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• Contact tracing is problematic in light of some existing cultural sexual practices
  N Malangu*
  Published on: 25 November 2005

• Published on: 25 November 2005

  Contact tracing is problematic in light of some existing cultural sexual practices

  • N Malangu*
  • Other Contributors:
    • Mirika Manyati and Mushamba Shingirai. *University of Limpopo

  Dear Editor

  Mullick, Watson-Jones, Beksinska and Mabey1 have done a great job in summarising the approaches for treatment and control as well as the prevalence and impact of STIs in pregnancy in developing countries. Among the approaches cited is the contact tracing or partner notification as an integral part of STIs control.

  Coincidentally we read this article after we discussed cultural sexual prac...

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  Dear Editor

  Mullick, Watson-Jones, Beksinska and Mabey1 have done a great job in summarising the approaches for treatment and control as well as the prevalence and impact of STIs in pregnancy in developing countries. Among the approaches cited is the contact tracing or partner notification as an integral part of STIs control.

  Coincidentally we read this article after we discussed cultural sexual practices that fuel the epidemic of STIs particularly HIV as part of a multidisciplinary course on “Integration of HIV/AIDS into the curriculum for institutions of Higher Learning”, held in Pretoria, South Africa. As the issue of contact tracing is considered in light of cultural practices, it seems that the approach would be difficult to enforce in some African countries where multi-sexual partnerships are expected and accepted

  In a focus group discussion facilitated by the authors, 31 participants whose characteristics are described in Table 1, were asked to comment on the following statement: “Using examples, describe cultural sexual practices that increase the spread of sexually transmitted infections (STIs) particularly HIV in your country, province, or tribe”.

  Their responses are summarized in Tables 1 and 2. The practice of “dry sex”, rites of passage into adulthood, sexual cleansing of widows and widowers, widow inheritance, wife-sharing, and couple-deceit prostitution are some of the sexual practices that were mentioned as having the potential to increase the spread of HIV and other STIs. As pointed out by Gausset2, these practices cannot be solely held responsible for the spread of STIs because they are not incompatible with safer sex practices. For instance, Okeyo and Allen3 reported that lack of condom use among African widows is related to their lack of knowledge about its ability to prevent STIs.

  Although some of the African cultural sexual practices may seem strange for other people, their philosophical basis and metaphysical significance are part of a broader concept of the universe by the people who practise them. For instance the practice of widow inheritance, or levirate, is founded on the concept that the dead brother can continue to live through his living brother who continue to fulfill his duties and responsibilities towards his wife, children and society at large. This practice ensures a safety net for children and the widow by guarantying their economic and social benefits. 4 Similarly, rites of passages and widow cleansing are milestones in life progression among the living as also practised in non-African cultures. 5-6

  But some of the African cultural sexual practices do not lend themselves to the idea of contact tracing: How would a 12-year old girl or boy who contracted an STI from the rite of passage ceremony bring a partner? The age gap between herself and the man who performed the ritual, the enforced secrecy, the hurt or shame experienced, and even the fact that the man (woman) may not be easily identifiable given the circumstances of the ritual which is generally conducted in the dark. Or in the case of wife-sharing practice, which partner should a Ankole, Masai, or Yao woman bring if requested to do so? How would one diffuse the potential conflict emanating from publicizing what is normally a private affair?

  While we concur with Mullick et al.(2005) that more information is needed on the acceptability and effectiveness of contact tracing in Africa, we also add that studies and interventions that seek deeper understanding of cultural sexual practices need to be undertaken. These studies should assist in finding ways to accommodate these practices as they transform in the face of the devastating effects of HIV/AIDS. 7

  Table: Participants’ characteristics (n=31) Age Value (years) Mean 40.9 Median 39.0 Mode 39.0 Minimum 28.0 Maximum 55.0 Gender Percent Male 45.2 Female 54.8 Marital status Married 74.2 Not married 25.8 Level of education Higher diplomas 22.6 Degrees 77.4 Country of origin Ethiopia 6.5 Kenya 12.9 Lesotho 12.9 Malawi 16.1 Swaziland 6.5 Tanzania 12.9 Uganda 3.2 Zambia 12.9 Zimbabwe 16.1

