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THE ROLE OF INDIGENOUS KNOWLEDGE (IK) IN HIV COMMUNICATION, PREVENTION, TREATMENT, CARE AND SUPPORT IN MALAWI
RESEARCH REPORT AND IK COMMUNICATION STRATEGY
Submitted to
By Adamson S Muula PhD, MPH, MBBS, CPH Michael Nazombe MA – Com & Devpt, BA
APRIL 2014
ABBREVIATIONS AND ACRONYMS AEC
Area Executive Committee
AIDA
Attention, Interest, Desire and Action
ALV
African Leafy Vegetables
CHW
Community Health Workers
DACC
District Aids Coordinating Committee
DEC
District Executive Committee
DEHO
District Environmental Health Office (r)
DHO
District Health Office(r)
HBCC
Health and Behavior Change Communication
HBM
Health Belief Model
IK
Indigenous Knowledge
ITP
Indigenous and Traditional Plants
KAPMODIA
Knowledge, Attitude, Perceptions, Motives, Desires, Interests and Aspirations
KISS
Keep It Short and Simple
MANASO
Malawi Network of AIDS Service Organizations
NAC
National Aids Commission
NAPHAM
National Association of People Living with HIV and AIDS
PHC
Primary Health Care
TBA
Traditional Birth Attendants
TOPA
Theory of Planned Action
TORA
Theory of Reasoned Action
TORs
Terms of Reference
WEF
Wild Edible Fruit
WHO
World Health Organization
2
GLOSSARY OF TERMS Community of practice:
Groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly.
Indigenous knowledge:
Local knowledge and tacit knowledge of a community which spans beyond indigenous communities
Local knowledge:
All knowledge that is shared in a local community of practice
Traditional beliefs
Beliefs that govern ethics and morality within any long standing religion or belief system
3
EXECUTIVE SUMMARY This report details findings, conclusions and strategic actions from a study on the Role of Indigenous Knowledge on HIV Communication, Prevention, Treatment, Care and Support in Malawi. The study was commissioned by the National AIDS Commission (NAC) who engaged two consultants; one epidemiologist, and another expert in anthropology, communication and behaviour change to work with its Social and Behavior Change Unit. The study which was carried out between November 2013 and February 2014 employed both primary data and secondary designs in collecting and analyzing the data. The primary component comprised cross-sectional and qualitative designs comprising in-depth and key informant interviews as well as focus group discussions (FGDs). Data were collected in ten main cultural sites of Malawi including two suburban cultures from two major commercial cities, Lilongwe and Blantyre. The secondary data collection was done through desk reviews of literature relating to the subject but also recommended by key players and partners in HIV research and programming. The research focused on two major areas: (a) Role of IK in HIV prevention, treatment, care and support and IK communications focusing on approaches, media channels, key holders of the knowledge, key communicators (players), appropriate media and channels, including time and other techniques. (b) Communication strategy which principally recommends appropriate approaches, media, channels and players. As the IK differs from one cultural group to another, the report has detailed specific IK and Communication for all the specific cultural groupings. Investigating on respondents’ opinion about whether IK plays a role in HIV prevention, care and support, the research has unveiled that 98 percent of the respondents accepts that IK can play a role in HIV prevention. This includes 52 and 46 percent of those who who strongly agree and agree respectively. Only three percent remains either neutral or skeptical. On IK for HIV prevention the study shows that the majority of people (78 of the 146) maintains that respect for parents’ and elders’ counsel is primary. This is followed by sexual abstinence, discipline and no premarital sex (59), initiation rites (50), abstinence and fear of extra-marital sex (49), respect for husband (44), enhancing sexual attraction and love for husband (34), religious morality (34). Others include measures include: isolation from sex (28), parental control over children, respectable dressing (27), proper marriage procedures and arrangements (26), social activities and sporting activities (23), traditional communication between spouses on sexual matters (23), sex education in private, Lobola (dowry) (23): circumcision and marriage counselling and conflict resolution (23)educational traditional dances and songs (22),punishments for premarial and outside marriage sex (21), value for virginity (20), norms for those who go to work outside Countries(20), counselling for the Youth (20), changing bad IK (19) approved polygyny (12), roles and responsibilities of childrens before marriage (12), wife inheritance (10), marriage within the same culture (9), social distance (9), maturity as a measure for marriage (9), literacy (8), responsible drinking (4) among Chewa (6) and going to hospitals for Treatment(7). To implement IK for HIV prevention the research proposed that the following challenge need to be eradicated or managed: westernization and modernization, stigmatization of those who want to live by the positive IK, unfaithfulness in the families, open sex education through mass and class room media; sexy or erotic modern dressing, misunderstaning of freedom, democracy and human rights education, restrictive religious practices, proverty that increases prostitution,failure to abstain, poor parenthood; specific cultural practices within marriages that have dissolved individual traditional practices of good life, unapproved polygyny, decline in religious morals and sexually provocative or erotic public dances. On communicating IK for HIV prevention, participatory interpersonal face to face communication has been identified as the most appropriate. On key players, traditional and community leaders (112) have been identified as the most important holders. These are followed by parents and gurdians (101), village elders custodians and cousellors comprising initiation rite counselors (97); women’s groups (97); mens’ groups (93); support groups and PLWHA (90), health workers (80) such as Health Surveillance Assistants (HSAs) community nurses probably because they experience the community life the include people values, traditions, 4
knowledge and practices, non-governmantal organizations (NGOs), community based organizations (CBOs) and other stakeholders (75), training institutions and professionals (71), youth groups (61) and lastly traditional healers and traditional music performers (59). The research has shown that the following, put in order of the most appropriate, ought to be used as key communicators of IK for HIV prevention: Chiefs and community leaders who comprise Traditional Authorities (TAs), Group Village Headmen (GVHs) and Village Headmen (VHs) (61); PLWHA, support groups and community based volunteers (CBVs) (60); elders, cultural custodians and counselors (61); health workers and staff (HSAs, community nurses, health promoters, clinicians, nutritionists); women’s and men’s leaders and groups; community development facilitators (59) respectively; youth leaders and peer educators (55); traditional birth attendants (TBAs), traditional healers (THs) and herbalists(51); religious leaders (50). Dramatists and traditional music dancers were considered least appropriate. On appropriate media and channels for communicating IK for HIV prevention, one to one education and counselling (101) has been identified as appropriate media and channel for communicating IK for HIV prevention. This is followed by door to door household education (97), funeral event announcements (96) FGDs, group discussions and meetings at village and community level (90); initiation rites (89), religious institutions (77); rallies and open days (68), talks, workshops or seminars (54); traditional songs and dances (50); drama, arts and oracles (morning and evening announcements) (41) and sporting and competition activities (40). Information Education and Communication (IEC) and community media materials were mentioned. On IK for HIV treatment the study shows most people (121 of 146) hold that herbs can be used to treat AIDS particularly booting the immune system. This is followed by Traditional nutritional diet (68), church prayers (37), encouraging hospital medication (16), traditional spiritual and exorcisms therapeutic dances (13), family care (25), community moral and material support (13), support groups (2), secondary prevention abstinence (5), food security and agricultural practices (2), and safety of drinking water (2). To implement the IK for HIV treatment a number of challenges need to be resolved. These include scarcity and cost of local herbs, religious beliefs and traditions, belief in modern medicine, stigmatization and denial; traditional beliefs, expensive overdose and side; local food regarded as old fashioned, alcohol consumption, religious teachings, negligence to take medication, excessive alcohol consumption (14), unpleasant taste of the herbs, lack of faith in prayers, long distance to herbalists and health facilities, hiding HIV and ART status, lack of balanced food, patient’s behavior and attitude, lack of training for traditional healers (TH) and traditional birth attendants (TBAs), lack of resources, government does not involve traditional healers, some traditional healer sleep with patients, ARVs are used for brewing and mixing herbs and modern drugs, late reporting of diseases and unprofessional ways of circumcising people. Of the 146 respondent 110 consider traditional healers and herbalists as the main holders of IK for HIV treatment. These are followed by PLWHA and support groups (105), health workers and their organizations (100); elders and cultural custodians (100); local and traditional leaders (98); parents and guardians (89); NGOs and CBOs and relevant other stakeholders (78); training institutions and researchers such as universities (70); religious leaders especially those that have healing powers. The main key players for HIV Treatment include parents and guardian (77), PLWHA, support groups and CBVs (70), traditional healers, TBAs and herbalists (65), health workers, (63); elders, counselors and cultural custodians (63), chiefs and community leaders (50); trained health dramatists /artists (40), community development facilitators (36); teachers and trainers (33) and religious leaders. To communicate IK for treatment, 89 of the 146 respondents consider one to one counseling and education as the most appropriate channels, , door to door household education (80); FGDs meetings in the 5
community and Psycho-social support visits to patients (70) home based care (68), use of funeral events (68); (Drama and Arts (66); public talks and speeches (60); public rallies, IEC materials such as posters and community mass media (59). On IK for care and support the research shows community care (90), social support (82), proper and balanced food: (59), encouraging hygiene (23), curbing discrimination and stigma (20), spiritual support prayer (19), cultural or ethnic groups care and support (17), herbalists care and support (7), farming and business (6), administering medication (6), role specification at family and mbumba levels (4), sexual isolation (3), empowering PLWHA and care takers as instrumental in promoting care and support. Indigenous Knowledge for care and support has been challenged by discrimination, lack of home based care equipment and resources, poor support and care from guardians, inadequate knowledge on caring for the PLWHA, poor diet for patients, long distances to hospitals, drug overdose, scarcity of local medicine, reluctance to take patient to health facility, death of therapeutic traditional dances, poor food preparation, lack of disclosure of HIV status:, denial, negative religious beliefs and too much of the modernized food. While interpersonal face to face communication has been identified as the most appropriate approach for communication care and support main key holders include support groups and PLWHA (101), traditional and local leaders (99), women’s groups, parents and guardians (98 respectively), elders, counselors, custodians (97), health workers (90) health and development committees (89), Training institutions and professionals (89) NGOs, CBOs, government departments (87) Traditional healers herbalists (80), religious leaders (80). The research further shows that chiefs and community leaders (58), health workers, staff and health promoters (54), PLWHA, support groups, CBVs (50) are the main key communicators of care and support. Others are women or girls’ leaders, counselors(33), community development facilitators and CBVs (32), religious leader and preachers (31), youth leaders, peer educators(30, teachers, trainers, facilitators(28), parents and guardians (28), and elders, counselors, custodians(27). Lastly, FGDs and meetings (78), door to door household education (72), one to one counseling and education (71), funeral events (70) are the most appropriate media and channels for communicating care and support. Others include Psycho-social and material support (62), talks, seminars and workshops (60), IEC materials and community mass media (58), night and morning announcements calling people to do a certain work in support of people affected and infected by HIV and AIDS(45). Open days, drama and art can also be used to communicate care and support. The IK communication strategy has recommended the most appropriate approaches and techniques, communicator, media, channels for effective communication of HIV prevention, treatment, care and support. .
