HIV AIDS Gender Inequality and Cultural

Perceptions and Behaviour of Sexuality: A

Literature Overview
I have conducted an extensive literature
overview regarding the social and cultural
reality
ofsexuality and gender roles in HIV/AIDSinfected societies in South EastAfrica;
societies characterized by male dominance,
femalesubordination and economic
marginalization. In these societies mens
identities are considerably linked to their
sexuality and their control over women while
womens identities are fundamentally rooted
in their traditional roles as mothers and wives.
16
Womens number one sexual and
ultimate priority appears to be to please
their men. In a situation ofeconomic decline,

gross unemployment and a weakening ofall

social structures and cultural traditions, many
men perceive themselves as having lost their
traditional dominant position. As a result,
sexuality has for many becomethe one
situation they feel they can control, including
having control over somebody beyond
themselves.
It is imperative that the fight against HIV in
South East Africa be seen within this context
of a traditional submission of women to men
and their long-suffering compliance to mens
dominance, in which many women have had,
and still have, no control over their own
lives and bodies. In addition to their
dependence in both sexual and economic
terms on
men, women are also physiologically more
vulnerable to HIV than men. Baylies (2000)
explains:

All else being equal, the probability of male to

femaletransmission is estimatedto
be two to four times that of femaletomale
transmission []. The reasons are
higher concentrations of HIV in semen than in
vaginal fluid, a larger area of
exposed female than male genital
surfacearea, greater permeability of the
mucous
membranes ofthe vagina compared with
those of the penis, and longer period of
exposure of semen within the vaginal tract.
(Baylies 2000: 5)
In the Strategy Note for the 2004 World AIDS
Campaign on Women, Girls, HIV and
AIDS, UNAIDS states that young women and
girls make up sixty-four percent of people
aged 15-24 living with HIV or AIDS. In Sub
Saharan Africa girls and young women are

twice as likely to be HIV-infected as young

men, with up to six times the infection rate of
their male counterparts in parts of the subregion. In parts ofEastern and Southern Africa
more than one-third of teenage girls are HIV
infected (UNAIDS 2004d: 4).
According to the social norms, girls are
expected to be passive and ignorant in
relation to
sex, while boys are encouraged to besexually
active and havemultiple partners. This
leaves decisions of condomuse to boys, with
many still deeply reluctant to use them. Sex
is often a taboo subject, and sex education
and general knowledge about ones own body
and reproduction is minimum,with most
young people ignorant of, orindifferent to, the
risks. Culturally, girls who do have knowledge
about their own sexualityand try to protect

themselves against HIV infection are at risk of

being stigmatized as bad girls (UNAIDS
2004b).
Akeroyd (1996) points at too little attention
paid to the topics of sexual practices, sexual
and reproductive health and violent or
coerced sex in the pre 1996 HIV/AIDS
literature
fromAfrica. Based on my findings, a general
acknowledgement of the importance of these
issues is yet to come, but topics of gender
inequality and sexual belief systems and
behaviour are present in literature, even if not
yet to a satisfactory degree taken into
account in politics and information and
prevention campaigns.
5.1 Taking Culture into Account: Belief
Systems vs.
Facts

UNESCO/ UNAIDS report A cultural approach

to HIV/AIDS prevention and care
fromZimbabwe revealed that even though
knowledge and belief about HIV/AIDS was
quite high among the sample population, only
52.5 % of the respondents perceived
themselves to be at risk of HIV infection, while
95 % stated a fear of AIDS. Condomuse
was tolerated or accepted by 87.5 % of
respondents,and condoms appear to be
available,
but 75 % felt that women have no capacity
tocompel condom use, whilst 62.5 % said that
women could not refuse sex in a relationship
(UNESCO/ UNAIDS 1999: 7-11).
5.1.1 Belief Systems
In Ocholla-Ayayos work fromKenya
(1997)many of the respondents had heard
about
AIDS, but the majority of themwere not
certain about what AIDSactually is, and not

everybody could say for sure how HIV is

transmitted. Suggested pathwaysof infection
were through kissing, shaking hands,
breathing a victims air, mosquito bites and
sharing
glasses or dishes. The virus was believed to
be brought to Kenya fromoutside by
foreigners such as tourists and truck drivers,
something which by way of sexual practices
is partially true, but by singling out a few
groups as potential sources of transmission,
people are very likely to ignore the more
common risks, thus unknowingly put
themselves
at considerable risk of transmission. This
belief in victimization inflicted fromoutside is
part of a large vision which relates to
historical experiences. Somealso believe AIDS
to

be imported in food, used clothes and

medicines, hence making the preventive
actions
promoted by educational campaigns futile.
The lack of knowledge and the amount
ofmisinformation is a general problem,
exemplified by one woman in a Ugandan
focus group saying that Look, I know I have
no
AIDS, I ampregnant (Obbo 1995: 83), having
been told that HIV-positive mothers do
not conceive. Another example fromUgandais
a man stating no reason for using a
condomsince they according to him anyway
are 99 % unreliable (Obbo 1995).
In Zambia sex is referred to as mixing bloods,
a unification which should only take place
within marriage, and successfulreproduction is
the result of a state of one blood. AIDS

is believed to be a result of mixing bloods

inan unsanctified sexual union, implying that
HIV can not be transmitted between spouses
(Dover 2001).
Another widespread misconception among the
Chiawa of Zambia is that monogamy
equals safe sex, withoutrecognising that both
mutualmonogamy and neither partner
having acquired an HIV infection before
entering into the monogamous relationship
are prerequisites for this to be true. Accurate
knowledge of STDs/HIV among the young
boys
surveyed in Chiawa was mingled with
misconceptions and less than accurate or
plain
incorrect information, and there were also
variations in level of knowledge. The majority
did not change to safer sex behaviour in spite
of the basic knowledge they had, which is

consistent with several other studies

withinZambia and elsewhere, and Ndubani
claims
that researchers have been too optimistic
about the role of knowledge in behavioural
change. Behavioural changes in one area may
influence on other aspects of life, and these
changes may not be welcomed, for instance
in cases where they oppose social norms
(Ndubani 1998).
Rweyemamu, writing on sexual behaviour in
Tanzania, quotes a bus driver stating that
condoms are not safe because they are
infected with the AIDS virus, and that is why
he
does not use them. The article does however
not say anything about whether this is a
common understanding or not. Other
concerns presented relating to condoms and

preventing their use were that wrongly worn

theycan cause friction and burst, they can get
trapped inside women, condomsreduce sexual
pleasure and buying condoms is for many
synonymouswith talking openly about sex,
which is a taboo, therefore condomsare not
displayed openly where they can be bought.
There also exists a belief that masturbation is
harmful and can make people mentally
disturbed, a belief which eliminates such
practice
as an alternative to HIV-exposure. For
somewomen, insisting on condom use is
equivalent to saying I am a prostitute,
which is a chance not to be taken because
one
must be careful not to anger ones partner
and financial supporter. Rweyemamu does
however sum up by stating that there are
signsof change, and young men have started
to

listen more to women who want to use

condoms, or who refuses sex, than what has
traditionallybeen the case
(Rweyemamu1999).
Pointing out inadequate health care systems
and poor sex education ascontributing factors
to the spread of HIV, Umerah-Udezulu (2001)
states that Most people are still unaware
as to how the disease spreads fromone
person to another (Umerah-Udezulu 2001:
9). On
the contrary,Hanne strem, a Norwegian
missionary to Kenya for the last thirty-five
years, claimsthat ninety to ninety-five percent
of the population in Kenya now knows
how HIV-infection is transmitted (Olsen 2005:
16).

Nossum(2002) argues that there is a disparity

between young peoples level of knowledge

and the context in which they live. The

knowledgeis not contextualized to being
relevant
in their lives, making much of the information
obtained an abstraction or a distant
knowledge. Ndubani (1998) on the other hand
argues that young people have a tendency
not to fear AIDS. They somehow have an
illusion of invincibility (Ndubani 1998: 55),
and because they do not see themselves as
vulnerable, behavioural changeis difficult to
achieve.
The issue of being misinformed keeps coming
up,
17
indicating a strong link between
cultural belief systems and sexual practices.
These beliefs, more than anything, should
serve as a starting point for development and
health officials in order to distinguish how to

make anti-AIDS campaigns more effective.

Haram mentions a woman telling her that
since her lover hated condoms they used
Vaseline creaminstead since it reduces the
risk
of HIV transmission by at least 75 %
(Haram1995: 43), whilst Baylies and Bujra
(2000)
present a belief that men get infected by
having sex with a woman having had an
abortion
or a stillbirth, before she has had
somemenstruations for the blood to be
clean.Kondowe
and Mulera (1999) furthermore point out that
many communities believe that HIV/AIDS
can result frommagic.
Setels research in Tanzania found knowledge
of AIDS and sexual transmission of HIV to
be very widespread, and people fear it, but
having the proper information and knowledge

do not necessarily generate behavioural

change. It seems that direct experience with
AIDS
has the greatest impact on behaviour. People
see sex as their greatest entertainment, and
their way of life is seriously affected by the
existence of HIV. Men have had to limit their
number of girlfriends and shorttermrelationships, and one man formulated
his discontent
like this: Even with one girl, there is not
much fun. You need to have several to have a
good time. [] Life has becomevery
miserable (Setel 1995: 65).
Opposed to for example Umerah-Udezulu,
Akwara, Madise and Hinde (2003) claimthat
ignorance is no longer an issue, however, in
their view it is still unclear how perception of
risk influences peoples sexual behaviour. It
appears that people often rationalize risky

behaviour with socially constructed

criteriathat could explain what appears to be
a mismatch between objective risk and
perceived risk. AIDS is generally perceived a
great
threat, but not so much a personal one.
Peoples perception of risk may also depend
on
how much they trust the accuracy of the
information they are given. In 2000 UNAIDS
pointed out that general awareness of AIDS
was no longer important in AIDS prevention;
what is importantis accurate knowledge about
how HIV is transmitted. A study of AIDS
knowledge in Zimbabwerevealed that
everybody questioned had heard of AIDS, but
15 %
of men and 26 % of women did not believe
that a healthy-looking person could carry the
AIDS virus (Akwara, Madise and Hinde 2003:
392), hence they would be less likely to

take precautions.
We see here somewhat contradictory reports
of peoples perception of risk. On the one
hand there issimply littleconsciousness ofrisk,
while on theother hand risk is perceived
personal while not really understood. The
belief that a person who looks healthy can not
have HIV is not necessarily based on wrong
information or misconceptions, but simply on
peoples experience of what it means to be ill.
People think they know whatdisease looks
like; if somebody is sick you can see it.
However, contrary to every other known
disease,
being HIV-infected shows no evidence
ofillness at an early stage.
In their paper, Akwara, Madise and Hinde
treat perception of risk as an explanatory
variable for sexual behaviour. In 1998 28 % of
women and 27 % of men in Kenya

perceived themselves to be at no risk at all

fromHIV infection (Akwara, Madise and
Hinde 2003: 395). It was revealed that
teenagers tend to engage in unprotected sex.
Sometimes there is a pressure for girls to
prove their fertility before marriage and for
boys
to prove manhood by impregnating a girl or
by having many sexual partners. The risk of
HIV is high among young people, but it is
often not perceived as high, which puts this
particular age group further at risk(Akwara,
Madise and Hinde 2003).
Baylies and Bujra (2000) explain that globally,
half the new infections are among people
aged 15-24. This is in part due to health
services seldombeing designed for the needs
of
youth. In many parts of Africa, traditional
forms ofsexual education, initiation
ceremonies

and teachingby older family members have

losttheir importance while new structures to
carry out the task is lacking. Parents and
children do not talkabout sex, in part due to
respect, and adolescents learn about sex
fromtheir peers,with the knowledge presented
not always being accurate. Premarital sex is
also becoming more common among young
girls, but without the proper education.
Furthermore, in Kenya and Tanzaniasomestill
donot recognise the existence ofAIDS, or
they believe that AIDS is temporary, like El
Nio (Rugalema2004), and Ndubani (1998)
reports from Zambia that AIDS-related
diseases are often attributed to witchcraft.
5.1.2 AIDS as Foreign
Until 1993 the belief among the Chagga in
Moshi, Tanzania, was that AIDS existed
elsewhere, and that there was no danger as
long as one did not have sex with those

returning ill with AIDS. This

attitudediminished, but was not necessarily
exchanged bya
real concern.AIDS was linked to the change of
local culture, a negative development
towards promiscuity. The perceptionwas that
businessmen brought AIDS fromcities,or
fromKenya, with urban life and urban items
perceived as dangerous, and the marked an
area for transmission (Setel 1995).
In Kagera, far west in Tanzania, AIDS was first
associated with traders,mobile young
men and women and commerce, and at first
the sexual transmission was not recognized,
thus preventing people fromprotecting
themselves. In the Kilimanjaro region AIDS
was
also related to business and for many poor
smuggling was an important livelihood, with a

source of HIV infection being

femalesmugglers engaging in sex at the
border not to be
arrested (Setel, Lewis and Lyons1999).
When research for Harams chapter on the
Meru women of Tanzania was done, mostof
those affected by AIDS had been outside Meru
land and were therefore perceived different
fromthe average and well-behaved Meru; they
were young or middle-aged men or women
who had transgressed Meru tradition, hence
their infection could be traced to this violation
(Haram1995). Ocholla-Ayayo (1997) reports
alsoolder people in Kenya saying that those
getting AIDS are people who violate cultural
norms by engaging in premarital and/or
extramarital sexual relations.

