Differences between the epidemiology of AIDS cases in Africa and that in Western societies have prompted speculation regarding risk factors that may be unique to Africa. Factors thought to influence this sexual transmission include 1 promiscuity, with a high prevalence of sexually transmitted disease; 2 sexual practices that have been associated with increased risk of transmission of AIDS virus homosexuality and anal intercourse ; and 3 cultural practices that are possibly connected with increased virus transmission female "circumcision" and infibulation. Other nonsexual cultural practices that do not fit the age distribution pattern of AIDS but may expose individuals to HIV include 1 practices resulting in exposure to blood medicinal bloodletting, rituals establishing "blood brotherhood," and possibly ritual and medicinal enemas ; 2 practices involving the use of shared instruments injection of medicines, ritual scarification, group circumcision, genital tatooing, and shaving of body hair ; and 3 contact with nonhuman primates. At the current time promiscuity seems to be the most important cultural factor contributing to the transmission of HIV in Africa. The recent spread of AIDS throughout Africa raises the question of whether the mode of transmission of human immunodeficiency virus HIV in Africa is different from that in the United States and other Western countries.
Though the procedure tends to be performed on young women and girls who are less likely to have had their sexual debut and are thus also less likely to be HIV positive Young black tranny treated cases of vertical transmissionanecdotal evidence Acrican this mode of transmission exists Brady For example, men consistently have higher rates of changing sexual partners than women, a behavioural pattern that creates vulnerability to HIV. This article has been cited by other articles in PMC. They want to make sure that he or she dies with African culture and hiv aids, because death is like sleeping Bruegel After childbirth the woman is often sewn up again.
Dysmenorrhea while pregnant. Services on Demand
In the so-called "matrilineal belt" centered in south-central Africa, there is an especially high degree of adolescent promiscuity and uncertainty about paternity. In the most extreme forms of FGC, the Banned clip porn introitus must be opened by incision for sexual intercourse or childbirth, which creates further scarring and may further increase susceptibility to infection. Intravenous-drug abuse African culture and hiv aids reportedly rare in Africa, but insufficient hard data African culture and hiv aids on this point. These studies have clearly shown that vulnerability to HIV and thus individual-level risk increase with early coital debut. There is also a definite problem in data collection by foreigners especially male foreigners on this topic. Website Feedback. Annual Review of Anthropology. These anecdotal accounts do not indicate widespread homosexuality like that which seems to occur in some societies. It is important Vintage airlines bahamas note here that a condom-only stance to HIV prevention in Africa will not work either. Canadian Medical Association Journal. They are also often in a position where they are working long distances from their homes and families, and sometimes do not see their partners for weeks or months at a time. When it can be afforded, infibulation now is often performed in hospitals primarily in northwestern Africa [ 12 ]so a "ritual" or "traditional" explanation for the practice seems less likely. Gray's study may reveal an association, but does not credibly describe causation in the link between religious affiliation and HIV status. Without a clear link to a specific risk-enhancing behaviour, a focus on correlations between religion and HIV positivity only serves to inappropriately discredit certain religious groups and beliefs as culturally inferior.
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Differences between the epidemiology of AIDS cases in Africa and that in Western societies have prompted speculation regarding risk factors that may be unique to Africa. Factors thought to influence this sexual transmission include 1 promiscuity, with a high prevalence of sexually transmitted disease; 2 sexual practices that have been associated with increased risk of transmission of AIDS virus homosexuality and anal intercourse ; and 3 cultural practices that are possibly connected with increased virus transmission female "circumcision" and infibulation.
Other nonsexual cultural practices that do not fit the age distribution pattern of AIDS but may expose individuals to HIV include 1 practices resulting in exposure to blood medicinal bloodletting, rituals establishing "blood brotherhood," and possibly ritual and medicinal enemas ; 2 practices involving the use of shared instruments injection of medicines, ritual scarification, group circumcision, genital tatooing, and shaving of body hair ; and 3 contact with nonhuman primates.
