“Condoms are good and I use them with girls – they have taught us how to use them… but here in the rural area there is a problem because we walk very far to get the condoms,” said Lemeo Ntalel, a 21-year-old Maasai moran – warrior – in rural Narok, in Kenya’s Rift Valley. “At times you want to use one and you don’t have it near so you just do it with a girl without it; it is hard to tell a girl ‘wait for me I am going to get a condom’, because she will lose interest and go.”
Ntalel has to walk to Narok sub-district hospital, 26km away, to fetch condoms.
Jactone Lelei – a peer educator who trains his fellow morans on the need to use condoms – says the demand is so high that he and his colleagues have started stocking condoms along with their education materials as they go around the community spreading the word about HIV.
“We have to walk with them so that as we sensitize people to use them, we also give the condoms out. I also keep some in my house so if they want, they just call me and I give them,” he told IRIN/PlusNews. “At least it helps a little… the lack of easy access gives people an opportunity to give excuses for not using them.”
He noted that many rural residents could not afford to or chose not to buy condoms – not considered a necessity – so stocking them in local shops did not really improve access.
Nicholas Muraguri, head of the National AIDS and Sexually transmitted infections Control Programme, NASCOP, said intense condom education by both the government and NGOs had seen awareness outpace access.
“We can now say knowledge and awareness about condoms both in rural and urban areas could be in the region of above 90 percent. However, access to these condoms has been hampered by procurement and funding challenges. KEMSA [the Kenya Medical Supplies Agency] which procures, can only distribute to provincial- and district-level health facilities and not many people have access to these levels of facilities so yes, this hampers access,” he said.
Erratic funding and supply chain problems have led to fluctuations in condom distribution over the years; in 2008, the government distributed 15.3 million condoms nationally, against a demand from 21.6 million people. According to the UNAIDS Modes of Transmission Analysis 2008, condom distribution is very low generally and very unequal, ranging from almost negligible in remote northeastern Kenya to a high of 1.65 condoms per person per year in Western Province.
Ineffective condom placement can also hinder access, according to Mary Leshore, coordinator of Pastoralist Health Network, a local NGO based in Narok. “There is awareness about condom use but people still fear going to where the condom dispensers are [health centres] to pick them because they think people will think they are immoral or because they believe the culture does not allow condom use.”
According to Dofa Abdi, AIDS and sexually transmitted infections control officer in the rural northern district of Samburu, government condoms are often kept at the chief’s camp, to which many young men are reluctant to venture.
“So other than promoting awareness and increasing availability, it is good to reduce the stigma associated with the condom,” Leshore added.
Despite shyness, condoms in health centres do go fast. “If you can determine demand by how many people pick the condoms from here, then it is good – but then picking and using are two different things… if they are picking and using then we are doing well,” said Linnet Kerubo, a nursing officer at Narok District Hospital.
NASCOP’s Muraguri says high levels of awareness and demand for condoms mean the government must increase access.
“People are ready now more than they were a few years ago to use condoms and the government must and will put efforts into ensuring they are made available to those who need them because it is their right to have them,” he said. “We don’t want people to say we want them and we can’t get them.”
Fuente: IRIN PlusNews
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