Sex as a Taboo

Writing on Uganda, Nossum(2002) points out

that in many places sex is not a subject for
open discussion.
18
The taboo is part of the culturalbelief
systems, and an important
problemwhich Obbo (1995) mentions is the
perception that there isno acceptable way to
educate school children about AIDS becauseof
the perceiveddanger of encouraging
promiscuity. Obbos representation of the
voice of the young reveal that parents can not
talk to young people about sex and condoms
because these are taboo subjects which can
not be touched upon without appearing to be
promoting promiscuity, hence the young
primarily learn fromtheir peers. Piot on the
other hand states that Nothingspreads HIV
faster than silence (Piot 2004: 16), arguing
for the need for every community to find its

own language for addressing painful and

sensitive issues central inthe epidemic (Piot
2004).
In their work from2002 Kvamand Eskildsen
point out that very few HIV victims in
Africa actually know that they are infected.
Itcan take months or years after getting
infected before any symptomsare visible and
therefore neither the person carrying the
virus nor the public may be aware of ones
infection and infectiousness. People may thus
have many sexual partners and transmit the
HIV directly and indirectly to a large number
of people before they even suspect their own
infection. Many live far away fromhealth
facilities, most often one have to pay for the
HIV-test, and there are anyway no drugs or
treatment available, so there islittle
motivation for getting tested. Iftesting
positive, one

also faces the dangers ofstigmatization, of

getting expelled fromfamily and community
and of loosing ones job and home. This is
inpart because HIV/AIDS is associated with
sex, in itself often being a taboo. Sex is a
private concern and not spoken about. Since
it is
such a big risk to be open about onesHIVinfection, since HIV-infected face
discrimination, many keep quiet, if they are
evenaware of their positive status
themselves,
and therefore condoms are rarely used and
the virus is passed on to partners and often
also
frommother to child. According to UNAIDS (in
Kvamand Eskildsen 2002) this silence is one
of the most important causes of the epidemic
spreading at the current speed and extent
(Kvamand Eskildsen 2002; Loewenson and
Whiteside 1997).

19
Williams, Milligan and Odemwingie claimthat
lack of accurate information is the most
obvious obstacle to young peoples sexual
and reproductive health. This they argue is in
part a consequence of the fact that most
adults in Sub Saharan Africa (if it is valid to
make
such a generalization) believe that
withholding information aboutsex from young
people
will discourage themfrom becoming sexually
active at an early stage, however an
interpretation which is discouraged by
numerous research studies. In most parts of
Sub
Saharan Africa, sex is generally considered a
taboo subject, and attempts to introduce
sexual education in schools have been
stopped by conservative opposition. Mass
media

and entertainment industries present

degrading sexual images, and often actually
give
factually incorrect information about sex
(Williams, Milliganand Odemwingie 2001).
Schoepf (1995) claimsthat: Throughout the
world, the power of fundamentalist religious
leaders constitutes one ofthe most intractable
cultural constraints (Schoepf 1995: 34).
She substantiates this statement arguing that
fundamentalist religious leaders are
discouraging communication about sex and
fertility, which she sees central to prevention.
Similarly, in Zambia someargue against
sexual education of young people, believing it
will make themwant to try it out. Sexuality,
the effects ofgender stereotypes, ideals on
sexual behaviour and sexual negotiation is
generally not spoken about, and public

discussion islimited to the morality message

(Dover 2001). Also in Kagera, Tanzania, sex
is traditionally considered private, hence it
should not be discussed openly with children
present (Lugalla et al 1999). Furthermore, in
the book Rethinking Sexualities in Africa
Machera reveals that girls are not supposed to
view their own genitalia and that it is
insulting to refer to the vulva by its real
name(Machera 2004).
Williams, Milligan, and Odemwingie (2001)
explain that while objecting to the taboos
surrounding sexuality, young people are
deniedaccess to family planning advice and
services unless they are already married. In
many developing countries there is a
development towards physical and sexual
maturityoccurring at an earlier age than
before,

while the age of marriage is rising and taboos

against premarital sex are breaking down.

More young people are sexually active at an

early age without being married and this
usually occurs without any use of
contraception, increasing the risk of infection.
A 1996 study fromKenya revealed that
religiouspeople considered AIDS to be a
disease
affecting those who transgressed against God,
thus they saw themselves as being at low
risk of HIV. Religious leaders have also
opposed sexual education arguing that it
encourages promiscuity. The perception that
AIDS is a disease for high-risk groups
furthermore makes people less likely to take
precautions (Akwara et al 2003).
Many men believethat in Africa women can
not say yes to sex because they then will be

labelled prostitutes, hence it is takenfor

granted that when a woman says no she
actually means yes. Moreover, for women it
can be a better alternative to agree to sex, if
not directly, than to be forced, since a real
no is not an alternative. Nossums
interpretationhere is thatthe problemmay
bethat girls can not say yes rather thanthe
fact that they can not say no (Nossum2002).
5.3 Good Sex - Perceptions, Attitudes and
Behaviour
In the Kagera region, Tanzania, in order to
beconsidered as sex, sexual intercourse must
involve penile-vaginal penetration with
ejaculation inside the vagina. Many believe
male
spermto be important nutrients for women,
and that male sexual desire can only be
satisfied with a release ofspermin a woman.
Male spermis also perceived to make the

woman feel good. Contrary to the practice of

dry sex, which I will return to later,
secretion of more fluid is highly admired
among most Ba-Haya. The very common
Katerelo sex style involvesthe rhythmic
digital manipulation of the penis around the
vulva for a prolonged timewithout
penetration. The mans penis is used to
excessively
strike and brush the womans genitals, and
the rhythms of striking becomeso excessive
that tender tissues can bruise and chafe,
facilitating the transmission ofHIV. Apparently,
this sex style only works well without
condoms (Lugalla et al 1999).
In Chiawa, potency and quality of semen are
of strong symbolic value, and both are
elements of male identity. Men are expected
to be productive, women the recipients. Oral

sex is seen as a perversion and masturbation

a waste of semen. Condomuse is also
compared to masturbation, and informants
argued that Its like fucking yourself and
you have to use your imagination, its not
real (Bond and Dover 1997: 381).
During sexual acts, men are supposed to
ejaculate more than once, and more than two
rounds shows love; that a woman is good
and a man is strong (Bond and Dover 1997:
381). Sexual satisfaction is here more related
to achieved ejaculations than prolonged
bouts of lovemaking. Men say that
condomsreduce sensitivity,
20
and both men and
women complain about the fact that it takes
longer and that the number of rounds is
reduced. Furthermore, It was pointed out as
embarrassing totake condoms on and off for

each round. Somewomen claimed they would

rather catch HIV than use condoms, since
successful sex implies both discharging
sperminto the vagina and achieving
conception.
Disposal is also a difficulty, and condoms are
disposed in latrines and in the bush where a
lot ofillicit sex takes place at night time. There
were also a few stories of children using
discarded condomsas balloons, and in the
intense heat of the Zambezi river valley,
storage is a problem(Bond and Dover 1997).
Akeroyd mentions that by someAfrican
cultures regular intercourse, without a
condom, is
believed to be necessaryfor the bodily health
of both men and women as well as often
also for a foetus, as condoms prevent the
healthy flow of sperm.Other problems relating

to condoms touched upon by Akeroyd are the

fact that they are perceived to be unreliable,
and that to suggest using one equals a
confession of unfaithfulness or signals too
much
knowledge about sex (Akeroyd 1996, 2004).
5.4 The Lack of Condom Use
There are many reasons why people in South
East Africa fail to use condoms. Lack of, or
little access to condoms is one major
explanation.
21
However, just as important are the
many local cultural traditions and values
rejecting condoms, the fact that sex is a taboo
subject which leads many to neglect the
factsof transmission out of ignorance, and
the
more general feeling among many of having
no control over their own destiny or their

present situation, making themsee no reason

to protect themselves against oneof the
many diseases and defeats killing people
around themevery day. This is a fatalismalien
to western thinking, distant fromthe despair of
many African societies, and I will addressit
more thoroughly later.
22
To legitimize not using condoms, Schoepfs
informants present what she calls imaginary
dangers, exemplified by women being
warned of the potential of infection and
permanent
sterility and death if the condomshould break
or slip off, and remain in the vagina.
Another important aspect of the lacking
determination to use condoms is that
traditionally
women would rather risk pregnancy and
illegal abortions than seeming prepared for
sex

by carrying condoms, due to the fear of being

perceived as prostitutes (Schoepf 1995).
Also Mulama (2003) reports that suggesting
the use of a condomis a sign of being
promiscuous.
Bond and Dovers work on Chiawa, Zambia,
show that sex is seen basically as a
procreative act, which in itself makes
implementation of condomsdifficult. One is
not
really adult before havingproduced children,
and large families are still the ideal. Good,
proper sex in Chiawa is vaginal penetrative
sex without condoms, and procreation is an
important part of good sex. Many of the
respondents in this research did not use
condoms even when wishing to avoid
pregnancy,as well as STDs and HIV, as there
are

general negative attitudes to condoms being

connected to promiscuous people, prostitutes
and disease.
23
A woman may be insulted by a man wanting
to use a condom, or see it as a
sign of himalready being diseased. Herbs and
safe days are preferred to prevent
pregnancies and a belief existsthat prolonged
use of condomsleads to impotence, along
with semen being perceived too valuable to
bethrown away. A need for women to feel the
ejaculation also makes themmore unwilling
than men to use condoms. Especially older
women resist the use of condoms, and
theyare the ones teaching younger women
about
sex and marriage. Many are afraid ofcondoms
getting stuck inside women,
24

and men
refer to condoms as breaking, not strong
enough and too small; statementswhich are
likely to be related to male pride in sexual
vigour. Furthermore, a woman initiating a new
style in marital sex facesaccusations of
infidelity,as she must have had experience
with
another man to have acquired such
knowledge. In Chiawa it is largely men who
control
condomuse in sexual encounters, while
women normally do not have any saying, and
only around 4 % of women respondents in
Bond and Dovers study (1997) reported to
have ever used a condom. 60 % knew where
to get condoms (Bond and Dover 1997: 387),
but women and girls are often too ashamed
ortoo shy to request them. Inthis area,
condoms used to be available for free, and
consequently many refuse to buy any, even

when they are cheap. Unavailability is

however the most common reason for not
using
condoms. It was also pointed out that drunk
people were more likely to have casual sex,
but less likely to use condoms. This is notonly
a Zambian, or African, phenomena, but
because of the high HIV prevalence in this
region, one is especially liable to face fatal
consequences here (Bond and Dover 1997).
Also among the youth interviewed by
Heguyein Kahe, Tanzania, condom use was
infrequent, but the youth had a rather high
level of awareness and knowledge about
condoms. The supply was inadequate, and
negative perceptions of condoms existed.
Condomswere believed to greatly reduce
sexual pleasure, a pleasure one is entitled to
as

married people, which is why a wife could not

ask her husband to wear a condomduring
marital sex. Furthermore, it is considered
inconvenient to putcondoms on, as well as
take
themoff again, especially for drunk people,
and condoms were associated with
unfaithfulness and prostitution,
25
while also being perceived too expensive to
purchase.
For a period of time the MUTAN project,
26
a Tanzania-Norwegian HIV/AIDS project,
supplied condoms free of charge, but when
the study group left the supply ceased, as the
local shops had given up providing condoms
due to no sale at all. The majority of the
young people reported to have unprotected
sex, arguing that they could not stop having

sex because of the lack ofcondoms(Heguye

1995).
Fromrespondents in Tanzania and Kenya,
Rugalema(2004) presents the perceptions and
attitudes that condoms reduce pleasure,
condoms often break, condoms are infected
with
HIV
27
and condomspromote promiscuity and
extramarital sex, while Ndubani (1998)
report fromZambia a perception
ofcondomsaffecting male potency.
Writing on sexual behaviour in Tanzania,
Rweyemamu (1999) says it appears common
to
have more than one sexual partner, and
condoms are not used once one are
acquainted with each other, with people
probably not considering that ones sexual
partners are just as

likely as oneself to have additional

partnerswith whomthey do not use
condomseither.
Talle (1995) reports a lack in knowledge about
condomuse also among the Maasai of
Northern Tanzania. Many young Maasai men
had heard about condoms, but never seen
one, and they neither knew how to use one,
nor where to get one. Condoms were
associated with non-Maasai lifestyle, and to
use themwithMaasai women was voiced as
almost impossible, as the women would
refuse. Touse one with a Swahili- or nonMaasai
woman was however plausible to many.
In her research site in Mbale, Uganda,
Nossum(2002) found the perceptions that sex
is
not pleasurable with a
condom,condomsbreak, they can hurt the girl,
condomsin steady

relationships are a sign of mistrust and

somefind condoms unavailable or very
expensive.
Nossumalso presents condomsas
problematicbecause they do not only protect
against
sexually transmitted diseases but alsoagainst
pregnancies.
28
Among the Basoga of South Eastern Uganda,
condomsare perceived to restrain ones
pleasure. They are compared to eating sweets
with the wrapping paper on, and are
believed to damage the skin ofthe genitalia. It
is also argued that since somecan have sex
with an HIV-positive person without getting
infected, and condoms are not 100 % safe,
why should one bother to use any?
What'smore, the children you throw away to
protect

yourself by using condomsare believed to

curse you, a belief that prevents people from
using condomsby fright. Suggesting or
demanding the use of a condomis also here
perceived as a lack of trust or love (Kyakuwa
2002).
29
The contraceptive effect of
condoms is another reason not to use themin
strongly pronatalist societies, and there is
also a problem of disposal, as to where one
should throw away used condoms. These
concerns are accompanied by fears and
rumours about healtheffects and reduction of
sexual pleasure fromusing condoms (Akwara
etal 2003). Writing on Kenya, also Akwara
et al (2003) report a low rateof condomuse in
risky sexual encounters, with condoms

being negatively associated with casual or

illicit sexual intercourse and therefore not
used
by people perceiving themselves not to
takepart in those categories of sex.

