Transcript impact of socio-cultural factors on hiv/aids

IMPACT OF SOCIO-CULTURAL FACTORS
ON HIV/AIDS
Paul Nchoji Nkwi (APAC, Nairobi)
Kofi Nguessan & Nd’a Constant, ENSEA, Abidjan
Judith Karogo/Jegida, APAC, Nairobi,
W.Masso APAC, Malawi
Socpa Antoine, APAC, Cameroon,
Adade Messan, Lome, Togo
RATIONALE
 Sub-Saharan Africa has a fastest growing
population rate in the world;
 Highest levels of Adolescent Fertility
 Of the over 40 million people living with
HIV/AIDS worldwide Two thirds live in SubSaharan Africa
 Rates of infection higher among women
and youth between 15 - 25 years old
RATIONALE : RESPONSE
 APAC launched in 1996 its ICAP program in
response to the pandemic with the aim at
reducing the vulnerability of youth and
women;
 Greater involvement of communities in
dealing with the pandemic culturally,
holistically and comprehensively;
RATIONALE : RESPONSE
 UNFPA launched the African Social
Research Program (ASRP) in 2002 seeking
to understand the role of culture in the
spread of HIV/AIDS
 ASRP was developed by a multi-dsicplinary
team of demographers, sociologists, public
health specialists, anthropologists, etc
ASRP FRAMEWORK
R EMOTE FACTORS
POPULATION
DYNAMI CS
SOC IETAL
FIG. 4 C:HANGE
HIV/AIDS
INFLUENCES EXTERNAL TO SOCETY:
Political Economy; Media and IC T;
Religious teachings; Transportation
systems
SOCIO-CULTURAL
SYSTEM: Enculturation and
socialization,
Traditional
medical
system (TBA);
social str ucture; household
structure,
residential
patterns, kinship system,
m arriage
rites,
social
stigm a, etc.
POLI CY ENVIRONMENT:
HIV/AI DS and drug
policies, education
policy, population
policies, communication
policies, employm ent
policies, AR H and
human rights, etc.
PRODUC TION SYSTEM:
Tourism/Trafficking in
young men and women,
access and control of
r esources and factors of
pr oduction, level of
technology, tr ade, etc.
ENVIR ONMENTAL
AND
ECOLOGIC AL FAC TORS:
Endemicity. natural and
SOCIO-ECONOMIC
FACTOR S:
education,
income,
housing
conditions,
econom ic
activity, health status
SOCIO-CULTURAL
F ACTORS: gender identity
and roles, intergenerational relationship,
attitudes, beliefs,
obligator y sex, inter nalized
values and norm s, puberty
r ites experiences
DEMOGRAPHIC
FACTORS: age and sex,
par ity, migration status
and dynamics:
separation/coital
frequency, post-partum
and post-mortem
exper iences
HIV/AI DS
Death Impact:
Behaviour
Change
Communication
(BCC):
Health Seeking
Behaviour:
Access and
Utilization of
Ser vices
Social and
Sexual
Networking
PSYCHO-SOCIAL
FAC TORS: motivations,
tastes, peer pressure,
HIV/AI DS
STATUS OF
YOUNG PEOPLE
OBJECTIVES
 The overall objective was to allow
communities identify and articulate
problems related to the socio-cultural
practices and HIV/AIDS
 Gain appreciation of how people relate to
population issues; how they internalise
and own them and how they seek
sustainable solutions ;
OBJECTIVES
 Identify relevant socio-cultural practices
and use them to design appropriate
interventions in perceived community
problems related to HIV/AIDS;
 Explore the correlation between cultural
practices and HIV/AIDS
 Increase awareness & advocate for safer
cultural practices and behavior
modification
NATURE OF THE STUDY
 Cross-regional and cross-cultural study
 Need to capture regional variations
 Regions and countries
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•
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West Africa: Cote d’Ivoire (10.7%) :AGNI
West Africa: Togo (6%)
Central Africa: Cameroon (12%): BASSA/FULBE
East Africa: Kenya (10%):SAMBURU/LUO/LUHYA
Southern Africa: Malawi (15%): CHEWA/YAO
Fig.1: National vs site sentinel
prevalence trend in Kenya
Natiaonal(Kenya)
25
20.1
15
13
10.3
10
5
15
14.4
11.8
9
14
22.6
20.1
17.2 16
12
11.3
10
10
17.1
17.7
12
12
13 14.3
10 10.2
6.1
5
YEAR
02
20
01
20
00
20
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
90
0
19
Perecentage
20
Site(Kakamega)
METHODOLOGY
 Desk Reviews ( also Gray literature)
 Ethnographic Case studies
 Qualitative methods: IDI, FGD, Observations
( direct and participative)
 Informants chosen on the basis of their
knowledge about the culture;
 Community-based approach, etc
SOCIO-CULTURAL FACTORS IDENTIFIED
 PRACTICES THAT SEEM TO IMPACT ON
HIV/AIDS
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•
•
•
•
Early Marriage
Uneven gender relations (sexual & RH)
Polygyny/concubinage
Widow inheritance (levirate)
Scarifications: curative & aesthetic
SOCIO-CULTURAL FACTORS IDENTIFIED
 Initiation Rituals
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•
•
•
•
•
•
Female Genital Cuttings(FGC)
Male Circumcision (MGC)
Hyena practice (FISI)
Funeral Rituals
Sexual Networking (Lycee)
Free access to sex among the Samburu
Curative sex
WIDOW INHERITANCE (LEVIRATE)
 Widow marries the deceased’s brother
 Rationale: Any lineage member can
perform the reproductive functions
 Performance opens access to wealth or
property of the deceased to the woman and
her children(Kenya)
 Among Bassa (Cameroon), widow chooses
WIDOW INHERITANCE (LEVIRATE)
 HIV/AIDS prevalence of ethnic groups that
still hold on to levirate is high.