At the current time promiscuity seems to be the most important cultural factor contributing to the transmission of HIV in Africa. The recent spread of AIDS throughout Africa raises the question of whether the mode of transmission of human immunodeficiency virus HIV in Africa is different from that in the United States and other Western countries. This report briefly examines cultural practices that may contribute to the spread of AIDS in Africa and highlights areas that require further research.
Any hypothesis that attempts to account for the equal sex distribution of AIDS cases in Africa must take into account the apparent age distribution of the disease. Cases are found in infants who presumably acquire the disease from their mothers and in sexually active adults. Although data for young children are still incomplete, AIDS cases have been reported only infrequently among those age groups, except in cases of blood transfusions.
Earlier reports of HIV seropositivity in children [ 5 ] may have been the result of nonspecific reactions [ 6 ]. Hence emphasis has been placed on sexual transmission of HIV. Factors thought to influence sexual transmission in Africa include 1 sexual promiscuity, with a high prevalence of sexually transmitted disease STD ; 2 sexual practices that have been associated with a high degree of transmission of HIV homosexuality and anal intercourse ; and 3 cultural practices that are possibly connected with increased virus transmission female "circumcision" and infibulation.
Other nonsexual cultural practices that do not fit the age distribution of AIDS but may expose individuals to HIV include 1 practices resulting in exposure to blood medicinal bloodletting, rituals establishing "blood brotherhood," and possibly ritual and medicinal enemas ; 2 practices involving the use of shared instruments injection of medicines, ritual scarification, group circumcision, genital tattooing, and shaving of body hair ; and contact with nonhuman primates.
It seems to be relatively difficult to pass HIV during normal vaginal intercourse. Thus, it has been proposed that heterosexual transmission is somehow enhanced in Africa. Of course, even with a low rate of transmissibility, large numbers of sexual contacts will place a promiscuous individual at high risk for acquiring the infection.
Enhanced heterosexual transmissibility may not required for explanation of the equal sex ration among AIDS cases in Africa if it is assumed that the virus originated and was spread in the promiscuous heterosexual population. The same type of "epidemiologic accident" may account for HIV transmission in the promiscuous homosexual and drug addict populations in the West.
However, it has been proposed that heterosexual transmission is, in fact, enhanced in Africa because of the widespread practice of female circumcision [ 8,9 ]. Figure 1. Distribution of female excision hatched area and infibulation cross hatched area in Africa see [ 1 ] [ 4 ].
Female circumcision is a euphemism for female genital mutilation. Although it is usually performed at or shortly before puberty in Africa, female circumcision has little relation to the practice of male circumcision and is not usually an initiation rite per se. Three types of female circumcision occur in Africa.
The most extreme, termed infibulation or pharaonic circumcision , involves partial closure of the vaginal orifice after excision of varying amount of tissue from the vulva, In its extreme form, all of the mons veneris, labia majora and minora, and clitoris are removed and the involved areas closed by means of sutures or thorns.
After the operation the thighs are strapped together for 4—8 weeks, with complete occlusion of the introitus being prevented by the insertion of a matchstick or other wooden object. A more moderate form of female circumcision is excision , which involves removal of the clitorus and part of the labia minora. The mildest form, Sunna circumcision is circumferential excision of the clitoral prepuce [ 10 ]. Another practice that involves female genital mutilation is making "gishiri cuts," which are incisions on the vaginal wall and presumably serve the same purpose as female circumcision [ 11 ].
In may cases of infibulation and occasional cases of excision, the vaginal opening must be cut open by the husband defibulation in order for childbirth or in severe cases, sexual relations to occur. After childbirth the woman is often sewn up again.
In premodern times there were various "ritual" explanations for the practice of female circumcision. However, the practice continues in modern Christian and Muslim Africa. When it can be afforded, infibulation now is often performed in hospitals primarily in northwestern Africa [ 12 ] , so a "ritual" or "traditional" explanation for the practice seems less likely. One recent theory proposes that the practice is an effort by males and lineages to curtail female sexual pleasure and hence illicit sexual liasons, thereby increasing certainty regarding paternity [ 13 ].