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TABLE OF CONTENTS GLOSSARY OF TERMS --------------------------------------------------------------------------------------------------------3 EXECUTIVE SUMMARY ------------------------------------------------------------------------------------------------------4 TABLE OF CONTENTS -------------------------------------------------------------------------------------------------------7 LIST OF FIGURES AND TABLES ------------------------------------------------------------------------------------------9 CHAPTER ONE: INTRODUCTION ------------------------------------------------------------------------------------- 11 1.0 INTRODUCTION AND BACKGROUND ----------------------------------------------------------------------- 11 1.2.2 1.3 1.3.1 1.4. 1.4.2
Significance of Indigenous Knowledge --------------------------------------------------------------------------- 12 Objectives of the Study----------------------------------------------------------------------------------------------- 12 Main Objective --------------------------------------------------------------------------------------------------------- 12 METHODOLOGY -------------------------------------------------------------------------------------------------- 13 Respondents, Sampling and Justification ------------------------------------------------------------------------ 13
1.4.4 1.4.5 1.4.6 1.4.7
Data Collection Tools ------------------------------------------------------------------------------------------------ 14 Content of the Tools-------------------------------------------------------------------------------------------------- 14 Data Collectors and Supervisors------------------------------------------------------------------------------------ 15 Data Recording, Organization and Analysis --------------------------------------------------------------------- 16
1.5 CHALLENGES AND LIMITATIONS ------------------------------------------------------------------------- 16 CHAPTER TWO: FINDINGS AND DISCUSSIONS ON IK & COMMUNICATION FOR HIV PREVENTION, CARE AND SUPPORT --------------------------------------------------------------------------------- 18 2.0 INTRODUCTION --------------------------------------------------------------------------------------------------- 18 2.1 GENERAL FINDINGS ON IK FOR HIV PREVENTION CARE AND SUPPORT-------------- 18 2.1.1 Opinions on the Significance of the Role of IK in HIV Prevention ---------------------------------------- 18 Summary of Opinions on the Role of IK for HIV Prevention --------------------------------------------------------------------- 18 2.1.3 (A) (B) (C) (D)
IK FOR HIV PREVENTION ------------------------------------------------------------------------------------- 19 NEGATIVE IK FOR HIV PREVENTION IN MALAWI------------------------------------------------- 19 POSITIVE IK FOR HIV PREVENTION --------------------------------------------------------------------- 25 CHALLENGES TO IK FOR HIV PREVENTION --------------------------------------------------------- 38 COMMUNICATING IK FOR HIV PREVENTION ------------------------------------------------------- 44
(i) Appropriate Communication Approaches ----------------------------------------------------------------------- 44 (ii) Key Holders of IK for HIV Prevention -------------------------------------------------------------------------- 44 (iii) Key Players or Communicators of IK for HIV Prevention --------------------------------------------------- 46 Summary of IK and Effective IK Communication for HIV Prevention----------------------------------------------------------- 47 2.1.4 (A) (B) (C) (D)
IK FOR HIV TREATMENT -------------------------------------------------------------------------------------- 48 NEGATIVE IK FOR HIV TREATMENT -------------------------------------------------------------------- 48 POSITIVE IK FOR HIV TREATMENT ----------------------------------------------------------------------- 49 CHALLENGES TO IK FOR HIV TREATMENT----------------------------------------------------------- 52 COMMUNICATING IK FOR HIV TREATMENT --------------------------------------------------------- 56
(i) (ii)
Appropriate Communication Approaches ----------------------------------------------------------------------- 56 Key Holders of IK for HIV treatment ---------------------------------------------------------------------------- 56 7
(iii) Key Players or Communicators of IK for HIV Treatment --------------------------------------------------- 56 Summary of IK and Effective IK Communication for HIV Treatment----------------------------------------------------------- 58 2.1.5 IK FOR CARE AND SUPPORT --------------------------------------------------------------------------------- 59 (A) (B) (C) (D)
NEGATIVE IK FOR HIV CARE AND SUPPORT --------------------------------------------------------- 59 POSITIVE IK FOR CARE AND SUPPORT------------------------------------------------------------------ 60 CHALLENGES TO IK FOR CARE AND SUPPORT------------------------------------------------------ 63 COMMUNICATING CARE AND SUPPORT FOR PLWHA -------------------------------------------- 66
Summary on IK and Communication for Care and Support ---------------------------------------------------------------------- 68 CHAPTER THREE: CONCLUSIONS AND RECOMMENDATIONS ------------------------------------------ 69 4.2 IK AND COMMUNICATION FOR HIV PREVENTION ----------------------------------------------- 69 4.2.2. Challenges to Implemeting IK for HIV Prevention ------------------------------------------------------------ 69 4.2.3 (A) (B) (C) 4.3
Communicating IK for HIV Prevention ------------------------------------------------------------------------- 69 Appropriate Communication Approaches ----------------------------------------------------------------------- 69 Key Holders (Sources) of IK for HIV presention -------------------------------------------------------------- 69 Key Players (Communicators) of Ik for HIV Prevention ----------------------------------------------------- 70 IK AND COMMUNICATION FOR HIV TREATMENT ------------------------------------------------- 70
4.3.1 4.3.3. (A) (B)
IK for HIV Treatment ----------------------------------------------------------------------------------------------- 70 Communicating IK for HIV Treatment -------------------------------------------------------------------------- 70 Approaches ------------------------------------------------------------------------------------------------------------- 71 Key holders of IK for HIV Treatment ---------------------------------------------------------------------------- 71
(C) (D) 4.4 4.3.3.
Key Players of IK for HIV Treatment ---------------------------------------------------------------------------- 71 Appropriate Media and Channels ---------------------------------------------------------------------------------- 71 IK AND COMMUNICATION FOR CARE AND SUPPORT-------------------------------------------- 71 Communicating IK for Care and Support ------------------------------------------------------------------------ 71
(A) Approaches ------------------------------------------------------------------------------------------------------------- 71 (B) Key holders of IK for Care and Support ------------------------------------------------------------------------- 72 (D) Appropriate Media and Channels for Communication Care and Support --------------------------------- 72 CHAPTER FOUR: GENERAL IK COMMUNICATION STRATEGY------------------------------------------ 73 4.0 INTRODUCTION --------------------------------------------------------------------------------------------------- 73 4.1 4.3 4.4 4.5
SITUATION ANALYSIS AND BACKROUND ------------------------------------------------------------- 73 OBJECTIVES --------------------------------------------------------------------------------------------------------- 73 THEORETICAL FRAMEWORK -------------------------------------------------------------------------------- 74 STRATEGIC COMMUNICATION APPROACHES ------------------------------------------------------- 74
4.6 4.6.1 4.6.2 4.6.3 4.6.4
MAIN STRATEGIC ACTIONS ---------------------------------------------------------------------------------- 74 Target Groups---------------------------------------------------------------------------------------------------------- 74 Participatory Advocacy and Partnership -------------------------------------------------------------------------- 75 Development of Project Plan and Document ------------------------------------------------------------------- 75 Orientation of Intermediary and Primary target groups ------------------------------------------------------- 75
4.6.5
Message Development------------------------------------------------------------------------------------------------ 75 8
4.5.6 Budgeting --------------------------------------------------------------------------------------------------------------- 76 4.5.7 Implementing interventions on Communicating IK for HIV Prevention, care and support ---------- 76 (A) COMMUNICATING IK FOR HIV PRIMARY PREVENTION ---------------------------------------------- 76 (B) COMMUNICATING IK FOR HIV TREATMENT --------------------------------------------------------------- 78 REFERENCES ------------------------------------------------------------------------------------------------------------------ 82 APPENDICES ------------------------------------------------------------------------------------------------------------------- 84 Appendix A: Questions Guide for Desk Review / Secondary Research --------------------------------------------------------- 84 Appendix C: Communicating IK for HIV Prevention, Care and Support ----------------------------------------------------- 90 Appendix D: Research Findings from the Specific Cultural Groups of Malawi ------------------------------------------------ 90 1.0 THE SENA ------------------------------------------------------------------------------------------------------------ 90 2.0 THE MANG’ANJA CULTURE----------------------------------------------------------------------------------- 96 3.0 4.0 5.0 6.0 7.0
LHOMWE CULTURE ---------------------------------------------------------------------------------------------102 THE YAO -------------------------------------------------------------------------------------------------------------111 THE NGONI CULTURE -----------------------------------------------------------------------------------------120 THE CHEWA CULTURE ----------------------------------------------------------------------------------------130 THE TUMBUKA NGONI ----------------------------------------------------------------------------------------137
8.0 9.0 10:0 11.0
THE TONGA CULTURE ----------------------------------------------------------------------------------------150 SOME CULTURES OF CHITIPA ------------------------------------------------------------------------------159 THE SUB URBAN CULTURE ----------------------------------------------------------------------------------165 THE TUMBUKA CULTURE ------------------------------------------------------------------------------------171
LIST OF FIGURES AND TABLES Table 1: Study Setting-------------------------------------------------------------------------------------------------------------- 13 Table 2: Summary of Respondents and Research tools ---------------------------------------------------------------------------- 15 Table 3: Data Collectors and Supervisors ----------------------------------------------------------------------------------------- 16 Table 4: Opinion Results on the Role of IK in HIV Prevention ----------------------------------------------------------------- 18 Table 5: Key holder of IK for Care and Support ---------------------------------------------------------------------------------- 66 Table 6: Key Communicators of IK for Effective Care and Support for PLWHA --------------------------------------------- 66 Table 7: Appropriate Channels and Media for Communicate Care and Support ----------------------------------------------- 67 Table 8: Key players and Specific Media and Channels for Communicating IK for HIV Prevention -------------------------- 76 Table 9: Key holders of IK for HIV prevention ----------------------------------------------------------------------------------- 77 Table 10: Key Players and Specific Media and Channels------------------------------------------------------------------------- 79 9
Table 11: Key holders of IK for HIV Treatment --------------------------------------------------------------------------------- 79 Table 12: Main IK Themes and Messages for HIV Treatment ----------------------------------------------------------------- 80 Table 13: Appropriate players, Specific media and channels for Communicating care and support ----------------------------- 80 Table 14: Key holders of IK for Care and Support-------------------------------------------------------------------------------- 81 LIST OF FIGURES Figure 1: Key holders of IK for HIV Prevention---------------------------------------------------------------------------------- 45 Figure 2: Key Communicators of IK for HIV prevention ------------------------------------------------------------------------ 46 Figure 3: Appropriate Media and Channels for Communicating IK for HIV Prevention -------------------------------------- 47 Figure 4: Key holders of IK for HIV Treatment---------------------------------------------------------------------------------- 56 Figure 5: Key Communicators of IK for HIV Treatment ------------------------------------------------------------------------ 57 Figure 6: Media and Channels for Communicating IK for HIV Treatment ---------------------------------------------------- 58
