The Human Immunodeficiency Virus (HIV) causes Acquired Immune Deficiency Syndrome (AIDS) in human beings. There is no cure that has been discovered for the disease ever since it was identified in human beings in the early 1980's. This deadly disease found all over the world has affected more people in the African continent, especially in Sub-Saharan Africa region (World Bank, 1996). The African continent is leading in the world in HIV/AIDS infected people. The continent is also leading in HIV/AIDS related deaths. In fact, more people are dying of aids than those perishing in the civil wars (World Bank, 1996).
Statistics indicate that while African countries have '10% of the world's population, accounts for about 71% of all people living with aids in the world' (World Bank, 2001). This is indeed a very high figure indicating the seriousness of the disease in the continent.
A UNICEF report published in 2001 reveal that the virus has infected 3.8 million children and more than sixty percent of them have died. The report also indicates that such figures are clearly showing an increase in HIV/AIDS incidences in the continent. Many leaders in Africa have shown a concern about the disease in various forums and conferences but there seem to be no change.
AIDS in Sub-Saharan Africa has become a threat to the young and old generation alike as well as to the economies of the countries. Studies indicate that AIDS is the leading cause of death between the ages of 15 and 39 years (World Bank, 1996). This age group, unfortunately, includes the economically active people in any society. A number of strategic plans have been in action in a number of countries to fight against the spread of the incurable disease, but statistics indicate that the disease is spreading in an alarming rate. The virus, which predominantly affects sexually active people, is now also found in children who are born with it from their mothers. The effect of aids in the region is felt by everybody; families, friends, and children who remain as orphans after the death of their parents. Several studies indicate that there are factors that promote the spread of the disease in the region, and they are economical, socio-cultural, and political in nature. A recently conducted study reveals that in several countries, cultural practices hinder the fight against Aids (Achieng, J., 1999). Therefore the purpose of this article is to discuss cultural practices that hinder the fight against the spread of HIV/AIDS in Sub-Saharan Africa. This paper will also consider the effectiveness of the HIV/AIDS education programs and the extent to which they are hindered by cultural practices.
Culture is a way of living for a particular group of people forming a society. Cultural practices are handed down from their ancestors and passed from generation to generation. The practice of a culture is what makes people one. It is also what identifies a person with a certain group of people or a family with a society. In Africa, some cultural practices are linked with beliefs that if not observed something bad would befall that individual or family, and sometimes the society. Hence, while the family members see to it that all its cultural practices are kept, the society leaders also keep an eye on its followers to ensure that they observe their practices. Cultural practices also vary from society to society, and from country to country. Therefore each society, country, or region may have unique cultures in addition to those that may seem universal to a race of people.
When the HIV/AIDS started infecting people, Africans were already practicing their cultures. Some had practiced them for decades and to them to say something contrary to their observance would not make any sense. However, no matter how good some of these cultures are there is a need to adapt them to the new social, political, economic, and cultural climate that exist these days (Achieng, 1999).
In Sub-Saharan Africa the most effective way of transiting the virus is heterosexual relationship (Mfume, 1999). However, the disease is also transmitted from mother to child if the mother is infected. The author continues saying that other studies identified sexual activity rather than sexual orientation as the main factor that differentiate western countries from African countries. In Africa, there is high sexual permissiveness due to polygamous families. The rate of sexual activity among the teenagers has also increased and in some countries it is attributed to cultural practices. Gender biasness, labor migration, child sexual abuse, fear of isolation has been identified as other major contributors to the spread of the disease (Kaya, 1999). Why therefore cultural practices are singled out as a hindrance in fighting HIV/AIDS?
In Botswana, studies indicate that cultural practices are the main agents of spreading the disease (Odirile, 2000 & Lesetedi, 1999). The practices involve polygamy, expectations from boys and girls when they reach a certain age that they should prove their manhood and bear children respectively, and belief in traditional healing. A study by Odirile (2000), conducted among undergraduate students in the University of Botswana indicate that the knowledge students have about HIV/AIDS is not reflected in their lifestyle. Student pregnancy rate is very high. This indicates that, the HIV/AIDS educational programs have not changed their attitudes. They still practice unprotected sex. A closer consideration of the reasons behind such a behavior reveal that reasons are culturally oriented. In Botswana it is culturally significant 'for a woman to prove that she is fertile by having a child' (Lesetedi, 1999 p53). At the same time man must also prove their manhood by making a woman pregnant. The studies also reveal that in Botswana there is a belief that a sick man can be cured of his disease if he sleeps with a virgin, and this belief is encouraged by traditional healers. Polygamy has been identified as the culture that encourages boys and girls to misbehave in society. The author argues that author argues that children from polygamous families usually do not get good counseling from their parents to keep away from bad practices. Perhaps the bad practices make them susceptible to contracting the virus.
