HEALTH-MOZAMBIQUE: Some Traditions Hamper AIDS Education Progress

Mercedes Sayagues

MAPUTO, May 2 2000 (IPS) - Some traditional beliefs and practices run counter to HIV/AIDS campaigns hampering progress, say Mozambican researchers.

Take the belief in “kaka”, for example. In Zambezia, people believe a sexually transmitted disease can be cured by having sex. The “bad spirit” moves on to another body and you are healed.

Sociologist Nelia Taimo, who recently surveyed attitudes and knowledge about sex and reproductive health among youth in Zambezia, was shocked by her findings.

In one village, women think HIV is transmitted by eating a certain fish from the lake.

Both girls and boys believe that a girl cannot get pregnant if she only has sex once with her partner. So boys and girls have many partners but only have sex with them sporadically.

Girls think they will not get pregnant if they have sex 10 days after their menstrual period. Menstruation is considered unclean; intercourse should be far from it. In actual fact this goes against the scientific belief that this is approximately when the peak fertile period begins.

In a display of fatalism, many people say that, if it is your destiny to get sick, you will, regardless of your behaviour.

“Even our local colleagues were surprised with our findings,” says Taimo.

Practices like “kaka” and multiple partners spread sexually transmitted diseases, STDs. High rates of STDs are associated with high HIV infection.

At the same time, people hear messages from AIDS campaigns, namely, the “abc” approach: abstinence, be faithful and use condoms. But they do not practice these.

AIDS campaigns will continue to fail unless they take into account local practices, warns Taimo. Moreover, beliefs differ among Mozambique’s nine provinces and various ethnic groups. “We can’t use the same messages from the Rovuma to the Maputo rivers,” she says.

Mozambique, with 14.5 percent of its people infected with HIV, ranks among the world’s top 10 most affected countries.

The problem intensified since the 16-year-old civil war ended in 1992. During the war, large portions of the country (pop. 17.3 million) were effectively cut off from the world. Road travel was reduced to small areas around cities.

HIV/AIDS is a mobile disease. When people move, the virus moves. After the peace agreement, Mozambique experienced one of the largest mass movements in modern Africa.

Two million refugees returned after many years in Malawi, Mozambique, Zimbabwe and Swaziland — countries severely affected by the pandemic. Nearly three million internally displaced people went home.

Nine thousand foreign peacekeepers and 50,000 demobilized soldiers from the two warring sides compounded the problem. Soldiers with money in their pockets and families far away are likely to have casual sex.

With peace, commercial traffic with neigbouring countries multiplied, bringing needed goods — and HIV. So did labour migration to South Africa and Zimbabwe. The recipe for an HIV/AIDS explosion was there.

Unaids estimates that Mozambique has 300.000 AIDS cases, but less than 10.000 have been reported. Under-reporting stems from poor health coverage in rural areas. Seven out of 10 rural Mozambicans go to traditional healers, not to health posts.

Most worrisome is that 65 percent of new infections are among people less than 30 years old. Unaids estimates that, by the year 2030, 37 percent of the youth aged 15 today in Maputo will be dead from AIDS.

Mozambique’s first HIV/AIDS plans were woefully inadequate.

Last year, the government designed a new national strategic plan. All ministries are involved. It looks good on paper. Then came catastrophic floods in March. Government efforts were re- directed to this disaster.

“Our work, specially in the central region, has been put on hold,” says Dr. Joel Samo Gudo, the plan’s technical advisor.

The floods brought new, massive displacement of people — and new chances for wide HIV transmission. People uprooted from their communities, crowded in makeshift transit camps, their social normatives (peer pressure, social sanctions, etc,) temporarily suspended, are prone to risky sexual behaviour.

On a warm afternoon in mid-April, drums beat and a crowd claps and cheers at the Marracuene accomodation camp for flood-displaced people.

They are watching a play about risky sex, performed by the Mavalane Youth Group against AIDS and Drugs. Its 12-member drama group is contracted by the British charity, Action Aid, to perform in the camps.

The Group also does peer education. Three days a week, in Maputo, three trained counsellors advise youth on drugs, sex and HIV/AIDS. Those who may have a sexually transmitted infection are referred to a local health clinic.

The Group operates from two small rooms in a large secondary and evening high school in a working-class neighbourhood.

Its coordinator, Luis Macave, 25, appears comfortable handling wooden penises sheathed with condoms to teach boys how to wear one. “Some kids believe HIV is transmitted by sharing clothes or cups, not by sex,” he says.

Ignorance about HIV transmission is compounded by myths regarding the disease, and not only in rural areas.

At a reporting workshop recently held in Maputo, none of the dozen odd Mozambican journalists had been tested for HIV.

Eventually, the course monitor realised why. They believed that, if a person learns he or she is seropositive, they die faster. If they don’t know, they live longer and healthier.

HIV/AIDS remains a taboo subject. Graca Machel, widow of President Samora Machel, now married to Nelson Mandela, created a furore late last year when she placed a death notice for Boaventura Machel, Samora’s brother, giving AIDs as the cause of death.

Since then, Mozambique’s main daily newspaper, the government- owned Noticias, has published just two notices with AIDS as cause of death. The third appeared in mid-April. The notice was first rejected, and accepted only after the person who brought it complained to the director of classified ads.

Against this background, it is not surprising that few HIV- positive people declare their status. This is changing, however slowly, as Associations of people living with HIV/AIDS are formed, in Maputo as well as in the provinces.

The oldest and largest is Kindlimuka (Awake, in the Shangaan language spoken in southern Mozambique). Among many other services, Kindlimuka provides counselling.

Counsellor Arlindo Fernandes sees his clients wherever they request — on the street, at the beach, in a park — because many are afraid to walk into Kidlimkuka’s offices, lest someone sees them.

In two years of activism and counseling experience, Fernandes has learned about people’s different cultural values. “Some communities talk easily about sex, some don’t. You have to take this into account,” he says.

Taimo agrees. “The more I research, the more I realise how many things we don’t know,” says Taimo. She explains that the long civil war preserved some traditions but destroyed others. Modern and traditional information coexist and interact among rural communities.

“What I do know, is that AIDS messages are not catching on because they do not match people’s cultural reality,” says Taimo.

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