Like Kissing a Cobra

It is impossible to fight HIV and AIDS without using the knowledge to be found among the locals. Especially women's knowledge and their networks must be used. Because a person's health is not only the result of individual choices, it is equally a result of environment, culture and society. Local culture and local institutions must be regarded as resources in the work against HIV and AIDS, not obstacles. This is the opinion of Vendelin Simon. The last two years he has been studying in Bergen at the 'Gender and Development' programme at the Centre for Women and Gender Research.

Working on his master thesis, he has done field studies in the Mbulu district in the north of Tanzania. It is estimated that about 90 percent of Tanzania's 30 million inhabitants live in the countryside. Vendelin Simon did his fieldwork here among what the west calls "tribal people".

Explosive epidemic

Statistics show that the number of people who are HIV-positive in the Mbulu district is increasing rapidly. In 1997, 1.6 percent of the local population was HIV-positive. By 2001 the number was increased to 7.5 percent.

- They go to the city of Arusha and to Dar es Salaam, and when they come home they bring the disease with them, he says. Vendelin Simon thinks that the numbers are lying - and that the real number is higher. Many AIDS patients die at home without their illness ever being identified. HIV/AIDS is not something that is spoken openly about in the villages. Many refuse to get themselves tested because they are afraid that the illness will come more quickly if they know they are sick. Those who are infected by the virus risk being stigmatised - and therefore they fail to inform others. Often the family is told only after the infected person has developed AIDS.

At funerals the relatives often say that the deceased suffered from cancer or tuberculosis. The story about the illness is rewritten to be more acceptable socially. Stigmatisation makes information and prevention extra demanding. Information often comes from health personnel or other experts who are in the cities.

- They told me that they went to the different villages once a month. Then they travel by car or motorcycle, something that almost no one in the village has. This contributes to underlining distance. The people who come have little in common with the people in the village and they do not know them. If I am going to talk to a woman about sex, I cannot talk to my mother or to a woman my own age. But I can talk to my uncle's wife or to my grandmother. That is permitted. The people who only come once in a while do not know things like that, Vendelin Simon underlines.

Much of the information on HIV and AIDS is spread through media. But in the Mbulu district infrastructure is limited and modern communication underdeveloped. Mbula town just recently got electricity, and only very few houses have it installed. As far as Vendelin Simon knows, there are only five televisions in the entire town. There are very few with access to newspapers and he did not meet many with access to a radio. In addition the number of illiterates is high. This all means that many people miss out on the warnings.

- When I spoke to the ones responsible for the national AIDS work in the area, they thought that their information reached 97 percent of the population in the district. These are numbers I doubt after having observed, interviewed people and led group discussions. Besides that, 'informed about' is quite relative: One of the men I interviewed said that he had slept with different women since 1990 but did not have the disease. There is little knowledge about the possibility of carrying HIV for ten years, without contracting AIDS, Simon says. And adds: - For those who do not know, unprotected sex is 'like kissing a cobra' - without knowing what risk you are taking. But even if people know what HIV/AIDS is, they are usually not willing to change their lifestyle and stop sexual activity that contributes to spreading the disease.

Women are vulnerable - and strong

- Women are especially vulnerable, Vendelin Simon thinks. - It is usually the men who decide whether or not to use condoms, and because women are economically dependent. They have few possibilities to leave, even though the man rejects their demands about protected sex.

- It is necessary to change people's way of thinking to be able to combat AIDS. Among other things the attitude that women are second-class citizens - whose most important goal is to get married, almost no matter what. Because of this, women are willing to take on large risks to get married. They are willing to marry men whose wives died of AIDS, because marriage gives them the status of 'normal'. HIV is then part of the marriage contract. Or they accept infidelity because they are brought up to excuse men. But even so, it is possible to mobilise the women's culture to fight HIV/AIDS, he thinks.

- It looks like women have little direct power in the community. But they do have a lot of influence on older men who traditionally are the community's leaders. Vendelin Simon describes how the women often meet in secret. And if they have a serious problem they march over in a threatening manner to confront the relevant local leaders. And they do not give up. They do not go home again before they have been heard and something is done with the problem. Their mobilisation is so strong that it has influenced those doing rituals and the older men to change their decisions and trust the women's advice. That the women have not yet taken action against HIV/AIDS he thinks is because they do not realise how many are carrying the virus, and also partly due to the fact that the disease is spread through sexual contact. This is therefore not a subject to be discussed in mixed audiences where both genders are represented.

- The authorities have to use women, Simon emphasizes. - They must organize this in a way that they include both the traditional women and the modern Christian women. And they have to be used to inform the community, to influence leaders and their own families. But of course this does not mean that men are excused of any responsibility. Vendelin Simon is especially concerned about the use of alcohol, which is on the rise among men. This is a contributing factor to spreading the disease. He would like to continue studying conditions such as these.

'…come to see me'

- Participant communication is the thing if knowledge and information are to break through, says Vendelin Simon. By that he means open, two-way communication. People have to arrive at their own suggestions of how to solve their problems. Such participant strategies have been ignored for many decades, but are now in the process of being acknowledged.

To illustrate he quotes a man he spoke with: 'They say I am rejecting the implementation of the project, but this is not true, they haven't consulted me, so I have to show them that the road cannot pass here until they come to see me'.

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