Pamela Dola, 32, who refused to be |
BONDO, 30 November (PLUSNEWS) - When Pamela Dola's
brother-in-law died in 1995, the tradition of her Luo ethnic group dictated that
her husband "inherit" his brother's widow, a responsibility he assumed as a
matter of course.
Three months after George Dola inherited her, his
second wife died. He was soon taken ill and did not last long.
"Before he
died in 1997, he tested positive for HIV. So I knew he had died of AIDS," said
Pamela Dola, who is HIV-positive and takes antiretroviral (ARV) medications.
Despite her illness, she single-handedly shoulders the responsibility of raising
eight children, including the five orphans left behind by her brother-in-law and
his wife.
Traditions
For members of the Luo community who
inhabit the Lake Victoria region of Nyanza Province in western Kenya, customs
like wife inheritance and widow cleansing threaten to extinguish a vast majority
of the population. Both practices have been cited as contributing factors to the
high HIV/AIDS prevalence rate in the province.
Nyanza has an average
HIV/AIDS infection rate of 14.7 percent, compared with Kenya's national average
of 9 percent. Alarmingly, the rate varies by as much as 30 percent across the
province: In Suba district, for example, it is as high as 41 percent, according
to Lennah Nyabiega, a health ministry official in charge of facilitating access
to antiretroviral therapy (ART) in the province.
According to Leonard
Oloo, chief coordinator of Rural AIDS Prevention and Development Organisation
(RAPADO), an NGO working in Nyanza's Migori district, wife inheritance is just
one manifestation of the importance of sex in Luo culture.
Custom also
dictates that because a widow is "unclean" she is obliged to undergo a cleansing
ritual immediately after her husband's death. Luo women who refuse to have
intercourse with another man are thought to be unlucky or cursed and are usually
ostracised by the community.
Sex is not exclusively linked to death,
however. According to Grace Ayieko of Community AIDS International, an NGO
working with AIDS orphans in Bondo district in Nyanza Province, sex is almost
sacred among the Luo.
"A man has to have sex with his wife before
cultivating his field. It is a ritual that has to take place at every stage of
the farming process," she said.
Oloo pointed out that many of life's
milestones, like moving to a newly constructed home, are preceded by sex. "In
the Luo society, sex seems to be more rooted in tradition," he
observed.
The sex act is believed to have protective powers as well. "If
your parent dies, you have to have sex with your wife before you can leave your
home. If you don't, there is a belief that you could die of chira [a curse],"
explained Ayieko.
Identifying risk factors
In addition to
harmful cultural practices, the lower status of women, the social stigma
surrounding HIV/AIDS and poverty all conspire against communities in Nyanza
Province. To curb the rampant spread of HIV/AIDS in the region, members of the
Kenyan government and international aid organisations are working together to
address factors that place communities at risk.
Oloo called for a
societal review of traditions that may be contributing to the spread of HIV/AIDS
in Nyanza Province.
"We have a situation in which people, especially
women, are culturally obliged to have sex," he said. "The woman may not like it
because she knows that the partner could be infected, but the cultural hold is
so strong on her, she is unable to say No."
Bernard Oduor Olayo, a health
systems analyst with the Nairobi-based Millenium Development Goals Centre,
previously worked as a doctor in Nyanza. He surmised that the low status of most
Luo women could be linked to the high incidence of HIV in the
community.
"By and large women are still seen as property. Typically, in
a rural Luo family the woman will not even complain when the husband brings
another woman home. They have been inculcated to accept the fact that husbands
are going to have extramarital affairs," he observed.
"Among polygamous
people there is a tendency of men having significant extramarital affairs. That
is what you observe when you live among them. Polygamy on its own has not been
documented in any literature as a risk factor on its own, but the man has
several sexual partners who are not necessarily his wives," he
added.
Olayo maintained that social stigma and a tendency to deny the
problem hindered efforts to control the spread of the virus.
"There is a
big number of number of people who do not want to go through VCT [voluntary
counselling and testing centres], who do not utilise the antiretroviral
programmes that are already in place in Nyanza. In fact, they do not want even
to know what killed people," he said.