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CHAPTER ONE: INTRODUCTION 1.0 INTRODUCTION AND BACKGROUND This report presents findings and strategic recommendations of the research commissioned by the National Aids Commission (NAC) on the Role of Indigenous Knowledge (IK) in HIV communication and Prevention, Care and Support. The research which as was lead by two consultants with summarized specializations in epidemiology, social and medical anthropology, communication for change and development, was necessitated by the need to explore various efforts aimed at achieving a significant reduction in HIV prevalence through decreased incidence in Malawi after noting that the use of imported knowledge may be inadequate. Specifically, the research stemmed from the background reality that despite the country’s effort to reduce HIV infection, the prevalence is still high at about 11 percent among adults. The country is among the in the world’s in terms of HIV prevalence. Further, an estimated 450,000 individuals are currently accessing lifesaving antiretroviral treatment. The background shows that Malawi’s National HIV and AIDS Strategic Plan (NSP 2011-2016) which follows the 2005 to 2012 National HIV and AIDS Action Framework (NAF) seeks to provide continued guidance to the national response to HIV and AIDS, building on work done in the past decades. It unveils that the NSP is designed to facilitate the reduction of new infections by 20% through reductions of children’s infection by 30% and adult infections by 15%. AIDS deaths are estimated to be reduced by 8% which will include 50% reduction of children’s death. The NSP also addresses the reduction of the number of new infections among people in the 15- 24 years age group in terms of behavior change. This research’s terms of reference show that the interventions that are needed to reach the NSP’s goals are structured under five key priority areas namely; (a) Prevention of primary and secondary transmission of HIV; (b) Improvement in the quality of treatment, care and support services for PLHIV; (c) Reduction of vulnerability to HIV infection among various population groups; (d) strengthening multi-sectoral and multi-disciplinary coordination and implementation of HIV and AIDS programs; and (e) strengthening monitoring and evaluation of the national HIV and AIDS response. The implementation plan of the NSP further takes into consideration geographic variations whereby some regions of Malawi are more severely affected than others. Based on the review of epidemiological and sociocultural issues the NSP, among other things, addresses the (a) high prevalence of unprotected heterosexual sex, multiple and concurrent sexual partnerships and discordance in long-term couples; (b) increased numbers of people in need of antiretroviral therapy; (c) low and inconsistent use of condoms; and, (d) gender inequalities, including harmful cultural practices that put women at greater risk to HIV infection. While these efforts are being implemented, limited attention has been directed towards indigenous knowledge which could play a role in HIV prevention, treatment and care and support. 1.2 NATURE AND SIGNIFICANCE OF INDIGENOUS KNOWLEDGE (IK) Explanations of the terms, concepts and significance of this research have been laid out prior to the study definitions and significance for the research. 1.2.1 Definition of Indigenous Knowledge Indigenous knowledge is the knowledge that is unique to a given culture or society or geographic area. This knowledge refers to the cultural values embracing traditions, customs and practices which influence people’s will power, knowledge, attitude perception, motives, disposition, interest and aspirations (KAPMODIA). Indigenous Knowledge is the basis for local-level decision making to solve local problems. Communities generate this knowledge from practice and experience, continuous evaluation and experimentation (Moyo, 2008; 2009; Briggs and Moyo, 2012). This Knowledge is the information base for a society, which facilitates 11
communication and decision-making. It is very important to appreciate that indigenous information systems are dynamic, being continually influenced by internal creativity and experimentation as well as by contact with external systems. In many rural and remote areas where external influence is limited, livelihoods depend almost entirely on specific skills and IK essential for their survival. Stereotypes best demonstrated in Tarzan movies, according to Claire (Robertson (2002,p 59) “Africa is presented as one place, usually a jungle inhabited by wild animals and primitive people belonging to unchanging time wrap worthy of Gene Roddenberry. These peoples are organized into “tribes” who lead isolated lives in rural settings and have implacable enmities towards each other. They exist on the remote periphery of the world. Africa’s characteristics are presented are ranging from maliciousness to ignorance and naiveté. Even when they have Western education, they are not able to cope on their own (the infantilized stereotype). Women in particular are seen as victims.” 1.2.2 Significance of Indigenous Knowledge Knowledge system of any country comprises both indigenous and non-indigenous forms and the two need to be balanced to attain meaningful and sustainable national and international change and development. In Malawi experience has shown that models of diffusion of knowledge, change and innovation that have depended more on the participatory approaches and the common impersonal media such as radio, television and print have left most behavior change interventions not able to be fully effective. Indigenous knowledge embraces culture as people’s way of life and bears several benefits. First IK is an inalienable element of people’s value system, and appeals to people’s will and intentions and drives the behavior change as expressed in various theories of behavior change such as Theory of Reasoned Action (TORA), Theory of Planned Action (TOPA), and the Health Belief Models (HBM). Consequent to driving the human will, IK shapes people’s aspirations and influences the direction of social and behavior change. As it appeals to values and aspirations of the people in their socio-cultural environment, the IK helps one discover the self-realization of the deficiency to change and hence cushions the self-efficacy which is a very important empowerment tool for sustainable behavior change. Indigenous knowledge (IK) pivots on the most preferred and available values and helps us to identify and use the most effective approaches and techniques (media and channels) for sharing information for change and development. Such approaches and techniques include the participatory interpersonal face-to-face community based media and channels which have proven most effective in bringing about sustainable behavior change. The use of IK is a call to the realization of importance of people’s perception, attitudes, and aspirations and the use of the same to fetch sustainable behavior change. IK promotes the use of available tools for awakening people’s need for change, to attain the change they want and that which they can afford within their time, environment and their knowledge and perception. Thus, IK is an effective instrument for empowerment of the local people as it gives sense of ownership that generates sustainable social and behavior change and development 1.3 Objectives of the Study The following were the objectives of this study. 1.3.1 Main Objective The main objective for the research was to contribute to the national strategic action response of incorporating indigenous and traditional knowledge in communicating HIV and AIDS prevention. 1.3.2 Specific objectives The following were the specific objectives of the study: 1) To explore the general knowledge of HIV prevention, treatment, care and support 2) To examine indigenous knowledge that contribute positively to HIV prevention, treatment, care and support 3) To describe communication approaches, media and channels that negatively affects HIV prevention, care and support
12
4) To identify indigenous communication approaches, media, channels, players - bearers of knowledge that promote HIV prevention, care and support 5) To explore views on what indigenous knowledge that should be included in HIV prevention, treatment, care and support 6) To document views on indigenous communication approaches, techniques and players who need to be included in Communication Strategy for Effective HIV prevention and communication 7) To design a communication strategy for communicating IK for prevention, care and support. 1.4. METHODOLOGY The methodology of the study was as follows; 1.4.1 Study Design This research was a cross sectional study which employed both primary and secondary data collection methods. It engaged interactive anthropological and ethnographic approach using in depth interviews. The secondary research comprised desk review of literature recommended by experts within HIV research and programming, selected organizations engaged in HIV and social cultural studies and interventions. The literature was identified by the consultants online, libraries and other publications, literature from the MoH – HIV and AIDS secretariat, Ministry of Gender, Social Welfare other national partners in the fight against HIV and AIDS such as MANET+, SAFAIDS, NAPHAM, Malawi Human Rights Commission, Medical Association of Malawi; Save the Children, university college departments and Mua Mission. Literature was also recommended by key informants meetings at district level during discussions in the selected study districts. 1.4.2 Respondents, Sampling and Justification Ten cultures sampled on the basis of being the major culture of Malawi were identified. These were the Sena, Lhomwe, Yao, Ngoni, Chewa, Tumbuka, Nkhonde, Mang’anja and Tonga and Tumbuka Ngoni including two suburb (peri-urban and semi-urban) cultures of major cities of Lilongwe and Blantyre. The research reached 146 respondents, although 151 were planned. The respondents comprised 64 focus groups for the FGDs, 82 key informants for the Key informant interviews (KIIs) and a total of 441 individuals. The focus group respondents included district executive committee (DEC) focusing mainly on district Aids Coordinating Committee (DACC), Area Development Committee (ADC) at TA level, group of men, group of women and group of youth. The key informants included one development partners at district level and another at community level, the traditional authority (TA), the group village head, or community leader in case of the suburban, the custodian of culture, and the community based volunteer or the health worker. Table 2 below summarizes the respondents and the tools used to collect data from them. 1.4.3 Study Settings The study was national in scope and primary data collection was done in the major cultures of the Malawi. Table presents the sampled cultures and their corresponding sites and areas for the study Table 1: Study Setting CULTURE
DISTRICTS
TA or AREA
GVH or Community
PARTNERS
Ngoni
Ntcheu (NU)
Njolomole
Catholic Health Commission, CBV
Yao
Mangochi (MH)
Mponda
Maseko Ngoni, Inkosi ya Makosi Gomani, Ku Ngoni Culture Centre San Mkawa, Mgunda Mapiri, Koche
13
SAFAIDS, Save the Children, Manet+, C-Change, Napham, SSDI Com, Manaso, Dignitas, Unima dept.
Sena
Nsanje (NE)
Malemia
Magulugulu and Mbeta
NAPHAM, Save the Children
Mang’anja
Chikwawa (CK) Phalombe (PE) Blantyre (BT)
Katunga
Salumeji
NAPHAM, Save the Children
Kaduya
Kaduaya Village
SSDI, COWLH, NAPHAM.
Ndirande and Chilimba Area 18 A & B, Biwi
Ndirande and Chilimba Area 18 A & B, Biwi
Chewa
Dowa (DA) Kasungu (KU)
Tonga
Nkhata Bay
Chiwere in (DA) & Chilowamatambe in (KU) Nkumbira
Gideon Village in TA Chilowamatambe in KU and Gawa Madzi in DA Nkumbira
WACRAD- Word Alive Commission Relief and Development, COPREDCommunity Partnership for Relief and Development SAFAIAIDS, FPAM, NAPHAM
Tumbuka Ngoni
Mzimba
TA Mbelwa, Edingeni
Villages around TA Mbwelwa
Napham, Save the Children, Manet+
Tumbuka
Rumphi
Themba la mathemba Chikulamayembe
Kalawilira, Bongololo and Nkhozo.
Life Concern, REAP, Eva Demaya
Integrated Cultures of CP
Chitipa
TA Lambia and TA Misuku
IBANDA, Chinunkha, Kapolo
Napham, Focus, Ebenezer
Lhomwe Sub-Urban
1.4.4 Data Collection Tools The main tool for data collection was in-depth interviews which employed semi- structured interview guide with appropriate open-ended and probing questions. Discussion guides were used in focus group discussions (FGDs). The research employed in-depth interviews for both for face to face focus group discussions (FGDs) guided by some semi structured questionnaires and focus group discussions. 1.4.5 Content of the Tools The content of the study tools (the questionnaire guide) mainly focused on the following; (1) Seeking opinion on respondents on whether IK plays role in HIV prevention, care and support. (2) Identification of the IK for prevention, treatment and impact mitigation - care and support (3) Identification of challenges faced in implement positive IK for prevention, care and support (4) Identification of some negative IK for HIV prevention, care and support (5) Key bearers of the IK and effective approaches, media, channels, players for communicating IK (6) Proposed effective communication strategies and action that can be preserved and used for communicating the IK for prevention, treatment and impact mitigation, care and support. 1.4.6 Testing Validity of Tools Testing of the tools was done in Thyolo district in TA Bvumbwe, one of the Ngoni ethnic cultural areas. The site was purposefully and conveniently sampled as it was close to the consultancy secretariat. Key informants interviews (KII) were held with district key persons, TAs and GVHs, custodians of culture and other partners. Focus group discussions (FGDs) were conducted in the sampled groups of ADC, men, women and youth. The testing was also done in Chilimba suburban where FGDs were held with groups of community development committees, health committees, men, women and the youth and where KII were conducted with the community leader, custodian of the suburban cultures, community based volunteers (CBVs) and health workers. The tools were revised accordingly.
14
Table 2: Summary of Respondents and Research tools
Lilongwe
Blantyre
5
5
5
5
5
5
5
5
2
KII - Focal Persons on HIV, culture, Behaviour change
-
-
1
1
1
-
-
1
1
1
1
-
2
2
2
2
2
2
2
2
3
2
2
8
8
8
8
8
8
8
8
8
16
8
1
1
1
1
1
1
1
1
1
2
3
3
3
3
3
3
3
3
3
6
3
3
5
5
5
5
5
5
5
5
5
10
5
5
5
5
5
5
5
5
5
5
10
5
5
5
5
5
5
5
5
5
5
10
TOTAL No. OF KII
6
6
7
7
7
6
6
7
7
TOTAL No. OF FGDS
5
5
5
5
5
5
5
5
34
34
35
35
35
34
34
11
11
12
12
12
11
11
3
4 5
6
7 8 9
KII - Devpt Partners: (health NGOs, training institutions – 1 at district level & 1 at local level FDG - ADC (ADC Health, Gender Committees) KII with Traditional Authorities KII - VDC Level -GVH or Leader of Community -Custodian of Culture -CBV or Health Worker FGD - men as Key informants at cultural site FGD - Women as Key informants at cultural site FGD - youth as key informants at cultural site
TOTAL No. OF INDIVIDUALS TOTAL No. OF RESPONDENTS
2
5
12
60
12
7
7
7
25
25
25
104
13
11
11
11
39
39
39
13
65
13
5
13
65
13
5
5
13
65
13
12
6
5
5
9
5
5
35
35
63
34
33
12
12
21
11
10
8
13
82 64
1.4.6 Data Collectors and Supervisors Data were collected by trained research assistants with experience in social sciences, anthropology, development, health and communication related jobs. The research assistants were also allocated to the site based on their compatibility with the culture and the local language of the area. There was also an almost equal balance between females and males. The research assistants were supervised by the consultants. Table 2 below gives a list of the research assistants and their areas of expertise.