Many participants in Nakuru focus-group

discussions suggested condomuse as a
protective measure, but saw problems in
carrying it out, and a blood test was
suggested as
the appropriate action totake. Half of the
womens groupswould not take any action,
out
of respect oftheir husband and to avoid a
fight, as the women have little or no
autonomy
in making important decisions, including sex
and their own health. One woman pointed

out that women can only get protection

secretly as the doctor would advise (Bauni
and
Jarabi 2000). Akeroyd in addition reveals that
at somehealth clinics a woman needs her
husbands permission for obtaining birth
control (Akeroyd 1996). Refusing sex is not an
option, and women taking initiativeto protect
themselves are likely to threaten their own
economic and social survival by provoking
their husbands and hence endangering their
position as wives. Somemen and women talk
about health concernsand family planning,
but family planning is believed to lead to
loose morals, and runs in the way of the
desires
to have a son and to achieve a family the size
of ones parents. Means suggested for
changing the behaviour of suspected spouses
were giving love, including sexual

satisfaction, reducing or stopping long trips,

counselling and prayer (Bauni and Jarabi
2000).
In Kagera, Tanzania, on a question of how to
avoid HIV, many responded to obey God,
stopping adultery, abstain and to be faithful.
Most conservative religious groupings
oppose the use of condoms. Condoms are
believed to cause female sterility, to pollute
the
womb, and to potentially cause injury or
death if they slipoff and get trapped in the
vagina. Some also think that condoms are too
thin to protect against anything. Men in
Kagera complained about condoms lessening
sensitivity, and condoms are also here
believed to promote promiscuity and
unfaithfulness, and they are seen as a sign of
loose

behaviour, something which is perceived

veryshameful. It is even shameful to buy
condoms, and condoms are in general
associated with mistrust (Lugalla et al 1999).
30
In Silberschmidts field work fromrural Kenya
and urban Tanzania (2004), condomswere
reported increasingly common, but new
partners stop using themonce they know each
other.
31
It is very difficult, or often impossible,for
women to negotiate safe sex, and to
suggest the use of a condomis seen as
disclosing ones disrespect too openly. When
extramarital relations are permanent, using a
condomis not an issue for either women or
men. People do generally not perceive
themselves to be at particular risk; therefore
they

see little reason for taking protective

measures themselves. Apparently,
condomshurt a
mans ego, and semen is necessary not only
for the conception, but also to grow the
pregnancy. Semen is perceived too valuable
to be thrownaway, and masculinity is
closely associated also with
fertility.Silberschmidt argues that men tend to
refuse
condoms because it is expected of them, and
not necessarilybecause they personallyresist
using them. Furthermore, the rumour that
condomsare infected with HIV is widespread
(Silberschmidt 2003; 2004).
In their thematic pamphlet on HIV/AIDS
inZimbabwe, Kvamand Eskildsen (2002) point
at the cost of condoms, stating that even if
condoms are available they are often so

expensive that most poor people choose

rather to spend the small amount of money
they
have on food. Another important element in
the deficient usage of condoms is the strong
position of the Catholic Church in Zimbabwe,
seeing that they do not approve of
condoms. In stead they want people to
abstain frompre-marital sex, and when
married
keep to one partner only (Kvamand Eskildsen
2002). Correspondingly, Setel (1995) refers
to a Lutheran priest who implied that
promoting condomswould equal promoting
experimenting.
Religious groups in Chiawa oppose condoms,
and the fact that condoms curtail fertility
and save lives is used against them. The
argument goes that condoms symbolises

immorality and womens uncontrolled

sexuality. Fertility is highly valuedand STDs
are
shameful, causing a negative view on
condoms asthey prevent conception and
represent
disease symbolising infidelity, as well as
unsuccessful sex and efforts to control
reproduction. Christian religious groups also
claim that HIV passes through condoms.
Moreover, condomsenable people to engage
in extramarital sex and cause mistrust in
relationships, being a symbol of
unfaithfulness. However, condomsare also by
some
associated with caring for oneself and ones
family. If people use condoms at all, they tend
to use themonly within certain extramarital
sexual relationships. The use is highly
inconsistent, which seriously undermines their
effectiveness for preventing HIV/STDs.

Condomsare less likely to be used with

steady or decent girlfriends orboyfriends,
steady meaning not being seen with too
many other men or women, without stating
how many is too many. In contrastto many
other places and communities, in Chiawa
there is a
pronounced preference for married girlfriends
and boyfriends as they are perceived likely
to have a lower number of sex partners,
hence being less likely than the unmarried to
have
STDs (Bond and Dover 1997).
In their article on family planning and sexual
behaviour in Nakuru district, Kenya, Bauni
and Jarabi (2000) say that even though the
prevalence of contraceptive use in Kenya has
been increasing, most people still object to
the use of condoms. While people in the
Nakuru district consider the risks of unwanted
pregnancies and HIV to be serious

problems, they do not use condoms within

marriage nor refuse their partners sex, even
when suspecting themof being infected and
having concrete and legitimate fears of HIV
transmission. Due to economic and social
inequalities and age disparity, women in the
Nakuru district are in a subordinate position,
lacking decision making power. STDs are
perceived as something one can contract
frompeople fromoutside the area, and rural
people see both STDs and HIV to be
mainlyurban phenomena, even though STDs
are a
serious problemin the area. Knowledge
aboutcondoms appears to be widespread, but
their acceptability and use are not.
However,many men resist condomuse within
marriage
while being more willing to use themwith
extramarital partners. The women did not

pronounce any explicit opposition against

condom use, and many wanted their men to
use
them, while one woman concluded that
people inrural areas lack knowledge of how to
use
condoms. Reservations against condomuse
mentioned were condomsrupturing in the
process of sexual intercourse, reduction of
sexual pleasure for both man and woman,
that
the condomis slippery, that men think
condoms encourage immorality in their wives
and
that they themselves do not fulfil their duty
asmen in terms of sexual satisfaction if using
condoms. Furthermore, religiousteaching
inhibits condomuse,
32
disposal is a problem,

people known to be using condoms are

considered promiscuous and condoms are
perceived to be something shameful.
Interestingly, though, without being stated
directly, it
appears that men here are expected to satisfy
their women sexually (Bauni and Jarabi
2000).

Condomsare also viewed as Western-imposed.

In Tanzania there is a widespread
suspicion that the national AIDS control effort
is subsidized by condomcompanies in
Europe and America. Setel (1995) explains
how rather than introducing regular condom
use, people in Northern Kilimanjaro,Tanzania,
reduce their number ofpartners. Some do
however use condoms with partners they
perceive to be especially risky, and young

women generally consent to sex only with

partners they consider clean, while some
insist on using condoms with all but one or
two regular permanent partners.
The dominant ideology in Uganda, according
to Obbo (1995), stresses morality, chastity
and monogamy as more effective than
condoms inthe fight against HIV. According to
the dominant male and elite voices (Obbo
1995: 80) information and knowledge would
be enough to change behaviour, and hence
they are supporting campaigns of abstinence
and faithfulness. Social relations surrounding
many sexual encounters are thereby ignored,
especially the issue that many women are in
no position to say no. Obbo also points out
that this moral encouragement takes place
ina condomless context. First condoms were
not available and then they were portrayed as
promoting promiscuity. Men also associate

using condomswith eating sweets with the

wrapping paper on, or with taking a shower
wearing a raincoat, an association made
throughout Eastern and Central Africa. Muslim
men have besides been reported snipping tips
off condoms before using themin symbolic
association with their circumcised bodies.
Used condoms are also perceived a problem,
as
they are discarded outside disco halls, and
there is a concern of goats choking on
themand
children playing with themas balloons.
Fearwasalso expressed of condoms falling off
and getting lodged in the vagina, an image
which naturally frightened women in terms of
their reproductive health in a society where
barren women are pitied and mothers are
respected (Obbo 1995: 83).

Contrary to most of the literature reviewed

here, Aliro, Ochieng and Fiedlers work on
male adolescence and sex education in
Uganda reveal that in a group of girls 15-19
years
old, none reported having problempersuading
boyfriends to use condoms as long as the
request was made at the beginning ofthe
relationship. This is however Uganda, the only
East Africancountry which has been
successfulin halting the spread of HIV, and it
is
unfortunately not representative of South
EastAfrica as a whole. InUganda urban boys
also tend to have more positive attitudes
towards women than their rural counterparts,
and condoms are an integral part of many
Ugandans sexual lives (Aliro, Ochieng and
Fiedler
1999).
5.4.1 The Importance of Offspring

Baylies and Bujra (1995) state that in Africa

fertility is very important to womens status,
and therefore womens knowledge and
attitudes relating to condomuse are not
enough to
change behaviour. For many African women
choosing childlessness isnot an option, and
to have children one must have unprotected
sex.
Throughout South East Africa offspring is very
important,
33
and therefore prevention of
conception in marriage is often unheard of,
making HIV prevention by promotion of
condoms difficult. When a womans value
depends on her ability to reproduce,
unprotected sex is necessary also when the
husband has become HIV infected elsewhere.

In Uganda, women are normally the ones

blamed for infertility, furthermore the desire
to
have children, or children of a preferred sex,
may trigger extramarital sexual relations
(Sengendo and Sekatawa 1999).
According to Karanjas work fromUganda
many men resist using condoms. It was
argued
that condoms do not work, and also here the
metaphor that having sex using a condom
would be like eating sweets with the wrapping
paper on, was used. For somereason, HIVpositive men were especially reluctant to
condom use, and one woman quoted her
husband
saying there was no reason for himtodie
alone. In order to havechildrenwomen are
forced to have unprotected sex whether or
notone or both partners are HIV-infected, and

somewomen secretly used undetectable

contraceptives for child spacing, but without
being able to protect themselves against
sexuallytransmitted diseasesincluding HIV
(Karanja 2003).
In Kagera, the aimof sexual intercourse is
procreation rather than recreation, and people
marry in order to have children. Having many
wives and fathering many children are signs
of manhood, success andvirility, andalso here
condomsface negative attitudes because
they prevent conception (Lugalla et al 1999).

Intravaginal Practices and DrySex

Based on their Zimbabwean study, Wijgert
etal (2001) explain that women believe
engaging in intravaginal practices
34

promote cleanliness, fertility and good health

in
addition to enhancing male sexual arousal.
Conception is believed to depend on a clean
environment and excessive vaginal secretion
and semen are classified asdirt. Insertion of
substances, often powder, inside the vaginato
narrow it in preparation for sex is
widespread. Resembling the cultural beliefs
concerning good sex, this is a cultural belief
of good conception. Other reasons for this
practice are to dry the vagina to please the
sexual partner, to warmthe vagina, to
increase the womans own sex drive and to
persuade the partner to be faithful.
Sometimesthese substances are left in the
vagina
during intercourse, but most often they are
washed or wiped out before sex. The decision

to use intravaginal practices is usually made

by the woman herself and is not discussed
with the partner, although dry sex is preferred
by Zimbabweanmen.
The phenomenon of dry sex is repeatedly
mentioned as a risk factor in the literature
reviewed.
35
Referring to Schoofs Death and the second
sex from1999, Umerah-Udezulu gives the
following description ofSouthern African
womens practice:
These women dryout their vaginal walls with
detergent, salt, cotton or shredded
newspaper to create a dryenvironment for
sexual intercourse. The dryness causes
vaginal lacerations during intercourse and
suppresses the uterussnatural bacteria,
which then leads to higher rates of infection
and contributes to the spread of