"People continue interacting
sexually with these women even after their husbands have died of HIV/AIDS,"
Olayo observed. "Alternative explanations are given for every death. It is
either a neighbour's witchcraft, or chira, or something else."
Extreme
poverty also played a role in the rapid spread of HIV/AIDS.
The findings
of a government survey released in early November showed that 65 percent of the
inhabitants of Nyanza Province lived below the poverty line, which was
calculated at 1,239 Kenyan shillings (US $17) per month in rural areas and 2,648
shillings ($35) in towns.
"Poverty has a causal relationship to
HIV/AIDS," explained Olayo. "In poorer areas women start having sex much
earlier. They do not have good education. Women who do not go to school have
been studied and found to have higher HIV prevalence than their counterparts who
do go to school."
The poor were also more likely to have sex for money or
marry at a younger age. They lacked access to good nutrition, healthcare and
other services available to other HIV/AIDS-affected people.
"The poor
also carry a bigger burden - like deaths from HIV/AIDS - and were more likely to
engage in sex as a source of income," Olayo said. "Even young men - there are
women who have been widowed by HIV/AIDS and tend to migrate to fish-trading
areas. These women generally give young boys money and keep them as sex
partners."
The fact that the Luo as a community do not practise
circumcision is also considered a factor in the high incidence of HIV/AIDS in
Nyanza.
According to a study carried out in Gauteng Province in South
Africa and whose results were presented at the 3rd International AIDS Society
Conference on HIV Pathogenesis and Treatment in Brazil in July 2005, male
circumcision showed promising results in reducing HIV acquisition.
The
Joint United Nations Programme on HIV/AIDS (UNAIDS), however, cautioned that
more research was needed to confirm the findings of the study in South
Africa.
"If you look at the Luo community as a whole - even those living
away from the lake - it has been observed that they tend to have a relatively
higher HIV prevalence," Olayo said. "One key feature of the Luo culture that has
been studied and documented is the lack of circumcision. Lack of circumcision is
a significant risk factor for contracting HIV/AIDS."
Working towards
change
Oloo said that people in Nyanza province were conscious of
HIV/AIDS, but they "are not changing their sexual behaviour despite the HIV
pandemic."
Awareness campaigns by groups like RAPADO were beginning to
bear fruit, however.
"People are now open. They can speak out," observed
Oloo. "More and more people are coming to our mobile VCT, saying they want to
know their [HIV] status. Last year alone we received 844 people."
The
government had also set up its own VCTs and made ARV medications available in
the main hospitals and health centres in the area. Oloo, however, criticised the
administration for its initial slow response to the pandemic.
Lazarus
Ouma, a community volunteer health worker in Bondo district, said people were
beginning to realise that some of their cultural traditions were outmoded and
potentially deadly within the context of HIV/AIDS.
"There are some people
who criticise when we discourage wife inheritance. They will say, 'You are
cheating people. Death has always been there [death predates HIV/AIDS].’ But
generally people are beginning to understand [that HIV/AIDS is a reality]," said
Ouma.
In the Wawai village of Bondo district, women who have been widowed
by AIDS and rejected wife inheritance have established a support
group.
"Wife inheritance is bad. It is because of it that I am now
HIV-positive. Were it not for it, I still would be a healthy person," said
Felista Aluoch, 37, who believed she was infected by her late husband, who took
his sister-in-law as his second wife after his brother died.
Aluoch said
she was "deserted" by her brothers-in-law after she refused to be inherited. She
now raises seven children on her own, despite the fact that she relies on free
ARVs provided by a government clinic in Bondo town, 58 km away.
Aluoch,
who ekes out an income fetching water for neighbours, selling firewood and
raising a few chickens, said she sometimes lacks the 300 Kenya shillings ($4) in
bus fare to travel to Bondo town to pick up a month's supply of ARVs.
The
National AIDS Control Council, a government agency, has in its strategic plan
acknowledged that although HIV/AIDS awareness in the country was high, people
have been slow in changing their behaviour where sexuality was closely linked to
traditional beliefs and cultural
practices.