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TOTAL No. OF RESPONDENTS
Suburban
Nkhata Bay Chitipa
5
TOTAL No. OF FGD’s TOTAL No. OF INDIVIDUALS
Suburban
Mzimba
5
TOTAL No. OF KII
Tumbuk a Ngoni Tumbuk a Tonga Rumphi
5
Lambya & Sukwa
Chewa Dowa & Kasungu
5
Ngoni
Mang’anj a Lhomwe
Chikwaw a Phalomb e Mangoch i Ntheu
1
FGD - Key Informants at DEC/District level MoH – DACC, DHO, DEHO, NAC, Social Welfare, Gender, Education
Yao
Sena
TOTAL NUMBER OF RESPONDENTS
Nsanje
RESPONDENTS & TOOLS
441 146
Table 3: Data Collectors and Supervisors CULTURE
SITE
Ngoni
Ntcheu
RESEARCH STAFF Paul Mphepo
EXPERTISE AND EXPERIENCE
SUPERVISOR
Journalism, Health Communication, 4 years Social Sciences – Anthropology, 5 years
Chris Makwero
Yao
Mangochi
Llyod M’dala
Sena
Nsanje
Steve Namwera
Chris Makwero
Sperecy Chigwale, Prof Muula Noel Kanfose
Development Studies - HIV, WASH, Social Work - 15 years Development Studies - HIV, WASH, Social Work - 15 years Social Sciences – Social Work, Anthropology Social Sciences- Social Work , Anthropology Research, Stats, Human Geography, 3yrs
Mang’anja
Chikwawa
Steve Namwera
Lhomwe
Phalombe
Francis Maganga
Sub-Urban
Blantyre
Chewa
Dowa
Sub-Urban
Lilongwe
Statistics, Health & Change Devpt Communication 15yrs+ Social Sciences - Research, 15 years
Mike Nazombe
Nkhata Bay
Mike & Chris Makwero Chris Nyirenda
Tonga Tumbuka Ngoni Tumbuka
Mzimba
Fales Moyo
Prof A Muula
Rumphi
Zione Themba
Integrated Cultures of CP
Chitipa
Christina Tembo
Community Health & Clinical Medicine, Social Research, 15 years+ Development Studies & Research, 12yrs+ Social Research, Rural Development and Livelihood : 6yr+
Prof A Muula
Prof A Muula Chris Makwero Prof A Muula Mike Nazombe
Prof A Muula
Mike Nazombe Mike Nazombe
1.4.7 Data Recording, Organization and Analysis Data from the in-depth interviews were recorded on questionnaire guides and on audio recorders and later transcribed. The transcriptions and manuscripts were analyzed and findings categorized into themes guided by the study objectives. The themes were mainly (a) IK for HIV prevention, (b) IK for HIV and AIDS Treatment and (c) IK for impact mitigation - care and support. The negative IK and challenges to positive IK were also organized as separate themes. Communication approaches, media, channels, players also formed part of the main themes and were coded for quantitative analysis that included the frequency of the response including exemplar quotations. Secondary data were analyzed in a similar way and combined with the primary data to form part of the findings. 1.5 CHALLENGES AND LIMITATIONS The following are some of the challenges experienced during this research: (1) As the research was conducted during rainy season, some targeted remote areas were hard to reach and this delayed the collection of data as the research assistants had to postpone the research until the time the roads were passable and people were available. (2) Some targeted resource persons and groups at district level were not ease to grant interviews as key informants. This is not only because, as they were not only busy but also advised to go for holidays in early January. This forced the data collection to be rescheduled (3) Some district official demanded ethical approval despite letter for introduction by the NAC and the identification provided by the research lead consultant. (4) On primary data, very little or no research has been done on role of IK in HIV prevention. Most partners we believe had done research on the area, focused on negative IK. (5) Some communities have been inculcated by imported teaching and believe that IK can offer little on HIV prevention. It was not easy to bring out anything positive about IK from respondents from such people
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(6) Some of the targeted HIV focal persons who were identified as key informants because of their expertise, positions, and research experience related to social and behaviour change related to HIV and AIDS, could not be reached either because they were tied up or not available for the interviews. This also delayed the research. 1.6 SOME POSITIVE REMARKS ABOUT THE RESEARCH Despite the challenges, most people have valued the research as a special and very important in the fight against HIV and AIDS in the country. The following were some of the notable quotations from respondents
We are now very happy that government has now started realizing the importance of us local people and our knowledge in development issues including mitigating HIV and AIDS. TA Kaduya – Lhomwe, Phalombe.
“The research is good and should be distributed to local people so that the traditional medicine should be known to boost immune system locally”. Ndirande Blantyre District AIDS Coordinating Committee
This research is very good because for the first time we have been given chance to express ourselves on about the positive traditions, customs and practices which we know can help prevent the HIV and AIDS” TA Chiwere, Chewa, Dowa”
“This research is also good because it help parents not only encourage us know those IK that can help prevent HIV but also help parents to discourage us from those piece of IK that that encourage spread of HIV and AIDS.” Youths from Ndirande
“The research is good but you don’t come to give us feedback on what to implement”
“It is time health organization started respecting traditions and cultural elements or people so that good health should be promoted”– Senior ART clinician – Tikondane clinic, Mangochi
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CHAPTER TWO: FINDINGS AND DISCUSSIONS ON IK & COMMUNICATION FOR HIV PREVENTION, CARE AND SUPPORT
2.0
INTRODUCTION
The findings have been divided into two main sections. Section 2.1 presents findings on the IK for HIV prevention, treatment, care and support while section 2.2 is on Indigenous communication employed in communicating the IK. Both sections present general or summarized findings for Malawi and specific findings from the major Malawian cultural groups that were studied. 2.1 GENERAL FINDINGS ON IK FOR HIV PREVENTION CARE AND SUPPORT This section presents findings on IK for HIV prevention, treatment care and support. Section 2.1.1 given general or summarized findings while 2.1.2 reports finding from the ten major Malawian cultural groups that were studied 2.1.1 Opinions on the Significance of the Role of IK in HIV Prevention The 146 respondents were asked to indicate their opinion as to whether Ik plays a role in Likert rating as Strongly agree, Agree, Neutral, Disagree, Strongly disagree. Table 3 summarises the responses. Table 4: Opinion Results on the Role of IK in HIV Prevention
RESPONDENTS 1 2 3 4 5
DACC and DEC HIV / AIDS Focal Person Partner (District) Partner (Community) Area Development Committees (ADC) 6 Traditional Authority (TA) 7 GVH or Community Leader 8 Custodian of Culture 9 CBV/ Community Health Worker 10 Men Groups 11 Women Groups 12 Youth Groups TOTAL
Strongly Agree 4 4 7 4 8
Agree Neutral Disagree Strongly Disagree 7 1 0 2 1 0 5 0 8 1 0 5 0
TOTAL 12 7 12 13 13
5 8
6 5
0 0
11 13
9 8
4 5
0 0
13 13
8 7 4 76
5 5 8 65
00 0 0 0
13 13 13 146
1 1 5
0
Summary of Opinions on the Role of IK for HIV Prevention The most significant findings are that 98% of the respondents accept that IK can play a role in HIV prevention. This includes (52%) and 46 percent who strongly agree and agree respectively. Only three percent remains neutral or skeptical. It is interesting to note the numbers of under the youth, partners, and district executive members is lower in the strongly agree section and higher in the agree column. These are groups have been inculcated with imported knowledge in HIV without overemphasizing the reality that most youths see most IK as outdated. Contrary to general expectations, for traditional authorities who are believed to be holders of IK have the majority only agreeing and lower number on strongly agree. They may also indicate the inculcation the chiefs have been given on the negative side of their culture on HIV prevention. It may
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also signify traditional leaders’ fear of promoting their cultural values that might have been condemned in most interventions that implemented and supported by government. 2.1.2 Indigenous Names of HIV AND AIDS Several names were used found to refer to HIV and AIDS. These names included magawagawa, matenda a boma, kafere kwanu, kwanu maliro kwathu maliro, kaliwondewonde, edzi, matenda a masiku ano, zomwezi and mliri. Local Name Adadaya tsitsi Magawagawa Ili muufa Kwanu maliro kwathu maliro Matenda a boma Kafere kwanu Kazunze amako Kaliwondewonde Kamatira Matenda a masiku ano Mtengano M’dulamoyo Zomwezi Mliri Makiyi a kumotchale Hang’ala Chilaya chalira Wonyamula makeni
Literal Meaning She or he dyed hair communicable disease It is in the (maize) flour a funeral both at your home and mine Government’s disease Go and die at your home village Go trouble your mother Slimming disease Incurable The disease of this age Stick with me The disease that cuts life These things Plague Morgue keys Court hanger The cemetery bells have rung Skeleton
2.1.3 IK FOR HIV PREVENTION This section examines IK for primary HIV prevention. It first details pieces of IK that is negative to HIV prevention. This is followed by IK for HIV prevention also described as positive IK. Challenges encountered in trying to implement the positive IK are then described. The section closes with a discussion of Effective Communication of IK. (A)
NEGATIVE IK FOR HIV PREVENTION IN MALAWI
Before identifying the IK that helps in HIV prevention, the research also took note of the following IK that encourages the spread of HIV. Chokolo (39): A brother marries the wife of a deceased brother. This poses a threat of one contacting HIV in a scenario when the wife or the new husband was HIV positive. Reported in the Sena, Lhomwe(2), Mang’anja, Tumbuka (8), Tumbuka Ngoni(10), Tonga(4), integrated cultures of Chitipa(11). Similar to chokolo is Kulowa kufa where in the Mang’anja (2), Sena, culture of Chitipa (2), Sub-urban a brother engages in sexual intercourse with the deceased brother’s wife. Disapproved polygyny (37): The traditional practice of marrying more than one wife has been reported amongst the Lhomwe(4), Yao (5), Ngoni (5), Chewa, Tumbuka (8), Tumbuka Ngoni(9) and culture of Chitipa (6)to have helped in the spread of sexually transmitted infections. Kulowa fisi (35): as well as having sex with a woman whose husband is presumed infertile and not able to make her pregnant. This has been reported among the Yao, Lhomwe (3), Chewa (14), Ngoni (8), Tumbuka Ngoni (4), integrated cultures of Chitipa (6) 19
Traditional Dances (31): A number of traditional dances have been reported as to encourage HIV transmission. The night m’bwiza dance (14) is highly sexually stimulating dance that involves both males and females common among the Yao. When done in the evening a group of women perform the dance while wearing the scanty clothes with just underwear and covering themselves with a “see-through piece of cloth. A man would join the lady who can wrap him with the cloth while dancing to accordion, drum and beating of a hoe in a dim light. As they dance or if the man wants sex with the lady, he can pay the dancers group leader and take the lady behind a house where they can have sex. It is not known or it is unlikely that the partners will use condoms. When such an act is done another man can also dance with the lady and does similar sex exercise. Sometimes men may not have sex with the dancing women but the dance itself may stimulate people to have sex at or from the ceremony. Gule wamkulu where youths are involved in sexual activities in the name of watching the dance in most cases at night (2). Mjiri, Lhomwe and Yao traditional dance that involves women and men and it leads to promiscuous behaviour. During the tchopa dance preparation time among the Lhomwe, men take advantage of the period and venue as ideal time to indulge themselves in secret sexual activities. Some late night dances such as Manganje among the Lhomwe and Yao and those in the Sena culture have been reported to promote sex. Vimbuza, a Tumbuka spiritual healing dance performed by intricacies of special drumming, songs and dances attracts a lot of people and chances of having sex are high (7), Chitipa cultures (5).The way women dress when performing serebwede Lhomwe dance encourages sexual activities . The women performing this dance show breasts and thighs and this was reported as enticing men to indulge in sex with the women (4). Vibwaira dance visits in the Tumbuka culture is performed when group of women go to visit women in another village and sleep over there. There are usually dances at night and a lot of women take this as a chance to have sex with other men (2). Chilimika dances where children and women stay away from home for more than one week- Tonga (5) Excessive beer drinking (30): Among the Sena, it has been reported that excessive alcohol drinking as occur when cheap liquor compared expensive ones increase chances of contracting HIV and AIDS. Among the Lhomwe, heavy alcohol consumption by both males and females was reported lead to more sex without protection. Excessive drinking makes men and some women irresponsible and vulnerable to sex - Yao, Ngoni (10) Chewa, and Tumbuka (13). Zilabu drinking and dance at night in the Chitipa cultures also make people vulnerable to HIV and AIDS (7). Sexy dressing (23): The practice of wearing trousers, tight and see through clothes, long slits, leggings, spaghetti tops, and not wearing bras and petticoats stimulate men into proposing them for sex – Tumbuka, Tonga, Lhomwe and suburban. This observation was reported in many of the study sites. Initiation rites (14): It has been found that some initiation ceremonies encouraged sexual activities. Men are sometimes told to indulge in sexual activities as a way of showing that they are real men. In the Yao and Lhomwe, some belief is imparted to girls during initiation rite to engage in sex activities to avoid being barren. (Lhomwe, Yao). At kugwa mdothi initiation ceremonies, it was reported that girls are advised to sleep with a man to have a smooth body or to be cleansed. Commonly known as kuchosa or kusasa fumbi which literally means removing dust, the traditional practice also involves boys after they come from initiation and is also reported among the Lhomwe (2), Mang’anja, Yao, Ngoni. Jando, common among the Yao and Lhomwe is said to promote use of unsterile and single material for circumcision for many boys which can easily spread the virus. It has been reported that the messages given to the young initiates at the Jando and Nsondo for girls do not suit them in terms of their age and readiness for sexual activities. This encourages the young men to start engaging in sex as soon as they are healed from the circumcision (4). After the kuswa mbano puberty (girls) ceremony for Chewa and Kulizyang’oma in the Tumbuka Ngoni, most initiates desire to do sex to practice what they have been taught at the ceremony. In the cultures of Chitipa, bridal showers have been observed to encourage sex amongst unmarried people as they come from the ceremony. Related to this is the Jando initiation itself. Kumveka chilemba, an initiation related ceremony among the Chewa where girls are asked to gather at chiefs house the whole night, also encourages sex as people go and come from the function
