impact of socio cultural factors on hiv aids l.
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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.

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    1. 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

    2. 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 Sub-Saharan Africa • Rates of infection higher among women and youth between 15 - 25 years old

    3. 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;

    4. 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


    6. 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 ;

    7. 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

    8. 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

    9. Fig.1: National vs site sentinel prevalence trend in Kenya

    10. 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

    11. 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

    12. 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

    13. 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

    14. 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%)



    17. 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



    20. 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



    23. 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

    24. FGC: choices

    25. FGC: Choices

    26. 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%

    27. 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


    29. 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

    30. 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.

    31. 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

    32. 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.

    33. 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)

    34. 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;

    35. 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

    36. 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.

    37. 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

    38. 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.