Responding to AIDS: A Look at Cultural Practices in Africa
It's not rooted solely in homosexual behavior, so what else is causing the epidemic?
Updated Feb 28, 2002
Editor's Note: Developing a biblical response to AIDS presents a challenge to many believers, as we discussed in part one of this series. Particularly in the case of Africa, where the disease is not the domain of the homosexual community, yet has the highest rate, it is helpful to understand cultural practices and attitudes when considering how to respond. Please note this article contains details on sexual practices that could make some readers uncomfortable.
Over 22 million Africans are infected with HIV, the virus that leads to AIDS, compared with 1.5 million Americans. An estimated 75 percent of all people infected with the virus live in sub-Saharan Africa.
Because the situation is dire, a cluster of Christian organizations has stepped to the forefront of relief efforts, providing medicine and supplies to the 16 countries of sub-Saharan Africa where HIV/AIDS is most intense. Other groups are responding to the pandemic by providing care, comfort and education.
World Vision is one such group. The international Christian relief and development organization was one of the first non-government groups to respond to AIDS in Africa more than a decade ago.
A thriving World Vision development program based in Tanzania has been looking after the welfare of children and their communities for years. But health experts warned World Vision that the problems associated with the high HIV transmission rate in the area must be addressed.
Thus, "Community Mobilization: A Comprehensive Approach to HIV/AIDS" was developed. The three-year project, funded through World Vision Australia, aims to improve the health status of the area by mobilizing the community to manage HIV/AIDS in a holistic way. Their goal is reduced transmission of HIV through sustainable primary health care, social support and behavioral change.
Nigel Marsh, World Vision's communication manager in East Africa, provides the following snapshot of cultural beliefs and practices in the mining area of Tanzania where the project is based.
Medical experts call Mirerani town, and the huge Moipo Division around it, a "High Transmission Area" for HIV. An explosive mixture of social factors gives the AIDS pandemic fertile ground in which to spread.
Thousands of young men spend weeks struggling in their dark mines before letting themselves loose in the town, where prostitution is widespread. Women, and even girls as young as 7, are part of the commercial sex business.
There is a curious counterpoint of profound poverty with flashpoints of sudden wealth, alcohol and drug abuse. Male homosexuality, never talked about and rarely practiced in East Africa, has been encouraged here by witchdoctors. According to at least one account, it is becoming "a fashion."
The majority tribe in Moipo Division, in which Mirerani Town lies, are the Maasai. This proud, nomadic people have a significant problem, though most do not know it yet - a few of their jealously guarded historical traditions could be helping to kill them.
Some experts in Maasai health issues are concerned that the conventions regarding sexual activity, which are extremely permissive, could actually lead to the destruction of the tribe in large areas by throwing a door open to the HIV virus.
The problem is compounded by the tribe's insularity. Government pronouncements, doctors' instructions, warnings on the radio and humanitarian workers' advice will all be politely listened to. But nothing will be done until the tribe's elderly opinion leaders have said it should be.
In this way, the Maasai have kept themselves safe and distinct through a hundred years of unprecedented cultural change - but it doesn't help the message of HIV prevention to spread.
Tradition
Frankly, says one village opinion leader, some of the customs need to be changed in light of HIV. "Our traditions will give us a good chance of suffering badly from AIDS. For instance, the young girls dancing at night with the men is very serious in light of the spread of AIDS."
This ceremonial dancing involves unmarried girls aged 10 and above moving in a circle one way, with the village men dancing in a larger circle outside them the other way. At key points the music stops, and whichever man a girl finds herself next to takes her into the bush for sex. Then, at a given signal, everyone returns and the dance continues. It's like musical chairs, and everyone gets several partners in the night.
It's all part of an extraordinarily open Maasai approach to sex. A young man will be affronted if he finds his new bride is a virgin, and if he complains to her village, the elders will berate their menfolk for not being masculine enough to teach the girl on sexual matters. A man may have several wives, and a married woman can sleep with any man of her husband's age without shame. An honored visitor to a Maasai homestead may be offered far more than a bed for the night.
All of this makes the spread of HIV more likely. And perhaps worst of all is the Tanzanite mining business, right in the heart of their land.
"Our people come here to do business. The men have their wives at home in the villages, but they make friends with women here in town - they will get the virus and take it home to their communities."
A Deadly Profession
The women who work in the town brothel - called the Mortuary because of the number of clients and workers who die of AIDS-related diseases - face a variety of threats, of which HIV is the most deadly. The women in the Mortuary struggle to understand the way the virus is transmitted. All agree that their profession is dangerous, but protest that they have no choices.
"We are poor - if you don't have money you can't live; that's why we are here in this situation. Some of us have children, but we have no other work. What else is there to do in this town?"
There is tremendous pressure on girls in the community to get involved in prostitution, and the business takes some of them out of school. "They have to be taught not to be friendly with miners," says Christine Lukwaro, who manages a World Vision area development project that works hard to keep sponsored children out of this lifestyle.