20
Offering girls for sex or marriage (13): This includes (a) Kupimbira among the Tumbuka whereby a family that is financially constrained goes to a richer man to ask for assistance and the rich man offers help in exchange for a girl. The man takes the girl at a very tender age so that he can guard her before making her a wife and usually makes her a wife while still very young. Sometimes some couples even offer an unborn child. (b)Girls entertain chiefs: during installation of a chief there is a tendency of picking young beautiful girls to serve the invited chiefs and they end up sleeping with them. (c) Bulangete la Mfumu (chiefs blanket) whereby a traditional leader such as TA or GVH is given a young woman to cook for him and sleep with him when he goes over to a village to settle disputes in the night -Ngoni (5) and Chewa (3). Among the cultures of Chitipa, a girl can be offered as Tsakulwa or shazi or szai token of appreciation to a husband who is taking care of the wife and her parents (3) Similar to this is the same is mbiliya (mbiligha) tradition whereby a man is rewarded with his wife’s younger sister when they feel that his wife has grown old. Pornography and prostitution (17): Sexual intercourse is now normalized for boys and girls (sex for fun) – Sena and Chitipa Cultures, video shows that stimulate people to undertake sex – (Sena, Tumbuka, Sub urbans). Market days are being used as sex days especially in the evening. These markets are usually not patronised in the morning but in the evening – (Sena, Tumbuka). Youths here like going to video shows and this is where they watch uncensored movies and in the end want to try what they watch –Tumbuka (2). Unsafe re-marriage after spouse dies (12): Several traditional customs and practices have encouraged unsafe remarriage of the widow or widower. For example, the Ngoni promote mbirigha chokolo cha akazi. This is when a wife dies and a female relative to the man takes over the widower. Among the Tumbuka (2) and the Tumbuka Ngoni skazi is a token of appreciation offer of a young sister to a husband who treats his wife and her parents very well. The sister can be offered as second wife to the “good man. (2), Tumbuka Ngoni (8). This is close to the then tradition among the Mang’anja. It was reported by the Chikwawa DACC that they together with NGOs are strongly de-campaigning against the nthena tradition. Chijula mphinga- When a man wife dies but they wife’s side was very happy with how the two were living the wife’s side offers another woman as a wife to the widower – Ngoni. Constraining husband from sex with wife (11) has encouraged men go for sex in other women. Examples include. Kudika mamba – no sex after the woman is 6 months pregnant and kudika chikuta – No sex for 6 months after the woman has given birth among the Ngoni. The mimba and chikuta period means 9 months of no sex (6). This makes men go have sex outside the marriage. Kukhuza maliro (5): When there is a funeral women stay at the funeral house for a month which result in men begin looking for sex from other women and girls from other villages and others go to bottle stores have sex with sex workers - Ngoni(5). Prostitution (8): When a woman goes to buy fish (e.g. usipa) at the lakeshore, for her to be served first it was reported that some sleep with a fisherman – Tonga (6). People diagnosed with HIV do not stop sleeping with different partners. –Tonga. “There is high level of prostitution here “(Tonga respondent) Mchenzo (8): During wedding ceremonies, youths do not sleep in their parents’ homes as they spend a night dancing and drinking beer in pre-wedding celebrations days. Many youths and even men and women use the mchezo as meeting points with sexual partners -Ngoni(6), Chewa(2) Unfaithfulness (7): Unfaithfulness within the married couples- Yao, Tumbuka Ngoni (3), Tonga (2), cultures of Chitipa Church activities and overnight prayers (6): Many people reported that as Christians they do not like that there are NGOs who give out condoms but these NGOs only give condoms to youths who cannot abstain. – Tumbuka. Sometimes after overnight prayers, used condoms are found within church yards – Tonga, Chitipa cultures. It has also been reported that youth have sex during retreats and choir functions -Tonga. Some pastors send women to church seminars in exchange for sexual favors. (Tonga). It has been alleged that some prophets engage in sex with the women or girls in the church as exorcism process of the evil spirits. 21
Rape (5): Immorality e.g. rape with the view that “nkhwani umakoma wa nthete” - Chewa (5) Traditional feasts (5): Feasts related to initiation rites have been reported to help in spread of HIV. Namchisamchisa is a Yao’s all-night celebration that marks a week before the initiates come out of jando where different activities take place including sexual related ones. Lyogo (4): This is a sexual feast that marks the day when boy initiates are getting better after being circumcised and it is an all-night feast comprising dances and songs while every man goes for a woman of his choice regardless they are married or not -Yao (4). Celebrations“...there are a lot of celebrations that happen here and the obvious thing to happen there is sex.” Sometimes women do what they call “zipongo” and they visit each other and sleep over at a friend’s house. Some women just take this as a way of running away from home to meet men._Tumbuka. Visiki (secret friends) – time for exchange of gifts between families with beer celebrating and end up having unprotected sex. – Chitipa cultures (3). Vibwaila feast is done at night and men and women are involved. This is a feast organized by the wife’s side in appreciation of the girl or women who has been marriage through the lobola- culture of Chitipa (10) Traditional counselors organizing sex for money (5): It has been reported in the Tumbuka that there are some women in the villages that are known for training girls in things like elongating labia. These women are entrusted with the girls and usually build a close relationship with the girls. However, they take advantage of this and find boys for the girls so that they should get some monetary gains from these relationships. Misunderstanding of human rights and freedom (4): Youth claim to have freedom to do whatever they want - Sena, Tonga. Human rights education has made youth have a platform where they can discuss dehumanizing effects of some traditions leading to them to report what was not true about their culture – (Tumbuka). Freedom of dressing (Tumbuka Ngoni Sharing of objects (4): Sharing of sharp objects for example razor “chigalo potemela phini, metera ndevu”_Chewa (2). Use of one razor (knife during application of local medicine).Use of one razor blade at funerals as people cut their hair. -Tumbuka Ngoni Early marriages (3): Parents force their children to marry earlier-Sena (2), Chewa. Some Lhomwe and Mang’anja communities still believe that AIDS is kanyera (an old sexually transmitted disease) which was successfully cure using local IK treatment, hence use local means of treating the disease only -Lhomwe (10). Arranged temporary sex or marriage (2): Musubizyo is a tradition among the Tumbuka and Ngoni whereby the parents of the husband who has gone to work or study outside the country. Temporary sex or marriage is then arranged for the wife to keep her busy especially if it is a new marriage and the woman is young. Arranged permanent marriages: (2) This usually happens with Tongas living in South Africa. They just ask for a Tonga girl to be sent to them without knowing each other’s characters. This can also promote infection of HIV – Tonga (2) Pre-marital sex (2): Young girls reported to have sexual relationships before they are married. This is promoting the spread of HIV-Tonga (2) Condoms promoting sexual behaviour (2): Use of condoms instead of abstinence (Chitipa). Youth groups encourage each other on dating and use of condoms instead of abstinence (Chitipa). Introduction and distribution of condoms especially in primary schools encourages and motivates people to practice sex (Chitipa cultures) Poverty (2): Poverty levels have led to premarital sex. -Tonga, Cultures of chutzpa
22
Games (2): Games that some of the children play for example ‘Chibisalirano’ where youths play hide and seek with opposite sex common at night. In addition, they also play cards where the one who finishes last is asked to strip clothes off so that the others should play with private parts exposed -Chewa(2) Lack of parental care and control (2): Lack of parenting culture makes kids do things their own way (Sena). Parents are busy making money and do not have time to advise their children. Beliefs and rituals (zizimba): In some ethic groups, some people still believe that HIV is not contagious but associated with witchcraft. Most people still don’t use condoms because they believe sex must be unprotected for it to be complete – Lhomwe (3). Women sleep with asing’anga (traditional healers) as a ritual solution to infertility in their families -Ngoni. Among the Tumbuka Ngoni, when a women reaches menopause they may refuse to have sex with their husbands for fear of mbulu (abdominal swelling that is believed to be due to sperms at menopause. In the suburban it has been learnt that some traditional healers suck blood from people in the name of draining the HIV and AIDS. Other healers sleep with those that are infertile in the name of satisfying the rituals of making the barren woman productive. Kulimbitsa mwana or Kuika mwana mmalo is a customary belief and practice among the Chewa where a man is chosen to have sex with a mother who has just delivered. Chidyerano or Chimwanamayi – two family friends can go out for a sex spree by exchange wives or husbands. They cook special beer for the two families and once they are drunk they do exchange the wives for a night, -Ngoni (6). Somehow similar to this is the chimwanamaye among the Tumbuka. This involves exchange of spouses and the practice is now openly discouraged as it was observed to have helped in the spread of HIV) Kolowetsa dzuwa: Girls go to the river to prepare themselves for marriages through genital manipulation where they handle each other private parts, fluids and blood without any gloves – Ngoni. The mbuyache concept: An uncle makes all decisions for Lhomwe women including who one should get married to. This has in one way or the other promote the spreading of the disease because many women are pushed into marriages which put them on the risk of marrying people they would not love or respect Lhomwe Use of one piercing of cutting instrument: At jando circumcision, and at traditional healers’ place where one blade is still used for several people – Yao and Ngoni Lack of openness between spouses: It has been found among the Ngoni that couples are usually not free or open enough with each other and when men meet prostitute who are very free to them they get carried away. Tobacco farming: After selling tobacco most men get money and go to get married elsewhere or go to places like bars and bottle stores and get to sleep with prostitutes. Even some tobacco farm owners like sleeping around with their tenants’ wives -Tumbuka, Chewa Women share wrong information. They share local concoctions like “munowa” which increases libido in women and they say it helps the man the sleep with to enjoy the sex. When they use this and their husbands cannot satisfy them they normally look from other who have bigger penises. Unfortunately such women do not like use of condoms. Some use some medicine to tighten their vaginas and these sometimes may cause thrush which allows HIV transmission -Tumbuka, Tonga, suburban.
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Woman refusing to have sex with husband: Transition of kupempha mwana (when a woman is a month pregnant, her parents come to ask to take her to their home to give birth and she only come back four months after the baby is born, making the man to go and look for sex elsewhere). Chidyelano: Apongozi drinking at night while friends of different sex are invited within the intergrated cultures of Chitipa (10) Too much drinking (black berries) and smoking encourages people to do bad things in the sub-urban cultures Kulawa anamwali: Respondents from the suburban culture has reported that men have strong preferences for virgins and young women because they want tightness and young girl’s breasts. Kuguga: men leave their wives who have reached menopause stage for those that are younger (Sub-urban cultures. Disregarding advice from elders: Youth taking up uphungu (traditional counseling) as old fashion – (Sena) Loose marriages: There are no proper procedures which people use to enter marriage. This makes it easy for men to marry many wives and marry several times as well - (Lhomwe) Restrictions on sex talks in marriages (2): The prohibition of sex talk in marriages: Talking about sex amongst spouses is considered a taboo. This leads to not satisfying each other in the family which leads to one having many sexual partners_Lhomwe, Tumbuka Husband borrowing and exchange (1): Some women exchange husbands as a way of showing friendship amongst themselves Lhomwe Labor migration (15): Labor migration encourages the migrant to engage in sex as they travel from place to place. The remaining spouse is also exposed to having sex with other men (in the case of women being left behind in the village). This is common in the Yao (3), Tumbuka (5), and Tumbuka Ngoni (7) Fictitious stories: “In our culture we don’t tell our children the whole truth, we just try to scare them with some stories but they need to know the truth.” –Tumbuka Use of family planning methods: "-Tumbuka Ngoni “Chi secret” encourages other women to do unsafe sex to get money to buy expensive gift for their asikiThe language sex: The absence of straight or open talk on sex between individuals as well as between parents and their children has been criticized in ‘Malawi’s culture.’ This “silence” is described as contributing to the continued spread of HIV on account that growing children and adolescents are largely ignorant of what sex is, how to be abstinent and what safer sex is. These observations are understandable as many parents and adults report being uncomfortable discussing sex with their children. Unprepared or dry sex: This occurs when a woman, not liking the physiological lubrication of the vagina uses any of the following: cotton, cloth, earth or dirt, ground herbs or washes the vagina with Coca-Cola, to remove the lubricant. Sex workers may particularly prefer dry sex following unprotected sexual intercourse to avoid subsequent clients complaining of increased wetness of the vagina. Although dry sex was reported to enhance sexual pleasure, scientific evidence suggests that it increase vulnerability to HIV transmission. Dry sex may also occur when the woman has been forced to have sex with a spouse when she is not adequately aroused.
