The cultural politics of secrecy during HIV home counselling and testing campaigns in Kenya

Abstract

How do the local cultural politics of secrecy intersect with biomedical and institutionalised global health knowledge and management of HIV? This question was ethnographically researched during a home counselling and testing programme as it was initiated twice in a Kenyan community. The programme was informed by worldwide efforts to organise and control HIV so as to ‘end AIDS’. We focused critical attention on the relationship between HIV testing and counselling and contend that local expertise in speaking about (or silencing) sexuality, intimacy and HIV intersected with the home counselling and testing campaign as an instrument in the co-production of local gender dynamics and power arrangements. We demonstrate how the home counselling and testing programme was put to use for local cultural projects aimed at (re)negotiating gender, sexuality, social roles, intimacy and power dynamics and, in consequence, produced uneven experiences with testing, treatment and AIDS-related health outcomes during a period of major social change.

Keywords:

• HIV counselling and testing
• Africa
• gender
• global health
• social change

Acknowledgements

The writing of this paper was made possible through the support of Rhode Island College, the Rhode Island College Foundation, and the Rhode Island College Alumni Affairs Office. The paper was also enhanced by the copy-editing by Joanna Broderick.

Disclosure statement

The authors declare they have no conflicts of interest in the publication of this paper.

Notes

1 Formerly, 3 Cs—Consent, Confidentiality, and Counseling—were included in the Kenyan HIV testing and counselling guidelines used between 2008 and 2015, thus in place while our research was conducted (see NASCOP 2008).

2 These goals expired in 2015 and were replaced by the UN Sustainable Development Goals.

Additional information

Funding

This research was made possible by support from the Kinsey Institute for Sex, Gender, and Reproduction, the NIH/NCRR-Indiana Clinical and Translational Sciences Institute-TL1 Program [NCATS TL1TR000162], and fellowship support and grants from the College of Arts and Sciences, Department of Anthropology and African Studies Program at Indiana University, Bloomington. The project described was also partially supported by Award Number T32AI007637 from the US National Institute of Allergy and Infectious Diseases. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases or the National Institutes of Health.