African Journals Online
African Journal of AIDS Research

Volume 1 Number 1 (2002)

African Journal of AIDS Research 1 (1) 2002

©2002 NISC Pty Ltd, www.nisc.co.za

It’s Never as Easy as ABC: Understandings of AIDS in Botswana

Suzette Heald

e-mail: [email protected]

Received May 2002, accepted October 2002

This paper argues for the importance of examining the way the messages of Government AIDS educational campaigns in Africa are interpreted at the local level. One of the striking features of the HIV/AIDS epidemic in Botswana is that it is not universally seen as a ‘new’ disease syndrome but as an ‘old’ one. It has been interpreted by traditional healers as a manifestation of old ‘Tswana’ diseases, acquiring new virulence because of the increasing disrespect for the mores of traditional culture, or to these diseases mutating as they have ‘mixed together’. This alternative discourses of AIDS is set first in the context of official Health Education programmes and policy. It is argued that the fact that these latter have been couched exclusively in biomedical terms, and in apparent ignorance of other conceptualisations, has been detrimental to public education and understanding. Further, it has encouraged the development of a powerful and coherent counter discourse, based in the common understandings of Tswana society and cosmology. The main concern of this paper is to contextualise this counter discourse in order to understand why there has been a move to ‘claim’ the disease, turning it thus from a global problem into a local one. It is argued that it allows not only for a trenchant critique of current morality but also of the Government and the west. In turn, this raises a more general policy dilemma with regard to the dissemination of medical information in societies with plural health care systems, each operating on the basis of different truth claims. Where, as in Southern Africa, these coincide with entrenched social divisions, educational interventions carry an inevitable political load, operating to locate the Government and its spokespeople on one or other side of the social (and epistemological) divide.

Keywords: AIDS, Botswana, traditional healers, indigenous knowledge

African Journal of AIDS Research 1 (1) 2002, 13—23

©2002 NISC Pty Ltd, www.nisc.co.za

The correlates of safe sex practices among Rwandan youth: a positive deviance approach

Stella Babalola¹, David Awasum² and Brigitte Quenum-Renaud²

1 Johns Hopkins University Center for Communication Programs (JHU/CCP), 111 Market Place — Ste 310, Baltimore, MD 21239, United States of America

* Corresponding author, e-mail: [email protected]

This paper presents the results of a 2001 sample survey and uses an ideation model to identify the factors affecting primary sexual abstinence and condom use among Rwandan youth. The findings showed that urban residence and age negatively influence primary sexual abstinence and positively affect condom use. Living within the same household as the father tends to protect girls from early sexual experimentation but has no noticeable effects on boys. Moslems are considerably less likely than Christians to report primary sexual abstinence. The use of alcohol tends to be negatively associated with sexual abstinence. The ideational factors that are significant for primary sexual abstinence are perceptions about the sexual behaviors of peers, perceived self-efficacy to refuse sex with someone truly loved, perceived self-efficacy to refuse sex with someone known for more than three months, self-esteem and attitudes toward premarital sex. As for condom use, the ideational variables with significant independent effects on the behavior are: discussion of HIV/AIDS with sexual partner, and to a lesser extent, the perceived self-efficacy to use condoms, and discussion of condom use with the sex partner. The programmatic and policy implications of the results are discussed.

Keywords: adolescent sexuality, ideation, positive deviance, condom use

African Journal of AIDS Research 1 (1) 2002, 25—35

©2002 NISC Pty Ltd, www.nisc.co.za

Kissing the Cobra: Sexuality and High Risk in a Generalised Epidemic – a case study of White university students

e-mail: tessa.[email protected]

This paper explores the social factors that may account for the way the HIV-Aids epidemic is unfolding in a racially segmented and social differentiated society. As a sexually transmitted infectious disease that particularly infects adolescents and decimates young adults, there is an urgent need to critically assess assumptions about the influence of culture and social relations on differences in patterns and the scale of infection across racial groups in South Africa. The point of departure is the recognition that while nationally there is a generalised epidemic of gigantic proportions, the epidemic among young White adults is still nascent. Through a qualitative exploration of white student perceptions of risk, sexual networking and practices in an HIV-AIDS environment, this small study hopes to shed light on some of the social and cultural issues surrounding the epidemic.

