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You are here: Home Modules Module Examples Module 1 Examples Example 9 - Socio-ecological assessment: HIV/AIDS in Kenya project
Example 9 - Socio-ecological assessment: HIV/AIDS in Kenya project Print E-mail
Module 1 Examples
Ontario Public Health Practioners

What factors (determinants) may be contributing to or causing the problem?

A socio-ecological assessment is critical in an intervention aimed at such an immense problem. In HIV/AIDS, many different factors at many levels form the context, interact, and come into play.

  • Individual factors: Individual factors that contribute to HIV/AIDS include having multiple sexual partners, sexually transmitted diseases, not using a condom and not circumcising males (Auvert et al, 2001). Individual behaviour is largely determined by the social environment, such as community norms and values, regulations, and policies.
  • Societal factor: Systemic discrimination. Stigma and discrimination also influence the spread of HIV/AIDS. Stigma creates barriers to the uptake of interventions to prevent HIV infection, treat it and give support to people living with the disease (Klein, Karchner & O'Connel, 2002; Hamra, Ross, Orrs & D’Agosrino, 2006, Parker & Aggleton, 2003). Issues such as promiscuity, homosexuality and blame tend to prevent people from disclosing their HIV status and seeking care. Prejudice against people with HIV/AIDS may mean people are denied their right to care. Interventions aimed at HIV/AIDS need to consider where there may be prejudice and how stigma-related factors interact at various levels.
  • Socioeconomic and political factors: Inequities. HIV/AIDS is increasingly concentrated in the poorest and most marginalized societies (Kumaranayake & Watts, 1999; Buve, Kalibala & McIntyre, 2003). Studies among African-American women (Espele, 2002; Lane, Rubinstein, Keefe, Webster, Cibula, Rosentahl, & Dowdell, 2004) and African women (Farmer, Nizeye, Sultac & Keshavjee, 2006) say the risk of contracting HIV/AIDS is related to socio-economic and political factors including gender and power inequalities, patterns of sexual interactions, inadequate resources and limited access to services. In Africa, socio-economic conditions conducive to HIV/AIDS transmission probably began during the slave trade and colonialism (Barnet & Whiteside, 2002), when economic livelihood, social practices and community cohesion were disturbed and the indigenous health-care system pushed aside. While traditional remedies for the opportunistic infections of HIV/AIDS exist, lack of recognition and support for traditional healers hinders many people from seeking care from them.
  • Cultural factors: Lack of factual information. In some communities in Africa, HIV/AIDS symptoms may be attributed to witchcraft and curses (Barnet & Whiteside, 2002). Because individuals can’t get the facts on the disease, misconceptions about its transmission and prevention can flourish.
  • Gender: Gender issues, including the relative risk of infection, stigma and discrimination, access to treatment and who gives care in families are all factors that affect HIV/AIDS interventions. In Kenya HIV/AIDS affects men and women differently. In 2003, prevalence among women was 8.4 per cent compared to 4.2 per cent among men (MOH 2004). Male violence against women in homes, schools and workplaces, and coercive and inequitable sexual practices have increased women’s vulnerability to HIV/AIDS in Kenya (Orege, 2005) because forced sex is more likely to cause abrasions and cuts that allow entry of the virus to a woman’s bloodstream. Unequal power relations also make women more vulnerable because they cannot negotiate condom use. Economic factors including inadequate education and poor economic opportunities for females also make them more vulnerable to unsafe sex. Women also bear the burden of caring for the sick at home (Glynn et al., 2001; MOH 2005).
  • Limited health care infrastructure: Effective implementation of HIV/AIDS interventions requires a strong health-care system with extensive infrastructure and trained personnel. All are limited in African countries (Wood, 2002).
  • Policy: A good political environment and favourable policies are crucial for initiating and sustaining HIV/AIDS interventions. Uganda’s success in fighting HIV/AIDS was attributed to supportive leaders, a strong health infrastructure and broad involvement by religious groups, civil organizations and community leaders as well as good relations with external partners such as World Health Organization (Parkhurst & Lush, 2004). Context-specific and evidence-based policies and guidelines are needed in order to scale up and sustain HIV/AIDS interventions organizationally and nationally (Secklinelgin, 2007).
Last Updated on Sunday, 31 May 2009 18:06