In Swaziland, cultural practices encourage woman's sexuality to be exploited (Nxumalo, 1999). Women are forced to engage in sexual intercourse with a person she had no love for, just for the purpose of ensuring that she bears an heir for the family. In Swazi tradition, an heir takes responsibility of the family property and ensures the perpetuation of the family name. It is therefore preferred that each family should have a boy child. Another cultural practice allows the family to choose a future husband for their daughter. If the man chosen is wealthy, as is the case always, most of the families send their children to him in order to get cattle in exchange. Now if this man is infected with the virus, he transmits it to all the girls given to him. Polygamy in Swaziland is still practiced and more so by the traditional leaders of the country. While many people realize that it is no longer suitable for this age because of high cost of living, there are those who still argue that if the culture is still followed by the authorities in the country they cannot leave it. Fortunately the culture is now loosing popularity to the young generation because of the high cost of living.
In Malawi cultural practices encouraging the spread of the virus include; arranged marriages, fisi system, gwamula, wife or husband inheritance, bonus wife, polygamy, exchange of wives, and attitude towards condoms (Kamowa & Kamwendo, 1999). The authors say that arranged marriages involve parents choosing a husband for their daughter that she cannot refuse. According to the authors, it does not matter whether she loves him or not, the culture forces her to accept the husband she is given to. The fisi system is the initiation of girls into adulthood. After the old ladies have spoken to the young ladies about what they should expect in the stage they are entering, they are put in a house overnight, and an experienced man is allowed to crepe into the house where the girls are to have sexual intercourse with them 'secretly'. This practice encourages the spread of the disease because if the man is infected with the virus, he can infect all the girls who may in turn infect their future partners. The Gwamula culture, almost similar to the fisi system, involves boys who force their way into the girls' huts during the night and have sex with them. This is a well-known practice, which, however is no longer encouraged by the adults. According to the authors, in Malawi they also practice the culture of wife or husband inheritance when a spouse dies. The surviving spouse is supposed to marry a relative of the diseased in order to continue the relationship. The bonus wife cultural practice, which is no longer popular, involves giving a man an extra wife. This practice by the in-laws is to show their appreciation that their child is well taken care of by her husband. In Malawi the article indicates that polygamy is practiced for several reasons. In some tribes a man takes many wives because of either his status, infertility problems, or because the wife has become old for his liking. If a man is a leader in a society he is expected to have many wives. Infertility of the wife allows the husband to take another wife in order to bear children. Whereas if a wife is getting old and cannot satisfy the husband, the husband can look for another wife who will satisfy him sexually. Another unusually practice by the Malawians is that of exchanging wives. The study reveals that in Malawi sharing is so much valued to the extent that friends at times exchange their wives. All these cultural practices encourage the spread of HIV/AIDS.
Cultural practices that promote the spread of HIV/AIDS in Kenya include wife inheritance, cleansing ceremony, and female circumcision (Achieng, 1999 & Whiteside, 1993). According to Achieng, the Luo clan believes that a widow needs to be inherited to complete the funeral rights of her husband. If that is not done, the funeral is incomplete. If that is not acceptable, she is compelled to undergo the cleansing ceremony through sexual contact with a member of the clan. If she still resists, she is made to remain in her home. This means that she would not be able to get food for her children. In short she is punished for not following the culture. In this practice, there is a high possibility that the surviving spouse might be infected with the virus, and when she meets with the member of the clan she might spread it. On the other hand if the surviving spouse is not infected, the member of the clan might infected the widow if he is infected. The two cases are highly possible owing to the statistics revealed by the World Bank concerning aids related deaths in the continent. The author continues to say that the rate of change in enforcing this culture is not encouraging at all. Adherence to the culture is still very high. Another cultural belief Kenyans have which hinders the fight against the spread of the disease is witchcraft. Whenever a person is sick it is always believed that he or she has been bewitched. The author says that the education campaigns carried out in this society do not have any impact. Witchcraft seems to hold more value in peoples' minds in explaining AIDS related deaths than the scientific facts. Hence the campaigns intended to educate them does not have an impact. In Kenya, they also practice female circumcision, which increases the risk of HIV transmission (Whiteside, 1993).