In rural tribes where female circumcision occurs, it is nearly universal in the female population; however, its prevalence is decreasing in urban areas [ 11 ]. Female circumcision has been postulated to increase the likelihood of AIDS transmission via increased exposure to blood in the vaginal canal [ 8 ]. The presumed explanation is that the small introitus, the presence of scar tissue which may cause tissue friability , and the abnormal anatomy of a mutilated vagina would predispose to numerous small or large tears in the mucosa during intercourse.
These tears would tend to make the squamous vaginal epithelium similar in permeability to the columnar mucosa of the rectum, with increased absorption of secretions and virus. A less likely explanation involves sexual intercourse shortly at or shortly after the time of female circumcision, when open wounds are present. Figure 2. Tentative distributions of areas with a high level of seropositivity for human immunodeficiency virus.
There are several reasons why female circumcision may not be an adequate explanation for enhanced heterosexual AIDS transmission. Although the presence of lesion in the vagina may increase male-to-female transmission, it is unclear how female-to-male transmission would be enhanced in this situation. A possible cofactor is untreated STD, which could result in the breakdown of the mucosal integrity of the male sex organs.
Another major problem is the lack of correspondence of the distribution of AIDS and that of female circumcision figure 1. The only area in Zaire that is affected is in the north. Although data are sketchy [ 10 , 11 , 14 ], female circumcision is not practiced in areas with the highest level of HIV seropositivity. From evidence presently available, these areas of high seropositivity are eastern Zaire, Rwanda, Burundi, western Uganda, northwestern Tanzania, and northern Zambia [ 1 , 3 , 5 , ] figure 2.
There is some overlap of areas in which excision is performed and areas with a lower degree of seropositivity, including parts of Zaire, Kenya, Central African Republic, and Tanzania. It must be stressed that data are incomplete for these areas.
Traditional anthropologists tend to pursue details of sexual practices in their studies, and various political upheavals have made work in the regions involved difficult in recent times. There is also a definite problem in data collection by foreigners especially male foreigners on this topic.
It is possible that population movements have introduced the practice of female circumcision into urban areas where it was previously not found. In fact, it is not clear that increasing westernization and urbanization have reduced the practice of female circumcision. For example, except for the Luo, the practice is still widespread in urban areas of Kenya.
This pattern may begin to change now that President Arap Moi has spoken against the practice; in contrast former President Jomo Kenyatta felt that excision was a traditional part of Kikuyu life [ 33 ]. Questions relating to female circumcision that require further research include the following: 1 Is there a correlation of female AIDS cases with circumcision? Needless to say, the study of many of those issues would be extremely difficult from both technical and political standpoints.
Although generalizations are difficult, most traditional African societies are promiscuous by Western standards. Promiscuity occurs both premaritally and postmaritally. For instance in the Lese of Zaire, there is a period following puberty and before marriage when sexual relations between young men and a number of eligible women are virtually sanctioned by society. The father of a woman may judge the suitability of the man on the basis of the perceived willingness to invest in his daughter [ 36 ].
In the so-called "matrilineal belt" centered in south-central Africa, there is an especially high degree of adolescent promiscuity and uncertainty about paternity. This situation has probably contributed to the prominent family role of the mother's brother. For example family wealth is inherited by offspringe of the maternal uncle rather than by patrilineal descendents from the husband.
That is, wealth is passed on to a known biologic relative, rather than to the offspring of a wife who may or may not be biologic kin. Matrilineal inheritance thus may reduce societal pressure to prevent promiscuity; matrilineal societies are often promiscuous societies [ 37 ].
However, promiscuity is correlated not only with matrilineal societies. Many patrilineal African societies are promiscuous as well. The distribution of infertility is patchy in affected areas. Regions of low fertility border on areas of high fertility. For example in two neighboring districts in the Sudan, the local infertility rates vary from 3.
This primary sterility is thought to be due to high levels of STDs that result in pelvic inflammatory disease in young women [ 39 ]; transmission of STDs is presumably enhanced by promiscuity. It is of interest that the "infertility belt" is in areas with a high prevalence of antibody to AIDS virus, which also may be related to promiscuity.
