances, and oppose most forms of sex education? Simply put, their actions are not useful. In fact, to the extent that they influence public policy, they end up endangering everybody in the community.

Knowing this, I think that those of us living and working in communities stricken by HIV/AIDS should persist in emphasizing that it is treated by government and health organizations as a public health issue, not a moral issue. From a public health standpoint, we can speak about HIV/AIDS in its complexity. We can also talk about risks, prevention, and treatment. Importantly, we can make an effort to protect everybody.

What is the place of religion in all of this? Well, I honestly think people are entitled to believe whatever their religions teach them. However, I also think their beliefs should be directed towards governing their personal lives and setting moral standards for their religious communities. They should not be imposed on the broader national population as public health policy.

Further reading
"Education, honest dialogue key to halting spread of AIDS," by Chris Carlin and Debra Stanley, 1/17/07, http://articles.southbendtribune.com/2007-01-17/news/26826941_1_hiv-prevention-hiv-testing-new-aids-cases
"HIV and AIDS stigma and discrimination," http://www.avert.org/hiv-aids-stigma.htm 
"Public health approach to combating HIV/AIDS," http://www.searo.who.int/LinkFiles/RC61_12-pa_Item-14.pdf
"HIV/AIDS stigma: an impediment to public health," by Ronald O. Valdiserri, MD, MPH, March 2002, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447072/pdf/0920341.pdf


This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.

In America, everything is politicized

http://fromthoughtsintowords.blogspot.com/2012/05/in-america-everything-is-politicized.html

When I read this article, I had to laugh. It brought to mind a conversation I once had with my friend, Maina, a Kenyan living in the US. We were both attending an event organized by an African American student group. Some of the African American women attending the event were dressed in the best of African couture, but there was a distinct difference between the way they carried themselves and the way a Kenyan or Tanzanian woman dressed in a similar outfit would have carried herself. I put it down to the fact that the American women probably felt self-conscious in their dresses. Maina, who had lived in the country longer, had another theory. He figured that Americans didn’t know how to simply be. Everything they took up, every cultural practice or idea they picked up from another nation, they had to repackage, politicize and turn into a movement.

I shook my head in doubt, but Maina smiled. “Believe me,” he said, “this lady in the Kitenge is probably wearing it to express political solidarity with pan-Africanism. She’s not wearing it for the reasons our moms or aunties would- because they liked the color or because the pattern flattered their figures.” I never did ask the lady in the Kitenge why she was wearing the dress. That would have been rude. But today, as I read this article on Digital Journal, I have to admit to myself that there may have been something to Maina’s words.The title of the piece is “Time magazine cover features boy,3, sucking on mother's nipple.”  And here is an excerpt from the article:

The cover of this week's Time truly shows a boy being breastfed by his mother, exposing some side-boob. Aram Grumet, 3, was asked to stand on a chair and place his mouth over his mother's breast, a practise familiar to mom Jamie Lynne Grumet. The Grumets employ attachment parenting in their household, described by Time as "extended breast-feeding, co-sleeping and 'baby wearing,' in which infants are physically attached to their parents by slings.

I come from a part of the world where women routinely breastfeed their children. It is simply what they do. Most Kenyans, female and male alike, don’t give a second thought to a breastfeeding mother in the room. I can't imagine a Kenyan photographer conceiving of breastfeeding as a controversial subject, and going out of his way to have the mother and child pose in a manner designed to provoke readers. It is true that, in Kenya, some kids still breastfeed occasionally beyond the age of 3. This is normal. They ultimately outgrow it. It's not an issue that has to be politicized.


Apparently, a different order prevails some hours West of the Greenwich Meridian. Not only is the decision to breastfeed or not to breastfeed a political stance backed by ideology, but basic childrearing practices are also labeled with special terminology. America has already given us “helicopter parenting.” Make way for “attachment parenting,” “extended breast-feeding,” “co-sleeping,” and “baby wearing.”

Seriously, it would never have occurred to women of my grandmother’s generation to come up with fancy names for these basic practices. Nor would it have occurred to them that, one day, parents would engage in battles over the legitimacy of their child-rearing ideologies in the comments sections of magazine articles and blogs on the Internet. I think Maina was right. Americans can be a tad bit too ideological about everyday matters.

This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.

The delicate balance of our ecological systems

When I was in school, we were taught that the cause of malnutrition in our communities was the lack of sufficient protein in the diet. Today, I am much older, and have observed that there is a malnutrition epidemic in the Lake Victoria region in Kenya where fish, a rich source of protein, is supposed to be a staple. At first, I thought this was a uniquely Kenyan problem. Then I saw Hubert Sauper's documentary, Darwin's Nightmare. Apparently, a similar problem exists in the Lake Victoria region of Tanzania.

