Marry the medicine and the myth

Most Africans know what to say about Aids. It is caused by a virus. Abstinence, fidelity and condoms prevent it.
Information campaigns have achieved this much and surveys confirm it.

But having this information does not automatically translate into behaviour change. The same person who in the morning answers a survey with the right facts may have unprotected casual sex in the evening.

Interpretations of reality are multiple. Aids campaigns are based on one: the Western biomedical model where a pathogenic agent causes disease.

Designed in the capitals by Western-educated health experts and NGO staff, and funded by Western donors, these campaigns ignore traditional explanations of illness, prevention, healing and death embedded in the cultural matrix of many Africans.

“Someone did witchcraft on me and my first child got polio,” said my friend Salim Mohamed Said, a dhow captain on the Kenyan island of Lamu. He knows polio is a disease; he also believes in witchcraft.

Such beliefs are strong among rural and older people. Among younger and urban people, different belief systems may coexist.

Traditionally, health in Africa is seen as the expression of a good relationship with one’s natural, social and spiritual surroundings. The origin of illness and other problems is a disruption of this relationship.

Anthropologists list four agents of illness in Southern Africa’s traditional medicine: pollution or contamination; witchcraft and spells; ancestors’ spirits or vengeful spirits; and natural causes. The latter, like a car accident or a snake bite, can cause health problems or death but may be the consequence of witchcraft, angry ancestors or breaking taboos.

Pollution or contamination is caused by contact with certain people or objects, by breaking taboos, or by spirits.

Blood, especially menstrual blood, is a contaminant. Sex with a menstruating woman or one who has had an abortion pollutes the male body and brings disease — just like Aids. Hence, sex with a premenstrual or menopausal female may cure Aids.

Research in Malawi found that traditional healers and rural people interpret Aids within their cultural framework. They attribute Aids to breaking the mdulo complex of taboos on sexual conduct. Built on concepts of order and contamination, mdulo regulates sexual life — pregnancy, birth, initiation, weddings and funerals.

Women in central Malawi believe their sexual pleasure depends on direct contact with semen, says a Red Cross study. For them, condoms work against both good sex and fertility. In Africa children provide social security and links to the ancestors. An infertile woman or man is very unlucky. Among the Shona people of Zimbabwe, she is buried with a dead rat tied around her waist.

In Zambezia, in northern Mozambique, youth believe that if you have sex only once with a partner you can’t get pregnant or catch a sexually transmitted infection. If you do catch one, sex with a third partner will rid you of it.

“The ABC [abstain, be faithful and use condoms] message is meaningless for them,” said sociologist Nelia Taimo, the researcher in Zambezia.

Even basic ideas about the body are different.

“Every Western kid knows about the liver. In Africa, the body is like a closed box, its interior shrouded in mystery,” said Dr Kwame Ampomah, a Ghanaian who works for UNAids in Botswana. “We need to change our approach.”

Yes, we do. One-size-fits- all messages don’t work. Campaigns must be tailored to different communities, lifestyles and beliefs.

In Southern Africa 70% of people consult traditional healers. At countless workshops healers and midwives have been taught to sterilise razors and knives before ritual incisions, that sex with virgins and children does not cure Aids, and that witchcraft does not cause it. The healers return to their communities. They may sterilise the blades but have not necessarily bought into a new belief system.

In Aids prevention one knowledge system is the winner. What is needed is a dialogue between different knowledge systems, not the systematic devaluation of one of them.

Aids campaigns could use familiar concepts — HIV as a contaminant agent, or bring the mdulo complex into Aids prevention.

“Today’s fad in Aids is the multisectoral approach; that should mean inclusive of different philosophies,” says Dr Leslie Nthoi, lecturer in African traditional studies at the University of Botswana in Gaborone.

Slowly, prevention campaigns are becoming more attuned to local culture. Rural health workers in Botswana liken HIV to ticks and condoms to a protective kraal.

In Mozambique an ad compares a condom to the way villagers build a mud-and-pole hut within a circle of fire to protect it from termites.

Fighting Aids at its epicentre requires unconventional initiatives that value myth, ancient practices and cultural truths besides the Western paradigm of disease.

For example: the Makhuwa of northern Mozambique, who believe in the contaminating agent atchikoko, compare it to HIV.

In Africa healing means restoring the individual’s harmony with family, environment, and spirits. This could underpin the message of living positively with HIV.

Traditional healing therapies from Asia, such as acupuncture, reflexology and Feng Shui have gained status in the West. There is room for coexistence of different knowledge systems.

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