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Raising children and adolescents: When children grow into adolescents, they are sent away from their parents’ huts to either gowelo and/or mphala (huts exclusively for young people). One main reason is to allow the parents enjoy privacy for their intimacy. However, adolescents sleeping in gowelos and mphalas may be at risk of transmitting or acquiring HIV through a practice which in the central region of the country is called gwemula. Gwemula is when a known number of adolescent boys ‘raids’ girls’ gowelo or mphala at night; the boys force themselves on the girls. A study participant said: “This practice may have happened in my father’s time. I don’t know if it still occurs. But society allows it. If boys know that one of their friends has a sister in the gowelo that is going to be raided, that boys is not informed and he is not part of the raiding group.” Perception of time: It has been found that perception of time affects ideas about HIV and AIDS, sexuality, community engagement and expectations. Perception of time among traditional cultures was different from the “western” approach. While the so called western approach relied heavily on the clock, the traditional way of time varied with the rise and setting of the sun and the seasons. It was reported that in the traditional society, day implied working and earning a living while night symbolized rest and also sex. The arrival of the night would symbolize the arrival of exercise of conjugal rights among married individuals. A visit by a member of the opposite sex at night was interpreted as an indication that the person visiting was ready for sex. Not surprisingly perhaps, community events happening at night, including youth prayer sessions were reported by respondents as facilitating unprotected sex among the youth. Projects and programs aimed at experimenting or rolling out interventions to promote safer sex, abstinence, HIV testing and counseling, treatment and its acceptance often have timelines as to when monitoring and evaluation ought to be done since their inception. There is need to engage and partner with traditional leaders to influence them to change their attitudes and practices. It was found equally challenging to record or stipulate the length of meaningful behavior change can be attained. This poses a problem when we consider that some projects have short project cycle period. The full process of change is generally a very difficult and slow journey, more-so when cultural values and beliefs are involved. Perception of the HIV: People still believe the absence of HIV and AIDS in their area but elsewhere. For example in Chitipa some people believe there is no HIV in their area but people can get it from zilabu chiwerewere(B) POSITIVE IK FOR HIV PREVENTION The research found that while some IK has helped in the spread of HIV, the following IK can play a major role in HIV prevention. Respect for parents and elders counsel (73): Parents were not only expected to have control over their children’s behavior. The children themselves were taught and expected to respect and give heed to the wise counsel of the elders or parents. These were pieces of advice given to children or initiates as measures of behavioral controls and this instilled good morals and behavior in children. Such advices were communicated through (a) one to one counseling, (d) group counseling to children by parents or clan elders, (d) at religious places by church elders (e) initiation rites by village or community elders and counselors including ngaliba and nankhungwi (initiation rite counselors). Among all the 12 cultures youths are taught to respect and heed the counsel of their parents. What is the content of the advice? At litiwo initiation rites for Yao and Lhomwe, young ladies were advised the dos and don’ts of good marriage for the sake of their marriage. The Ngoni have reported that parents or elders would advise the youth to avoid premarital sex. The children would obey, not only on basis that akazi amaluma and amaotcha (women can burn or bite) and that amuna ndi zilombo (men are animals) but only on grounds that the advice would assure them better marriage in future. If a boy is told that women burn or can hurt you, you need to believe that. 25
Some boys may wish to try what they are being discouraged.” However, it was also observed that such advice does not happen in a vacuum as the adolescents are also advised that suzumile adanka nawo (which has the same meaning as curiosity killed the cat). Further “we Ngonis do have special advice to the youths when getting married on how they can satisfy each other in bed to prevent the partner from seeking extra marital sex partners -Mlango for boys and girls (5) In the Tumbuka NgoniNgoni, daughthers -in-law were taught never talk anyhow, with her father in-law, elder brothers to her husband and other men once married. Girls were taught that if a man touches her breasts her mother would die, perhaps indicating thatamuna nzilombo (6). Boys and girls used to stay away from each other as girls were told that amuna ndi zilombo amaluma and boys were told that akazi amaotcha or amapana. Men using Mpolowoni so satisfy their sexual desires when ever they are not with their wives. Mpolowoni is an indiginous tree which men carry with them when they go out of their homes for bussiness trips or to see relatives and friends. By twisting removing the hard core of the tree, one is left with a bulk with a hole where a man whole put his penic to relieve himself. Among the ngoni the teaching would include, Njulira – a way of having oral and non penetrative sex to satisfy the man ( instead of him sleeping with other women). This was done by caresing the man and the man will put his penis along the thighs of the woman until he releases semen. Mostly used when the wife is expecting or has just given birth. It was reported in Tumbuka, that in the past, parents had power over their children and could even undress their children to see if she had sex but now with the children`s rights you cant do that. Previously girls were usually called together and advised by elders and they were really very desciplined (8): Girls are advised a lot, when they start their period (menarche) they are taken by aunties, if there is an elder sister and may be inlaws and advised for about seven days. Boys were reported as never advised properly but only if they have done something bad (2). Long ago people used to eat together because they used to live like a community and their children were sleeping in one building. For girls their house was called nthanganenge and boys Mphara. This is where the children were being advised by elderly people. This was helpful because there was no difference between an orphan and the other children. In the Tumbuka Ngoni, girls were taught on how to behave. The were kept indoors for seven days to learn how they are supposed to behave. Girls were counseled at puberty and were advised not to have sex with boys because their parents will die and they themselves will die during delivery. Youths were taught not to engage in premature sexual activities due to bad effects that could befall them such as having parents dying.. In Tonga culture when a girl reaches adolescence she was summoned and advised by the ngaliba or nankungwi (counselor). The girls are advised about how to take care of themselves and or personal grooming. Parents had control over their young children’s movements. In the Tonga tradition young girls were not allowed to have sex until they got older. When they were older, they were advised on how they can take care of themselves and refrain from sexual activities until they got married. Folk tales were used as a platform for advising young children indirectly but in a non embarrassing manner. Among the Tumbuka, vibwaira help sustain the family. This is a tradition that after a month in marriage, women from the bride’s side go to visit where the woman is staying with the husband, mainly to give serious advice to the just married young lady on how to behave and sustain the family. Vibwaira was usually occuring at night but now it is prohibited and only done during the day. Abstinence, Discipline and No premarital sex (69): The research has established that in the past people were advised delaying sex until getting into marriage, “People would reach eighteen years before having sex. but now people are starting at eight”. They would get married after they had been taught all the skills and behavioral expectations for marriage. (Tumbuka, Tumbuka Ngoni, Chewa, Chitipa cultures). Girls were sleeping in one house and it was called nthanganene or Mphara ya wakazi. This was kind of securing the girls and it was reported as 26
helping in ensuring no premarital sex occurred -Tumbuka Gnosis advice girls not to move about at night but during the day. Five respondents from Tumbuka culture asserted that girls and boys were abstaining from sex until marriage. “We could visit each other and spend the night in one room but never have sex because of the teaching we got from parents and elders “said a culture custodian in the Tumbuka culture. People were disciplined and respected their parents especially their mothers. Men were disciplined. People including women were just putting on a small cloth around the wasewe used to call “Sambi” but you could not hear that a man has raped a girl. “There is one of the few things that would positively help in HIV prevention. The main discipline is that in the past, people used to abstain from sex until they got married’ In the Ngoni Tumbuka discipline and sexual abstinence have been highly upheld as the best means preventing people from getting infected with HIV (15) It has been reported that youths were disciplined by being beaten up (corporal punishment) by parents or elders once they have done something wrong including having sex-Tumbuka Ngoni. Youths were well disciplined , they were taught that once they have sex, their parents would know and parents would die, girls would die while pregnant (mapinga) while boys would get burnt (11). When found having sex, the youths were beaten up and even killed in the bush as they would bring a bad cough and bad luck to the community. Both men and women were taught to abstain from sex within and outside their relationship or marriage when woman is five to nine months pregnant for fear of wife dying with nose bleeding and weakness (mapinga) (dying during delivery). Among the Tonga (4) people were told to avoid having sex with people they did not know. Young girls were not allowed just to walk aimlessly. Children grew up not knowing where babies come from. Sexual abstinence is highly promoted in the Chitipa cultures (17). Abstinence has been described as the best way of HIV prevention even in the sub urban communities (3). Many cultures teach girls to avoid sex until they go into marriage. This knowledge is positively given in initiation rites that are coupled with the advent of western religion, particularly the Yao and Lhomwe. Girls or boys having sex prematurely were told that they would die and it was a taboo for girls to seduce boys. Initiation rites (50): Commonly known as zinamwali, is rite of passage ceremony whereby a person undergoes some training in form of a ceremony after reaching a recognized stage of physical development e.g. adolescence, menarche, engagement, marriage, pregnancy and childbearing. The initiation entails session of imparting advice and appropriate life skills that would shape their future and handle themselves appropriately according to the social norms and roles of good behavior and deportment. The first common rite is one given to young people at puberty and particularly to girls after the first menstrual cycle (menarche). Among other things, the most significant positive elements of the rites was that it provided the opportunity for children to be told to ‘fear’ members of the opposite sex as ‘getting close’ to these can result into negative social consequences such as unwanted and early pregnancies and sexually transmitted diseases. Adolescents are advised not to engage in premarital sex lest they invite bad omens to the community. The study shows that initiation ceremonies trained boys on how to ‘keep’ a woman while women were taught and allowed to demonstrate how to “satisfy a man.” Such common initiation rites are nsondo among the Yao, also called chinamwali in Chewa, thezo in Lhomwe and, Jando in Yao. The research revealed that the following girls’ initiation rites could play a significant role in HIV prevention. The Maseseto initiation rite among the Sena and Manag’anja (3) emphasized on fear of early pregnancies and instilled the need for girls to delay pregnancy until marriage. Among the Sena, Mang’anja and Lhomwe, girls go through special initiation rites after kuntha msikhu (menarche) to learn to use various ways of using beads and msasi (castor oil) and other ways of sexually satisfying a man”. As a demonstration an old woman lies on top of the girl as the latter wriggles and gyrates. In some cultures, a raw egg is place between the girl’s bottom and the ground with advice that she lifts her hips, gyrates but not tire so as to break the egg. It is believed that 27
a married man or woman who is satisfied his or her partner in bed, is likely to avoid “wandering” in search of sex outside marriage. This was reported as having helped men to be satisfied with their wives and therefore being faithful to one partner. Between ten and sixteen years children undergo a two to three week initiation into adolescence at church or any organized house where some Christian instructions are offered. They are taught the morality, chores, tradition customs related to sexuality and reproduction. They are instructed with elder women of the village; the ceremony usually takes or goes on for two to three weeks. Sena, Mang’anja, Lhomwe. In the Mang’anja, the kugwa mdothi initiation also teaches women to take care of their families. At the initiation rites women were told not to add salt in relish when menstruating to avoid causing some diseases tsempho to the husband. This signified the need for a woman to be clean when one is menstruating. At the Litiwo, the Lhomwe initiation and the ndowa Yao initiation ceremony young women are advised on how to take care of themselves and their spouses and what they are supposed to do in marriage. Abstinence and Fear of Extra-marital Sex (49): The research has established that almost all the cultures in Malawi uphold sexual abstinence as evidence of virtue and purity and a means to primary prevention from diseases and other bad luck in the community. The study has shown that sexual abstinence has been promoted in two ways (a) by inculcating good moral values and (b) by instilling fear of the consequences of extra- and/or pre-marital sex. In Ngoni culture for example, when a husband goes to a far area or country e.g. South Africa to work, the wife was told not be involved in sexual activities for fear of being ‘locked’ and the “new” man may get stuck inside the woman in he sleeps with another woman. Among the Ngonis, girls at chinamwali were advised to stay away from men saying men are ruthless animals (ndi dzilombo) (5). Boys were told by their parents and elders that women bite (amaluma) and amaotcha can burn (5). Youth were told that if they sleep with a man or woman before mariage their parents would die. This was to let the youths abstain and only start having sex when married, (Chinamwali for both) (5). At Mlango initiation, adolescent girls were told not to have sex before marriage or else risk killing her parents by doing so (Mlango for girls (7). This was also taught in initiations (Chilangizo) organized at churches. Ngonis do not only promote this through counselling, initional rites but also through songs. “As Ngoni people we have songs that talk about sexual abstainance and prevention and sexually transmitted diseases that include HIV and AIDS, (Ngoni Songs for prevention (8). Tumbuka NgoniFear of sex outside marriage to avoid tsempho was instilled and highly believed in the most cuture in Malawi. In Tumbuka culture for example, it was believed that when people were having extra-marital sex the whole village could be affected by illnesses like (chikhoso) unstoppable coughing. Fear of extramarital sex was deeply settled in people such that if one day an old person says „“I am not feeling well these days and I know its not normal sickness, someone has done something bad, one perosn could always come up and confess that he or she was fornicating or a girl was pregnant“. – Tumbuka. Pregnant women would die with pregnancy once husband has extramarrital sex.-Tumbuka Ngoni. People in the past were afraid of sex outside marriage, getting pregnant out of wedlock and getting sexually transimitted infections- Tumbuka In Lhomwe, Man’ganja culture, the tsempho concept, is inculcated through kuthunda (waiting period without sex). Lhomwe men used to wait for six months without having sex with anyone including a spouse after a wife had given birth for fear of killing the new born b. Having one wife is highly upheld in the Lhomwe culture. Among the Yao, a magic snare or trap is used. This is when a woman is magically trapped by a husband who goes away for a long time so that the woman should not be engaged in sexual activities with other men. It is believed that when a man has extramarital sex his pregnant wife will have prolonged labor. In the case of a family with a young child, the baby may die. The baby will get diarrhea and possibly die from it, and various calamities are likely to affect society (e.g. famine). Such beliefs and practices where extra-marital sex is discouraged have potential to prevent couple acquisition of HIV as well as subsequent mother to child transmission of HIV.