Keywords: HIV-Aids, sexual networks, perceptions of risk, race and perceptions of risk

African Journal of AIDS Research 1 (1) 2002, 37—40

©2002 NISC Pty Ltd, www.nisc.co.za

Evidence of AIDS mortality from an alternative source: A Swaziland case study

Alan Whiteside¹*, Chris Desmond¹, John King², Jane Tomlinson² and Conway Sithungo²

1 Health Economics and HIV/AIDS Research Division, University of Natal, Durban 4001, South Africa

* Corresponding author, e-mail: [email protected]

This paper explores a way of measuring AIDS mortality in the absence of vital registration. It looks at the death notices in the major daily newspaper in Swaziland, The Times of Swaziland, and asks if this can be analysed to give a picture of changing mortality. It shows how clear trends can be discerned.

Keywords: AIDS, mortality, newspapers, Swaziland, vital registration

African Journal of AIDS Research 1 (1) 2002, 41—52

©2002 NISC Pty Ltd, www.nisc.co.za

 ‘Before we were sleeping, now we are awake’: Preliminary evaluation of the Stepping Stones sexual health programme in The Gambia

Katie Paine¹, Graham Hart², Michelle Jawo¹, Saihou Ceesay³, Mariama Jallow^4, Linda Morison⁵, Gijs Walraven¹, Keith McAdam¹ and Matthew Shaw¹

1 Medical Research Council, PO Box 273, Banjul, The Gambia

2 MRC Social and Public Health Sciences Unit, University of Glasgow, Scotland

4 Gambia Family Planning Association

* Corresponding author, e-mail: [email protected]

Community-based behavioural interventions aimed at reducing risky sexual behaviour have yet to be shown to be effective in the developing world. Stepping Stones is a participatory STI/ HIV prevention workshop programme based on empowerment techniques, which has been adapted to an infertility prevention framework for The Gambia. This paper describes a preliminary evaluation in 2 villages where the intervention was carried out compared to 2 control villages. Methods used include: participatory evaluation; 84 in-depth interviews; 7 focus group discussions; a knowledge, attitudes and practice questionnaire administered to a random sample of 25% of the adult population at 3 time points; and monitoring of condom supply. The structure of the evaluation is based on the themes derived from the qualitative data. The infertility prevention approach made it possible to overcome resistance to discussing the topics of sexual and reproductive health. An atmosphere of trust was created and men were persuaded to participate in the programme as they felt that their own needs were being addressed. Participants enjoyed the programme and found the content relevant. Knowledge of the modes of transmission of HIV and sexually transmitted infections and levels of risk awareness increased. The value of condoms in particular situations was recognised: for sex before marriage, within marriage (when the woman is breastfeeding) and with non-marital partners. Women reported that they would insist on condom use outside marriage and even ask their husbands to use condoms for non-marital sex. Condom monitoring data suggested that condom uptake had increased. It was reported that there was significant increase in dialogue within marriage with the consequence that there were fewer disagreements and incidents of domestic violence. Diffusion of the messages of Stepping Stones appeared to have taken place with non-participants including children. The evaluation techniques used can now be refined in order to generate further evidence on a larger scale and over a longer period.