As people leave rural villages and migrate to urban areas, the general level of promiscuity usually increases.
This increase may be attributable in part to the relaxation of traditional village values but appears to be due primarily to the destitution of poor migrant women, who may become prostitutes, and to the greater mobility and rootlessness of young male migrants and soldiers. Unlike some Asian societies, traditional African societies have no apparent pattern of ritual prostitution, and it is unlikely that women who become prostitutes for purely monetary reasons would be tolerated in traditional surroundings.
Increased prosmiscuity is especially common among upper- and middle-class urban men, who can afford the services of prostitutes. As has been noted previously, levels of STDs are generally high in Africa [ 4 ]; this fact may reflect both casual attitudes toward sex and high levels of promiscuity as well as the lack of easily available treatment.
Schuster [ 42 ] provides an in-depth treatment of the lives of Zambian career women who preceive themselves as better off trading sex for favors and expensive gifts than marrying; contemporary urban life provides wives with little of the traditional support systems of the village, and the lives of married women are isolated, bleak, and improvished [ 41 ] It is perhaps significant that the first cases of AIDS in Central Africa were reported by in upper class Zaireans seeking medical treatment in Europe [ 14 ].
Except for a few rural areas e. However, not enough data are available on either the presence of AIDS in rural areas or sexual patterns of urban and rural areas for the establishment of definite correlations.
Population movements in Africa contribute to the "sexual mixing" of various African groups and may be related to the spread of AIDS. The entire Central African area and indeed the whole of sub-Saharan Africa is experiencing large shifts in population.
Some patterns have existed for long periods, such as the movement of Arabic and Nilotic peoples into the northern part of Central Africa [ 44 ]. The long-term movement of rural population into urban areas is also continuing. Other more recent trends include the movement of migrant workers from Zaire and Rwanda to neighboring countries e. It is probably significant that AIDS cases seem to have been present in Africa only since the s [ 15 , 45 , 46 ]--a time frame that correlates with the intensification of urbanization and population shifts.
The relative efficiencies of HIV transmission from male to female and from female to male are still unclear. If these efficiencies are equal and prostitutes represented the major reservoir of HIV infection, a higher male-to-female ratio of cases would be expected since each prostitute has many sexual contacts. However, it is unlikely that female promiscuity is confined to "professional" prostitutes, especially in urban areas [ 42 ].
It is also possible that the male-to-female transmissibility of HIV is higher than female-to-male transmissibility, presumably because of the higher concentration of HIV in semen than in cervical secretions [ 47 ]. Both of these factors would tend to produce a more equal sex ratio among cases of HIV infection. Data from a high-infertility area of Uganda indicate that the rate of carriage of gonorrhea is 8.
These values are in contrast to the corresponding carriage rates of 4. Hence gonorrhea rates in this high-infertility region tend to be at least as high in women as in men. Of course, data on gonorrhea and other STDs are not strictly relevant to HIV infection since classical STDs can be successfully treated and are more often asymptomatic in women than in men. Although the link between the risk of acquiring AIDS and promiscuity seems to be clear at this time, there are some unanswered questions: 1 How does viral transfer occur from male to female and from female to male?
Lancet Infectious Diseases. Nkwi point to culturally sanctioned indiscriminate sexual behaviour at rituals in Kenya, while Macdonald suggests that attitudes supportive of fertility encourage multiple partnerships and unsafe sex in Botswana. Religion and HIV risk behaviors among married men: initial results from a study in rural sub-Saharan Africa. Similarly, Takyi , reporting on a Ghanaian population, concluded that Christian women had greater knowledge about behaviours affecting HIV transmission than other religious groups but found no consistent correlation between religious affiliation and actual preventative behavioural change. The distinction between the two, as proposed in a groundbreaking paper by Rose , is fundamental to the consideration of the causation of any pathological process.
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Understanding culture and HIV/AIDS in sub-Saharan Africa.
