This document discusses sociocultural responses to HIV/AIDS in Africa from the perspective of an expert in Senegal. It notes some progress made in reducing HIV prevalence, increasing access to treatment, and prevention of mother-to-child transmission, but that more rapid prevention efforts are still needed. It examines how culture and biomedical research can be better integrated, cultural concepts that could inform youth education, and social networks and concepts that could support women and vulnerable groups. Communication challenges and opportunities to build on social capital and cultural heritage for HIV prevention are also discussed.

1. SAHARA
5th African Conference on Social Aspect of HIV/AIDS
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SOCIOCULTURAL RESPONSES TO HIV
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CULTURE : AN AFRICAN
PERSPECTIVE ON HIV PREVENTION
Cheikh Ibrahima Niang
SAHARA,
Université Cheikh Anta Diop, Dakar, Senegal

2. Progress is made
• Level off or Decline of HIV Prevalence among Pregnant
women attending antenatal clinics in
– South Africa, Swaziland, Lesotho, Namibia, Botswana, Zambia,
Zimbabwe (26 in 2002 to 16 in 2006)
• Decline among young people and among the General
Population associated with behavioral change
documented in
– Uganda, Kenya, Rwanda, Benin, Burkina Faso, Ghana, Cote
d’Ivoire (in Abidjan from 10% in 2001 to 6.9% in 2006)
• Low and stable prevalence in the general population
– in Mali, Senegal (0.7%)
• Progress in PMTCT:
– Pregnant women tested for HIV rose from 17% (2007) to 28%
(2008)
• Increased number of people having access to ARV
treatment in
– most of African countries in particular in South Africa and
Botswana

3. …Still too little and too slow
• Low speed of prevention effects
– Every day over 6800 persons become infected with HIV and
5700 die from AIDS
• Sub-Saharan Africa: More than 2 out of 3 of adults and nearly 90%
of children infected with HIV live in sub-Saharan Africa
• Crisis for young people
– Half of new cases (15 to 24)
• Gender crisis
– AIDS has the double face of a woman and the baby she carries
on her back
• 61% of adults living with HIV in Sub Saharan Africa are women (sex
ratio 1 man for 4 women, for some age groups in some countries)
• Low percentage of Pregnant women receiving PMTC (less than
10% for many of African countries)
• High prevalence of HIV among Female sex workers (Senegal: 19%)
• Crisis of Epidemiological denial and human rights
violations against MSM and sexual minorities

4. Biomedical research and Societal Contexts
• Body of knowledge on biomedical responses that work
– (condom, circumcision, behavioral change…)
• Gap Biomedical Research – Sociocultural contexts
– Antagonistic approach to culture (by the scientific official discourse)
• Culture seen as a set of practices (mainly “harmful practices”)
• Unequal epistemological status (science, basic science, “hard science”
constructed as the hegemonic fabric of the truth)
• Culture is seen associated to traditions which are considered as Static,
one-dimensional, one-semantic / used to justify gender and social
inequalities
• Missing research questions
• How culture is a framework of understanding and functions as a fabric
of identities and decisions making processes concerning HIV/AIDS
prevention?
• What are the Cultural Concepts underlying cultural practices?
• What are the multiple senses associated to cultural concepts and web
of concepts (Polysemic)?
• How to reconstruct harmony between biomedical research findings and
reinterpretation of cultural concepts?
• How cultural research and biomedical findings could provide ground for
social transformation needed for HIV prevention?

5. Sociocultural context for HIV/AIDS prevention among youth
• “Etic perspective” on Youth vulnerability to HIV/AIDS
• Intergenerational sex
• Multiple concurrent partners
• Socioeconomic vulnerability
• Sexual debut without having sex education
• “Emic perspective” on Risk taking as a metaphor for
sexuality
• Wolof (Senegal): HIV/AIDS risk taking as a metaphor of masculinity The
Guerrier (warrior) : “Gelbi Jaralnama SIDA” (this women deserves I get
AIDS)
• B. Davidson: (about the Venda girls in 1920s) “The Venda sexually
mature girl who continually stay with her mother was… called “afraid of
men” (the same in Wolof)… not considered as a normal human being
(wolof symbolic of beads “songe ko”: attack him; “songe ma” attack me)
• Articulating risk taking metaphors with HIV/AIDS preventive
messages
• The warrior is the one who take the risk of facing social and
interpersonal adverse effects of condom use
• Fulle (individual responsibility and self protection) applied to sex
education among the Wolof: “You seduce the one you want he seduce
you”

6. Cultural capital for youth sex education
• Inter-femoral non penetrative sex
– Documented in ethnographic research
• Masai, Luo, Zulu, Venda (Gregersen 1982; Werner 1987); The word
exist in Wolof, Senegal (ñapaaxu)
– Concept:
• Sex is not a sin
• Sex is a mechanism for harmony (cosmological harmony) Wolof: sey /
seey
• Control : A compromise between expression of sexual pleasure and
delaying penetrative sex that has to be integrated in social rituals (above
interpersonal relationship)
• Offence of the women in case of premarital pregnancy (family apology)
• Provisional concepts in case of non virginity (at the
marriage)
– Unknown (Interfamily arrangements)
– Juddu alarbay kayré
• Concept of compromise as condition for individual self
expression

