Combatting AIDS in Africa: Cultural Barriers to Effective Prevention and Treatment

Traditional African1 Beliefs and Customs: Implications for AIDS Education and Prevention in Africa

Many Western-based AIDS education and prevention programmes have failed dismally in Africa and they may only succeed if traditional African beliefs and customs are taken into account. This article discusses relevant aspects of the traditional African worldview by explaining what health, sickness and sexuality mean in traditional Africa. Traditional African perceptions of causes of illness (including AIDS), perceptions of sexuality, and cultural beliefs inhibiting the usage of condoms are described in terms of the influence of the macro-cosmos (the ancestors), the meso-cosmos (witches and sorcerers) and the micro-cosmos (everyday life). The implications for AIDS education and prevention in Africa are discussed and suggestions are offered for the development of such programs.

Perceptions of HIV/AIDS on a Johannesburg Gold Mine

Semi-structured interviews were conducted with 40 mine workers on a Johannesburg gold mine, focusing on workers' perceptions of health, HIV/AIDS and sexuality. The paper seeks to highlight a range of factors which might predispose mine workers to high-risk sexual behaviour, despite the fact that they had all attended HIV-education programmes. These factors are presented within a framework that views the process of sexual decision making as a debating process - in which competing facts and beliefs are weighed up against one another - within the context of a range of normative and social parameters. Firstly, attention is given to a number of pre-existing perceptions and doubts which may blunt the force of the facts that HIV educational messages seek to impart to this particular group of people. These include a lack of perceived urgency regarding the treatment of sexually transmitted diseases (STD's), a commitment to ‘flesh-to-flesh’ sex, a dislike of condoms, and faith in the ability of traditional healers to cure a range of STD's and possibly also HIV/AIDS. Secondly, attention is given to the normative context of sexuality, and in particular the way in which norms of masculinity predispose people to high-risk sexual behaviour. Finally, the paper focuses on some aspects of social and occupational life on the mines as the context within which sexual relationships are conducted. These include the phenomenon of single sex hostels, an acceptance of high levels of disease and accidents as the norm, and the use of alcohol. The paper concludes with a discussion of the challenges these findngs pose for a peer education programme which is shortly to be implemented in the mining context.

Evaluation of HIV/AIDS Prevention in South African Schools

This article reports on the implementation of a schoolbased HIV/AIDS and life-skills training program to prevent the spread of HIV/AIDS among the young people in secondary schools in South Africa. The implementation of the program was evaluated for a period of two years, using process and outcome evaluation and a systems approach to understand the higher-order feedback processes that obstructed the implementation and effectiveness of the intervention. Although HIV/AIDS is a medical condition, this article emphasizes that HIV/AIDS prevention is interrelated with the psychosocial context within the community. Interventions should therefore be conceptualized and implemented in terms of the various levels of interaction in the community.

African Families' Perceptions of Traumatic Brain Injury

Using semi-structured interviews, this study explored the perceptions of traumatic brain injury (TBI) held by a group of 22 brain-injured individuals and their caregivers living in rural African communities. While there are similarities between these findings and those in other parts of the world regarding the cognitive, emotional, personality and behavioural changes experienced by brain-injured individuals, the perceived aetiology of brain injury differed according to the individuals' worldview. Most of the participants believed that the accidents considered in this study as well as the injuries they gave rise to were the result of witchcraft, ancestral anger, God's will or thwasa. The reactions of family members to caring for, and living with, a brain-injured person appeared to be influenced by specific social practices and local cultural beliefs. It is important to incorporate these beliefs into the rehabilitation process. Suggestions for rehabilitation are discussed.