  Table 2: Cultural sexual practices (n=31) Men’s demand for “dry sex” : To ensure that there is less lubrification, and render the vagina as small as possible (Leosotho) Lesotho, Swaziland, Zimbabwe, Malawi, Zambia, Tanzania Rites of passage called “washing” in which boys and girls aged 11-15 are required to sleep either with an old lady (boys) or a old man (girls) chosen by the community for the purpose ; or pick up any woman during the closing moments of the ceremony (Luhya tribe-Kenya) Lesotho, Malawi, Kenya, Wife’s inheritance (levirate): A brother of the deceased man inherit the wife and all other family responsibilities Ethiopia, Kenya, Lesotho, Malawi, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe The practice of women-sharing based on the concept that it is the “Woman’s duty” to accept sexual intercourse with any man from the community who request it – A Yao woman should never say no to a request for sexual intercourse because sex is a free gift from God! Yao tribes of Malawi and Tanzania The practice of giving a sister, cousin or niece to help the breastfeeding mother and her husband. Once the husband sleeps with sister, … she becomes automatically his second wife; the man cannot be given another sister or cousin. Swaziland The acceptance that a woman must always have 3 stones (men) to sustain her. The woman must ensure that the three men never know each other. Zaramo tribes in Tanzania The practice of sharing wives among all men of the same generation in Masai tribes (Kenya, Tanzania); or of a wife among sibling men (Ankole tribe-Uganda) Kenya , Tanzania, Uganda Couple-deceit prostitution where a man and his wife agree that the wife must seduce a rich man (who has more cattle) so that the husband can catch them during the intercourse and oblige the rich man to pay fines (1-5 cows) Zambia, Kenya (Tribes: Wajibana, Nduruma, Ndjibe, ..etc) Widows’ cleansing ceremony in which a widow is expected to sleep with a man chosen by the community (Lesotho) or herself (Zimbabwe) to mark the end of her mourning period. The man chosen for the purpose is somewhat the one who is known not to mind about doing it. Ethiopia, Kenya, Lesotho, Malawi, Swaziland, Tanzania, Uganda, Zambia

  Table 3: Methods and items used for dry sex (n=31) Methods and Items used for dry sex and enhance pleasure Country Douching is done with Coca-Cola, Soda water, snuff, magnesium salts in solution (from chemists), some mines’residues stones; herbal mixtures (such as “Mutiburo” means heighten libido; “Chiswabunga” means sexual prowess or strength for the man; and “Mugondorosi” meaning extend duration of man’s stay) Lesotho, Zimbabwe, Malawi, Zambia Insertion into the vagina prior to sexual intercourse of blue soap; cataplasms made of some herbal mixture made into small balls that are sold as such and referred to as “baboon urine” in Zimbabwe Lesotho, Zimbabwe, Malawi, Zambia

  References 1. Mullick S, Watson-Jones D, Beksinska M, and MabeyD. Sexuallly transmitted infections in pregnancy: prevalence, impact on pregnancy outcomes, and approach to treatment in developing countries. Sex Transm. Inf. 2005;81;294-302.

  2. Gausset Q. AIDS and cultural practices in Africa: the case of the Tonga (Zambia). Social Science and Medicine 2001;52:509-18

  3. Okeyo TM, Allen AK.Influence of widow inheritance on the epidemiology of AIDS in Africa. Afr J Med Pract. 1994 Mar-Apr;1(1):20-5.

  4. Phiri, Z.(2002). Inculturating African widowhood rites. Available at: http://www.jctr.org.zm/bulletins/incult-widows.htm {Retrieved 21 September 2005)

  5. Goseyun, A. E. (2001). Sunrise Ceremonial: An Apache Girl's Coming of Age White Mountain Apache Reservation, Whiteriver, Arizona, 1990. Balch Institute. Available at: http://www.balchinstitute.org/rites/apache.html. [Retrieved on September 21, 2005]

  6. Holland, E. (2001). Quinceanera: Latino Sweet Sixteen. Balch Institute. Available at : http://www.balchinstitute.org/rites/latino.html. [Retrieved on September 21 , 2005]

  7. Malungo J. Sexual cleansing (Kusalazya) and levirate marriage (Kunjilila mung’anda) in the era of AIDS: changes in perceptions and practices in Zambia. Social Science and Medicine 2001;53:371-82.

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  Conflict of Interest:
  None declared.

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