HIV/AIDS. Even when condoms are used,

women still risk becoming infected
because condoms mayslip or tear due
toexcessive friction in the dry vaginal
environment. (Umerah-Udezulu 2001: 6)
Akeroyd (1996) adds that the use of
intravaginal substances, vaginal drying and
tightening, can cause both penis and vagina
tobecometraumatized during intercourse and
cause lesions.
According to Wijgert et al (2001), many
researchers have expressed concern about
the
problems of reduced acceptability and
efficacyof condoms where intravaginal
practices
are widespread. Condoms are usedless
frequently and when used they are more likely
to

break due to the increased friction, whilemany

women do not want to use condoms because
skin to skin contact is necessary for the
magic of drying agents to work
(Wijgert et al 2001: 142). Whereas most
women intheir study indicated a liking of dry
sex, many also regularly experienced pain
during sex.
Dry sex is common also in Chiawa, Zambia,
and women here believe it is shameful to be
watery, as wet sex implies infidelity and a
wish to prevent conception. Men and women
agree that women should be dry and warm,
not like a snail (Bond and Dover 1997: 383).
Dry sex makes men feel big and women feel
small and the lubrication provided by
condoms is the opposite of this ideal.
Somewomen also state that condomscause
pain.
The use of agents to dry out the vagina may
give women the perception of controlling

intercourse and fidelity, and their need to

satisfy men justifies the practice (Bond and
Dover 1997).
5.5 Womens Subordinate Position
The UNAIDS report Facing the future
together (2004) focuses on gender inequality
and
the need to transformthe status of
SouthernAfrican women. It points at the
inability of
many women and girls to engage in sex as
equal, or even willing, partners as well as the
pressure on women to care, leading them
further into poverty and making them more
likely to engage in high-risk sex. Young girls
are especially at risk due to physiological
factors, as their vaginal membranes are still
immature and easily torn during sexual
intercourse, along with the fact that girls tend
to have sex with boys and men at least 5

years their senior. This age difference creates

unequal power relations which are often
reinforced through coercion, abuse and
violence. The older the man is the higher is
also
the likeliness of himhaving contracted HIV.
Still, in Sub Saharan Africa, girls aged 15-25
are two and a halftimes more likely to be HIV
positive than their male counterparts, and
in Zambia and Zimbabwe almost 80 % of
those aged 15-24 with HIV/AIDS are female
(UNAIDS 2004b: 8).
Lugalla et al (1999) moreover bring forward
girls early age of first sexual intercourse as
an issue of concern. Before menstruation
begins, the lower reproductive tract is
immature
and especially vulnerable to tearing, whereas
to men, breaking virginity is a sign of power

and control of female sexuality. Sometimes

penetration is even done without foreplay
while the vagina is still dry. A male informant
summed up the gender inequality well,
stating: Even if they suffer, it does not
matter to me. Women are born to suffer
(Lugalla
et al 1999: 395).
The IRINnews article Traditional Culture
Spreading HIV/AIDSfrom2004 on East Africa
argues that the legal systems,
36
governance structures, value systems and
wife exchanging
with land or cattle all uphold the subservience
of girls and women. Furthermore, widow
inheritance, widow cleansing, wife sharing,
polygamyas well as femaleand male
circumcision, both due to reuse of unsterilised
knives or razor blades and increased risk of

female bleeding during sex, all contribute to

the spread of HIV. Whereas boys are taught
that being able to control relationships is a
sign of manhood, while they are encouraged
to
be promiscuous, girls learn that males are
superior in all spheres of life and are to be the
masters of sexual relationships.
37
In addition, dowry payments make women
mens
property, lack of basic education among girls
and women make themunable to access
HIV information
38
and young women are kept ignorant of sex as
a sign of innocence,
which is alsomaking themunable to
negotiatesafe sex (Traditional culture 2004).
This is

also in line with Macheras description of

coercive gender relations existing in most of
Africa that predispose most women
toinfection (Machera 2004: 167).
Akeroyd argues that especially young women
may be powerless to control the sexual
behaviours of their partners, asthey are not in
a position toresist sex. She also sees
womens vulnerability as in part a result of
their legal status. Women are disadvantaged
in
respect to customand they are deprived
ofsomecitizenship rights which make them
subordinate to their husbands and their
husbands family in everyday gender
relations.
These are gender inequalities which are taken
for granted by women as well as men
(Akeroyd 2004).

Writing on Tanzania and Zambia, Baylies and

Bujras (2000) starting point is that low
levels of literacy among women in Africa
make themespecially vulnerable to HIV/AIDS.
Womens access to information about STDs
and HIV, as well as health care, is limited
because they are less mobile and also
economically dependant.
39
Baylies and Bujra argue
further that generally women are subordinate
in sexual encounters and havevery little, if
any, influence on these. Subordination of
womens needs and desires in intimate
relations
is linked to a general subordination in wider
society: Women have less access to
education, they are in a weaker position at
the labour market as well as politically, and

with little education and few saleable skills

the subordination is most profound in
womens economic position. The promotion of
the ABC of HIV-prevention Abstain, Be
faithful and use Condoms is based on a
behaviour model of free choice, but in these
societies there are often no real choices,
especially not for women. Hence, this
campaign
rings false for most Africans and it has not
been as effective as intended.
Based on research fromTanzania,
Rweyemamu points out that women
experience
domination and discrimination their whole
lives, as they are fed less than boys, they are
less played with, they lack control of their own
bodies, and many live in fear of violence.
40

This hegemony is deeply rooted and

somemen claimthat for a woman to be
dominated by
a man is one of Gods plans; women were
created to service and be submissive to men,
leaving no option for girls to say no to sex or
negotiate safer sex. Others do, however,
disagree with these cultural beliefs and
claimthat today a girl and a boy are on par
and
that a girl can complain if she is not pleased
sexually by her husband. This author also
believes that gradually Tanzanian men,
particularly the educated ones, are starting to
accept womens sexual needs. A Dar es
Salaam butcher even claimed that a
husbandis
never offended if his wife initiates sex, which
is an example of women in cities having
greater sexual freedom, while lack of
education tend to make village husbands

conservative (Rweyemamu 1999).

According to Lugalla et al (1999), the Ba-Haya
of the Kagera region, Tanzania, consider
women to be a weaker sex. This perception
isput forward in the distinction that women
are married; they do not marry. Men are
the ones who marry theactive tense ofthe
word. The sameverbal difference applies to
sex; men act upon somebody sexually while
women are acted upon. This is referred to
astypical in most cultures in Sub Saharan
Africa. Men take the lead and womens
preferences are not discussed. Women are in
fact
not allowed to negotiate sex, and men
decidewhen, where, how and with
whomsexual
relations areto take place. Most women are in
no positiontodiscuss condomuse or refuse

risky sex. Patriarchal authority is strong, with

male dominance in both family and
community, and polygamy is strongly
supported.Trying to negotiate safer sex with
their
husbands may result in being thrown out
ofthe marriage and losing access to work and
farmland as well as children. A certain level
ofviolence by husbands tends to be allowed
by Ba-Haya traditions. Womens role is to
obey and implement, and women are by men
put on par with children. Men caneasily throw
their wives out and take new ones in their
place. If a woman shows signs of HIV before
her husband does, she risks being kicked out
of the household and sent back to her
parents. Somewomen thus refrain
fromvoluntary
HIV testing out offear oftesting positive.
Womens experiences in marriage are
summed

up as oppression, subordination,
powerlessness, poverty and exploitation.
Akwara, Madise and Hinde describe how
Kenyan married women, trying to negotiate
safer sex, face a danger of being suspected of
promiscuity bytheir husband, even when the
reason for bringing up the issue is knowledge
about the husbands extramarital relations.
In their study higher proportions of men
thanwomen reported risky sexual behaviour,
but
mens sexual behaviour also affect their
women. While men have multiple sexual
partners,
women tend to have only one casual partner,
and someare engaged in such sexual
relations for economic reasons (Akwara et al
2003). Furthermore, Dover point out that in
pre- and extra-marital relationships women
are especially disadvantaged in negotiating

(safe) sex because they have no ability to

enforce men to take responsibility if they get
pregnant (Dover 2001).
Writing about Africa in general, also Baylies
and Bujra (1995) point out the striking
gender inequality. While men may divorce
wives who test HIV positive, most women are
in no position to even negotiate safer sex. The
two co-authorsstate that Social structure
limits the ability ofwomen to
becomeindependent actors exercising social
agency
(Baylies and Bujra 1995: 213). Women in
Rugalemas work see AIDS as a disease they
have no power either to control, or to run
away from, as they were unable to control
men,
and for a woman to even talk about
condomswas unheard of (Rugalema2004).

Akwara et al (2003) see womens

powerlessness to negotiate safer sex as the
central
obstacle (Akwara et al 2003: 386) to HIV
prevention in Africa, while Akeroyd (2004)
argues that what is important to notice is
thatemphasizing the situation of the weaker
part
in sexual interactions does not solve the
problems of HIV transmission. When women
are
not in a position to protect themselves, it is
not sufficient to teach themabout the risks.

Karanja (2003) points out male infidelity tobe

a principal cause of HIV infection in
women; married women are actually more at
risk of contracting HIV than single women,
due to the power relations in marriage. In the
report this viewis substantiated by the

statement: The single woman does not have

a contract (Karanja 2003: 23), which is
important in a society where the belief is
thatwives have no right todeny their
husbands
sex.
Referring to the muted voices of women,
Obbo(1995) states without a question that the
accepted religious and social practicesthat
allow men to enjoy multiple partnerships
while
strongly condemning womens expression of
their sexuality, havebeen key factors in the
spread of HIV. While men choose sex partners,
women are expected to be available.
Someadult male informants felt that it is a
mans right to have pleasurable sex no matter
what may occur, furthermore men
increasingly perceived marriage to young
women, and

sometimes girls, the solution to AIDS.

5.5.1 Economic Dependence andLack ofRights
Williams, Milligan and Odemwingie(2001)
state that: In mostAfrican cultures, womens
lack of economic opportunity leads themto
dependence on men (Williamset al 2001: 6),
a situation which deprives women of the right
to refuse sex or demand safer sex.
41
In her
thesis fromthe Mbale district, Uganda,
Nossumclaimsthat many women contract HIV
having sex with nobody but their husbands,
42
and being economically dependent
43
they
can not leave the marriage. Women have a
weak position in society, and cultural tradition

often conquer modern laws when it comes to

inheritance from man to woman. This often
leaves women with nothing, even though
legally claiming 15 %, and that is an injustice
with pronounced consequences in a timewith
AIDS (Nossum 2002). Correspondingly,
Loewenson and Whiteside (1997) argue that
women have more vulnerable employment
status and security, lower incomes, less
access to formal security and less entitlement
to,
or ownership of, assets and savings.

A 2004 UNAIDS report states that in many

southern Africancountries, women still lack
property and inheritance rights. They are
treated as legal minors and made dependent
on
men, putting themfurther at risk of sexual
exploitation and violence.

44
The fear of stigma
and violence fromones partner is for many
women an impediment not to getting tested
or
seek treatment for HIV. The power relations
also contribute to women being reluctant to
confront the family bread winner on the
sensitive issue of using condoms (UNAIDS
2004b). Baylies and Bujra (2000) moreover
point out that AIDS-widows without
inheritance rights have limited options,
making the path to sex work and other risky
behaviours short. Also Akeroyd (1996)
acknowledges that women have a relative
economic, personal and social vulnerability,
and someturn to sexual survival strategies
which are in fact, due to HIV/AIDS, becoming
strategies of death.

Obbo (1995) talks about patrilineal

descent,the reality of women having no
economic
rights without husbands, and womens task
being to be mothers to mens children, which
force HIV-positive women to opt formaternity
asthe only way to access socialstatus and
resources. Based on her pre 1995 studies in
Tanzania, Haram(1995) saysthat traditionally
women wereeconomically dependent on
marriage,lacking the right of ownership of
land,
and their sexuality was closely connected
withfertility and reproduction. She then
present
it as a positive development that women
cannow exchange their sexuality for a job
opportunity, money, education or school fees.
Haramstates that single women, unmarried,
separated, divorced and widowed alike, are

socially and economically marginalized, and

therefore they tend to have multiple partners.
If a single mother marries, she has to leave
the children behind (thetext does not say
where/ with whom), and consequently such
anopportunity is refused. Apparently, it is
more attractive to have a sexual relationship
with a married man with enough money for
extramarital relationships. Women keep
boyfriends to attain a higher economic
standard,
which in the time of AIDS can lead to death,
but many can not afford to abandon the
relationships in order to reduce the risk.
Sexual relationships are often investments in
social security for women in female
headedhouseholds. Single mothers optimal
sexual
partner is the affluent or elite man who has
accessto scarce resources, but since he is also

likely to have a wide sexual network, he is a

very risky partner. While men are considered
polygamousby nature, female extramarital
sex equals adultery and is disrespectful.
Haram
refers to a Ugandan study stating that the
major risk factor for HIV among wives is the
extramarital sexual activity of their husbands
(Haram1995: 45). Furthermore, the fact
that women can not control their husbands
sexual life is a partof themnot being able to
control their own (Haram 1995). However,
there are considerable national and local
differences in womens degree of dependence
and independent roles, most emphatic
between rural and urbancommunities.
5.6 Risky Traditions, Rituals and Ceremonies
In this section I will present a number
ofcultural traditions, rituals and ceremonies
that are

all facilitatingthe spread of HIV. Traditional

practices of female circumcision, widow
inheritance, katerelo the practice of
achieving arousal by drumming the clitoris
with
the penis, which is seen incompatible
withcondomuse, wet and dry sex, which
are
both likely to cause skin abrasions, and
abstinence fromsex with pregnant women or
new
mothers are all repeatedly mentionedas
potentially generating the spread of HIV in
South
East Africa.
According to a National AIDS control
programme(NACP) study referred to in
Kondowe
and Mulera (1999), Malawians continue to
uphold cultural values, beliefs and practices

which entail the risk of HIV infection. Kondowe

and Mulera make mention of a series of
cultural aspects that may contribute tothe
spread ofHIV. The list consists of initiation
ceremonies,where boys and girls learn theory
and practice ofsex before, and in
preparation for, marriage, death rites,where
the widow is required to have sex as a
cleansing ritual, property grabbing,in which a
widows property is taken by male
relatives andshe is left with nothing, making
the road to selling sex short, widow
inheritance,
45
polygamy,
46
traditional medicineand the belief in
witchcraft,which may
prevent scientific understanding of HIV/AIDS
and the practice in cases where a woman

does not get pregnant, a traditional healer

have sex with her, or recommend her to have
sex with others, as part of the healing process
(Kondowe and Mulera 1999).