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•
•
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Luo (Kenya ) 14%);
Luhya (Kenya): 14.3%
Bassa (Cameroon) : 14%
Chewa and Yao (Malawi ): 16%
Agni (Cote d’Ivoire) 11%
Ouatchi (7%)
OPTIONS/CHOICES
a) MEN
ADAPT
5%
ACCEPT
85%
RJECT
10%
OPTIONS AND CHOICES
b) WOMEN
REJECT
40%
ACCEPT
50%
ADAPT
10%
POLYGYNY
 Common among ethnic groups studied;
 Promote more affinal relations & alliances
 Search for gender balance in offspring
 Male infidelity tolerated
 Fidelity :zero grazing option in age of
HIV/AIDS
POLYGYNY: OPTIONS/CHOICES
a) WOMEN
REJECT
40%
ACCEPT
60%
POLYGYNY: OPTIONS/CHOICES
b) MEN
REJECT
20%
ADAPT
10%
ACCEPT
70%
SCRARIFICATION
 Performed for curative & aesthetic purpose
 Use of same instrument for collective
scarifications rituals
 Aesthetics: piercing of lips/Nostrils/Ears
 Witchcraft protection:
 Enhancing love or reinfiorcing a love
relationship(Kutema mphini in Malawi
SCARIFICATION:CHOICES
a) FOR CURATIVE PURPOSE
REJECT
15%
ACCEPT
85%
SCRARIFICATION: OPTION
b) AESTHETICS & IDENTITY
ACCEPT
25%
RJECT
75%
FEMALE GENITAL CUTTINGS (FGC)
 Performed to reduced sexual drive,
 Reduce premarital & extra-marital affairs
 Usually performed by women married with
children and in their menopause
 Believe FGC increases fertility of women
 Common among the Arabes Choas/Kotoko
in Cameroon
FGC: choices
a) ADULT CIRCUMCISED WOMEN
REJEC
T
40%
ACCEPT
60%
FGC: Choices
b) CIRCUMCISED GIRLS
REJECT
20%
ACCEPT
80%
MALE CIRCUMCISION
 Rite of Passage among certain groups
(Samburu, Toupouri, etc) performed at
puberty
 Use of same knife for all initiates: bonding
and brotherhood
 Some ethnic groups perform earlier in life:
 In some groups no MGC at all: Luo with a
prevalence rate of HIV/AIDS is 16%
MALE CIRCUMCISION (CONT’D)
 Among the Samburu (Kenya) it takes place
every 15 years, once initiated morans are
allowed to have sex with whomever they
want; for them sex is like food
 Circumcision rituals grants free access to
sex, ; concept of extra-marital or premarital
affairs are strange concepts.
 They provide sex in the tourism industry
MALE CIRCUMCISION: CHOICES
1. MALE CIRCUMCISION
REJECT
15%
ADAPT
50%
ACCEPT
35%
HYENA PRACTICE (FISI)
 Two forms of the Hyena Practice
 First is the sexual initiation of Girls in
preparation for marriage/adulthood
 Rite: Girls at puberty camp for several
weeks during which time that receive
education on sexuality and culture
 As part of the preparation 1 or 2 two men
will have sex with the girls
HYENA PRACTICE (FISI)
 Second Form occurs when a man is unable
to have a child with his wife, another man is
hired to have sex with his wife: it is
believed this performance can create
infertility.
FUNERAL RITES
 Lung’anya (commemoration of the dead)
conducted after 30 days of burial
 It regroups family members and relatives;
the widow becomes the wife of the brother
of the deceased & marriage consummated
that night, the shaving of the woman’s head
and pubic beginning a new life for her and
her children
FUNERAL RITES
 Amukumba (rebirth of the deceased). This
takes place 40 days after the burial
 Regroups family members, relatives and
members of the village community
 Feasting, drinking and eating culminating
in indiscriminate sexual activities. It is
believed through these ephemeral unions
the spirit of the deceased will be reborn.
TESTIMONY

During the night the deceased person is supposed to be
reborn.All the family members must be present. As the
festivity gathers momentum people start picking their
partners randomly, culminating in sexual intercourse. You
just choose whomever you come in contact with. Nobody
us supposed to refuse these advances because everyone
knows the essence of the assembling at the deceased’s
home. People look forward to this ceremony because of
sexual activities that will take place (informant, Butere,
2003)
REMARRIAGE OF WIDOWS
 Among matrilineal societies, the
remarriage of widows is important for
lineage continuity;
 Failure to remarry leads to social stigma
 Remarriage must occur only after 12
months of the death of the husband
 Remarriage for the third time is not
permitted;
FINDINGS
 Socio-cultural practices are still very much
part of people’s mindset irrespective of the
social status
 The underlying ideologies of these
practices inspire and motivate behaviour
 Most policies (RH, youth, gender, etc)
ignore the underpinnings of culture
FINDINGS
 Uneven gender relations continue to
persist
 Some of the negative cultural practices are
major channels through which HIV/AIDS is
propagated;
 Many positive cultural practices can be
harnessed to serve the fight against
HIV/AID but these are often ignored.
FINDINGS
 Communities have not been involved, nor
consulted on the planning, design,
implementation and monitoring of projects
 Communities are prepared to form
coalitions for the fight against HIV/AIDS
especially in the design of alternative
 HIV/AIDS messages on billboard often do
not take care of cultural sensitivities
CHALLENGES
 The major challenge remains how to
change cultural norms, values and
attitudes and behaviour
 Despite education and awareness creation
campaigns little significant change has
occurred
 Will a holistic approach may bring us
closer to understanding why these
practices persist.
CONCLUSION