Anecdotal evidence that entrenched cultural beliefs among Swazis actively encourage the spread of HIV/AIDS has been confirmed by a joint government and UN report. The study, called 'The State of the Swaziland Population', echoes warnings by local NGOs that 'AIDS cannot be stopped unless there is a change in people's sexual behaviour.' 'Swazis are very traditional people, and their sexual behaviour is inbred and totally against safe sexual practices, like condom use and monogamous relationships, that limit the spread of HIV,' noted an HIV testing counsellor in Manzini, the country's main commercial city. The report, based on focus groups and surveys, found that maintaining a centuries-old cultural belief in procreation to increase the population size, was having devastating consequences in the age of AIDS.
Equity and HIV/AIDS
This article examines the dynamic role of law as a tool, and potential barrier, to public health interventions designed to ameliorate the negative impacts of HIV and AIDS globally. Laws may empower public health authorities, reinforce the human rights of persons living with HIV or AIDS and protect them from social risks, stigma and other harms by respecting privacy and prohibiting unwarranted discrimination. However, laws can also create legal barriers by penalising HIV+ people through criminal sanctions or other policies. As a result, it is recommended globally that laws should facilitate the prevention and treatment of HIV/AIDS consistent with scientific and public health practices and with a human rights framework.
A shortage of free female condoms in public hospitals in Kenya's Coast Province is compromising the ability of women to protect themselves from unwanted pregnancy and sexually transmitted infections. Female condoms are available in private hospitals and pharmacies in the province, but at a cost of up to US$5 – five times the cost of a male condom – they are too expensive for most women, especially in a time of famine, where every penny goes towards food. Sex workers are among those affected most by the shortage. Some have reported that that the female condom was a key part of their business. If customers refuse to wear a condom, sex workers at least have the option of wearing a female condom to protect themselves against sexually transmitted diseases like HIV.
The layering of HIV-related stigma with stigmas associated with gender, race, and class poses a methodological challenge to those seeking to understand and, thereby, to minimise its negative effects. In this meta-study of 32 reports of studies of stigma conducted with HIV-positive women, the researchers found that gender was hardly addressed despite the all-female composition of samples. Neither sexual orientation nor social class received much notice. Race was the dominant category addressed, most notably in reports featuring women in only one race/ethnic group. The relative absence of attention to these categories as cultural performances suggests the recurring assumption that sample inclusiveness automatically implies the inclusion of gender, race, and class, which is itself a cultural performance.
Stepping Stones, a 50-hour programme, aims to improve sexual health by using participatory learning approaches to build knowledge, risk awareness, and communication skills and to stimulate critical reflection. This article details the results of a randomised trial to measure the impact of the programme on HIV and herpes rates in rural South Africa. The trial also measured unwanted pregnancy, reported sexual practices, depression, and substance misuse. The article shows how there was no evidence that Stepping Stones lowered the incidence of HIV. However, it significantly improved a number of reported risk behaviours in men, with a lower proportion of men acting violently towards their intimate partners and less transactional sex and drinking problems. In women, desired behaviour changes were not reported.
A self-administered survey was distributed to a convenience sample of church-goers in both urban and rural areas, which included questions about religious beliefs, opinions about HIV, and knowledge and attitudes about anti-retrovirals (ARVs). Results indicated that shame-related HIV stigma is strongly associated with religious beliefs such as the belief that HIV is a punishment from God or that people living with HIV/AIDS (PLWHA) have not followed the Word of God. Most participants said that they would disclose their HIV status to their pastor or congregation if they became infected. Although most respondents believed that prayer could cure HIV, almost all said that they would begin ARV treatment if they became HIV-infected. So, the decision to start treatment was hinged primarily on education level and knowledge about ARVs, rather than on religious beliefs.
HIV serostatus disclosure to community members has been shown to have potential public and personal health benefits. This study examined the impact of bonding and bridging social capital (i.e. close and distant ties) on public disclosure. Data was collected from a public sector ART programme in the Free State province in the form of semi-structured, face-to-face interviews with 268 patients. The study identified bonding social capital as a leverage to maximise potential benefits and minimise potential risks so as to shift the balance toward consistent public disclosure. Furthermore, the importance of bridging social capital initiatives is demonstrated, especially for the most vulnerable patients, namely those who cannot capitalise their bonding social capital by disclosing their HIV serostatus to family and friends at the start of treatment.
Fifteen percent of South African school children between the ages of 12 and 17 years would knowingly spread HIV, the South African Broadcasting Corporation has reported. This was revealed in a study of more than 15 000 school children by an international group of epidemiologists based in Canada. The organisation's Nobantu Marokane said that most of the learners who said they would spread the virus had been abused. 'These learners were not tested so they did not know if they were HIV positive. In most cases, these learners have been exposed to some kind of abuse.'
Complementary breastfeeding represents an important source of risk of HIV infection for infants born to HIV positive mothers. The World Health Organisation recommends that infants born to HIV positive mothers receive either replacement feeding or exclusive breastfeeding (EBF) followed by early weaning. Beyond the clinical and epidemiological debate, it remains unclear how acceptable and feasible the two options are for rural populations in sub-Saharan Africa. This qualitative study aims to fill this gap in knowledge by exploring both the socio-cultural construction and the practice of breastfeeding in the Nouna Health District, rural Burkina Faso. Information was collected through 32 individual interviews and 3 focus group discussions with women of all ages, and 6 interviews with local guérisseurs. The findings highlight that breastfeeding is perceived as central to motherhood, but that women practice complementary, rather than exclusive, breastfeeding. Women are reported to recognise both the nutritional value of breast milk and its potential to act as a source of disease transmission. Given the socio-cultural importance attributed to breastfeeding and the prevailing poverty, the authors suggest that it may be more acceptable and more feasible to promote EBF followed by early weaning than replacement feeding. A set of operational strategies are proposed to favour the prevention of mother to child transmission of HIV in the respect of the local socio-cultural setting.
The female condom is reported to have resurfaced in Uganda's prevention programme almost one and a half years after the government halted distribution of the prophylactic due to poor uptake by women. The Ministry of Health carried out a situation analysis to gauge the acceptability of the female condom by women across the country before it was reintroduced. It found that women wanted a method that would give them control in protecting themselves from sexually transmitted infections and unwanted pregnancy. However, women in western Uganda felt it went against their culture. The Ministry is reported to have plans to embark on a sensitisation campaign to ensure the prophylactic is accepted in all parts of the country and to distribute one hundred thousand female condoms to target groups that have showed interest in them, mainly in the eastern and central parts of the country.