To illustrate the influence ofculture on

HIV/AIDS in Uganda, Sengendo [s.a.] gives a
list
of cultural features including twin
rituals,which are associated with large
consumptions
of alcohol, dancing, and merry-making: an
environment conducive to risky sex, postpartum sex, a ritual where the
parents,whether married or not, must have
sex before they
can have a normal sex life with any other
person and sex in the event ofsending away
ones daughter to get married, the parents
being the biological ones, no matter their
relation atthe time.

47
Male healers specializing in treating infertility
by having sex with
their clients is also here mentioned as a likely
source of HIV infection. Also Obbo (1995)
writes about a male diviner treating a woman
for infertility by sleeping with her. He points
out that even with high HIV prevalence in the
area, no one seemedconcerned about the
dangers of that practice.
Initiation ceremonies are by someseen as a
healthy formof health promotion, minimizing
premarital sexual experimentation, while
others blame it for promoting early sex
between
boys and girls and between men and young
girls, as well as early marriages and divorces.
In someof these ceremonies, a man has the
task of anonymouslydeflowering virgins

(Lwanda 2004). Webb reports fromZambia a

concern that because the average age of
marriage is rising, the time period between
girls puberty initiation ceremonies, which
teach about sexual behaviour, and marriage,
isextending. Girls are eager to act out what
they have learned, and here being sexually
aware also appear more attractive to boys.
Initiation is however now on the decline in
Zambia (Webb 1997).
Kondowe and Mulera (1999) also make
reference to initiation and the fact thatin
some
cases the initiates are encouragedto have sex
upon graduation.Other cultural factors
potentially facilitating HIV-transmission,
mentioned by Lwanda (2004), are unmarried
females postnatal abstinence being
concluded by surrogate sex, the use of
surrogate in

male infertility, the belief that STDs can be

prevented with charmsand vaccines, men
generally refusing the use of condoms, the
use of vaginal tighteners and men having
mistresses.
In somerural Tanzanian communities it is
common for a wife to return to her parents
while pregnant, leaving the husband
searching for other sexual partners.
Rweyemamu (1999) also makes mention of
somecultures in which it is believed that after
a child is
borne, the mother has to abstain from sex till
the child reaches a certain age,because of a
fear that sexwill seriously affect the child,
whichis even another reason for the husband
to look for sex elsewhere. The text does
however not explain this belief any further,
nor
does it state any time period of the prescribed
abstinence.

48
Correspondingly, Blystad
(1995) points out that while Tanzanian wives
are abstaining sex due to pregnancy, birth,
convalescence and nursing of infants, their
husbands have sex with other women within
the acceptedpartner categories.
According to Akwara, Madise and Hinde
(2003), it has been suggested that African
societies aremore tolerant ofmens infidelity
because ofthe practice ofpostpartumsexual
abstinence.
49
In Kenya this abstinence is as short as 2-4
months, and the region with
lowest level of reported risky sexual behaviour
also has the lowest median duration of
postpartumsexual abstinence. In Baylies and
Bujra (2000), long postpartumabstinence is

mentioned as protecting women against HIV,

but at the sametime their husbands are
likely to haveextramarital sex during this
period, increasing womens risk.
Among the Basoga of South Eastern Uganda,
blood and mothers milk have been the basis
for the local culture of kinship. This is now
threatened by the knowledge of HIV
transmission through sex and breastfeeding,
at the sametimeas these fluids cultural
importance act as hindrance for changing
traditions and risky behaviour. Ones mothers
family is referred to as those who breastfed
us and the belief is thatif your mother never
breastfed you, you would not have grown. To
betray ones siblings, with whomone shared
the breast, is to betray oneself and the
mothers love. Handing out infant formula as
breast

milk substitute to prevent mother-to-child

transmission of HIV thus undermines the
reproduction of intimacy, family and
belonging, and also womens social value, as
giving
birth is not sufficient to qualify as a good
mother, one is obliged to express ones
motherliness by breastfeeding ones children
(Kyakuwa 2002).
Writing on Kenya, Akwara, Madise, and Hinde
(2003) inaddition draw attention tothe roleof
ethnicity. Ethnicity is here presented as
analogous to other cultural identifications in
the way that it may influence sexual
behaviour through cultural beliefs and
practices. This is
exemplified by the traditional practices of
widow inheritance and the practice of widows
having sexual intercourse with a male relative
of the deceased as ritual cleansing. In his

press article fromKenya and Uganda,

Mulama(2003) correspondingly presents a
widow
cleanser whose work is to performa sexual act
with women whose husbands have passed
away. Most likely he is also spreading HIV on
his way.
5.6.1 Widow Inheritance and Wife Sharing
Practices
Widow inheritance is repeatedly mentioned,
whereas not very muchis said about it.
50
In
addition to widow inheritance where the
deceased mans brother is given the widow,
Lwanda (2004) also tells about widower given
wifes younger sister.
In the Kagera region, Tanzania, widow
inheritance is common. Men here marry or
have

sex with widows of AIDS victims if they

seemto remain healthy (Lugalla et al 1999).
Also among the Basoga of South Eastern
Uganda, widow inheritance has been
common,
but are, due to AIDS, now hardly visible
(Kyakuwa 2002). Among the Iteso of
Kawempe,
Uganda, widows belong to the heir. A widow
isinherited by the heirregardless of the
cause of death, and thatman is entitled to all
privileges and benefits of the deceased. Thus,
if the deceased died of AIDS, the heir will
most likely also inherit his HIV infection
through the widow (Sengendo [s.a.]).
Among the Basoga of South Eastern Uganda,
the practise of double succession is very
important. Sex between a man and his
brothers wife is traditionally accepted, and
when a

man marriesa woman, she becomes a wife,

and hence property, to the entire clan.
Children born out of such relationships are
legitimate children.
51
Basoga men may
however refuse such sexual relationships,
except if it is a death where a brother has to
take
over as the heir. The word adultery does not
have any equivalent in Lusoga
vocabulary,
52
but women are punished for sexual
relationships outside their husbands
family or lineage (Kyakuwa 2002). In Kagera,
if the husband is absent, other men within
his family are also allowed to have children
with his wife (Lugalla et al 1999).

Sengendo also makes mention of a practice

inUganda where boys have sex with younger
wives of their fathers, girls often their own
age (Sengendo [s.a.]).
53
Sengendo and
Sekatawa (1999) note that among the
BahimaofUganda, the father of the
bridegroom
used to have the first sexual access to the
new bride to test where his cows have gone
(Sengendo and Sekatawa 1999: 10), as the
bride was an addition to the family and the
clan. The report does however not reveal ifthis
is still a current practice.
5.6.2 Genital Surgery
Akeroyd (1996) argues that too little attention
has been paidto cultural modification of
genitals in the pre-1996 HIV/AIDS literature
fromAfrica. According to Umerah-Udezulu

(2001) on the other hand, there is no direct

statistical connection between genital surgery
and the spread of HIV in Africa, but poor
performed surgeries and genital bleeding
during
intercourse are potential sources of HIV
transmission.
According to Akeroyd (1996), the results of
the research on the connection between male
circumcisionand HIV-prevalence vary
fromcircumcised men having a lower HIV
prevalence to circumcised men having a
higher HIV prevalence than those
uncircumcised.
She hence argues that the additional finding
ofmale circumcision also benefiting women
against HIV-transmission should not be given
too much emphasis.
According to Nossums thesis (2002)
fromUganda, male circumcision is what gives
a boy

his identity as a man, along with it being an

arena for HIV transmission. In her view, the
following party with lots of alcohol and sexual
activity is however more important as a
potential source of transmission thanthe
surgical procedure itself.
Correspondingly, Schoepf (1995) mentions
Eastern Ugandan male circumcision
ceremonies as an arena of HIV transmission
as family return to their villages to honour the
boys and engage in a celebration where
alcohol and sex is a valued part of the
exchange
between visitors and hosts.
In his listing of risky cultural practices,
Sengendo [s.a.] mentions female genital
modification through labial elongation. He
refers to it as a means of promoting mutual
pleasure
54

, but he does not explain why he perceives it

to constitute an increasing risk of
HIV infection.
5.7 Gendered Sexuality
In the following I will look into gender
inequalities and gender roles relating to
sexuality.
The article Traditional Culture Spreading
HIV/AIDSpoints out that much due to rape,
coercion and sex with older men, as well
asbiological factors and man-made sociopolitical factors, girls aged 15-19 in Kenya,
Uganda and Tanzania are six times more
likely to be HIV-positive than their male
counterparts (Traditional culture 2004: 1).
5.7.1 Polygamyand Multiple Sexual Partners
An explanation often proposed for the high
levels of HIV infection in Africa is polygamy.

It is argued that multiple partners increase

the sizeofsexual networks, and hence
increase
the risk of HIV transmission. Polygamy is also
perceived to promote extramarital sexual
relations as young women married to old men
seek younger partners for sexual
satisfaction, while competition between cowives about the sex and number of ones
children may encourage themto search for
alternative partners for conception outside
the
marriage (Ocholla-Ayayo 1997).
55
Among the Barabaig in Tanzania,
polygamyisthe preferred marriage form. Both
sexes
have sexual relations with others than their
spouses, and women may receive their

husbands clansmen or friends as lovers and

have their children. Both love and
reproduction are motives for extramarital
relations, and the women have considerable
control and power of persuasion in
relationships with men, although less so with
their
husbands than their lovers (Blystad 1995).
In Tanzania,tribal customs as well as Christian
and Muslimreligions dictate abstaining
fromsex before marriage and staying faithful
within, while neither ofthe two is widely
practiced. Both Muslimand many tribal
customs do however allow a husband more
than
one wife. In someregions the husband is also
free to seek a son with another woman if the
couple is childless after five years of marriage
or their only offspring are girls
(Rweyemamu 1999). Among the Meru in the
Arusha region, Tanzania, a strong

Puritanismexists, but in real life there is much

more tolerance for both premarital and
extramarital sex, as long as it is done with
dignity and respect, discretely and not for
everybody to know (Haram1995).
Sengendo and Sekatawas report (1999) from
Uganda present the general belief that men
are inherent polygamousand thatit is normal
formen to have more than one wife. A man
cannot be satisfied with only one wife, and
the respondents in the study perceived
absolute
monogamyto be rare. The wives in
polygamous marriages are however not
always aware
of each other, as they dono longer always live
together. The overt polygamy has also been
declining, but the number of sexual partners
has not. Reasonsfor having multiple partners,

given in earlier studies mentioned here,

werelack of sexual satisfaction,
unfaithfulness,
conflicts between partners, alcoholism,
impotence, infertility,lust for too much sex,
partners labour migration, seeking a child of
another sex, potential material gain, peer
influence and curiosity.
Kyakuwa (2002) points out that Uganda is
traditionally polygamous, and both the formal,
legal formand the more informal version are
deeply rooted.
56
All marriagesstart with only
one wife, and there are many reasons for
moving on to polygamy. Reasons mentioned
by
Kyakuwa are infertility, desire for children of
the other sex, demonstration of virility, and

economic gain for the husband in the form of

free labour. Kyakuwa argue that polygamy
does not in itself increase the risk of HIV, as
long as all parties are faithful and were
clean from the start, but in addition to men
tending to havemultiple sexual partners,
many wives feel neglected inpolygamous
marriages and unmarried men tend to have
relationshipswith these. For the first wife, an
additional wifedoes however also mean one
more person to share the burdens and work
with, and therefore also many women
appreciate this type of arrangement.
Nonetheless, among the Basoga, the social
valuing of
polygamyis on the decline, but men still
appreciate multiple partners, which is putting
themat increased risk of HIV. The degree
ofsexual relations between relatives, due to

wife sharingpractices, can represent a risk of

HIV, but this limitation of potential sexual
partners can also protect against
transmission, as long as nobody gets infected
fromother
sources and hence brings HIV intothe sexual
network (Kyakuwa 2002).
Sengendo [s.a.] also links polygamyto
poverty. He argues that polygamous
marriages
may lead to too large families, resulting in a
domestic deprivation where the family is
incapable of acquiring the amountof resources
necessary toeducate and support all its
members in social and economic well-being.
In accordance with Kyakuwa, also
Nossum(2002) assert that the attitudetowards
polygamyis changing in Uganda, but only in
marriage, not in relationships. Female lovers
do, however, have fewer rights than if they
were wives, and the lack of wedlock hence

makes their situation less secure.

