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African Traditions Hinder Aids Prevention

Ancient beliefs that are widespread in rural South Africa directly affect attitudes toward AIDS prevention, though the effect appears to be contradictory among older adults and weakening among younger adults, a new study led by a University of Ulster academic has found.

Older adults who believe in ritualized ancestral protection from disease have more negative attitudes toward condom use, which “could, therefore, be construed as a risk factor in HIV/AIDS prevention among older participants,” found researchers led by Dr Christine Liddell, of the University of Ulster in Northern Ireland.

“Since older participants were between 35 and 45 years old, most were probably sexually active, rendering this a noteworthy risk,” the authors added.

The 407 study participants live in a remote, impoverished rural area of KwaZulu-Natal, South Africa, a region extending from the borders with Swaziland and Mozambique to the Eastern Cape in the south.

Participants, who fell into one of two age groups, were given questionnaires designed to measure and correlate AIDS-prevention attitudes to beliefs about ancestral protection and illness. The younger group (ages 18 to 24) showed more positive attitudes to AIDS precautions, with no significant correlations between those attitudes and traditional beliefs still held in their communities.

The study appears in the current online issue of the Annals of Behavioral Medicine.

To their surprise, Liddell and colleagues found that strong belief in traditional explanations of illness among the older participants was associated with more positive attitudes toward condom use.

“One possibility is that condoms fit harmoniously with traditional views of infectious substances, and how these can be avoided,” the researchers suggest. “A variety of protective charms and amulets can be worn as a means of warding off their harmful effects, and condoms may fit well with the concept of warding off contamination by polluted substances.”

In 2003, an estimated 38 percent of pregnant women in KwaZulu-Natal were HIV- positive, as were 14.1 percent of 15- to 24-year-olds. Per capita income is less than half the South African average.

The study “points to a major problem,” said Thomas Coates, Ph.D., director of the global infectious disease program at the David Geffen School of Medicine at the University of California, Los Angeles. “Accurate information about how to prevent transmission or acquisition is lacking, especially among older individuals. Thus, there should be little wonder that the HIV epidemic is out of control, especially in places like KwaZulu-Natal.”

In KwaZulu-Natal, as in much of traditional, tribal Africa, sexually transmitted diseases, premature death and epidemics are attributed to witchcraft and sorcery. According to study background information, it is believed that “an individual’s ancestors accord protection from disease and other misfortunes, provided the individual observes a variety of customs and rituals.”

"It is heartening, in this study, that younger people had more accurate information, and that traditional beliefs did not interfere with their understanding of the modes of HIV prevention," said Coates.

As for future studies: “When trying to understand any community or group of individuals, it will be essential to realize that any such gathering has texture, and that a variety of understandings and beliefs coexist and any attempt to provide education or behavior change will have to respect this variety," Coates said.

David Young | alfa
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