Nolipher Moyo; Julian C. Correspondence to. Culture plays a significant role in people's lives in Zambia and in Africa as a whole. Consequently, there is a need to take Zambian or African culture seriously in order to look at the salient elements of cultural practices in rites of passage that influence the spread of HIV and AIDS. This article analyses four rites of passage associated with birth, puberty, marriage and death.
There are numerous rites of passage in Zambian culture. Using the Reformed Church in Zambia Bible Study Method of Subgroups, discussions were held that allowed victims of cultural practices to tell their stories using the narrative model. This article sought to shed light on cultural practices that exacerbate HIV and AIDS and more importantly, provide culturally sensitive alternatives to these harmful practices.
One is inclined to ask whether Africans are more promiscuous than their European or American counterparts. There is no evidence to support this idea. There is an urgent need to establish the causes of the high rate of the HIV infection in Africa, so that appropriate strategies can be put in place to combat this pandemic. My experience has influenced me to take a serious look at the salient cultural practices that put women at serious risk of contracting HIV and AIDS.
The good cultural values, which can help in the fight against HIV and AIDS, are dying out whilst the bad ones, that promote the spread of the disease, continue to exist. Society should see the need to promote good cultural values and discourage bad ones.
The United Nations Children's Fund UNICEF report says that women are more vulnerable to AIDS than men, for a number of reasons such as the collapse of support systems and therefore there is a need to intensify our efforts to promote effective joint involvement into finding the solution to this problem.
It will provide an understanding of women's untold stories about salient cultural practices of Zambian rites of passage that promote or hinder the spread of HIV and AIDS. As a researcher, I wanted to be a part of the discussion on the influence of cultural practices during rites of passage on the spread of HIV and AIDS amongst the Zambian people, especially amongst women and female children.
The rites of passage in question are those associated with birth, puberty, marriage and death. This research was based on a number of pertinent methods, which include literature reviews, interviews, conversation and field studies.
The main source of data was field trips and the conducting of qualitative interviews. The women are the ones who are involved in rites of passage. They follow the demands of their cultural beliefs. They also believe that if they do not carry out these rites of passage something bad will happen to them. As a result, my primary partners in conducting this research were the ordinary women of Zambia; they are the ones who have the stories to tell.
They are the caregivers in the community. Three focus groups, comprised randomly selected men and women, were interviewed the men and women were interviewed separately. The participants were randomly selected by their congregation leaders, who were pastors, laymen, laywomen and the youth, who met at Justo Mwale Theological College Booth Center on 25 and 27 May The participants first explored and described Zambian cultural practices that take place during rites of passage.
As the participants felt free to describe and explain the cultural practices in their sub-focus-group discussions, they prepared the ground for many women and men to share their personal stories with me.
Some shared the stories of their relatives who had been victims of some cultural practices. The focus group discussions brought release to many women, by allowing them the opportunity to share what they had kept within themselves for some time.
These were women from different backgrounds who shared their stories, narrating how they became victims of some of the cultural practices, discussed later in this article. Some of the women were HIV positive; some had gone for voluntary counselling and testing VCT , but emotionally they were not strong enough to deal with their results.
We travelled together through stories. Through stories of experiences, we were able to interpret the problems facing the women of the society, and discuss possible alternatives to these problems. Through telling the stories the social realities were found.
Most interviewers value stories, because most of the time they contain issues that the interviewee feels too awkward to share directly, but will tell in a story. Gergen describes social construction discourse as the processes by which people come to describe, explain or account for the world in which they live.
Here, knowledge is seen as something socially constructed into the language that makes people communicate. Gergen , further states that knowledge is not something people possess somewhere in their heads, but rather something that they do together. This is why we must explore the phenomenon of cultural practices to interpret the stories into the language that a person can understand.
Freedman and Comb pointed out that deconstruction can help us unmask the 'so called truth'. This hides biases and prejudices behind the disembodied way of speaking, giving an air of legitimacy to restrictive and subjugating dominant stories.
That is why practical theology has a part to play, to make room for people to encounter God, and live in fellowship with God and others. This may be an alarming statement, but it is very much true in our present scenario. HIV and AIDS have brought a new dimension to the theology of suffering, in which pastoral care and counselling is very much involved.
