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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 • • • • • 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 • • • • • Early Marriage Uneven gender relations (sexual & RH) Polygyny/concubinage Widow inheritance (levirate) Scarifications: curative & aesthetic 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 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. • • • • • • 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