7. Cultural heritage for women’s responses to HIV
• Structural factors affecting women and HIV/AIDS
– Gender inequalities and power unbalance
– Women Socioeconomic vulnerability
– Violence against women
• Social networks of women as a fabric of “sexual
power” (tuur; mbotaay)
– Sexual codes and tools for sexual power
• Beads, Incense, traditional perfume, postures and attitudes
• Discourse of self esteem (taasu)
– Surveillance of male sexuality (multiple partners)
• Intra gender secret is stronger than cross gender secret; The
story of Cocc “jigeen, soppal te bul woolu”

8. Facing socioeconomic vulnerability
• AIDS women’s economic dependency
– Micro processuses of economic survival for women and children
– Accomplishment of prescribed social roles
• Taylor (1992; Faser 2001) How to bring dignity apart from
redistribution and material support
– Cammen – jigeen model
• Jigeen = women; my jigeen = my sister (biologic or social sister), not
my wife
• Cammen = my brother (the one with whom I have a sexual taboo)
• Cammen – jigeen the strongest mutual social and economic support
unit
– Other support units: Baay-doom; Nijaay-jarbaat
• The naming system excludes sexual relations
• But they happens; when they happens they are hidden
• Suggar dady: nak fayda (lost of personality; non eligible to prestigious
functions)
– Rewards for non sexual partners
• Premarital : in some cases extra marital sex (dube in Cote d’Ivoire)
• Tudde doom (to name the child after him/her)
• Honorific status: Njekke; bayle

9. PMTCT and social construction of maternities
• Structural issues
– Non attendance of antenatal visits and of medically assisted delivery
– Breastfeeding
– Violence and social exclusion around the HIV status of the female spouse
• Women centered maternity
– Uncertainty and Non spoken
– Women observation (posture, spit, food, urine)
• Concept of breastfeeding
– Breastmilk is a genealogical vehicle including the male part (wolof soow)
– The breastmilk can be spoiled (but the decision on the quality of the milk
is a collective)
• Women’s counter power (how to reinforce women’s networks to face
HIV AIDS related violence and exclusion)
– Boo amul werukaay, da ngay gawa danu (if you do not have social
support, you become vulnerable)
– Dimba and violence
– Women’s networks in towns

10. Traditional protection to sexual minorities
• Situation of increased vulnerability to HIV
– Violence, discrimination and social exclusion against MSM, sexual
minorities and People living with AIDS (recent case of Senegal)
• Heritage of Cultural Concept
– Men women (Goorjigeen)’s model in Senegal
• Recognized identity
• Social roles (entertainers, counselors, social capital engineers)
• Political roles alongside with Diriyanke
– Crowder (1950) :
• « The elders and faithful Muslims condemn men for this, but it is typical
of African tolerance that they are left very much alone”
• Looking beyong classical gender paradigms
– Ghana (Eva Meyerowitz 1920 - 1940)
• “Men who dressed as women and engaged in homosexual relations with
other men were not stigmatized... There were good reasons for Akan
men to become women; the status of women among the matrilineal Akan
was exceptionally high”.
– The Gabra (John Colman Wood, 1999)
• «… they regard their most prestigious men – the d’abella, who are ritual
experts- as women »

11. Communication challenges
• Successes and limitations of biomedical discourses
• Social networks are interconnected communication networks
• Low-Beer and al. : The most important behavioural changes in Uganda
associated with communication networks: The societal communication
networks … proved to be more effective than the institutional mass
communication channels.
• Heritage of social capital
• Huge cross communities, cross gender communication for traditional
circumcision that could be re-conceptualized for medical circumcision for HIV
Prevention (Africa is the birth place of the invention of circumcision; 2300 BC)
• James Fernandez (1986 among Fang in central Africa) : How consensus are
generated by multitudes of specific operations of various forms of verbal
and ritual, through “performances” and metaphors
• New Metaphors for AIDS prevention
• Foot, urine (STIs)
• purse, sox (youth and young women “condom revolution” and bias in
quantitative studies)
• Societal metaphors for community mobilization
– Lesotho: KHOLUMOLUMO (Dr. Mokhantso Makoae, HSRC, personal
communication) similitude in Senegal (Diola)
• KHOLUMOLUMO and Transforming mythology into metaphors
• The monster, The fishermen’s filets (social networks), the child (the powerless
or marginalized person)

12. Conclusion
• More ethnographic and qualitative research need to be
done in order to study why things that work technically
do not work at the societal level
• The process to response to that question will help to
produce a new discourse and new response to HIV/AIDS
• The paradigm shift is underway
• As in African mythologies and in recent struggle for
freedom and human rights in Africa, it’s a woman who
takes the initial step to change the course of “business
as usual”
• So, Thank to Dr Olive Shisana the founding mother of
the new vision that focus on social sciences and
multidisciplinary research and response across Africa