IMPACT OF SOCIOCULTURAL FACTORS ON HIVAIDS

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IMPACT OF SOCIO-CULTURAL FACTORS ON HIV/AIDS

• Paul Nchoji Nkwi (APAC, Nairobi)
• Kofi Nguessan Nda Constant, ENSEA, Abidjan
• Judith Karogo/Jegida, APAC, Nairobi,
• W.Masso APAC, Malawi
• Socpa Antoine, APAC, Cameroon,
• Adade Messan, Lome, Togo

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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 Sub-Saharan
  Africa
  
• Rates of infection higher among women and youth
  between 15 - 25 years old

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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

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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

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ASRP FRAMEWORK
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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

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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

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NATURE OF THE STUDY

• Cross-regional and cross-cultural study
• Need to capture regional variations
• Regions and countries
• West Africa Cote dIvoire (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

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Fig.1 National vs site sentinel prevalence trend
in Kenya
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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

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SOCIO-CULTURAL FACTORS IDENTIFIED

• PRACTICES THAT SEEM TO IMPACT ON HIV/AIDS
• Early Marriage
• Uneven gender relations (sexual RH)
• Polygyny/concubinage
• Widow inheritance (levirate)
• Scarifications curative aesthetic

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SOCIO-CULTURAL FACTORS IDENTIFIED

• Initiation Rituals
• Female Genital Cuttings(FGC)
• Male Circumcision (MGC)
• Hyena practice (FISI)
• Funeral Rituals
• Sexual Networking (Lycee)
• Free access to sex among the Samburu
• Curative sex

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WIDOW INHERITANCE (LEVIRATE)

• Widow marries the deceaseds 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

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WIDOW INHERITANCE (LEVIRATE)

• HIV/AIDS prevalence of ethnic groups that still
  hold on to levirate is high.
  
• Luo (Kenya ) 14)
• Luhya (Kenya) 14.3
• Bassa (Cameroon) 14
• Chewa and Yao (Malawi ) 16
• Agni (Cote dIvoire) 11
• Ouatchi (7)

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OPTIONS/CHOICES
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OPTIONS AND CHOICES
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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

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POLYGYNY OPTIONS/CHOICES
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POLYGYNY OPTIONS/CHOICES
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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

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SCARIFICATIONCHOICES
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SCRARIFICATION OPTION
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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

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FGC choices
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FGC Choices
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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
  

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MALE CIRCUMCISION (CONTD)

• 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

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MALE CIRCUMCISION CHOICES
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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

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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.

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FUNERAL RITES

• Lunganya (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 womans head and pubic beginning a
  new life for her and her children

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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.

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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 deceaseds home. People look forward to this
  ceremony because of sexual activities that will
  take place (informant, Butere, 2003)

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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

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FINDINGS

• Socio-cultural practices are still very much part
  of peoples 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
  

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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.

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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

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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.

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CONCLUSION