Furthermore, inNossums work it also appears
easyto
get involved with a new partner, both for men
and women, when ones steady partner is
far away due to education or work.
Writing about Kenya, Akwara Madise and
Hinde (2003) explain that while men are
allowed to have multiplepartners, women are
not, leaving women out ofcontrol of
elements of their own sexuality. Risk-taking
behaviour in Sub Saharan Africa is
associated with gender inequalities, and while
women are generally subordinate, the belief
is that men have stronger sexual drives than
women, and that men can not do without sex.
Haram(1995) talks about the Meru people
inthe Arusha region, for whom social and
economic circumstances are important for the
choice of partner. It is commonly held that

it is difficult to find a husband, due to a

drastic decline in polygamyand anincreasing
number of boys leaving the area for education
and work elsewhere. The result is a
deficit which creates an atmosphere
inwhich young women would enter into risky
sexual situations to hooka potential
husband. Tooptimize ones chances of
marriage
young women often maintain sexual
relationships with many men simultaneously.
Meru
boys also engage in risky sex as they go to
town to work in order to save up money for a
house and bride wealth. The social sanctions
are less strong in towns and there is an easier
access to women. Many get involvedin a wide
sexual network, exposing themto the risk
of HIV infection, which they may again pass
on to their future wives.

Heguye (1995) reveals that in Kahe, Tanzania,

the perception is that a normal and healthy
person should not go long periods without
sex, as lack of sex may lead to physical
disorders and insanity. Single young people
ofboth sexes here consider it almost
impossible to have only one sexual partner.
Sexual relationships are not permanent and it
is convenient to have more than one partner
when a relationship ends, as it may take some
time to find a replacement. Everybody
practice penetrative sex, as the normis.
Looking at Talles study (1995) among the
Maasai of Kenya and Tanzania, it becomes
extremely clear how impossible it is to
generalize over a regionas vast as South East
Africa. Due to certain social practices and
cultural norms, the pastoral Maasai of
Tanzania
and Kenya are at particular risk of STDs
including HIV. Men are organized into age-sets

and then divided into corporate age-groups

arranged hierarchically within a framework of
authoritative positionsand rules of
appropriatebehaviour (Talle 1995: 71).
Fromabout
the age of 16-18 years, boys are separated
fromthe rest of the group and close
friendships
develop between themduring this time which
is called moranhood. The Maasai morality
systemallows men of the sameage-group to
have sex with each others wives, for Maasai
girls to make their sexual dbut before
maturity, and for polygamyto be widespread.
While it is perceived obvious that men
searchmating partners (women) everywhere
they
go, women are expected not to showsexual
desire by initiating or taking a lead in the act
itself. Sex is here linked not only to fertilitybut
also with pleasure and joy. Within

marriage, inequality is built into the sexual

relationship, while lovers are related to as
equals.
57
Traditionally, marriage is arranged by others
than the two getting married, and
the marital sex is first and foremost to have
children. To performmarital sex is thus an
obligation. Sex before and outside marriage
means pleasure and entertainment, and in
such relationships, gifts of love are
exchanged. Not having lovers is an
unthinkable
phenomenon among theMaasai, and being a
virgin bride is awkward, bringing
embarrassment to ones family. Sexual debut
of Maasai girlsis at the age of 10-12 years,
and they have sex with the morans only, the
age group undergoing moranhood. There is a

high level of sexual activity witha multitude of

partners, and there is a pronounced social
pressure on young men to performsexually.
Loveaffairs are created, and these continue
well into thegirlsmarried lives. The morans
they interfere with are however not potential
marriage partners because of the difference in
marriage age for men and women.
Furthermore, the morans have meat-camps in
the bush with sexual abstinence, which is
believed to make themvery potent and fertile,
and their compiled semen is believed to
help, being almost a prerequisite, forgirls to
reach maturityand develop breasts. Both
women and men have several partners
simultaneously, with two or three permanent
lovers
in addition to their spouses being common.
Some do also have someadditional short-term

love relationships. Unmarried or

divorcedwomen may have 10 lovers
simultaneously,
with the most popular ones having 15-20 or
more. The love relationships are regulated by
strict principles of moral and social
conduct,and a woman who does notattract
any lovers
is perceived abnormal.
In 1995, AIDS was a disease the Maasai had
heard of, but not yet seen. They saw sex with
prostitutes or women outside their own
community as the major source of infection,
but
the idea of paying for sex was for
themdisgusting as it was wasting money on
something
circulating free in Maasaicommunities.
Maasaiwomen do not traditionally seek
marriage

or sex with men outside their own society, but

this is changingas Maasai women make
friends with Swahili males in urbancentres
where they sell milk and buy consumer
goods, explained by economic needs. The
concept of monogamy is alien, and sex with
multiple partners is not of itself perceived
risky. What is believed to be risky by the
Maasai is sex in relationships transgressing
moral norms(Talle 1995).
Nossum(2002) reveals that the average age
of sexual debut inthe Mbale district, Uganda,
is 11-14 years, with girls ranging even
younger.Sex is socially and culturally
expected.
Wives are expected to befaithful, husbandsare
not. A man sticking to one partner is
looked down on by his peers for lack of sexual
prowess, and therefore feels pressure to be

sexually active. To express ones sexual

prowess implies having several partners, and
celibacy is socially deviant among men. To
choose abstinence implies a reduction of
masculine identity and isfeared more than
HIV; being clean means nothing if one is no
longer a man. A cumulative prestige is
associated with a mans number of partners
and/or
children.
Kyakuwa (2002) points out that among the
Basoga, a decrease intraditional sexual
education means that people do not know
howto please each other, contributing to
increased infidelity. The new freedom of
speech given by president Museveni, which
now allows people to tell their partner about
sexual needs, has not changed this. Kyakuwa
does however not address to what degree this
freedomis actually present in individual omes.

However, he declares that women do havea

certain degree of power in sexual
relationships and many are in a position tosay
no, as well as demand their own
satisfaction, even though there is little focus
on how to please women.
Furthermore, the fact that Basoga women can
refuse sex and report their husbands for
marital rape gives men a reason to seek
additional extramarital partners to satisfytheir
sexual urge. There is a beliefthatsome men
and women are sexually unsatisfiable,
needing several partners while looking for
onewho can truly satisfy them. Among peerat
the bar, having lots of experience is
prestigious, and it is moreover claimed that
experience is the best teacher. In addition,
economic benefitsare also here a motive for
extramarital relations (Kyakuwa 2002).

Ocholla-Ayayos study (1997) fromKenya

shows that also here extramarital sex for
many
is an economic necessity as a source of
income.
58
For others, the fact that many men
migrate to towns in search of employment
contribute to both husbands and wives
starting
additional sexual relationships outside the
union. Extramarital affairs are common and
somerespondents believed that access to
contraceptives increases sexual activity.
Traditional normsrestricting pre- and
extramarital sex are no longer applicable in
Kenya,
and the participants in Ocholla-Ayayos study
appeared to be more concerned about the

physical consequences of these sexual

relations (STDs/ HIV and pregnancies) than
about
the morality.
In his article on Tanzania, Rweyemamu (1999)
claimsthat the more educated a woman is,
the more likely she also is of having only one
sexual partner, while educated men are more
likely to have several partners. Many
believethat sexual abstinence is harmful for
both
men and women, and young men believe in a
physical need to have regular sex. This also
legitimises sex before marriage, and
adolescents are ridiculed by their peers if they
have
no boyfriends or girlfriends. The issue of nonsexual relationships is somewhat missing
here, as it appears assumed that having a
boyfriend means having sex. Furthermore, for

men it is important to produce children to

inherit them, which is also a rationale for
extramarital sex.

Also among the Tonga people of Zimbabwe,

premarital sex is common, as is polygamy,
extramarital affairs and rape. Moreover, 21
out of the 40 respondents in the 1999
UNESCO/ UNAIDS report on a cultural
approach to HIV/AIDS prevention and care,
agreed that women have no right to demand
fidelity fromtheir husbands, while 39
reported men to be the ones initiating sex in
a relationship (UNESCO/ UNAIDS 1999).
The report does however not say anything
about the variation in answers given by men
and women, which I think would be
considerably more informative and
interesting.

According to Ocholla-Ayayo (1997), in Kenya,

adolescent sexuality and premarital sex is
not condemned like before, and premarital
pregnancies are no longer considered a
disgrace because they are so common. A
1989 study fromthe Rift valley province
revealed an average age of first intercourseof
11 years, thus many are even younger when
starting sexual activity. Many Kenyans
however prefer to think that all young people
will
abstain until marriage, even though not many
did themselves. This is an attitude which is
likely to restrain the HIV prevention, and
adolescent sex often involves numerous
partners, as teenagers generally change
partners often. The respondents in OchollaAyayos work show little faith in school-based
education campaigns, arguing that young

people learn by experience. The impression

given is that sexual education does not
already
take place inschools.
5.7.2 Transactional Sex and Age Differences
Someancient traditions or culturaltraits which
facilitate the spreadof HIV may also be
reinforced by the presence of HIV. Sugar
daddies
59
and the appurtenant age difference is
not new,
60
but it appears that HIV has caused men to
seek out younger and younger girls,
believing themto be clean and safe, not
yet infected with HIV.
61
Having sex with a

virgin is also by many believed to cure

HIV/AIDS.
62
The younger the girls are, the more
vulnerable they are to HIV transmission,
63
and as more men look for younger partners
more and more of the young girls are already
HIV infected.

Webb (1997) states that the direct link

between HIV and poverty is often referred to,
but
not so often explained. In his book on HIV and
AIDS in Africa, he makes use of the term
transactional sex to explanation. Somesort
of exchange in return for sexual favours is
common in regular relationships as well asin
more casual liaisons.

64
In Africa, sex is
commodified and according to Dervla Murphy,
who travelled through Tanzania, it is quite
common forgirls to sell sex without feeling
ashamed of it, and rich men like to show their
money by purchasing a variety of girls as
commodities. Women are economically
dependent on men and the phenomenon is
also an embodiment of economic power
manipulation. Webb claimsthat the concept of
sugar-daddies, and in someinstances also
sugar-mummies, is common across all of
southern Africa. He moreover argues that the
sugar-daddyphenomenon has grown because
of the widespread belief that young girls are
free fromHIV infection, which in turn to
someextent explains the low rate of
condomuse
in these relationships.

Among the Meru people in Arusha, most

sexual networking has a transactional aspect,
and according to Haram some kind of giftgiving is central to the understanding of both
the gender-specific differences and the reason
why teenage girls are the most vulnerable to
the spread of HIV (Haram1995: 32). At the
sametime, if girls agree to sex too early,
they are at risk of being labelled loose and
the boy will move on, but agreeing to sex
means more gifts, and for many young girls
and women, sexual relationships are the only
means of gaining items like soap, body lotion,
shoes and nice dresses. The exchange of
gifts is however very important in creation
and maintenance of any social relationship,
not
only the sexual ones. Among the Meru it is
perceived ideal to have several premarital

relationships simultaneously for both boys

and girls, but girls must be careful not to
cross
the line of being loose (Haram1995).
Schoepf (1995) state that economic
insecurityand dependence among women
lead to risk
behaviour aswomen use sex with multiple
partners as a means of supporting themselves
and their families.
65
Young girls are especially vulnerable,
exchanging sex for food,
clothes or grades in school. The fear of AIDS
encourages older men to have sex with
young girls, who they perceive unlikely to be
infected. In 1995 HIV was spreading fastest
among adolescent women and ten years later
young African women still surpass their

male counterparts in the statistics. Women

without an incomeof their own are not in a
position to negotiate safe sex or refuse unsafe
sex, and what used to be a strategy for
survival for poor women now leads to AIDS
and death.
Sengendo and Sekatawa (1999) state that the
phenomenon of sugar daddies is common
also in Uganda and somechose to take on
small children both because they do not yet
have rentexpenses, hence they are relatively
cheap, and because they are perceived less
likely to be HIV infected. Sengendo [s.a.] sees
the sugar-daddy- phenomenon as sexual
exploitation, where grown men give schoolgirls little favours in return for sex.
In Tanzania, girls aged no more than 10 or11
have sex with men for chips, coke and

money for transport or school. This practice

does also put boys at risk, since their
potential
sexual partners and wives may already have
got HIV infection fromolder men. Baylies
and Bujra point at the need for young girls to
sell sex for survival as it is cheaper for men
to pay for casual sex than to get married, and
a rising number of people stay unmarried.
They argue further that it is not gender
difference but gender inequality that puts
both
women and men at risk (Baylies and Bujra
2000).
In Kagera, Tanzania, sex is seen as a formof
reciprocity and exchange, as men give
material things in return for child bearing and
sexual satisfaction. Both men and women
commonly refer to womens sexual organs as
her asset or capital, and sexual relations are

considered womens work, not pleasure

(Lugalla et al 1999).
Writing about young people in Kahe, Tanzania,
Heguye (1995) claimsthat single women
aged 18-25 have sexual partners for
economic survival. Many informants had one
or two
children, and with several partners
simultaneously they were materially more
secure. It
was also common for single mothers to sell
local beer and supplying the customers with
sexual services. Many of their customers were
traders visiting during market day.
Haram(2004) reports fromurban Tanzania that
a growing number of women choose to
stay unmarried while being involved in
transactional sexual relationships. Adult,
independent women keep relationships with
men acting as sugar daddies and many enter

into relationships with men to gain access to

resources, including houses, land and jobs.
Polyandrous motherhood is also described
as common, with women giving birth to a
number of children with various fathers. Thisis
explained by men wanting their lovers to
have their children while the mothers must
restrict the economic support they receive
from
each man not to be perceived financially
incapable of providing for her child. The fear
is
that such an accusation can result in the
mother being deprived of her child by her
lover,
and hence loose respectability, as
motherhood isequated with respectability.
Furthermore,
having the attachment of husband and wife is
by many perceived to limit the womans

freedomboth in relation to her money and her

movement, and accordingly one can see a
steady increase in unmarried women and
single mothers.
In her article on the age and
economicasymmetries in sexual relationships,
Nancy Luke
(2003) points out that adolescent girls are at
a disadvantage in negotiating sexual relations
with older men. Womens sexuality is
particularly pronounced in terms of economic
value, and population growth has created a
surplus of young girls in relation to older men
who are at a shortage. Because of a reduction
in traditional sex education, adolescents get
most of their information fromtheir peers,
leaving many girls with little knowledge about
their own bodies, reproductive system and
sexual processes, while valuing sexual
relations

which gives themsocial statusamong their

peers as well aseconomic benefits. Adolescent
girls having older partners appears to be the
normin Sub Saharan Africa, but the majority
of their partners are only a few years their
senior. Luke concur that sugar-daddy
relationships are common, but exchanging
gifts or money for sex is common also in
relationships where both parts are
adolescents, as girls tend to expect somesort
of
payment for sex. None of the adolescents
inthe studies reviewed by Luke did however
associate this practice with prostitution,
something which is socially unacceptable in
their
eyes. This missing link might be explained
by the fact that gifts are not given at every
interaction (Luke 2003).