The film demonstrates how commercial fish harvesting over the years has exhausted the fishing stock in Lake Victoria, creating an ecological crisis. The Nile Perch fillets harvested from the Lake are processed then transported by commercial aircraft to Europe. The same aircraft rarely arrive in Tanzania empty. In fact, they usually bear arms that are then off-loaded under the cover of darkness. So we have a situation whereby Europe is enjoying fish fillets from Lake Victoria while the locals feed on the remains of the processed fish: skeletons from which the fish fillets have been removed. In the meantime, other locals are killed by the buyers of the illicit firearms when violence erupts in the region.

After watching Sawyer's documentary, I looked into the history of the ecological crisis in the lake region. According to available information the Nile Perch are an alien species of fish, which was introduced into the lake in the 1960s, just before Kenya became independent. Over the years, this alien species had decimated local fish stocks by predating on indigenous fish species. Thus, an ecological imbalance has resulted in the lake.

The locals used to subsist on the lake's indigenous food species. However, these have been depleted by the Nile Perch. In the meantime, the most substantial protein source in their diet is the waste from the Nile Perch processing factory:  Nile Perch remains. Thus, they live on a diet deficient in the nutrients that they need. The people in the region have no means to secure separate sources of vitamin A and omega 3 fatty acids. They  do not thrive. Hence poverty, malnutrition and disease are common in the region. As if this is not enough, Lake Victoria is considered to be one of the large fresh water lakes whose future survival is threatened.

For long, residents of the Lake Victoria region have complained about the exhausted fish stock in the lake. There has been little if any response from the sitting governments. A few years ago, I remember reading newspaper reports that indicated that Monsanto was already in the region, and that the introduction of other genetically modified species in the region was a possibility. In some areas, the locals were uprooted from their ancestral land to facilitate these 'innovative projects'. Their only compensation was a promise of maize supplies to subsist on every harvest season.  Maize based diets are apparently at the root of chronic malnutrition in the region. So that news did not bode well for Lake Victoria region's people, whose nutritional status is already declining .

When I read reports of this kind about environmental degradation and the development of supposedly superior species for human consumption anywhere in the world, I often wonder how local leadership fits into the picture. How do governments decide that the efforts of scientists and multinational corporations are for the good of their people? Is there a rigorous effort to look into the pros and cons of the proposed projects? Does money change hands? Are the locals informed about the details of the deals? How about the rights of other nations? In the case of Lake Victoria, which is a resource shared by 3 countries, how do the decisions made by one nation impact the other 2? Most importantly, what is the long-term impact of foreign species and GMOs (genetically modified organisms) on the environment and on the people?

Concerned people need to start taking these questions more seriously and thinking about the legacy are we leaving our children.

Changing our attitudes towards homosexuality

 http://fromthoughtsintowords.blogspot.com/2012/03/changing-our-attitudes-towards.html

When they think about what it means to be gay, many East Africans focus on its physical implications: they think about gay people as those who have physical relationships with members of the same sex. Because sex is a physical act that one chooses to engage in, they figure that one can choose whether or not to be gay. This perspective fails to take into consideration the fact that, for many gay people, being gay precedes the act of sex. To them, being gay means feeling attracted to people of the same sex. Even if they never act on these feelings and choose to live a life of celibacy or one of heterosexuality instead, they know deep down inside that they feel attracted to members of the same sex and that they have felt that way for as long as they have been sexually aware.

I have read narratives by gay people who speak about becoming teenagers and realizing that, unlike their age mates, they felt absolutely no attraction to members of the opposite sex. They grew older and the status quo held: the heterosexual attraction that other people took for granted was never a part of their experience. Instead, they remember their first experience of feeling romantic love for another as involving somebody of the same sex.

I notice that most discussions of homosexuality in the East African media have not evolved beyond the expression of horror or disgust at the possibility that two men or two women can be physically intimate. Very few East African writers set aside the focus on the sexual angle to ask what it is that makes it possible for a man to feel attracted to a man or for a woman to feel attracted to a woman. Very few even ponder over what it is that makes them heterosexual. They just assume that they are heterosexual because that is the natural state of things. They don’t think about the biological and environmental factors that influence their sexuality. Nor do they realize that if a few factors in their lives had been different, they could possibly have been gay.

The truth of the matter is that there is no single definitive factor that makes a person gay or straight. Rather, a variety of factors interact to influence a person’s sexuality. They include genetic heritage, the hormones to which a fetus is exposed while in the womb, the structure of the brain, family influences, birth order and other factors.

Over the years, I have read of studies where it was shown that there were demonstrably distinct differences between people who self-identify as homosexual, and those who self-identify as heterosexual. These include physiological differences, e.g. differences in the sizes of specific parts of the brain, different brain responses to certain chemicals, and different ways of processing certain forms of information. One study I read about in a science magazine a few years ago (unfortunately, I can’t remember which one now) looked into the family structures of gay and straight men. It found that the gay men’s maternal female relatives tended to have more offspring than their paternal female relatives. The conclusion was that the X-chromosome, which was passed to these men by their mothers, was involved in some way. The scientists speculated that this chromosome was carrying genes that increased female fertility and the likelihood that male offspring would be homosexual.