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In several cultures, it was reported to be taboo to have sex when there was a funeral, when men had gone hunting – taboo for both those left behind in the village and those among the hunting party and when there was burning of brick kilns. The present interpretation is that such practices were important in the prevention of extramarital sex. As hunting parties would have unlikely brought with them their wives, having sex would have meant having intercourse with non-marital partners. Similarly, the hunters’ wives having sex back in the village would have meant them having sex with non-marital partners. Similarly, if people are sleeping at the funeral wake, chances that it will be extra-marital sex if an individual at the funeral or at home is having sex are high. There may be other reasons these taboos were implemented other than to protect from extra-marital sex. In the case of burning bricks, a participant wrote: “…in the case of brick kilns (uvuni wa njerwa) the owner and the workers must abstain from sex. It is still being practiced. I was advised so by my workers last year. This ban also applies to hunting and wars/battles which may take days, even weeks. But I think the philosophy behind the ban is that men who are away from home must not have sex because they are likely to do it with a woman who is not their wife and then invite all kind of problems into their family life.” Fidelity and Respect for husband (44): The Lhomwes believe this reduces infidelity amongst spouses. The Chewas uphold this as evidence of a “true marriage” (8). There is marriage where partners are faithful to one another. The research shows that the Tumbuka Ngoni see faithfulness and respect as very important tools for the the success of marriage (6). Girls and women were taught to be respectful and submissive to their husbands. They were trained and taught to be respectful to their husbands including elder in-laws and elders in the communities. Married couples were taught to abstain or being faithful to each other during marriage counselling. Women gave consent for their husbands to marry another wife and they could even help to chose a good wife or their younger sister and this encouraged men to be faithful to the wives he marries. The Tongas uphold faithfulness in terms of one partner (5). Youth are also encouraged to abstain from premarital sex. “If you avoid sleeping around and if you are married stick to your partner and be faithful”, they are told. Being faithful to one partner is a prime teaching in the cultures of Chitipa (14). The suburban cultures maintain that “Emphasis on being faithful to one partner is the best way to discourage promiscuity”. Among the Ngoni, women were taught how to respect their husbands. This included responding respectfully when called by the husband. Responding by mentioning the husbands clan name or mfunda, such as we ngozo or wawa meaning dad impressed men and encouraged them to be faithful to their wives (5). The Lhomwe, Mang’anja and most culture in Malawi, encourange a woman to kneel when talking to husband or give him water to wash hands while she is kneeling. This also encouraged respect for wives on the part of the husbands. Enhancing Sexual attraction & Love for husband (34): Apart from respect, cooking good food and using tradition herbs to enhance love, the research has shown that women were and are still taught through various elders counselling, specific initiation rites how to attract their husbands sexually to enhance love and fidelity. In sub urban, zokoka (elongating the vagina labia a tradition from the local traditions) has been desired as one of the IK ways of encouraging a man to love his wife more than admire other ladies. Wearing any modern sexy dressing such as g-string, see through, leggings for your husband in your room as a surprise; decent hair styles have been described as promoting love and fidelity. The same applies to general cleanliness and smartness of woman. Girls and women were encouraged to wear waist beads to increase sexual attraction. Waist beads are put round young girls “because they help the girl have prominent bottoms” as they grow old. A woman without a prominent bottom was perceived as inadequate as men would leave their wives in search of women with prominent and large bottoms. Beads were reported to help a girl child develop a good waist line as she grows. Waist beads around a married woman’s waist were also reported as an aphrodisiac. Further, there were reports that the rubbing and rolling of waist beads between the woman’s and the man’s waist during sex 29
heightened sexual pleasure. From desk research Yvonne Sundu’s articles reports TA Kachindamoto of the Ngoni culture as saying “men who are married to women who use beads were likely to be sexually satisfied and therefore unlikely to have extramarital partners” “It was a must for women in the past to wear waist beads for sexual purposes. Every Malawian woman has to have mikanda; it shows the difference between a man and a woman. The beads arouse the men during foreplay. They bring in that special energy that transfers from the man to the woman, and there comes the network that connects the two.” Wearing beads is not only the solution in the modern society but understanding each other and using modern mean of arousing interest in the man. “I have been to school. I know what makes up a marriage and what does not and I certainly do not think that my husband will leave me because I do not wear beads. If that happens, then I would think he already had the intent of leaving me.” Olivia Kanyenje quoted by Paida Mpaso. Kukoka maleveni (elongating the labia), respect for husband, proper dressing and personal care were reported to increase men’s love and fidelity to their wives. Religious morality (34): People’s traditional beliefs in religion form integral part of the moral deportment and ground for HIV and AIDS prevention. The research has unveiled that the Muslim religion which has largely got acculturated in some traditions and beliefs like among the Yao has instilled morals amongst the Yao to avoid immoral behaviour and women to dress properly to avoid alluring men. Prioritising the fear of God and Chisumphi in all activities are roots for morality among the Chewa (3), Lhomwe, Tumbuka and most cultures in Malawi. Tongas find pride in taking part in church activities. “This does not only instil morals that include faithfulness, but it also keeps busy with such activities instead of indulging in bad behaviours that can make one contract HIV. “Kudziwa Yesu, kupemphera, kumvera ulangizi, kudziletsa, kusiya miyambo yoipa (imphyana)” (knowing Jesus, praying, self control and leaving bad behavior (imphyana), obedient to good morals of having one partner, has also been reported to have promoted good morals among the culture of Chitipa (4). In the suburban cultures , overnight prayers, women organization, (mvano, catholic women organization, Dorica), Christian teachings of one man for one woman, prayers, praise and worship by Pentecostal churches have helped enforce IK religious morals for HIV prevention. Isolation from sex (28): Among the Yao, this was a custom that helped men and women avoid having sex outside the marriage and helped in preventing contracting sexually transmitted diseases including HIV and AIDS. Such occasions were for example when boys or girls go for jando or nsondo initiations respectively for some days. Parents would stop engaging in sexual activities. A woman would also be isolated from a husband who cannot handle the pressure of waiting for her to heal after giving birth. In the Ngoni, a man would bring tsempho (disease) to the new born baby if he goes to have sex outside mariage after the woman has given birth. The child would be stunted and at times the child may even die. When a woman has given birth they are not supposed to have sex for 6 months but the man is not supposed to have sex with another woman (2). Tradition of construction of a special house for new couples was reported as preferred as it promoted HIV prevention as it gave them ample time to know each other better sexually. In the Tumbuka, when a man died. the widow was always putting on a doek which was called chithawezi and men were always keeping off, this could help these days only that people would argue that what about if a woman dies what will a man put on. There are serious issues about rights that need to be explored. In the Tumbuka Ngoni, when woman is pregnant men were told not to have sex outside marriage because they would kill the wife with Mapinga (dying during delivery) Tumbuka Ngoni. When women are pregnant men are not supposed to have sex outside marriage as they would kill the wife with Mapinga (death during 30
delivery of a baby) Tumbuka Ngoni. No sex for couples when the woman is breast feeding a baby till the baby stops breast feeding. Tumbuka Ngoni. Men/women were told to abstain from sex once wife is breastfeeding the child in fear of killing the child with moto (causing fever for a child and die) till the child stops breast feeding. Tumbuka Ngoni. Family ties (extended families) support system helps children not to indulge in sexual activities. Tumbuka Ngoni. Men could sleep in another room once the woman is breast feeding in fear of impregnating her. (no sex outside marriage) Tumbuka Ngoni. Emphasis of not having out of wedlock children for example making those found pregnant wear dog intestines. In the urban and suburban, emphasis is put on sex after marriage. Sex break after child birth also encouraged men to be at home. Once a couple has a baby women are not supposed to cook instead relatives or husband should stay home and cook for the wife till the child is 2-3 months. Sex could only resume following rituals where local medicine is used. This also helped the man not to have extramarital sex. Among the Lhomwe, people were obliged to take sex breaks under the kusempha mtundu tradition (causing epidemic to the clan or village). There was belief amongst the Lhomwe’s that when a man marries in a village and before five years the wife dies due to sexual transmitted diseases or kanyera, the man was chased from the village as a way of cleansing the community because the man was believed to have polluted the village and the clan. This belief prevented people from having multiple sexual partners for the fear of being chased from the community. Parental control over children (27): It has been generally reported (Tumbuka, Lhomwe, Ngoni) that parents and guardians used to take total control of their children in terms on interests, activities, movements and behavior. This used to and still does help in prevention of development of behavior. It has been reported that in Tonga culture that “children used to be monitored wherever they went and were given what time to go back home, what they do and get exposed. But nowadays children are exposed to bad things and parents seem to have lost control or given up”- Tonga respondent. Parental control also embraced ensuring that the young lady does not have sex before marriage, that she is given advice on various social and survival skills. Respectable dressing (27): The Yao people have reported that the tradition of encouraging women to dress in a modest manner such as putting on clothes like zitenje, skirts which do not expose legs, thighs and breasts, helps in HIV prevention. This is because such dressing helps them not allure men and lead them into temptation. Such advice is given in parental counselling and specific initiation rites. Ngonis believe in mavalidwe a Chingoni. Women used to wear Nyanda (made from chikopa) and men used to wear njobo - kuboola chinkho ndikuvala (Though most of their part is exposed during the dances, the men wear gourds where they would place the man’s penis). Men always take with them the Chishango (a protective war regalia) and whenever the woman bends or kneels down the man was supposed to put the chishango behind the woman to avoid other men from being lustful over her. Good dressing is encouraged amongst women in Chewa (6). This prevents HIV and AIDS. Among the Tumbuka girls were encouraged to dress decently and respectfully to avoid tempting men3). “Girls and women used to dress appropriately not like these days when girls are walking almost naked and tempting men“Tumbuka culture respondent. In the Tumbuka Ngoni of Mzimba, boys, girls and women were taught to dress in long dresses and skirts (3). Boys or men were taught not to show their underwear. Girls were told to dress in long dresses or wrappers. The dressing code was good. In Tonga, girls were told to dress properly because this was believed to promote fidelity and consequent healthy family. Proper marriage procedures (26): A man or a woman would not get into marriage without proper processes and arrangments.“In our culture we believe that when you want to marry you do not just pick anyone anyhow. You need to know the person and where he or she comes from ” his helps to choose a good 31
spouse who you have known to have good behaviour - Tumbuka(5). In the Tumbuka Ngoni culture, the parents were choosing a bride to help mentor her and inculcate good morals and shaping her for good marriage with their son. . To allow them know each other better, the girl or boy could chat with their fiancée in a small house or outside in company of other friends without even having sex. Majaha- two boys could go to one village to look for a girl and chose one to marry then ask his parents to agree on dowry. Boys could go a village and meet girls parents if they have girls that they could marry away from their village. Chichezya- once dowry has been paid to brides‘ parents, girls and boys could sleep in one room without having sex. In most cultures including Tumbuka Ngoni, proper chitomero (engagement) would be undertaken prior to the wedding. Social activities and Sporting activities (23): The sub urban and some culture of Chitipa reported that engaging in some activities has made people busy, integrated and collaborative to curb the the spread of HIV. Such activites includeweddings parties, discos, “top ups”, football, kitchen and “dressing top up”, bridal showers, bridal shower, ‘chi secret’, youth groups and women groups. Among the none, men used to play games like fuwa which is like bawo with 32 holes and can be played by not less than 10 people at a time and one game takes more than a day to end. Men were busy with this game and hence no time to go and meet extra marital sex partners. The same applies to other cultures. Forming clubs, training activities, football, netball, malipenga, kulima, and boxing has kept people busy in cultures of Chitipa, and those in the suburban areas. Punishments for premarial and outside marriage sex (21). This helps enforce good moral. In Tumbuka, punishment is given by the chiefs to all who are caught or accused of committing adultery. “when a women report to the chiefs about a missing husband, when he is found, he is arrested by the chief and given a punishment. In the Tumbuka Ngoni, once one in a family was caught having sex outside marriage was charged with consequent penalty at hand. A man found having sex with another mans‘ wife or just touching her breasts, pays one bongwani (one cow) to the husband.. A woman caught having sex with another man pays chaludengere or thokazi or (one cow or one goat to the husband and sometimes gets divorce. The woman‘s parents can also be asked to return the cattle the husband paid when taking her. Chapamusana is a punishment imposed on a man for impregnating a woman out of wedlock. When a girl was found with a boy more than twice they were forced to marry each other in fear that they would impregnate each other and bring shame to the family. Boston Moyo tells his story how he married Iness Mtonga“I was forced to marry Iness because her parents found me chatting with her in my gowelo (small house) without having sex, we were told to marry each other instantly. Now we have been married for 3 years, we have one child and we are expecting another child” Kadumuliro (5), This is a place in Tumbuka culture of Rumphi where people were burnt to death if they were found having sex with someone else‘s spouse or found pregnant before marriage. ´ Lobola (dowry) (23): In the Tumbuka Ngoni, the lobola tradition enforced fidelity and prevented HIV and AIDS. Payment to the brides’ parents when getting married helped both couples to be faithful to each other because once one is found having sex ouside marriage the dowry (cattle) was returned to husband‘s family and if it was man he could lose his cattle(9). The dowry to the bride was paid by the man’s parents to show respect to the first wife and committment that they do not entertain divorce. The dowry could be paid inadvance (kujalira) that made both boys and girls faithful to each other till they become mature to get married without disappointing their parents. Parents are committed to pay dowry for their son’s first wife and she is treated with much respect. This would make men behave responsibly. Tonga women were reported as usually faithful. This is because for you to marry one, you pay a price. Women’s ranks in marriage are of primary importance. The first wife wife is more respected by groom’s parents as the parents are committed to pay dowry for her and divorce is not entertained.
