‘If you start thinking positively, you won't miss sex’: narratives of sexual (in)activity among people living with HIV in Nairobi's informal settlements

Abstract

Drawing on qualitative data, this paper examines narratives of sexual activity (or the lack thereof) among people living with HIV in two urban poor contexts in Kenya and the ways in which these narratives intersect with the discourse of a ubiquitous HIV-prevention strategy – the ‘ABC’ (Abstinence, Be Faithful, Condom Use) approach. The exploration of these narratives gives insight into the ways that the notions and meanings around sexual activity are informed and re-shaped by the experience of living with HIV in urban poor settings and into the complex ways in which the components of the ABC approach feature in the lives of PLHIV in these contexts. As the sexuality of people living with HIV in sub-Saharan Africa is an under-researched area, this paper sheds light on the realities of living with HIV in urban poor settings and illuminates the context that informs constructions of sexuality in this milieuí.

En exploitant des données qualitatives, cet article examine les récits centrés sur l'activité sexuelle (ou sur son absence) parmi des personnes vivant avec le VIH dans deux environnements urbains et pauvres au Kenya, et les différentes manières selon les quelles ces récits s'entrecroisent avec le discours d'une stratégie de prévention du VIH omniprésente – à savoir, l'approche «ABC» (abstinence, fidélité, préservatif). L'exploration de ces récits donne un aperçu de la manière avec laquelle les notions et les significations qui gravitent autour de l'activité sexuelle sont informées et redéfinies par l'expérience de vie avec le VIH dans des contextes urbains et pauvres, et de la complexité de l'application des composantes de l'approche ABC dans la vie des PVVIH, dans ces environnements. La sexualité des personnes vivant avec le VIH en Afrique subsaharienne étant un domaine sous-étudié, cet article apporte un éclairage sur les réalités de la vie avec le VIH dans ces environnements urbains et pauvres, et sur le contexte sur lequel se fondent les constructions de la sexualité dans ce milieu.

A partir de datos cualitativos, en este artículo examinamos las narrativas de la actividad sexual (o la falta de la actividad) de personas seropositivas en dos contextos pobres urbanos en Kenia y el modo en que estas narrativas intervienen con el discurso de una estrategia omnipresente de la prevención del virus del sida, el ABC de la prevención (abstinencia, fidelidad y el uso de preservativos). El análisis de estas narrativas nos da una perspectiva en cuanto a cómo se informan y reforman las nociones y los significados de la actividad sexual mediante la experiencia de vivir con el VIH en entornos urbanos pobres y las complicadas maneras en que los componentes de este ABC de la prevención caracterizan las vidas de personas seropositivas. Dado que la sexualidad de las personas seropositivas en el África subsahariana es un campo poco investigado, este artículo arroja luz sobre las realidades de vivir con esta enfermedad en entornos urbanos pobres e ilustra el contexto que informa sobre las construcciones de la sexualidad en este medio.

Keywords:

• sexuality
• people living with HIV
• urban poverty
• ABC
• Kenya

Acknowledgements

The authors acknowledge general support to the African Population and Health Research Center provided by the Rockefeller Foundation (Grant no. 2008AR001) and the Hewlett Foundation (Grant no. 2006–8376). The qualitative data collection and analysis were supported in part by the Rockefeller Foundation (Grant no. 2006AR013) and the UK Department for International Development (DfID) through the Realising Rights Research Programme Consortium (HD4).

Notes

^1. An HIV serological survey pilot study conducted in two informal settlements of Nairobi from 2006 to 2007 by the African Population and Health Research Center.

^2. As one male respondent explained: ‘I was rather feeling ashamed to go to [a particular community-based organization] … You know, here in [the slum], [the community-based organization] is like a women's affair so how can I, a man, go for services there? I would feel slightly shy among all those ladies and children … I hear men are welcome, but then there are so many ladies there and no other man … I think I can work and get my own meals … Why should I stop doing my job and then go and queue up with some ladies for what they are going to get? I would rather go and work and earn my own money.’ Another male participant recommended that community-based organizations give men attention as well and ‘not just front [i.e. cater to] women alone’.

^3. A more appropriate term for this phenomenon as it is framed in this paper would be ‘secondary abstinence’, which differs from the more conventional use of the term ‘abstinence’ as delay. For convenience purposes, however, we have maintained the use of the term abstinence throughout the paper.

^4. Orza's paper was based on information provided by HIV-positive women from Namibia, Uganda, and Zimbabwe during the 2006 International AIDS Conference in Toronto, Canada.

^5. A recent media report by IRIN PlusNews (2009) entitled ‘Jane, “I told them I was HIV-positive… they raped me anyway”’ seems to support this anecdotal evidence from slum communities.

^6. For example, one woman narrated how when she initially discovered her HIV status, she was saved from two suicide attempts by her spouse. Several other respondents spoke of forming a united front with their partners against the outside world.