African Journal of AIDS Research 1 (1) 2002, 53—63

©2002 NISC Pty Ltd, www.nisc.co.za

Necessity and Sufficiency in the Aetiology of HIV/AIDS: The Science, History and Politics of the Causal Link

Ulrike Kistner

Graduate School for the Humanities and Social Sciences, University of the Witwatersrand, Private Bag 3, wits 2050, South Africa

e-mail: [email protected]

This paper was presented at the AIDS in Context Conference, University of the Witwatersrand, Johannesburg, 4—7 April 2001

Public debates on HIV/AIDS in South Africa have, for the last three years, been dominated by the controversy around the causal link between HIV and AIDS. A decision on this question has direct consequences for health policy, treatment, and education. However, this question also warrants a medical-historical investigation into concepts and models of causality and the way they have panned out in medical-scientific revolutions, and in diagnostics and treatment. As this paper attempts to show, necessary and sufficient criteria for disease causation are crucial in the debates on the aetiology of HIV/AIDS. In the course of the history of medical diagnostics, the sufficiency criterion has been considerably modified, while the necessity criterion has been foregrounded. It has been shown that the difficulties surrounding the establishment of strict sufficiency criteria do not preclude the elaboration of an aetiology of HIV/AIDS. While mainstream medical science privileges the necessity criterion, the AIDS dissenters insist on strict sufficiency for conclusive proof of the causal link between HIV and AIDS. This paper aims to show that both criteria have a role to play, but in differentiated ways and at different and distinct sites of intervention.

Keywords: aetiology of HIV/AIDS, causality in medical diagnostics, necessary and sufficient causes, medical history

African Journal of AIDS Research 1 (1) 2002, 65—70

©2002 NISC Pty Ltd, www.nisc.co.za

 Embodied history. Uniqueness and exemplarity of South African AIDS

Didier Fassin

Ecole des Hautes Etudes en Sciences Sociales, 54 boulevard Raspail, 75 006, Paris

e-mail: [email protected]

The exceptionality of AIDS in South Africa, both for its epidemiological features and public controversies, seems to have its correspondence in the exceptionalism of South African history, with its unprecedented regime of apartheid and its unexpected turn to democracy. The article shows that AIDS in this country can simultaneously be seen as unique (because of the historical context in which it is inscribed) and exemplar (of social determinants observed in other countries characterised by similar past or present of domination). As an alternative to cultural and behavioural models of the epidemic which have been widely spread on the African continent, the concept of embodiment of history is proposed in order to account for both the structural facts underlying the epidemic (inequality, violence, migration) and the construction of collective as well as individual narratives of the disease (including victimisation and accusation).

Keywords: Political anthropology, Social history, Embodiment, South Africa, AIDS

African Journal of AIDS Research 1 (1) 2002, 71—76

©2002 NISC Pty Ltd, www.nisc.co.za

HIV/AIDS Policies, Practices and Conditions in South African Prisons: Criticisms and Alternatives. Toward a Research Agenda

KC Goyer¹* and J Gow^2,3

1 Department of Political Science, University of Natal, Durban, South Africa

2 Health Economics and HIV/AIDS Research Division (HEARD), University of Natal, Durban, South Africa

3 School of Economics, University of New England, Armidale NSW, 2351, Australia

* Corresponding Author, e-mail: [email protected]

The level of HIV infection in South African prisoners is unknown. However, given that 4.2 million citizens or 20% of the adult population are infected by HIV then the problem of infection within the prison system would seem to be a large and a significant management issue.

Policies to treat HIV+ prisoners and prevent HIV transmission have been developed. However, the efficacy of those programs implemented to prevent HIV transmission is questionable. The reasons for this situation include lack of resources like condoms, lubricant, disinfectants and availability of testing. Prison conditions also militate against success especially overcrowding, poor health care and nutrition.

Little research has been undertaken into HIV within the prison system and the lack of transparency in management of the system is a major hindrance in achieving better public policy outcomes.

The issues of importance to policy research on HIV/AIDS in prison, which should receive early attention, include: 1) Prevalence rate determination; 2) Treatment of HIV+ prisoners; 3) Education programs; and 4) Early release policy and practices.

Keywords: HIV/AIDS, South Africa, prisons, policy

African Journal of AIDS Research 1 (1) 2002, 77—86

©2002 NISC Pty Ltd, www.nisc.co.za

HIV/AIDS: South African women at risk

1 Wits Institute for Social and Economic Research (WISER) University of the Witwatersrand, Private Bag 3, Johannesburg, WITS 2050, South Africa