Most of the women in the Mortuary were sucked into the dark netherworld of life in Mirerani when they traveled here from other places years ago. "The town was very much advertised as a place with a lot of money," says one girl. "Once you get here you can't afford to go home, so you have to work."
The girls discuss with Lukwaro the myriad forms of unfaithfulness and bad practices that could speed HIV on its destructive course. Finally, one girl ventures, "We also have this problem of homosexuality in Mirerani, and in other areas around here."
It takes some follow-up around town to get to the bottom of this comment, because most African cultures find homosexuality difficult to discuss. Community leaders confirm, however, that miners who approach Mirerani witchdoctors for help in finding the best underground sources of gems are often advised to have sex with another man as part of the magic.
Community counselor Menes Masuwa laughs a humorless laugh when asked to confirm the witchcraft link to the rise in homosexuality. "That's true, but that's not the main reason any more. It's just a fashion here now."
Perhaps the main issue for the people of this town is, when faced with the daily terrors of working in a breathless dark under millions of tons of rock, the issue of HIV and AIDS, and a death that may come years hence, is of purely academic interest to most of the people.
"We hear about this on the radio sometimes, but no one has ever come to tell us the details," says one man, who acknowledges that his lifestyle probably predisposes him to catching the disease.
"We are very busy, and we don't really have much time for visitors," he adds, though he and his friends are not rushing to get away from this discussion. "We have all seen people dying a bad death from the disease, though, and we would accept someone coming to us with this message."
Changing Beliefs is Key
On the final day of a U.N. Special Session on AIDS, experts testified that knowledge and information alone won't reduce risky sexual behavior in young people or increase awareness about transmission. "It requires a change in one's beliefs."
A study by J.D. Caldwell on the African AIDS epidemic shows "Cultural beliefs about sexual practices are so pervasive that behavioral approaches, such as the encouragement of condom use, have not been successful. Unless knowledge and information are linked to beliefs and values," the study said, "providing knowledge and information alone is a very weak intervention tool."
And this is where Christians, in particular, are taking the lead. In addition to World Vision, the groups International Aid, the South African Council of Churches and World Relief, among others, are beginning to steer the communities to Christ and a Biblical perspective on sex.
According to Laura White of World Relief, that group is mobilizing churches in Nkhota Kota, Malawi, to start youth Bible studies that emphasize God's plan for sexuality.
"From the pulpit, in patient fellowships, youth groups and private homes, the Church is widely proclaiming abstinence and faithfulness in every way it can, while still loving and caring for the many affected families," says White.
Sarah Ruden, a freelance writer who lives near Cape Town, South Africa, adds, "The Christian churches are strongest and best positioned to bear the greatest responsibility for what can be done ... they can fit their traditional teachings about chastity and monogamy into programs to fight the disease."
Over 22 million Africans are infected with HIV, the virus that leads to AIDS, compared with 1.5 million Americans. An estimated 75 percent of all people infected with the virus live in sub-Saharan Africa.
Because the situation is dire, a cluster of Christian organizations has stepped to the forefront of relief efforts, providing medicine and supplies to the 16 countries of sub-Saharan Africa where HIV/AIDS is most intense. Other groups are responding to the pandemic by providing care, comfort and education.
World Vision is one such group. The international Christian relief and development organization was one of the first non-government groups to respond to AIDS in Africa more than a decade ago.
A thriving World Vision development program based in Tanzania has been looking after the welfare of children and their communities for years. But health experts warned World Vision that the problems associated with the high HIV transmission rate in the area must be addressed.
Thus, "Community Mobilization: A Comprehensive Approach to HIV/AIDS" was developed. The three-year project, funded through World Vision Australia, aims to improve the health status of the area by mobilizing the community to manage HIV/AIDS in a holistic way. Their goal is reduced transmission of HIV through sustainable primary health care, social support and behavioral change.
Nigel Marsh, World Vision's communication manager in East Africa, provides the following snapshot of cultural beliefs and practices in the mining area of Tanzania where the project is based.
Medical experts call Mirerani town, and the huge Moipo Division around it, a "High Transmission Area" for HIV. An explosive mixture of social factors gives the AIDS pandemic fertile ground in which to spread.
Thousands of young men spend weeks struggling in their dark mines before letting themselves loose in the town, where prostitution is widespread. Women, and even girls as young as 7, are part of the commercial sex business.
There is a curious counterpoint of profound poverty with flashpoints of sudden wealth, alcohol and drug abuse. Male homosexuality, never talked about and rarely practiced in East Africa, has been encouraged here by witchdoctors. According to at least one account, it is becoming "a fashion."
The majority tribe in Moipo Division, in which Mirerani Town lies, are the Maasai. This proud, nomadic people have a significant problem, though most do not know it yet - a few of their jealously guarded historical traditions could be helping to kill them.
Some experts in Maasai health issues are concerned that the conventions regarding sexual activity, which are extremely permissive, could actually lead to the destruction of the tribe in large areas by throwing a door open to the HIV virus.
