AIDS and cultural practices in Africa: the case of the
Tonga (Zambia)
Quentin Gausset
Social Science and Medicine 52 (2001) 509-518
Abstract
The fight against AIDS in Africa is often presented as a fight against ``cultural barriers'' that are seen as promoting
the spread of the HIV virus. This attitude is based on a long history of Western prejudices about sexuality in Africa,
which focus on its exotic aspects only (polygamy, adultery, wife-exchange, circumcision, dry sex, levirate, sexual
pollution, sexual cleansing, various beliefs and taboos, etc.). The article argues that those cultural aspects are a wrong
target of AIDS prevention programs because they are not incompatible with a safer behavior, and because their
eradication would not ensure the protection of people. To fight against them might alienate the people whose
cooperation is necessary if one wants to prevent the spread of AIDS. The major problems of AIDS prevention in Africa
are not specifically African, but are similar to the problems existing in Europe or America. Therefore, anti-AIDS
projects should not fight against one local African culture in order to impose another (Western), but should rather try to
make behavior and practises safer in a way that is culturally acceptable to people.
© 2001 Elsevier Science Ltd. All
rights reserved.
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Sexual cleansing (Kusalazya) and levirate marriage (Kunjilila
mung'anda) in the era of AIDS: changes in perceptions and
practices in Zambia
J.R.S. Malungo
Social Science & Medicine 53 (2001) 371-382
Abstract
Since sexual cleansing (kusalazya) and the intertwined ritual of levirate marriage or widow and widower inheritance
(kunjilila mung'anda) have come to be implicated in the transmission of HIV/AIDS, alternative rituals to sexual
cleansing have emerged. Using both quantitative and qualitative data obtained from Zambia in the second half of 1998,
this study reveals that the alternative rituals to sexual cleansing include sliding over a half-naked person (kucuta) or over
an animal (kucuta ng'ombe or cow-jumping); use of herbs and roots (misamu); cleansing by a married couple.
Concoctions or other rituals that were otherwise considered `alien' in Southern Province, such as cutting of hair (kugela
masusu) and application of some powder (kunanika busu), have also been adopted. The study, therefore, discusses
various aspects of these alternative practices: who performs them and how; whether the processes are connected to
polygyny (maali), levirate marriage (kunjilila mung'anda), and grabbing or inheriting property (kukona); and whether
these practices are also risk factors in the spread of HIV/AIDS. © 2001 Elsevier Science Ltd. All rights reserved.
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Adolescent girls, illegal abortions and ``sugar-daddies'' in Dar
es Salaam: vulnerable victims and active social agents
Margrethe Silberschmidta and Vibeke Raschba
Social Science & Medicine 52 (2001) 1815-1862
Abstract
Adolescent girls' early sexual activity, early pregnancy, induced abortions and the increase in HIV infections have
become major concerns in Sub-Saharan Africa. Efforts, though, to understand their sexual behaviour and to prevent
reproductive health problems are almost non-existent. Adolescent girls are normally seen as victims and easy preys of
(often older and married) men's sexual exploitation. This article, which is based on a qualitative study of 51 adolescent
girls who had just had an illegal abortion in Dar es Salaam, Tanzania, reveals that these girls are not only victims but
also willing preys and active social agents engaging in high-risk sexual behaviour. In order to get material benefits they
expose themselves to serious health risks, including induced abortion } without realising their own vulnerability. In
our study, one out of four girls had more than one partner at the time they became pregnant, and many counted on an
illegally induced abortion if they got pregnant. Even if adolescents are now allowed free access to family planning
information, education and services, our study shows that this remains in the realm of theory rather than practice.
Moreover, most adolescent girls are not aware about their right to such services. The paper concludes that the
vulnerability of adolescent girls increases without the recognition that sexuality education and contraceptive services do
not constitute a licence to practice illicit sex } but rather a means to create more mature and responsible attitudes and
to increase sexual and reproductive health. © 2001 Elsevier Science Ltd. All rights reserved.
