How do you shape your hopes, ambitions and expectations when growing up in an environment devastated by HIV/AIDS?

For her doctoral thesis, epidemiologist Ellen Blommaert looked for answers in Winam, a rural area of western Kenya where HIV/AIDS wreaked havoc among the population but where sexuality is very important.   She found that young people between 16 and 25 do modify their approach to sexual risks - but not in ways the western world understands. Sexuality plays an important role in their quest for a better future but because of the instability of social networks due to HIV and other factors, some of the youngsters increase their sexual networks, including, sometimes, sexual liaisons with multiple, concurrent partners. 

It all comes down to how people understand love and money. 

Nyanza province, of which Winam is part, was hit harder by the HIV/AIDS epidemic compared to any other Kenyan region because of its sexual culture, unwillingness ti use protection and the high cost of drugs. While trying to enjoy “playing sex”, youngsters behave pragmatically to avoid the health risks linked to sex. But instead of reducing their number of sexual partners or changing their sexual behavior as advocated in government and NGO health campaigns, they have developed a tactic, which is embedded in locally meaningful modes of reasoning.

Within their social network, they try to reconstruct the sexual and medical history of their potential sexual partners through informal conversations. They hope thus to minimize their risk of exposure to HIV. However, the many small groups of sexually active people are in turn combined to several larger groups.

The result is that the sexually active youngsters in Winam were, one way or the other, all sexually connected to each other, even though they had no direct sexual contact. " Individuals could escape infection by chance, but in the end, all were structurally highly likely to get HIV.," says Blommaert.

In the American comedy "The League", this kind of sexual network was given a name - "Eskimo brothers", which was sure to displease residents of Alaska.

In Winam young women under 20 are HIV-positive more often than their male counterparts (6% vs 0.5%). According to Blommaert, this development is directly related to "structural violence", created by the prolonged socio-economic crisis in Winam and the fragmentation of social networks. It is important to see the decisions young people face in this context of enduring uncertainty in which youngsters, despite their inventiveness, struggle to realize their plans. In her study, she tried also to broaden the concept of 'transactional sex' and untangle stereotypical ideas about female subordination, male dominance and transactional sex in sexual relationships.

The study in Kenya confirms that biomedical prevention messages, promoting the use of condoms and Voluntary Counseling and Testing (VCT), are incomplete and do not reflect the realities of young people’s lives. In her thesis, Blommaert describes and analyses an existing HIV prevention project for young people in Winam and whether this type of projects makes a difference at all in the everyday lives of these youngsters. And while these projects do certainly have an impact, it is not necessarily the one anticipated by the designers, the implementers or the participants.

According to Blommaert, these activities often start with objectives which respond to the priorities of funding agencies but are not necessarily connected to the needs of young people. At the time when ARVs were only available at a very high cost, young people had few future perspectives when they were informed about their HIV status. “Therefore, many youngsters in Winam preferred to live in uncertainty instead of knowing the biomedical truth. Prevention projects should take this into account,” said Blommaert.

Her study was part of a collaboration between ITM, the U.S. Centers for Disease Control and Prevention (CDC) and the Kenyan Medical Research Institute (KEMRI) aimed at developing and testing prevention interventions for young people. Blommaert conducted participant observation for 20 months. This was supplemented by informal and formal in-depth interviews (including family history), life histories, focus group discussions and a diary kept over a long period by one of the youngsters.

Dr. Blommaert defended her thesis July 2nd at the University of Amsterdam - “Aspirations and Sex: Coming of Age in a Context of HIV”