Unintended Consequences: How Fighting HIV in Kenya Created Benefits Beyond Health

Wednesday, 19 October 2016 17:49 GMT

Mural created to help promote acceptance of HIV positive people as part of the HOPE program

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The threat posed by HIV and AIDS in East Africa is nothing new. For years, we have seen efforts to curb the spread of the virus, which often means tackling behaviors among at-risk populations. In Kenya, issues like high poverty, substance abuse, and low levels of education put young people, especially girls, at increased risk for HIV infection. Reducing the prevalence of HIV and other sexually transmitted infections is a goal that should be vigorously pursued. But what if work that helped reduce risky behaviors had positive spillover effects, from better academic performance, to stronger familiar relationships? Wouldn’t that be even more effective in protecting the health of young people especially?

HOPE (Health Outcomes through Prevention Education) Program, was designed to help address the spread of HIV and STI’s and promote healthy outcomes among at-risk youth. Funded by PEPFAR, the program aimed to work primarily in schools and help improve student’s knowledge about HIV and AIDS, STI’s, and how to prevent health risks including unintended pregnancies. Support was also given to schools, teachers and the Ministry of Education to help improve classroom instruction on HIV prevention and Life Skills Education and co-curricular activities.

By the end of the program, more young men and women — knew much more about how to prevent transmission of HIV, and they could distinguish between facts and myths about STI’s. 93% of them recognized how abstinence could stop infection of the virus, and over 57% understood the role condoms can play in preventing the spread of disease. We also saw increased acceptance of those living with HIV, with 93% of young saying they would remain friends with a HIV positive person. This is significant since stigma around HIV and STI’s has long been prevalent in East Africa.

HOPE Program accomplished what it set out to do. But that wasn’t all. Throughout the implementation of the program, we heard from teachers, parents, and even the youth themselves that they were seeing positive changes that we hadn’t originally anticipated, including improved coping skills, better inter-ethnic and inter-generational communications, and even better academic performance. Surveys of the youth revealed that 86% of primary school males, 62% of primary school females, 77% of secondary school males and 81% of secondary school females felt that their academic performance had improved. While this data could not be corroborated with actual academic records, the fact that students could self-report that they are performing better is still significant. Students and parents also reported dramatic improvements in communication between students of different ethnic groups, students and their teachers, and students and their parents. Teachers said their schools had become a ‘safe haven,’ and that problems affecting students while not in school were finally being addressed. Finally, data showed an overall reduction of risk behaviors, including less conflict in schools, more awareness of gender-based violence, and increased awareness about drug and alcohol use. What can account for such dramatic improvements in areas that weren’t even being targeted by the HOPE program?

The answer appears to lie in the structure of the program itself. Of particular import is the peer to peer learning model, where students are trained to deliver the program’s messages to other students. This makes sense; as anyone who as dealt with children knows, they are often more receptive to information when it comes from their peers, rather than adults. This approach also provided leadership opportunities for students, giving them the chance to take on important roles in their schools and communities and interact with teachers, administrators, and other authority figures. Even those who weren’t peer educators still benefited, since the skills learned throughout the process had broad applicability beyond sexual health. Added to this is the fact that The HOPE Program used an integrated, hybrid approach to address issues– channeled through schools, homes and the community at large, and you can see that all of the gains, not just those related to HOPE’s stated goals, could be more effectively sustained.

The lesson of HOPE Program is not just that some programs can have unintended positive consequences. For those of us in the development community, these pleasant surprises occasionally occur. What is important here is that the design of a program, specifically one that works to build capacity and empower participants, can have tremendous impact. We could have simply had teachers deliver the HIV and AIDS-related messaging, but even in the unlikely event that it would have been effective, we would not have seen the other gains from the program. Perhaps with more investment in peer to peer education programs, we could see even more unintended results, something that everyone in at-risk communities benefit from.