Another study conducted by Whiteside (1993) in South Africa, indicates that, women are victims of cultural obligations because of their low status in society. The study found out that about 80% of the women (involved in the study) are not aware that they have a right to encourage their partners to have one wife, while 64% wanted their husbands to use condoms. However, 67% of those who wanted their husbands to use condoms did not tell them (husbands), they believed that it was not proper to tell the husband to do so. Culture, not only in South Africa but also in Swaziland, forbids women to take initiatives in issues related to sex. Therefore even if they are aware of any dangers concerning their sexual practices, culture encourages them to keep quiet. Hence the spread of the virus sometimes occurs in circumstances where the people involved are aware but because of culture they cannot prevent it. This state of affairs has been confirmed by a United Nations report (Infection Control Today, 2001), which states that women are at a higher risk of contracting HIV/AIDS because their culture disallows them to refuse sexual advances from men. However women in South Africa, seeing that they are more vulnerable to contracting the virus, have come out to demand action against HIV/AIDS (Agenda, 2000). They have realized that the virus is preventable as long as they can heed the prevention measures taught during the HIV/AIDS education programs. Unfortunately, some people in South Africa perceive the issue of HIV/AIDS as 'an apartheid derived idea to discourage sex amongst the blacks' (Whiteside et al, 1995, p29). Perhaps this thinking came to the blacks because when the disease was discovered they were still struggling for independence, and the youth was in the forefront. Therefore, if the blacks were to stop producing children the problem of the whites would be minimized. The authors continue to reveal possible other reasons encouraging the spread of the disease such as the belief in traditional healers and the possibility that the effect of the disease are not clearly explained to the people because there is no word for virus and immunity in their own native languages. Perhaps illiterate people can be forgiven for this, but what is surprising is that the majority of people who are HIV positive are literate and well educated and known in the society, especially in Swaziland.
Mbozi (2001) describes three categories of culturally defined practices associated with the spread of HIV/AIDS in Zambia. All of them are related to sexual patterns and social relations. The author states that the first one involves conduct. They believe that supernatural powers can cause a person to fall sick if he or she has not conducted him or herself well with regard to prescribed traditional rituals. Hence their explanation of someone who gets sick of aids after his or her spouse has passed away is that the late spouse caused the sickness. However the trend, as stated earlier, is that if a spouse died of aids the surviving spouse is also infected. The second category, almost similar to the first one involves belief in social traditions and practices concerning marriage union. The author says that those practices involve 'initiation ceremonies, dry sex, and the general use of herbs to boost sexual performance, and circumcision rituals' (p75). The last category involves social relations based on the belief that some practices need to be done because they have been part of the society from the past. Such as property and wife inheritance as well as marrying the younger sister of the wife to prolong the relationship with the in-laws. Ritual cleansing practices are also common among Zambians. Indications are that even though people are being educated about its problems in relation to HIV/AIDS, it is deep rooted among the ethnic groups. In Zambia, the surviving spouse is married to a relative of the deceased to ensure continuity of the family.
Education has been identified as the most effective means of promoting HIV/AIDS prevention amongst the youth and the adults (UNICEF, 2001). Ignorance about the disease is one of the factors encouraging the spread of the disease. UNICEF argues that since the disease have an impact in education, by affecting ' demand for education, the supply and quality of education, and management of education system' (UNICEF in Action, online), education can be made to have an impact on HIV/AIDS. The article reveals that drop out has increased in schools due to shortage of qualified teachers, and long-term planning has lost value because of the high turn over of teachers. UNICEF policy is to encourage effective HIV/AIDS prevention through education programs, targeting those who are still not infected. The article emphasizes on skills-based strategies using information relevant to the different groups. However, each country must have policies and health services that would support it.
In Zambia and Zimbabwe there are school based HIV/AIDS and life skills lessons that are being conducted. In Zambia there are indications that young people are changing their life style. In South Africa, they are trying to incorporate the program in their curriculum reform exercise. Furthermore, women in South Africa are calling for effective campaigns that would address adults in this regard (Agenda, 2000). In Namibia, the president launched a program to control AIDS in 1990 (Tjingaete, 2000). The program follows the global aids strategies of the World Health Organization. The UNAIDS campaign by means of radio programs are most used. However the rate at which the disease is spreading seems the existing campaigns do not have impact (UNICEF 2000). UNICEF has also identified culture as the main hindrance.
In another study conducted among students in Lesotho, culture emerged as a contributing factor in the spread of the disease (Chere-Masopha, 1999). In Lesotho the students involved in the study expressed the view that polygamy can be used to control the spread of the disease because the men would have as many wives as he want, and as long as he is faithful to them the spread of the disease will be controlled. However, they pointed out that while that could help solve the problem, it can also have dire consequences in that if one the wives have the virus it can be transmitted to all the other women. Having said that they also expressed the concern that the culture is unfair because it only allows men to have many wives, and in the age of gender equity, women should also be allowed to have other sexual partners like the men.
