East African Journal of Public Health Volume 5 Number 1 April 2008

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ROLE OF GOVERNMENTAL AND NON-GOVERNMENTAL ORGANIZATIONS IN MITIGATION OF STIGMA AND DISCRIMINATION AMONG HIV/AIDS PERSONS IN KIBERA, KENYA Margaret A. Odindo1 and Mutuku A. Mwanthi2 Abstract Objective: This study assessed the role of governmental and non-governmental organizations in mitigation of stigma and discrimination among people infected and affected by HIV/AIDS in informal settlements of Kibera. Methods: This was a descriptive cross-sectional study and used a multi stage stratified sampling method. The study was conducted in Kibera, an informal settlement with a population of over one million people which makes it the largest slum not only in Kenya but in sub-Saharan Africa. The study targeted infected individuals, non-infected community members, managers of the organizations implementing HIV/AIDS programmes and service providers. In the process 1331 households were interviewed using qualitative and quantitative data collection instruments. Statistical Package for Social Sciences (SPSS) and Nudist 4 packages were used to analyze the quantitative and qualitative data respectively. Results: More than 61% of the respondents had patients in their households. Fifty five percent (55%) of the households received assistance from governmental and non-governmental organizations in taking care of the sick. Services provided included awareness, outreach, counseling, testing, treatment, advocacy, home based care, assistance to the orphans and legal issues. About 90% of the respondents perceived health education, counseling services and formation of post counseling support groups to combat stigma and discrimination to be helpful. Conclusion: Stigma and discrimination affects the rights of People Living with HIV/AIDS (PLWHAs). Such stigmatization and discrimination goes beyond and affects those who care for the PLWHAs, and remains the biggest impediment in the fight against HIV/AIDS in Kibera. Governmental and non-governmental organizations continue to provide key services in the mitigation of stigma and discrimination in Kibera. However, personal testimonies by PLWHAs showed that HIV positive persons still suffer from stigma and discrimination. Approximately 43% of the study population experienced stigma and discrimination.

Key Words: Government, non-governmental organizations, stigma and discrimination, HIV/AIDS, Persons Living with HIV/AIDS. Introduction Stigma and discrimination affect the rights of People Living with HIV/AIDS (PLWHAs), societal coping mechanism and caring for the sick and forms the biggest impediment in the fight against HIV/AIDS. The net effect of stigma and discrimination discourages people from declaring their HIV-positive status. Without treatment, care or support, mortality rates would continue to rise and the number of orphaned children will continue to increase. Therefore, reduction of stigma and discrimination would result in reduction in HIV infection rates, and subsequently in reduction in mortality rates (1-3). This descriptive cross-sectional study assessed the role of governmental and non-governmental organizations in the mitigation of stigma and discrimination against individuals with HIV/AIDS in Kibera, Kenya. It targeted infected and affected people, non-infected community members, and organizations implementing HIV/AIDS programmes. Methodology Study Site Kibera is the third largest informal settlement in the world and a settlement for all ethnic groups in Kenya (4). It covers approximately 250 hectares of land with an average population density of 2,000 people per hectare. That density translates into an estimated population of 1 million people (5). Correspondence to: Margaret Odindo, Community Capacity Building Initiative (CCBI), P.O. Box 1244 - 00606, Nairobi, Kenya. E-mail:[email protected] 1 Department of Community Health, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya

Sampling and Data Analysis Multi-stage stratified sampling was used to select study households (6). A sample of 1,331 participants were interviewed using qualitative and quantitative data collection instruments; the managers of 50 organizations implementing the programmes in the selected study sites were interviewed, including government and nongovernmental organizations, community based organization and faith based organizations. All the organizations were registered and recognized by the Ministry of Health or Ministry of Social Services. Statistical package for social sciences (SPSS) and Nudist 4 packages were used to analyze quantitative and qualitative data respectively. Results and Discussion A total of 1,331 household participants were interviewed. Overall, 90% of the respondents were adults, who were either heads of households, spouses or relatives of heads of households. About 2 % of the respondents were the oldest children of the households or household relatives. Number of people in a household About 76% of the households had up to 10 occupants (mean 3.8). Figure 1 represents the total population in the study households (n = 5,024 from 1,331 households), which is typical of a developing country population structure with a broad base, typifying the preponderance of a youthful population. Age groups between 0 – 15 and the elderly (> 60 years) are at a greater risk of HIV/AIDS impact than the rest of the population, and also vulnerable to insecurities due to HIV/AIDS epidemic, especially

East African Journal of Public Health Volume 5 Number 1 April 2008

when their children and grandchildren succumb to AIDS and leave them with the burden of taking care of the orphans, the children and the youth. Male

Female

2

Type of assistance The study established that support from care givers was mostly in the form of medicines (74.5%; n = 529), but materials particularly food items and clothing (18.5%) and money (4.7%) were also provided (Figure 2).

2% 5%

60++

19%

Money

A ge in years

50-54

Materials

40-44

Medicines 30-34

Others 74%

20-24 10-14

Figure 2: Types of assistance given to communities in Kibera (n = 529)