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`I think condoms are good but, aai, I hate those things':
condom use among adolescents and young people in a
Southern African township
Catherine MacPhail and Catherine Campbell
Social Science & Medicine 52 (2001) 1613-1627
Abstract
Levels of heterosexually transmitted HIV infection are high amongst South African youth, with one recent survey
reporting levels of 18.9% amongst 17-20 year olds and 43.1% amongst 21-25 year olds. In these groups levels of
knowledge about HIV are high, but perceived vulnerability and reported condom use are low. Much existing research
into youth HIV in developing countries relies on survey measures which use individual knowledge, attitudes and
reported behaviour as variables in seeking to explain HIV transmission amongst this group. This paper reports on a
focus group study that seeks to complement existing individual-level quantitative findings with qualitative findings
highlighting community and social factors that hinder condom use amongst youth in the township of Khutsong, near
Carletonville. Study informants comprised 44 young women and men in the 13-25 year age group. Data analysis
highlighted six factors hindering condom use: lack of perceived risk; peer norms; condom availability; adult attitudes to
condoms and sex; gendered power relations and the economic context of adolescent sexuality. Informants did not
constitute a homogenous group in terms of their understandings of sexuality. While there was clear evidence for the
existence of dominant social norms which place young peoples' sexual health at risk, there was also evidence that many
young people are self-consciously critical of the norms that govern their sexual behaviour, despite going along with
them, and that they are aware of the way in which peer and gender pressures place their health at risk. There was also
evidence that a minority of youth actively challenge dominant norms and behave in counter-normative and health-
enhancing ways. The actively contested nature of dominant sexual norms provides a fertile starting point for peer
education programmes that seek to provide the context for the collective negotiation of alternative sexual norms that do
not endanger young peoples' sexual health. © 2001 Elsevier Science Ltd. All rights reserved.
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Sexual health seeking behaviours of young people
in the Gambia
Kevin Miles, Matthew Shaw, Katie Paine, Graham J. Hart
and Saihou Ceesay
Journal of Adolescence 24 (2001) 753-764
Abstract
In the Gambia, sexually transmitted infections (STIs) and their complications are a
major health problem and although the prevalence of HIV-1 in the Gambia is currently
low, it is increasing. Relatively little is known about the sexual health treatment-
seeking behaviours of young people in West Africa. This information is vital to target
resources appropriately. To investigate this concept, twelve single - sex focus group
discussions (FGDs), within three rural villages, elicited the views, opinions, attitudes
and experiences of 49 young men (mean age 17.4 years; range 15-21) and 48 young
women (mean age 18.2 years; range 15-25). The participants talked openly about
sexual activity within their peer communities. Six major themes were identified from
the FGDs: (1) groups perceived to be at risk of acquiring STIs; (2) STI transmission
and classification; (3) treatment- seeking behaviours; (4) barriers to treatment;
(5) consequences of non-treatment; and (6) problem resolution strategies. The study
concludes that whilst there may be barriers to improving sexual and reproductive
health, young people in rural West Africa have enthusiasm for and commitment to
finding solutions to the problems that local communities face.
© 2001 The Association for Professionals in Services for Adolescents
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Condom use, power and HIV/AIDS risk:
sex-workers bargain for survival in Hillbrow/Joubert Park/
Berea, Johannesburg
Janet Maia Wojcicki and Josephine Malala
Social Science & Medicine 53 (2001) 99-121
Abstract
Through interviews with 50 female sex-workers in the Hillbrow/Berea/Joubert Park area of Johannesburg, this paper
explores sexual negotiations between men and women in the sex industry. This paper focuses on factors that affect
sexual decision-making including safer sex practices. In moving beyond approaches that emphasize women's
`powerlessness' in sexual negotiation, this article focuses on ways in which sex-workers capitalize on clients' reluctance
to use condoms in sexual exchanges. We emphasize sex-worker's agency and use a broader, Foucauldian understanding
of power, which couples power with resistance. Further, this paper examines other elements of the sex industry that
contribute to unsafe sex such as competition between women for clients and violence in the industry. Finally, this paper
suggests that HIV-prevention programs take cognizance that power negotiations between men and women cannot be
simplistically understood as men having power and women being powerless. Rather, this article contributes to a
growing body of literature in medical anthropology, which elucidates the complexities of sexual negotiations between
men and women. This focus on agency is important in trying to lessen the stigma and discrimination that sex-workers
face at the hands of clients, pimps/managers, police and health care workers. © 2001 Elsevier Science Ltd. All rights
reserved.
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