Many young girls choose much older partners

looking for love and eventually a spouse, as
they are morelikely than younger males to
beeconomically secure, more serious about
marriage and perceived more likely to marry
or support a girl if she gets pregnant
unintentionally. Older partners also ensure
girls ofattracting boyfriends and of being
sexually active, which is expected of them, in
addition to providing money and gifts for
luxuries. Others keep older partners for
material benefits only, while having younger
boyfriends with the intention of marriage. The
literature Luke reviewed suggests that girls
reasons for engaging in these relationshipsare
more often desires for status and gifts
than economic need and extreme poverty.
Girls seemto have a high degree of control
over
partnership formation and duration, but the
older men are in power within sexual

relationships, including when it comes to

decisions about safer sex and condomuse
(Luke
2003). Baylies and Bujra (2000) report that
insomeareas it is common to marry women
the age of ones children, or even
grandchildren.
In addition, Webb (1997) reports from
Zimbabwe that young girls have been
choosing
younger boys, believing themto be HIV free.
Targeting one age group believing it to be
HIV free can however result in this group
experiencing an increased spread.
Furthermore,
a study of adolescent sexuality in Uganda
revealed a belief also among male students
that
young girls contracted HIV from adult
partners, with whom they had sex for money,
and

then passed it on to their young boyfriends

(Webb 1997).
66
Akeroyd (1996, 2004) sees age difference
between the spouses likely to encourage
compliance and passivity in women, and she
gives the example of Setswana culture in
Botswana where the ideal gap is at least ten
years.
5.7.3 Masculinityand Expectations to Perform
Sexually
In addition to the phenomenon of men
choosing younger and younger sexual
partners, also
notions of masculinity can be reinforced by
the presence of HIV. In situations of
economic decline, gross unemployment and
increased focus on the empowering of
women, their masculinity is by many men
perceived the only asset they have left. Often

men are made aware of the risk of HIV, but

dismiss this risk ifit challenges any part of
their masculinity - a masculinity which often
implies a high frequency of unprotected sex
with more than one partner. Women are
notthe only ones without control of their
situation; nor men are in control of the
environment in which they live and act, taking
part
in what appears to be a self destruction
ofsociety. While men are more often than not
responsible for physically spreading HIV, they
are not alone to blamefor the spread orthe
consequences of the HIV/AIDS pandemic.

According to Ndubani (1998), young boys in

Zambia spend most of their time together
with other boys and men as partof the
socialization process.Men are to have a
superior

position, and the perception goes that one

can not learn anything froma woman. In
Zambia there is a general high level of premarital sexual activity, and boys are supposed
to experiment or test whether they are real
men. The saying a man can not eat the
same
food everyday (Ndubani 1998: 55) is used to
explain the desire for having more that one
sexual partner. In addition, Bond and Dover
(1997)present the belief that men have a
need
for release, and that they are not able to
control their sexual appetites for long periods.
Hence, if a man works away fromhome he is
suspected of having a girlfriend.
In their article on Uganda, Aliro, Ochieng and
Fiedler(1999) point out that across Uganda
there are many differences, but also
similarities. Men are expected to perform,to
have

frequent sexual intercourse, with one or

multiple partners, and boys are encouraged
by
peers and fathers to get girlfriends to prove
that they are real men and notimpotent, while
women are expected to remain faithful to
their husbands and to please themsexually.
Most Ugandan cultures mark the transition
from child to adult, but the formand extent of
sexual education varies widely, and there is a
traditional belief thatgirls, but not boys,
should be virgins on marriage. It is the opinion
of most that boys should have sex before
marriage to practice, andbecause it is difficult
not to. Furthermore, in a group of young
boys, everybody agreed that when a girl says
no she actually means yes, and if a wife
refuses sex, the husband may have sex with
another woman.

Sengendo [s.a.] also reports fromUganda that

boys are encouraged and expected to have
frequent sexual relations, while girls are
expectedto stay virgins until marriage and be
faithful in marriage. In his study it is also
indicated that love without sexual intercourse
is
considered to be empty love whereas
people who chose to remain virgin for long or
beyond twenty (Sengendo s.a: 16) are
considered impotent or abnormal. Two pages
later
it is however stated somewhat to the
contrarythat virginity brings honour to the
family
and the individual, being associated with
freedomfromdisease. But virginity is
emphasized and gives cultural esteem for
girls only. Kondowe and Mulera (1999), writing
on Malawi, correspondingly present the
perception that manhood without sex is

incomplete.
According to Foreman (1999), men are more
likely to have two or more concurrent or
consecutive partners while women are more
likely to be faithful to men fromwhom they
contract HIV, and less likely to passit on.
Inaddition to the socialand economic factors
of poverty, illiteracy andtraditional customs,
mens refusal to condomise or to be
monogamous denies women of the
opportunity toprotect themselves. Even when
aware of
the risk ofboth transmitting and getting
infected with HIV, many men fail to protect
themselves. Foreman argues further that
while women are vulnerable to HIV because
they
have limitedopportunityto protect themselves,
men are at risk because they refuse to

protect themselves. The combination of

cultural perceptions of masculinity and lack of
knowledge can thus be fatal.
In her article Silence, AIDS and sexual culture
in Africa, Leclerc pointsout that men are
perceived to be biologically programmed to
need sexual relations regularly with more
than
one woman, whilst the use of condoms is a
sign of mistrust and promiscuity, and almost
unheard of in marriage. Many partners avoid
direct communication and assumethat men
are to be in control of sexual encounters, and
men are believed to have a right, or even
duty, to force themselves onto women who
display reluctance or shyness (Leclerc 2001).
In his doctoral thesis on gender and
HIV/AIDSin Zambia, Dover (2001) explains
how the

culture of gender is strongly related to the

biological reproductive differences between
men and women. For boys, positive masculine
values are the negation of feminine
attributes, and growing up they prepare for
looking after females, including their mothers.
Womens role is linked to domestic and
mothering identities, while mens role is
dependent onthe modern economy
asproviders. Moreover, mens definition of
masculinity in terms of potency, strength and
hegemony is dependent on the
counterweight in women. A real man should
have others dependent on him while not
needing support himself; he is the headof the
household and the undisputed final
decision-maker, an authority which is related
to his ability to financially provide for his
family. Economic decline does however make
this problematic, as womens contribution

fromsubsistence economy, informalsector,

food for work, and formal employment is
increasingly important for the family economy
(Dover 2001).
In Dovers Zambia, having a mistress is
proofof male wealth and potency, but a
mistress
also provides a more relaxed sexual
relationship by avoiding the spouse role.
Sexual abstinence is perceived harmful to
male potency and mental balance,
67
and men consider
themselves as needing sexual variety, thus
having the right to seek it. Female sexual
desire
is on the other hand downplayed, and women
are characterized as tempting men to have
sex because they are greedy for presents, or
because of poverty. Male risktaking can be a

consequence of the ideas of male strength,

exemplified by one young man in Goba who
believed himself to be too strong to be
overcome by a womans blood, as sex is
referred to
as mixing bloods, thus he did not see himself
atrisk of contracting HIV. The perception of
mens sexuality as natural also takes away
the responsibility which is normally a part of
the male role, and the stereotypical roles
actually prevent both genders
fromnegotiating
sex (Dover 2001). Baylies and Bujra (2002)
alsodepict a belief among men that without
sex they becomeabnormal, but intercourse is
perceived crucial for the physical and mental
wellbeing ofboth men and women.
Young Zambian girls would like for a husband
to listen and discuss, but still be the head

of the household. If the wife would take on

male responsibilities, both man and wife
would loose respectability. Western
feminismput forward in aid projects to
empower
women thus feels like a threat to male and
femaleroles with ideals of proper and
respectable women and men. Zambia is
however changing and women are entering
politics and what used to be male professions,
while tasks and responsibility at the
household level is increasingly shared a
cooperation which is positive for the fight
against HIV/AIDS. Both men and women in
Zambia are positive about womens rights,
but many are suspicious of the genderfocus, and men do not see themselves as
benefiting fromequal rights (Dover 2001).
Silberschmidt (2004), writing on Kenya and
Tanzania, argues that socio-economic change

in East Africa has increasingly disempowered

men, and to strengthen their masculinity
and self-esteemmany men engage
inmultiplesexual relations and aggressive
sexual
behaviour.
68
As many men have becomelabour migrants,
their women, being structurally
subordinate, have taken chargeat home, and
malecontrol over women has weakened as
their position as breadwinners and providers
is challenged. Men are often expected to have
multiple partners and both men and women
interviewed in Kenya and Tanzania reported
opinions that a real man needs to
demonstrate that he can handle more then
one partner
(Silberschmidt 2004: 238). Three wives is
herepresented as the ideal, having one for

getting children, one to work and one for

pleasure. The belief is that men have a
constant
need for sex and since women do not, men
need to go outside to feel like a man
(Silberschmidt 2004: 239). Men can not resist
women, so in need of control they turn
aggressive asthe concept ofa real man still
includes male (sexual) control over women.
Most boys are taught that they are the
superior gender, and their identity as men is
defined
through sexual ability and accomplishment.
Poverty reinforces this violent and aggressive
behaviour which men see nothing wrong in as
they are only exercising their right based on
the ideologyofsupremacy, clinging to previous
positionsofpower. For men, sexual
potency gives social potency, while for
women, sexual modesty is what gives social
value,

and men and women engage in sexual

relationsfor different reasons (Silberschmidt
2004).
In her 2003 article on male disempowermentand sexuality in East Africa, Silberschmidt
explains that men are expected to have sex
regularly with their wife or permanent
partner,
plus with other casual or steadier partners.
Abstinence is perceived harmful and against a
mans nature, while condoms are unmasculine and limit mens pleasure. Women
are
expected to adjust to mens desires and it
isneither possible nor appropriate for a decent
woman to control sexual activity. Hence,
onecan not stop the spread of HIV by giving
women the responsibility alone. Silberschmidt
argues that the fact that men hold on tight

to old attitudes and definitions of

masculinitybased on hegemonic values and
behaviour is
a threat to their own as well as others health
(Silberschmidt 2003).
Without referring to one particular place or
country in Africa,Alexis (2003) states that
boys are socialized into believing that they
are the superior sex. They are given priority
over their sisters at home, they receive more
attention in school, boys get to stay longer in
school and the community leaders are
mostoften men. Boys learn that men and
masculinity are more appreciated in their
communities, and men are morepowerful and
more important than women. Men are
supposed to be brave, courageous,
adventurous,
aggressive and strong. Simultaneously they
learn to look at women as soft, gentle,

talkative, caring, nurturing and affectionate.