I remember reading another article which indicated that more gay men tended to experience rejection from their fathers than straight men. Gay men also tended to have closer relationships with their mothers than straight men. The conclusions were not clear cut in this one. It could be argued that the fathers rejected their offspring because they sensed that they were somehow different from the norm and that the mothers tried to compensate. It could also be argued that the rejection by the fathers played a role in influencing their sons’ psychosexual development.

I can think of many more studies that focus on different biological and environmental factors, and show them to have some kind of influence on an individual’s sexuality. The conclusion I am bound to draw from all of this is that sexuality is complex, and that there are no easy explanations for the way it manifests in individuals. Thus, being gay or straight is not about simply deciding to feel a certain way.

Given that homosexuality is complex, and is determined by a variety of factors, our attitudes towards it need to change. We are living in the age of information. With access to the internet, many people really have no excuse for holding on to superstitious beliefs about sexuality.

This work is licensed to Rose Kahendi under a Creative Commons Attribution-Noncommercial 3.0 Unported License.

How cultural norms contribute to malnutrition

This week, I have been reading Richard K'Okul's book, Maternal and Child Health in Kenya. The book explores the different factors that contribute to malnutrition in the community. These range from bad policies to poverty, ignorance and cultural factors that influence maternal nutrition.

One of the factors that I found unnecessary and sad was the cultural norm in Western Kenya, whereby a young married woman is not allowed to cook for her family. Instead, she has to comply with her mother-in-law's wishes. If her mother-in-law doesn't feel like cooking, then even small babies are condemned to remain hungry until she is ready to cook.

To make matters worse, the food cooked may not necessarily be suitable for small children. In parts of Nyanza Province where polygyny is common, it is the senior wives who control the cooking. It is common to see very young women who are married to elderly men carrying small children with kwashiokor. When asked why they can't feed their child better, they give answers like, ' I have not been given food'.

The point of this little story is to point out that  the time has come for Africans to reexamine and restructure their cultures in order to survive. It doesn't matter how many highly educated specialists Africa produces, if we don't take care of the basic anomalies in our family dynamics: Malnutrition, disease and death will remain common among African children. Young African men must therefore play their part in condemning these practices, and African mothers must advocate more for the welfare of their children. Then Africa will take one step closer to joining the global community.

Contemporary Africa's implication in its own underdevelopment

In early April of 2010, I was hosted at a Public Library for the presentation of my book, A Healthy You: Tame Africa's Child Malnutrition. I was quite surprised at the interest the contents generated: I had assumed the book would primarily interest Africans, but the audience was predominantly American. To cut a long story short,the presentation went well, and gave me fresh food for thought.

One issue that came to the fore during the question and answer session was the poor utilization of quality protein maize (QPM) in the place of ordinary maize to tame childhood malnutrition on the continent. Other developing continents seemed to have made greater use of this resource than Africa. One participant in the audience hinted that the African establishment seemed to enjoy "victimhood." The person speculated that they preferred to exploit the sympathy that poverty, disease, the orphan burden, and violence attracted than to do the hard work that was necessary to undo institutional dependency on foreign aid.

Globally, research on QPM has been ongoing for many years. On the African continent, it is only in Ghana that  community studies have been documented. These studies have shown that Ghanaian children with Kwashiorkor fed on QPM recover. I have thoughtfully compared these with my own casual observations that Western Kenyan children, fed predominantly on a white hybrid maize staple diet continue to suffer from Kwashiorkor. The high infant mortality rate in Wetern Kenya is a crying shame, yet any possible solutions must come down to political will. When political will catches up with the reality on the ground the problem will receive the attention it deserves. The officials concerned with addressing malnutrition nationally then will be well advised to break down the national statistics for disease burden, poverty rates, and child mortality into regional figures. It will be important to identify the communities most afflicted and to apply the most intense programs within them.

Several reasons have been cited for the minimal undertaking of QPM research efforts on the African continent. One of these reasons is that many nations do not have the technical capacity to support such research. However, if Ghana can do it, why can't other African countries do it? Keep in mind that much of the hard scientific work that would facilitate such research has already been done. It seems more likely that the absence of such research efforts is attributable to the absence of coherent national development goals in many African nations. Such goals are rendered impossible because of the degree to which resources are commandeered for ethnic interests rather than national interests.

Leaders focus more on meeting the superficial needs of "their people" so that the tribal voting blocs on which they are dependent can get them back into office during the next political cycle. There really isn't much time or energy left to look into the more profound needs of their communities in the long-term, or to even think about other communities nationally. What this means is that ordinary Africans who want to see Africa change for the better have to learn to do the dirty work themselves, often without government support.

The African culture of poor leadership is bred in our homes. We must start taking responsibility for this culture: If there is something you can do to change Africa for the better, do it now, starting in your home. Don't just complain about "Africa's poor leadership." Leadership should start with you, dear reader. If you can't make the necessary sacrifice, why should you expect that somebody else will? Leadership arises from the people.