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Despite more than a decade of work in the field of HIV/AIDS prevention, global estimates of HIV infections indicated that, 34.0 million [31.4 million–35.9 million] were living with HIV at the end of 2011. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults (4.9%) living with HIV and accounting for 69% of the people living with HIV worldwide. (UNAIDS Global Report on HIV 2012, p. 11). Kenya as one of the Sub-Saharan countries and severely affected, it declared HIV/AIDS as a national disaster in 1999, since then, Kenya has witnessed an upsurge in behavior change campaigns to prevent the disease from causing future destruction on the economy. recent statistics has indicated that there are 88,000 new infections by the end 0f 2013, with the most highest statics recorded in Nyanza part of Kenya. The questions many people are asking are what is the challenge. Here a review issues of culture that hinder prevention messages in Africa (A case study of luo community)
Majority of the HIV/AIDS Prevention campaigns have given limited attention to contextual and structural barriers that prevent community from accessing HIV/AIDS and health information services. Culture is one of many factors influencing human behavior; it is a determinant of socially accepted behavior, value systems, beliefs, and practical knowledge. Culture is deeply rooted in all aspects of a society, including local perceptions of health and illness and health seeking behaviors. However, culture in the broader sense, includes also traditions and local practices, taboos, religious affiliations, gender roles, marriage and kinship patterns, and so forth. (Körner, Henrike 2007, p 137)
In this regard, socio-cultural norms are some of the key issues that have rendered HIV prevention a challenge in most Kenyan cultures. In order to understand HIV prevention in this context, it is therefore important to understand various social and cultural traditions that reinforce vulnerability to HIV in Africa.
Socio-Cultural Factors Influencing Vulnerability to HIV
Marriage: Gender inequality in marital relations, especially in sexual decision-making, increases vulnerability to HIV transmission. Trends in current data on new HIV infections suggest that the incidence of HIV is rising among married women and girls worldwide, with unsafe and unprotected heterosexual intercourse being the single most important factor in the transmission of HIV among women. Marriage, which greatly increases women’s sexual exposure, has in itself become a risk factor for women and girls in many countries, for example it is more dangerous for a woman to getting married to a polygamous husband in the name of inheritance (Luo and Luhya culture) The dramatic rise in the frequency of unprotected sex after marriage is driven by the implications of infidelity or distrust associated with certain forms of contraception such as condoms, a strong desire to become pregnant, and an imbalance in gender power relations. This results in women’s increased inability to negotiate safer sex. In spite of having knowledge of their spouse’s extra-marital sexual interactions, women are often unable to protect themselves due to an imbalance of power within relationships created by economic and emotional.
Polygamy: The traditional practice of polygamy, which is legally sanctioned in African culture , allows husbands to have more than one wife. Polygamy operates to create concurrent sexual networks within marriage between multiple wives and their husband, and in addition to any extra-marital sexual contacts the spouse may have. Direct sexual transmission of HIV can occur in these concurrent sexual networks where the virus is introduced through the spouse’s extra-marital sexual contacts or where a new wife who is already HIV positive enters the polygamous union. In luo community for example, polygamy is widely accepted with no room to HIV testing and condom use before picking on a new wife.
Early Marriage: Early marriage severely increases young girls’ vulnerability to HIV as they are most likely to be forced into having sexual intercourse with their (usually much older) husbands. Young girls have softer vaginal membranes which are more prone to tear, especially on coercion, making them susceptible to HIV and other STIs. Older husbands are more likely to be sexually experienced and HIV infected. The dramatic rise in young married girls’ exposure to unprotected sex is driven by pressure to bear children and their inability to negotiate safe sex. The significant age gap in spouses also further intensifies the power differential between husband and wife, which in turn discourages the open communication required to ensure uptake of voluntary counseling and testing for HIV, sharing test results and planning for safe sexual relations throughout the marriage. In Kenya the Turkana community is struggling with early marriages arranged between an older man with under aged girls in the name of parents getting cows as wealth.
Multiple Sexual Partners: Gender inequality and patriarchy (social structures where men take primary responsibility and dominate in their households) encourage multiple sexual partners for men inside and outside of marriage, while women are required to be faithful and monogamous. Such socio-cultural practices and norms make men and their partners especially vulnerable to HIV. Luhya, Luo communities and Kalenjin communities in Kenya take women as part of children in the house and have to follow the orders of the usually authoritative husband. The Husband decides on when to sleep with the wife or spend a night elsewhere and no question from the wife.
Harmful Cultural and Traditional Practices: Harmful cultural practices such as widowhood-related rituals, sexual cleansing and female genital cutting heighten the risk of HIV transmission. These practices are often justified in the name of cultural values and traditions. No doubt cultural values and traditions are important to community identities, but it is important to realize that they cannot be continued at the cost of the right to health of the individual. For example wife inheritance practice in luo community poses vulnerability-Among the Luo, widows sometimes have sexual intercourse with a male relative of the deceased as ritual “cleansing” before she can be inherited or remarried. In a situation where either of the couples have HIV they will pass to one other. Sex is a secrete in Luo community and it proceeds every function such as new house construction or planting the first seed.
