Fire for Our Children
by Wendy Driscoll, Press Officer
The Greek god Zeus stretches his arms to the sky and thunders his denunciation to the trembling humans below. "I'll not give fire to such a wretched lot!" he bellows.
A young woman steps forward, removing a strip of colorful cloth from her waist as she speaks: "Is it possible," she asks smoothly, "to relate what is happening to the relationship between parents and children?" The watching crowd is silent for a moment. Then, hesitantly, an older woman in the third row raises her hand and speaks. "We can talk about opening the channels of communication, but it doesn't matter. As long as we, the adults, are not living what we speak, it will continue."
"It" is the curse of AIDS that is slowly and silently attacking Africa. More than one million people in Kenya alone are infected with the virus that causes HIV/AIDS, and this number is projected to nearly double in the next 10 years. But there is a second meaning to the woman's words, for she is one of a group of Kenyans who have come to watch a CARE-run theatrical presentation aimed at provoking a discussion both of AIDS and the sexual behaviors which lead to infection. And the point of today's parable, which draws from the Greek myth The Creation of Man by Prometheus, is to convince parent's to give a "gift" -- not of fire, but of something equally lifesaving.
Prometheus, after all, was the Greek god who defied Zeus by giving fire to his beloved creation, human beings. Through his example, parents are being subtly urged to break the ultimate cultural taboo and discuss sexuality with their own "creations" -- their children.
AIDS is killing Kenya. The World Health Organization (WHO) reports that AIDS cases have increased a stunning 241% from 1991 to 1992. Up to 85.5% of high risk populations are infected, and the United Nations estimates that 1.6 million Kenyans may currently carry the HIV virus. In Nyanza Province in western Kenya where CARE works, more new AIDS cases are documented than in any other Kenya province. And up until recently, those most ignorant of the ravaging effects of AIDS -- youth -- have been the most vulnerable to infection.
Youth, after all, comprise a huge proportion of our growing world population: about 30% of people on the planet today are between 10 and 24 years of age. In many developing countries more than half the population is below the age of 25 years.
In many countries over two-thirds of adolescents aged 15-19 years, male and female, have had sexual intercourse. Adolescents and young adults (20-24 years of age) account for a disproportionate share of the increase in reported cases of syphilis and gonorrhea worldwide. Further, at least one-fifth of all people with AIDS are in their twenties, and most trace their infection with HIV from adolescence.
Because there is no cure or practical treatment for HIV infection and many viral STDs, and because treatment for other STDs may be neither sought nor available, primary prevention through education has been a traditional public health approach. But the sensitivity of issues associated with sexual behavior create major obstacles to education. And, according to WHO, these problems "increase when prevention measures are specifically aimed at young people between the ages of 10 and 24 years."
Certainly for a conservative society such as Kenya, discussion of the behaviors that lead to the disease are taboo. Parents cannot, or will not, discuss sex with their children. Youth, particularly young girls, are terrified of the publicity the purchase of a condom will draw. And the Roman Catholic Church, prevalent in Central Africa, teaches that the only sure way to prevent AIDS is to abstain from sex. Hence, even the instructional comic books CARE distributes to educate youth about AIDS were renamed to appease conventional mores: Captain Condom and Lady Latex (at war with the army of sex diseases) becomes the less risqué Captain Wait and Lady Don't.
"I went into a shop to buy a condom once, just to see what would happen," says Benta Osamba, a training officer with CARE in the Kisumu district in Western Kenya. "All business stopped. Suddenly, I was the only one being served. I was quite open about it, because I wanted to see what the reaction would be, and everyone in that shop assumed I was a prostitute."
In 1992 CARE launched CRUSH (Communication Resources for the Under 18s on STDs and HIV), an experimental effort to break through traditional barriers to AIDS education. The project's philosophy drew upon a universal wisdom: in matters of sex, parents and children have difficulty communicating. More often than not, the first sexual information a child gets is not from a member of his or her immediate family, but from a peer. Often, such information is not reliable. Sometimes, such information kills.
Education programs designed to alter sexual behavior are not new to Africa. But CRUSH did something unique to AIDS education: It concentrated on people 18 years or younger, not just as a victims at risk of infection, but as tools to fight the spread of the disease.
"Imagine you're a young girl being pressured by a boy to have sex. Your parents don't feel comfortable talking to you about sex, or may punish you for even bringing the matter up. Who can you turn to but your older sister, or your best friend, or someone else your age that you can trust simply because you know they're wrestling with the same choices?" says Hillary Musyoka, who worked on the CRUSH project for three years before it closed in 1995.
"The problems parents have talking to their kids don't exist between the kids themselves. That's why youth make such effective educators."
Baseline research by CRUSH staff verified that youth strongly preferred to learn about sexual and reproductive health from their peers. CRUSH thus focused its efforts on identifying and training youth group leaders to act as educators and role models in their communities. CRUSH particularly focused on out-of-school youth, who were unlikely to benefit from health programs offered in some Kenyan schools, and were therefore the most at-risk. But these youth were often unable to read or write, pushing CARE to experiment with non-literate, "interactive" education techniques. The role-plays, focus groups and skits proved popular, and led, in the second year of the CRUSH program, to the formation of CARE's other AIDS education initiative, PETAAK (Participatory Education Theater Against AIDS) in Kenya.
"PETAAK was born out of the understanding that you can't reach inside someone's head and change their thought patterns," says George Otiu-Kidenda, leader of the PETAAK program. "You have to create a space where people can think for themselves about issues they would otherwise avoid."