The problem is compounded by the tribe's insularity. Government pronouncements, doctors' instructions, warnings on the radio and humanitarian workers' advice will all be politely listened to. But nothing will be done until the tribe's elderly opinion leaders have said it should be.
In this way, the Maasai have kept themselves safe and distinct through a hundred years of unprecedented cultural change - but it doesn't help the message of HIV prevention to spread.
Tradition
Frankly, says one village opinion leader, some of the customs need to be changed in light of HIV. "Our traditions will give us a good chance of suffering badly from AIDS. For instance, the young girls dancing at night with the men is very serious in light of the spread of AIDS."
This ceremonial dancing involves unmarried girls aged 10 and above moving in a circle one way, with the village men dancing in a larger circle outside them the other way. At key points the music stops, and whichever man a girl finds herself next to takes her into the bush for sex. Then, at a given signal, everyone returns and the dance continues. It's like musical chairs, and everyone gets several partners in the night.
It's all part of an extraordinarily open Maasai approach to sex. A young man will be affronted if he finds his new bride is a virgin, and if he complains to her village, the elders will berate their menfolk for not being masculine enough to teach the girl on sexual matters. A man may have several wives, and a married woman can sleep with any man of her husband's age without shame. An honored visitor to a Maasai homestead may be offered far more than a bed for the night.
All of this makes the spread of HIV more likely. And perhaps worst of all is the Tanzanite mining business, right in the heart of their land.
"Our people come here to do business. The men have their wives at home in the villages, but they make friends with women here in town - they will get the virus and take it home to their communities."
A Deadly Profession
The women who work in the town brothel - called the Mortuary because of the number of clients and workers who die of AIDS-related diseases - face a variety of threats, of which HIV is the most deadly. The women in the Mortuary struggle to understand the way the virus is transmitted. All agree that their profession is dangerous, but protest that they have no choices.
"We are poor - if you don't have money you can't live; that's why we are here in this situation. Some of us have children, but we have no other work. What else is there to do in this town?"
There is tremendous pressure on girls in the community to get involved in prostitution, and the business takes some of them out of school. "They have to be taught not to be friendly with miners," says Christine Lukwaro, who manages a World Vision area development project that works hard to keep sponsored children out of this lifestyle.
Most of the women in the Mortuary were sucked into the dark netherworld of life in Mirerani when they traveled here from other places years ago. "The town was very much advertised as a place with a lot of money," says one girl. "Once you get here you can't afford to go home, so you have to work."
The girls discuss with Lukwaro the myriad forms of unfaithfulness and bad practices that could speed HIV on its destructive course. Finally, one girl ventures, "We also have this problem of homosexuality in Mirerani, and in other areas around here."
It takes some follow-up around town to get to the bottom of this comment, because most African cultures find homosexuality difficult to discuss. Community leaders confirm, however, that miners who approach Mirerani witchdoctors for help in finding the best underground sources of gems are often advised to have sex with another man as part of the magic.
Community counselor Menes Masuwa laughs a humorless laugh when asked to confirm the witchcraft link to the rise in homosexuality. "That's true, but that's not the main reason any more. It's just a fashion here now."
Perhaps the main issue for the people of this town is, when faced with the daily terrors of working in a breathless dark under millions of tons of rock, the issue of HIV and AIDS, and a death that may come years hence, is of purely academic interest to most of the people.
"We hear about this on the radio sometimes, but no one has ever come to tell us the details," says one man, who acknowledges that his lifestyle probably predisposes him to catching the disease.
"We are very busy, and we don't really have much time for visitors," he adds, though he and his friends are not rushing to get away from this discussion. "We have all seen people dying a bad death from the disease, though, and we would accept someone coming to us with this message."
Changing Beliefs is Key
On the final day of a U.N. Special Session on AIDS, experts testified that knowledge and information alone won't reduce risky sexual behavior in young people or increase awareness about transmission. "It requires a change in one's beliefs."
A study by J.D. Caldwell on the African AIDS epidemic shows "Cultural beliefs about sexual practices are so pervasive that behavioral approaches, such as the encouragement of condom use, have not been successful. Unless knowledge and information are linked to beliefs and values," the study said, "providing knowledge and information alone is a very weak intervention tool."
And this is where Christians, in particular, are taking the lead. In addition to World Vision, the groups International Aid, the South African Council of Churches and World Relief, among others, are beginning to steer the communities to Christ and a Biblical perspective on sex.
According to Laura White of World Relief, that group is mobilizing churches in Nkhota Kota, Malawi, to start youth Bible studies that emphasize God's plan for sexuality.
"From the pulpit, in patient fellowships, youth groups and private homes, the Church is widely proclaiming abstinence and faithfulness in every way it can, while still loving and caring for the many affected families," says White.
Sarah Ruden, a freelance writer who lives near Cape Town, South Africa, adds, "The Christian churches are strongest and best positioned to bear the greatest responsibility for what can be done ... they can fit their traditional teachings about chastity and monogamy into programs to fight the disease."
Originally published July 17, 2001.