Boys are socialised to believe that it is
unladylike to initiate sex or have sexual needs
and wishes, which is why women mustbe
persuaded or forced. Boys also learn that
onecan not trust women, and the availability
of birth control offers a woman somecontrol
over her own body, which raises issues of
trust.
Women are perceived to care most about
relationships and to be not as easily aroused
as
men. Boys are taught that they need, and
should want, more sexual activity than
women
do, and that they should initiate sex; they
actually have a right to do it, as women tend
to
be passive, reluctant, hesitant and rejecting.
In many cultures boys learn that girls sexual

desire and experiences are unimportant, while

girls learn that boys needs and experiences
are importantfor their own economic survival.
In general, girls learn and prepare
themselves for satisfying men (Alexis 2003).
5.7.4 (Domestic) Violence
The UNAIDS report Facing the future
together draws attention to the issues of
marital
rape and domestic violence, stating that
marital rape is disturbingly common
throughout
southern Africa, with the reluctance of
judicialand politicalauthorities to consider it a
crime being part of the problem. Judgements
havedeclared that consent to sex is inherent
in marriage; hence husbands can not rape
their wives. Abuse is widespread and many
women regard beating part of their daily lives.
In studies from Malawi, Zambia and

Zimbabwe, large numbers of women agreed

that a husband was justified in beating his
wife if she argued with him,went out without
his consent, neglected the children, burned
the food, or refused to have sex (UNAIDS
2004b: 16). Furthermore, violence increases
womens vulnerability to HIV not only as a
result ofthe violent act itself, but also due to
the fact that sexual violence increases their
likelihood of engaging inhigh-risk behaviour
later. What is more, the use of rape and other
forms of sexual violence is not only
widespread; it is also widely accepted and
approved of (UNAIDS 2004b).
In the Human Rights Watch report Just die
quietly: Domestic violence and womens
vulnerability to HIV in Uganda, Karanja
(2003) explains how the spread of HIV in
Uganda happens in an environment where
women are economically dependent on men

and domestic violence is a part of everyday

life, leaving women with no authority over
their own sex lives or reproductive health.
Ugandan men haveabsolute dominion in
marital sexual relations as in most other
areasof family life and society at large. It is
believed that by saying I do women
concede to sex whenever the husband wants
it, and
women have no cultural or legal power to
neither refuse sex nor control safe sex. Marital
rape or forced sex is widespread, but since
women think it is their duty to have sex with
their husbands, they do not very often object.
For many women it feels more dangerous to
stop having sex with their husbands than to
riskthe infection or re-infection of HIV. The
danger of re-infection is repeatedly mentioned
here, but nowhere else, being the
possibility for a person who is infected with
HIV to be re-infected with the samestrain of

HIV or being infected with two different

strains at the sametime. In another Ugandan
study, Luke (2003) found that bothadolescent
boys and girls thought rape to be justifiable
in situations where the girl tried to get the
material benefits from a relationship without
giving sex in return.
According to Matsamuras study on
domesticviolence linked to HIV/AIDS, women
in
Uganda are still valued as property, and brutal
attacks and marital rape has becomea
barrier in the fight against HIV/AIDS. She
refers to the Just die quietly- study pointing
out womens lack of authority to refuse sex or
insist on condomuse. Many women face
verbal threats fromtheir partners, and their
bodies, labour and productive capacity are all
controlled by their husbands. Matsamura
reveals that domestic violence by many is

considered a normal part of marriage, maybe

even a sign of love, and women are taught to
be subordinate and not to disobey their
husband (Matsamura 2003).
Silberschmidt (2003) talks about Kenya and
Tanzania where there is a widespread
understanding that men need a lot of sex,
perceived a biological fact, and men are
polygamousby nature while women are
monogamous. Violence and even rape are
accepted ways of demonstrating masculinity
and are used as tools for regaining control,
social dignity and self respect. Sexual
modesty gives social value to women, but not
to
men, and mens honour is dependent on their
womens appropriate behaviour. Mulama
(2003) points out that fear of violence
fromtheir spouses also prevent many women
from

accessing the necessary information about

HIV/AIDS.
The media backgrounder Violence against
women and AIDS [s.a.] also points out that
violence against women increases female
vulnerability to HIV. Because they fear
violence, many women do not access
HIV/AIDS information, they do not get tested
or
they disclosetheir HIV status, they do not
accessservices toprevent mother-to child
transmissionand the fear prevents many
fromreceiving treatment and counselling. Still,
violence against women is widespread and
often socially sanctioned or tolerated. A
Zambian study also revealed that only 11% of
respondent women believed that a woman
had the right to ask her husband to use a
condom, even when she knew he was being
unfaithful and HIV-positive (Violence against
women [s.a.]: 2).

Writing about Africa in general, Leclerc

(2001)states that not only is premarital- and
extramarital sexual activity high, but so is
also the rate of sexual violence. A woman
suggesting condomuse, refusing sex,
curtailing a relationship,having another
partner or
being suspected of having another partner
may all lead to beating, a violence which is
often perceived a sign of affection. At the
sametime, sex is believed to be a part of the
marriage deal which the husband can
demand atany time. Also Umerah-Udezulu
(2001)
reports perceptions of rape in the form of
intermarital coercive sexual relations as part
of
mens marital rights.
Violence against women, especially rape, is
mentioned also by Sengendo [s.a.] as a major

risk factor, and unemployment and

deprivation among youth make themmore
likely to
engage in risky behaviours. He presents
seasonal commercial sex workers as one
example,
and being desperate for survival, they are ina
weak bargaining position for safe sex.
Fromthe late 1990s, attention has been paid
to the position of men and their involvement
in the transmission ofHIV, as well as to
gender-related violence and sexual abuse
against
women and children and their involvement
inthe spread (Akeroyd 2004). Akeroyd states
that women are far more likely than men
tohave sexual intercourse forced on them;
consequently women are at greater risk of
infection. She also points outthe belief that
sex

with a virginwill cure AIDS as a contributing

factor to the extent of rape ofyoung girls
and even babies (2004).
5.7.5 Focus on Men
Baylies and Bujra (1995) start their paper by
pointing out that in Africa HIV is largely
transmitted through heterosexual sex.This
takes place in an environment of gender
inequality, and these authors claimthat to
control the AIDS epidemic, a transformation in
gender relations is required, which can not
happen without first recognizing the existing
power relations and the embedded structure
ofmale power. Without a change in male
behaviour and response, women can not
protect themselves.

Looking at the pre 1996 literature on causes

and effects of HIV/AIDS, Akeroyd argues

that what is needed above all is the

empowerment of women, while pointing out
that calls
for men to restrict their number of sexual
partners may actually worsen womens
position
further, as many women are dependent on
what they get in exchange for sexual services.
Akeroyds stand is that the focus should
rather be shifted towards gender relations of
inequality, or even all the way to men alone.
While women need to be empowered, men
face de-powerment, which they have reason
tofear, as givingwomen power in sexual
matters may very well impact on other
aspects of gendered relations as well. Akeroyd
sumsup that men may be the solution, but
men are also the problem(Akeroyd 1996).
In Mbale, Uganda, women are not in a position
to create a safe sexual environment for

themselves, but Nossumpoints out that due to

the expectations to and perceptions of what
it implies to be a man; nor men are free to
choose one sexual partner, safesex or
abstinence. While women are not ina position
to initiate condoms, men believethatsex is
better for women without condoms, and many
men have a desire to satisfy their womens
appetite. Nossumpoints at the need to focus
on men and women together in prevention
campaigns and development aid, as the two
genders and their roles can not be regarded
independentof each other (Nossum2002).
Akeroyd (2004) argues that while women
contractHIV at a faster rate than men due to
physiological susceptibility, men have a
greater number of sexual partners and she
thus
sees men as driving the epidemic. Also
Kvamand Eskildsen (2002) call for a focus on

men as men have more sexual partners

thanwomen do, thus men contribute stronger
to
the spread ofHIV. The fact that men are also
normally the ones to decide whether or not
to use a condom, being the dominant part,
isimportant here. Also Schoepf (1995) says
that to reduce the amount of risky behaviour,
the focus must be set on men, but
concurrentlyalso women need to realize the
importance of and accept the use of condoms
in risky relationships.
After presenting perceptions ofmale nature
and culture, also Leclerc (2001) concludes
that a focus on men and their attitudes and
behaviours is needed. The editor ofWIN News,
where Leclercs article was published, ads (in
Editors note) that African men need to
drastically change their sexual activities and
behaviour and pointsatthe traditional

attitude of treating women as property. In

addition, he misses mentions of child
marriage and the bride price system in
Leclercs article, and he statesthat Going to
school is a
huge hazard for girls who are raped both by
their teachers and classmates quite aside
from
being easy prey for any man on the way to
school (Leclerc 2001: 3). He claimsthat a
culture of rape is dominating all of Sub
Saharan Africa whilemen are regarding it a
right
of manhood to have sex with any female they
wish (Leclerc 2001).
In circumstances where men are losing their
traditional control over women, most men do
not welcome the general safe sex massages
including sticking to one partner, and it is in
this connection that Silberschmidt (2004)
brings forward her main argument that

strategies to empower women and improve

their deteriorating sexual and reproductive
health are only meaningful if they are
balanced against efforts to deal with mens
increasingly frustrating situation
(Silberschmidt 2004: 245). She points out a
need to pay
attention to men and question the
stereotypes of male domination and womens
subordination which is prominent in current
HIV/AIDS prevention efforts.
5.8 Fatalism
An important termin the study of culture and
the spread of HIV in South East Africa is
fatalism.Fatalismis the beliefthatlife is predetermined and that individuals are
powerless to change what happens to them.
Men and women seemto show two different
faces of fatalismand different reasons not to
protect themselves against HIV and use

condoms. While women calculate what is

worst, what is the lesser of the two evils
having
unprotected and often involuntary sex or
facing the consequences of refusing ones
partner, men gamble with unprotected sex
with multiple partners, not wanting to think
about potential consequences, rather
enjoying the moment.
The most explicit expression of fatalismand
what appears to be an ignorance towards
ones own fatality, is men referring to the use
of condomsby the metaphors of eating
sweets with the wrapping paper on
69
or taking a shower wearing a raincoat
70
. Other idioms
used are that you can not enjoy the taste of
chewing gumif you do not remove its cover,

and that you need to peel a banana in order

to enjoy eating it (Lugalla et al 1999). Many
find no justification for preventing their own
pleasure since were dieing anyway, and if it
is not HIV, it will be something else, with a
number of mortal diseases and other death
causes being an innate part of every day life.
Some of Rugalemas respondents in Kenya
and Tanzania moreover argued they would
rather die happy than abstain fromsex
(Rugalema2004).
Among Bauni and Jarabis informants in
Kenya, someargued that getting AIDS is like a
road accident in the way that you cannot stop
a driver fromdriving because of the fear of
an accident (Bauni and Jarabi 2000). Among
the Basoga it was argued that one can not
run away from AIDS, so why try?(Kyakuwa
2002) In Zambia it was also stated that

avoiding AIDS is impossible because it is

Gods choice, and Ndubani (1998) argues that
rather than encourage behavioural change,
seeing many people with AIDS can actually be
a source of fatalistic conceptions.
Silberschmidts work among men in Kenya
and Tanzania, an area with STDs and HIV
rates ranging sky high, shows little
consciousnessabout the risk of sexually
transmitted
infections (STIs) including HIV. An example
given by an informant was the attitude that
one can get hit by a bus tomorrow, but that
does not stop one fromgoing out, implying the
unlikelness of getting hit (Silberschmidt
2003).
Among the Barabaig, illness is a culturally
accepted notion of punishment. Being
accustomed to suffering, for the Barabaig
death and dying are parts of everyday

experiences, and AIDS is only one of many

perils (Blystad 1995).
FromZambia Dover (2001) reports the attitude
being that ones timeis up when God
decides; hence there is no reason for taking
protective actions. Akwara, Madise and Hinde
(2003) report an equivalent fatalistic attitude
towards AIDS fromKenya with people
arguing that one does have to die of
something.
Bergholdt Jensen, Information Officer in a
Danish NGO working in Mozambique, sums
up that the fatalistic vision oflife in African
societies sometimes make it difficult to
change peoples behaviour concerning
HIV/AIDS. Kirsten Madsen, an HIV/AIDS
adviser, explains that people often do notsee
themselves as having any option, nor
personal responsibility. It is a common belief
that it is Gods will whether one gets AIDS

or not, hence there is nothing one can do

tohave any influence on ones destiny. When
people do not see how their own actions can
have an influence on their lives, promoting
behavioural change is a considerable
challenge. The harsh living conditions of
people in
poverty are also of importance in their
fatalistic approach towards HIV/AIDS. It is
argued
in Bergholdt Jensens article that when people
know they can easily die fromcholera or
malaria, HIV/AIDS is just seen as another
unpreventable illness like the others (Jensen
2004: 8.paragraph). Which disease you die
from does not make much of a difference.
Fatalismis integrated inthe culturalbelief
system. It can in partbe traced back to
experiences of being victimof failed
institutions and corruption, and an overall
scepticism

towards foreign imposed rules and systems as

well as towards western medicine and
western values in general. Attitudes to, and
perceptions ofHIV, are henceparts ofa larger
fatalismofvictimisation,ofliving and dieing in
Africa. Peoples experience is that there is
nothing one can do to change ones situation.
Life expectancy at birth is falling dramatically
in the region, but that is not a number most
people acknowledge or are even aware of.
There is however a correlation between low
life
expectancy and fatalism; both are most
pronounced in poor countries. Moreover, even
though people are probably not aware of the
actual numbers, theydo of course notice that
people around themare dying. There appears
to be a lacking awareness as to how deadly
HIV/AIDS actually is; either people are not
fullyaware ofit or it is justnot really dealt

with. The traditional belief systemis not

equipped to deal with this new set of
standards
for what disease is, and the traditional means
of protection against illness are no longer
sufficient. This is furthermore in line with pre
scientific perceptions and experiences of
HIV/AIDS in the West.

their perceptions of risk relating to HIV are not

limited to their factual knowledge about
passageways and probabilities. Just as
significant are the risks faced by refusing sex
or
suggesting condomuse: The risks of not giving
pleasure to men and of being stigmatised
as promiscuous.
Enhancing womens empowerment means a
radical change in social relations, which

seems necessary in order to achieve changes

also in male sexual behaviour. At the same
time people need to understand what HIV
means for themas a community. It is myhope
that by taking culture into account, the
international communitycan help enable not
only
the most vulnerable, but also the South East
African population in general, to protect and
forestall themselves and future generations
against the threat ofHIV/AIDS.