Otiu-Kidenda is a young Kenyan actor with a deep voice and piercing black eyes. He has been leading his troupe of actors around Kenya for nearly three years, preaching tolerance, communication, prevention and other HIV/AIDS related messages through parables and skits that ask the audience to put themselves in the place of the afflicted. Typically, a situation is presented and audience members, assisted by a facilitator and a CARE-scripted storyboard with multiple plot variations, are asked to make key decisions for the actors. Should a man who contracted AIDS through a prostitute tell his wife? Should an HIV-positive wife whose husband died from AIDS marry her brother-in-law, as custom ordains? Should a nurse who contracts AIDS at the hospital where she works be forced to leave her husband?
When this last question was presented to an audience of 100 or so people in rural Kisumu, the initial reaction of the crowd was for Joan, the nurse, to leave her husband. But, a small minority felt the husband should keep his wife. One PETAAK actor recalls what happened next:
"One member of the audience suggested that a friend should talk to him. The facilitator asked him to come on-stage and step into the shoes of the friend. He did so, speaking to the husband for approximately 20 minutes, during which time the audience remained acutely attentive. The friend argued that marriage is not just about having children, that he had not married her just for sex, that if he was sick he would want her to care for him. Gradually, the husband began to reconsider, and finally agreed that he may be able to keep his wife and use condoms. There was a spontaneous round of applause from the audience."
PETAAK, taking its cue from CRUSH, was initially created for people between the ages of 12 and 18. Youth groups, such as the Kama Kazi Youth Group in urban Kisumu and the Apondo Youth Group in rural Ahero put on the first performances, working in partnership with CARE staff to create the unique plot structures. However, early on in the PETAAK project, it became clear that adults wanted to watch and participate in the performances.
Story lines were changed to reflect not just AIDS-related dilemmas of sexuality and health, but the problems of communication between adults and youth. This mix of issues and ages, says Otiu-Kidenda "sometimes provokes a passionate discussion not only of the AIDS epidemic, but of traditional beliefs versus modern pressures." During one performance this interaction occurred:
"A respected elder of the community, who does not believe in the existence of AIDS, suddenly clears his throat. He is interested in the character of the village carpenter who, upon his elder brother's death, is forced to marry the widow. A sudden hush falls on the audience, made up of 400 members of the community. Here is a village sage, whose word on custom and tradition is faultless. He explains the philosophy behind wife inheritance slowly but firmly, citing a wealth of ageless ancestral wisdom. The elder sits down after 20 minutes and there is no doubt in the minds of the people that wife inheritance is blameless, as far as AIDS is concerned.
"Then, the carpenter begins to tell his story. He tells how he discovered that his elder brother committed suicide after he was diagnosed with AIDS. He declared that he himself has since tested positive, together with his first wife, their last born baby and the second wife he inherited from his late brother. Nobody speaks for a long time, until a teenage schoolboy in the audience begins to point out the contradictions of wife inheritance. For the next half hour a discussion ensues between the youth and the elders. What was accepted before the drama as sagacity is slowly reconstructed in the light of HIV/AIDS. People listen, people argue, people venture into the performing area to wear the cap of the carpenter at the crossroads of his life. This culminates in instantaneous applause when the elder who started the argument declares he has been convinced by a doctor (played by another member of the community) that AIDS does exist.
"Where social norms and values are in the process of change or are confusing, an individual -- and often a large number of individuals -- in such a societal conflict is no longer sure of what is the appropriate or expected behavior in making certain decisions," explains Otiu-Kidenda. "In other words, the rules of the game are not clear...Modern education has made us 'modern' but cannot remove the traditional self from within us, nor has 'modernity' taught young people how not to feel or given them better control."
The strength of CRUSH and then PETAAK is that both programs confront the issues of youth and age, tradition and modernity, freedom and control inextricably linked to the spread of HIV/AIDS. The results have been encouraging. When CRUSH ended in 1995, youth involved in the project reported a 25% decrease in the average number of sexual partners and a 20% increase in the percentage of youth reporting no sexual contact with a partner in the four weeks proceeding the interview. More than 70% of youth participating in CRUSH said they felt it was important to use condoms, 83% could identify a virus as the cause of AIDS and 97% were able to name sex as the main mode of spreading HIV/AIDS.
"In three years, to see numbers like these is remarkable," says Diana Altman, CARE's Regional Technical Advisor for Reproductive Health. "Educators have been working in Uganda for more than a decade, and are only now starting to see change. But in this one program in Kenya we've seen a great leap in learning in a far shorter period of time."
The focus on youth helping youth is how many explain CRUSH's success. Likewise, PETAAK performances demand the presence of young people in the audience, and PETAAK facilitators frequently call upon younger audience members to participate in the dramas. CARE has now drafted a proposal for a follow-up project that will continue and extend its innovative education techniques throughout Kisumu called the KASAH (Kisumu Community Action Against STD and HIV) Project, and is awaiting funding.
For staff, the urgency of such programs cannot be underestimated. Says Otiu-Kidenda: "When I am standing in front of a school audience ready to begin an AIDS awareness program this question pops into my mind: How many of these boys and girls will survive the pandemic to tell their grandchildren about the 'Dark Days' when there was no cure for the 'Dread'?".
But the Dark Days of AIDS are still upon us. And as long as they are, CARE will continue to give fire to our children.
Sidebar:"REMOVE YOUR VEILS!"
Notes from a PETAAK discussion group
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