The results of this study will be shared with members of the Reformed Church in Zambia and some other member churches under the Christian council of Zambia. Presently, the church in Zambia is encouraging people to find means and ways to discourage evil ways and promote biblical morals, which will make the world a better place to live in. The results will also be shared in some interdenomination churches, even the Pentecostal churches through the Pastor's Wives Fellowship, anti-AIDS groups, women's lobby groups, NGOs and other social work groups.
Van Niekerk, quoting Heyns , expresses that practical theology is 'that part of theology that concerns itself with this event - the encounter between God and humanity - and particularly with the role of human beings in this encounter'.
Practical theology seeks to help humans to encounter God and live to in fellowship with God and other people. It is concerned with those religious actions that communicate with others so as to make room for God in this world. Living amongst people in society, practical theology becomes a way of life amongst the people you live with. Therefore, in order for this study to succeed, I needed to join the people of Zambia in their daily challenges of life, such as birth in the family, initiation, weddings, funerals and other ceremonies.
The alternative practices proposed in this article also include Christian alternatives. Cultural practices in line with birth. Children are of special value to both men and women in African societies.
It has been pointed out that the respect and status that motherhood confers on a woman is greater than that conferred by marriage Dolphyne In many cultures in Africa, people marry because they want to have children. If a woman does not give birth she can be divorced or another wife taken to produce children for the husband.
According to Drews , 'In many Zambian tribes no one talks about pregnancy and birth'. This is because they fear that the pregnant woman may be bewitched at the time of delivery.
The delivery day is also kept secret. Motherhood is defined as the fullest acceptability in the world of female adulthood. Children give status to a woman.
The woman without a child in African society is treated as a young person. If the problem lies with the man, if he is infertile for example, he will be advised to drink some herbs to increase the power of his manhood.
If he is still unable to conceive a child with his wife, then the family will arrange someone to sleep with his wife until she conceives.
This is kept a closely guarded secret between the husband, the hired man, the wife and the family member who made the arrangement Moyo The situation is grave for girls, particularly when they are orphaned, as is clear from the personal experience of Tibale.
Tibale of the Kamanga compound said that her relatives have nicknamed her 'Eve' meaning she is evil and deserves punishment for her status. She added that, she is being labelled a killer by her own relatives:. I was unable to conceive with my husband and so the elderly women in my family made arrangements for me to sleep with another man to conceive a child. The world is unfair. I don't understand it. May God help me. I am now the victim of fate.
I am now HIV positive and pregnant'. The possibility of HIV transmission. The girl did not know the HIV status of the man she had sex with, nor did she know her husband's status. If she is HIV positive, then both the man and the husband can be infected.
If this man is HIV positive, he can infect her, the coming baby and the husband. If her husband was HIV positive, then he can infect his wife and the coming baby and also the man she had sex with and his future partners. They should see a doctor who can examine them and give them advice. Those who decide to follow this practice should ensure that both parties have been tested and are not infected by HIV.
If the man asked to father the child, tests positive for HIV, then another man should be found. Alternatively, they could adopt children using legal methods or using a traditional way, where the couple asks one of the relatives who has many children if they may take care of one.
If the parents of the child agree, then that couple should invite this particular child to live with them. This child will be treated well, with many favours, so that he or she forgets about their real parents.
Cultural practices in line with puberty. Puberty is the stage at which an individual is described as having reached adulthood. It means an individual is then regarded as a responsible member of the clan and of the whole society Breugel Puberty is a very important right of passage for girls in many African cultures.
The rite is associated with the beginning of menstruation, which is believed to be a sign of growing up. Girls are taught how to keep themselves clean during the menstrual period, but above all, they are taught how to use the newly acquired powers of life. A girl is told to be careful in her conduct and relationships with others Breugel The stage of puberty is an important entry point for reproductive health messages. The traditional initiators form an important group in the society through which reproductive health messages can be passed on to young people.
The whole initiation period sets a stage for reaching out to adolescents.