HIV/AIDS educational programs are found in most of the countries. They are to a large extent supported by governments. UNICEF has noted that Aids prevention programs work well with young people, especially when supported and reinforced by other structures. However the report continues to say that specific education has been disappointing in developing countries due to lack of comprehensive strategies, inadequate policy attitudes and lack of teacher training about the programs. In Botswana the focus is on fidelity and the use of condoms (Lesetedi, 1999). The author suggest that the solution in the country lies in empowerment of women through advancement of their socioeconomic status, as well as to encourage men to change their behavior. This suggestion leaves the question how far that can address the problem of cultural practices.
Meanwhile in Swaziland there are a number of non-governmental organizations involved in educational campaigns against practices that encourage the spread of the disease. The organizations include the Family Life Association of Swaziland, Swaziland National Aids Program, The Aids Support Center, and the school HIV/AIDS and Population Education. The latter organization work with schools, organizing workshops for school children to educate them about the virus. The other organizations play an important role in alerting the public about the disease through workshops organized in their work places and even through radio programs (Nxumalo & Thwala, 1999). In Swaziland, quite a number of non-governmental organizations are involved in HIV/AIDS education programs.
The government is also committed in the exercise and has shown this by including funds in the national budget to assist in educating people in the rural areas. This program is under the deputy prime minister's office, which is responsible for the constituencies all over the country. It is envisaged that if the message is brought to the people by government structures, most people would listen. The old generation perceive the teachings of the non-governmental organizations as unofficial hence they do not pay attention to them. However the committee responsible of preaching the gospel of change in life style among the nation is confronted with questions intended to find out whether the nation is being asked to change their culture. In this regard, the nation believes that it is only the king who can summon the nation to the cattle byre to make any changes pertaining cultural issues. Also, they believe that they do not have to abandon a culture that is still being practiced by the authorities of the land.
In South Africa a number of campaigns do exist and are sponsored by no-governmental organizations (Makgotho, 1999). Whereas in Namibia a national campaign was launched by the president started immediately after independence (T ,). In Malawi, Zambia, Zimbabwe, and Botswana, radio programs are mostly used, and have been found to be effective because they reach all parts of the country (UNICEF, 2000). Despite the fact that education programs are found in most of these countries, aids infection is still on the rise. These programs are hampered by the beliefs and culture. In Kenya for example, the Lao clan are on record to have expressed through a leading judge of the court of appeal that their customs are sacrosanct and cannot be changed (Achieng, 1999). Now if such statements come from respectful people like a judge, it becomes difficult for the educators to convince the public to change their behavior concerning these customs.
Educating children in schools has been also identified as the most effective means of promoting HIV/AIDS prevention amongst the youth (UNICEF, 2001). Ignorance cannot be ruled out as a contributing factor in the spread of the disease. UNICEF argues that since the disease has an impact in education, education can also be used to fight against it. Education in Africa is heavily affected by the consequences of the disease, and according to Kelly (2000), statistics in Africa indicate that there are more cases of aids in children aged 5years and below because of mother-to-child infection than in the 5 ' 14 age group. Therefore programs that would target this group (5-14) would be useful in ensuring that those who are not yet infected are educated about the disease in order to prevent themselves from being infected. However there is some difficulties in including HIV/AIDS education in the curriculum because of the belief that it is a taboo to discuss sex issues with children (Mbozi, 1999, Kelly,2000 & Malambo, 2000). In Zambia, the studies indicate that teachers say, 'the community believes that they teach promiscuity because they teach children how to use condoms'(Malambo, 2000, p14). However, other parents appreciate the awareness given to their children about the disease. The attitude of parents in Zambia who are not supportive of the education programs targeted at the school children is also found in the other countries. In many African cultures it is not acceptable for parents to discuss se related issues with their children, and such issues are reserved for the grandmother and grandfather for the girls and boys respectively. Even then, the children must have reached a certain age. Unfortunately by the time they reach that certain age most of them find themselves already involved in sexual activities because of the information they get through the media. The old generation forgets that during their time media was not as developed as it is today. Even if they can avoid talking sex issues with their children, children will always get information, either good or bad about the subject.
From the cases enumerated above for the few countries in the Sub-Saharan Africa region, the role played by cultures in the spread of the disease can be noted. Indeed, culture does play a major role in the spread of the disease. However it cannot be said that the scaring figures of aids infected people are caused by culture related factors only. As mentioned earlier, economical related factors contribute a lot in this regard. The difference is that with economical issues, people easily change their mind because their status economically is not associated with any belief of some sort. Many of these countries share some of these cultures and in particular the belief in polygamy. South African ethnic groups share the same sentiments about polygamy. They believe that if one of the women is pregnant or ill, the man continues to have sexual intercourse with the other women and thus preventing himself from having sex with other women
(Chere-Masopha, 1999). Unfortunately the practice put many people at risk. Other practices probably were meant to safeguard the future of the child. For instance, if the parents give their daughter to a wealthy man, she would live a happy life because the man would provide her with the needs of life.
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