Gender-based Violence: Gender-based violence has become common place in almost all societies. Violence has many facets. Within the household this can include battering by an intimate partner, marital rape, dowry-related violence, and sexual abuse. Violence outside the home can include rape, sexual abuse, sexual harassment and assault. Various social, cultural, and religious norms produce and reinforce gender inequality and the stereotypical gender roles that underpin gender-based violence. Gender-based violence is a key factor in increasing risk of contracting HIV. Violence increases vulnerability to HIV infection in several ways. Sexual violence can result in ‘direct transmission’ of HIV which can be the result of forced or coercive sexual intercourse with an HIV infected partner. The biological risk of transmission in a violent sexual encounter is determined by the type of sexual exposure (vaginal, anal or oral). Marriage by abduction in Luo culture is one way of violence against women that is accepted and practiced (Wight D, et al 2006, p 62, 63)
Stigma and Taboos: Cultural stigma and taboos (social bans), especially related to sex and sexual activities, increase men’s and women’s vulnerability to HIV. The taboos associated with sex and knowledge of sex act as barriers to seeking knowledge of HIV prevention and to providing the treatment care and support needed by those infected and affected by HIV. HIV- related stigma is triggered by many forces such as a lack of understanding of HIV, myths about how it is transmitted, prejudice, lack of treatment, irresponsible media reporting, social fears about sexuality, fears relating to illness and death, and fears about illicit drugs and injecting drug use. HIV and AIDS possess all the characteristics associated with stigmatized diseases.
Religion: Religion and religious beliefs are the foundations of community life in a majority of societies. Religion prescribes ethical guidelines for many aspects of daily life and also navigates belief systems and norms surrounding sexuality. The majority of religiously tailored belief systems condemn premarital sex, contraception including condom use, and homosexuality. Catholic church in Kenya for example it does not encourage condom use among its congregation and up to now, this is a controversial issue with media houses in Kenya. Some religions also advocate a submissive role for women, foster gender inequality in marital relations, and promote women’s ignorance in sexual matters as a symbol of purity.
The sexuality and gender stereotypes constructed by religion can inhibit prevention efforts and increase vulnerability to HIV infection. HIV vulnerability caused by religious beliefs and practices is the result of religious institutions’ denunciation of HIV infection as sinful. Such religious judgments play a significant role in generating HIV- and AIDS-related stigma which increases vulnerability. Religions advocating against condom use pose a serious challenge to preventing the spread of HIV in the communities where they operate. Similarly, religions that denounce homosexuality tend to fuel stigma against those who engage in same sex behavior, thus indirectly increasing their vulnerability to HIV
Influencing Culture to Enhance HIV/AIDS Prevention
Establishing dialogue with political and religious leaders-giving accurate information to sensitization so that they can take a leading role in negotiation process aimed at involvement in the HIV/AIDS control activities and or influence policies and legislation against harmful traditional practices that increase vulnerability to HIV. Priority to community-based interventions including the interventions particularly considered communities, groups or whole populations. "Outflanking the target” that is well-targeted groups, such as practitioners in the sex industry, towards a rapid integration will also influence the direction of prevention.
Identifying Socio-ecological niches-interventions which include the use of approaches aimed at influencing all the social groups present in some places or contexts reflecting vulnerable situations. Involving women in HIV/AIDS control activities including taking a gender approach to interventions thus involving both male and female in HIV/AIDS programmes to facilitate involvement and participation in designing of prevention programmes. Social networks have also played a vital role in influencing HIV/AIDS prevention programmes.
Conclusion
People’s control over their sexual lives and choices is in turn shaped by gender-related values and norms defining masculinity and femininity. These culturally-defined gender values and norms evolve through a process of socialization starting from an early stage of infancy. They determine and reinforce themselves through traditional practices such as wife sharing, widowhood related rituals, early marriage, female genital mutilation and the condoning of gender-based violence. These cultural practices, values, norms, and traditions have strong influences on the visible aspects of individual behaviors and are important determinants of men’s and women’s vulnerability to HIV. However cultural factors could also be utilized to influence the prevention of HIV/AIDS in the community.
Bibliography
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- Joint United Nations Programme on HIV/AIDS (UNAIDS) Global 2012 Global Report on HIV/AIDS
- Barker D, Ricardo C: Young Men and the Construction of Masculinity in Sub-Saharan Africa. Social Development Papers No. 26. Washington: The World Bank; 2005.
- Campbell, C. and MacPhail, C. “Peer education, gender and the development of critical consciousness: Participatory HIV prevention by South African youth.” Social Science and Medicine
- Khan, Shaheen. Domestic violence against women and Girls. Innocent Digest: UNICEF, Italy, 2000.
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- Körner, Henrike. “Negotiating Cultures: Disclosure of HIV-Positive Status among People from Minority Ethnic Communities in Sydney.”Culture, Health & Sexuality 9.2 (2007) 137-152. Retrieved fromhttp://www.jstor.org/stable/4005515 on 15th April 2011
Author: Nandoya Sharanya Erick
Programme Coordinator of Health
Rafiki Wa Maendeleo Trust
P.O. Box 75 Bondo
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