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Circumcision (23): Male circumcision which today is promoted under the voluntary medical male circumcision has been part of the initiation process of the Yaos and partly the Lhomwes for centuries. Current evidence from randomized controlled trials and observational studies have shown that voluntary medical male circumcision (VMMC) is protective against HIV acquisition in a predominantly heterosexual cohort. Questions however remain as to how the Malawi circumcision belt (Yao and Lhomwe areas) have the highest HIV prevalence estimates. Vulnerability to HIV infection is multi-factorial while circumcision provides partial protection and the extent of removal of foreskin during traditional circumcision may be subtotal. Secondly, modernization and Christian religions that strongly discouraged its followers to go for circumcision which was highly promoted by Islam. Thirdly, traditional circumcision could expose the initiates to high risk of transmitted and acquisition of HIV infection if a single cutting blade is shared among several boys. There have been different interventions that have been implemented to reduce the risk of such transmission. For instance, programs can work with traditional leaders and circumcisers to allow that initiates are circumcised at a health facility using sterile techniques. Other programs advocate the use of single surgical blades to traditional circumcisers. There have also been programs where a clinical officer or another allopathic surgeon has visited the simba or thezo (the local site where initiates are camped for several days) to provide sterile circumcisions. Perhaps an area that remains to be explored to assess is the extent of foreskin removal in the traditional circumcisions in different tribal or geographical settings. Sex education in private (23): The study has established that talking and teaching sex matters publicly through mass and electronic media to the general public has encouraged immoral and risky behaviour because such messages may reach people who are not yet mature enough to get hte messages.The research has estabblished that sex is a private matter and needs to be taught privately-Chewa. In the past it was taught by right people during special intiations or when people are going into marriage“People were never taught sex until they got married. Sex education was not done publicly like now and this helped young people to wait until they are taught properly or when they were married” - Tumbuka Ngoni. Apart from the teaching the best way of doing sex and satisfying each other, couples were taught on withdrawal method during sex when a child is young (Tumbuka Ngoni) and (kumasukilana) being free to discuss and do everything together with your wife-Tonga. Parents therefore need to open up with their children on sexual issues but privately- sub urban. Marriage counseling and conflict resolution (23): Malawian marriages have in-built marital conflict solving provision. Traditional marriage counselors (ankhoswe) are required from both the groom’s and the bride’s side before most forms of marriages in the country. Soon after the marriage officiation the new couple is taken to a place where several advisors present various sorts of advices, but largely on sex and satisfying one another in sex. This experience is expected to ensure that none in the relationship is left unsatisfied so as to seek extra-marital partners. Further, should any of the partners engage in extra-marital affair, the aggrieved party has right to complain to ankhoswe. The threat of being reported to one’s nkhoswe (who is often one of your own relatives) may discourage the ‘offender’ from continuing with the extra-marital affair. On the negative side however, ankhoswe’s have been known to discourage marriage dissolution under any circumstance to the extent that unhappy marriages may be promoted and/or HIV transmission occurring. In his 1974 publication, Chimango reports that the definition of ankhoswe is varied, i.e. surety, marriage advocate, and marriage guardian. The nkhoswe is often a close and senior relation of the party to the marriage. When a woman and man agree to marry, the woman refers the man to her ankhoswe who then informs the woman’s parents. If the woman’s parents are agreeable to the marriage, the ankhoswe verifies with the man whether his parents are also agreeable to the proposal. Following the marriage, if there are significant disagreements between the (married couple) it is the duty of the ankhoswe to advise, counsel and contribute to the resolution of the problem (Chimango, 1974; Ibik, 1970; 1966; Malekebu, 1952).
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The marriage counselling include one session specifically for women : In the Tumbuka Ngoni women were trained not to talk anyhow to their fathers-inlaw and brother in-laws and all elders that led them to keep distance from getting used to the extent of having sex with them despite being given money (kuwongozya). Women are told not to shave their private parts when the husband is away in order to stop them from having extra marital sex. Chiusya nyumba – when a wife dies her parents provide another wife (sister, niece, cousin) to the deceased husband to marry and as consolation -Tumbuka Ngoni. It is common in the Chitipa culture to counsel married people and the counseled people were told to obey the ulangizi. Communication between spouses on sexual matters (23). While some studies have reported lack of openness and communication in marriages especially on sex matters, this research has found out that there is openness between partners especially on the part of women. However, this is often done non-verbally and in private because culturally sexual matters are not for public discussion. From both primary and secondary approaches, the research has unveiled that such openness on sexual matters entails use of symbolic cultural objects that communicate sexual disposition, readiness and attraction. A typical example is the wearing of waist beads of various colors by women. For example red beads connote that a woman is having her monthly period. Yellow means “I am almost done with the period”. white means safe and ready for sex and black means “I do not want to have sex tonight”. Colors such blue or green also signal that the woman is ready for the man anytime.” Such sexual communication has been reported to have helped in prevention because a man does not do sex with a women who is not prepared for it, a situation that has led to dry sex which causes some bruises creating entry for some sexually transmitted diseases. Educative traditional dances and songs (22): Nyimbo za chingoni promote faithfulness. Daylight traditional dances for example “gule wamkulu wamasana” give people something to do to refrain from sexual activities. The songs also contain good messages of responsibility, good manners and fidelity in families (5). Among the Tumbuka Ngoni, ingoma warrior dance or khonyo kept both men and women and the communities busy not to indulge in sexual and extra marital activities (3). The same for beni among the Yawo (2), chilimika and malipenga among the Tonga youths. Today because of education and other modern activities many families have stopped sending their children to chilimika dances Value for virginity (20): It was reported in subcultures that the expectation of virginity helps youth to preserve them for marriage. Against the common belief that most youth is urban and suburban engage in premarital sex, we found that in the sub urban, keeping virginity till marriage is highly admired amongst women and girls and those men look for such ladies for marriage. Amongst the Tumbuka Ngoni, it has been found that men do check for girls’ virginity on chibwezi, on a wedding day, honey moon, or any first day of having sex and that the relation would be strong if the man discovers that the lady is indeed a virgin. This may bring a different sense if value of thesex debut and sustenance of the marriage. Kuzinga (13): Common in Chitipa cultures, there is traditional custom which is also known as ugwiritsa kamchichi mtima wa nkhunda entails giving medicine to man or woman so that he or she does not love another person. The research also found out that this also means “mwamuna ndi mkazi kudyetsana mankhwala kuti asamaone ena” a man and woman in love or marriage giving each other love medicine so that one does not go from the other. This also included medicine that was given to man or woman so that they should not get attracted to another person. The traditional practice is also locally known as kukolera (kugwirira) ndi kuzinga (kuperena timwanene). In Chewa traditional medicine called phundabwi or mpungabwi also serves the same purpose. Traditional groupings(12): Youth, men and women would form groups in which they would share advice including good morals and how to prevent spread of diseases. At mphala, the youths are advised by the elders on how to behave to become good citizens. “Prevention of diseases is also tackled here” Tonga (5): At ‘nthanganane’ (a house where young girls and unmarried women are advised and taught the Tonga culture) we 34
are advised not to have sex until you are married. Tonga: are also taught how to conduct themselves to prevent diseases. These were the traditional groups not those formed by the CBO or NGOs to complement their interventions. Approved fisi (hyena) (12): In Tumbuka Ngoni, the practice of kulowa fisi also known as chiphongo in which a family that is failing to bear children hires another man to sleep with the wife to bear a child is seen as positive when the fisi is approved. He would be a man identified and approved by the family because of his good health and morals. In some cultures this could be a brother or a close friend. This would prevent the HIV because women would not secretly sleep with any other man she does not know better to have a child. In the modern times, the fisi would be required to go for HIV test first. (Lhomwe, Chewa, Yao, Tumbuka Ngoni) Wife Inheritance (10): While wife inheritance has been regarded negatively, the study established that it could help in HIV prevention especially when the man inheriting the woman has been approved as good man based on moral standing. It is advocated in the Tumbuka Ngoni that wife inheritance helped to keep the deceased woman from sexual desires as she could get sexual satisfaction from the inherited husband. It also help young children of the deceased not to indulge in sexual activities for their food and other needs; they could be well looked after by the man who inherits the mother (5). Approved polygyny (12): Polygyny (marrying of more than one wife) is not encouarged by many Christian denominations. However, although many Malawians are Christian, many men have have extramarital affairs . In the villages mitala is not considered as harmful multiple concurrent partenership. Chewa. Polygamy is good as it lessens women‘s burden to work and keeps men within marraged with no sex outside. Further when one has a new child he can have sex with another wife (when sex with a woman who has just delivered is prohibited) within polygamy family.Tumbuka Ngoni. Polygamy was good to keep husbands and wives have sex only within the marriage since if they indulge in extra marrital sex they would pay a cow as a penalty for the offence. _Tumbuka Ngoni. Polygamy was good for the Ngonis as it restricted them having sex within marriage. _Tumbuka Ngoni. Reduction in the rate of polygamy has also helped in reducing HIV and AIDS. Tonga. Polygamy gives satisfaction to the man; he may get HIV tested before he marries other wives. Roles and responsibilities of children before marriage (12): Teaching children roles and responsibilities before marriage. This counseling was done by parents and other elders and through initiation rites (Mang’anja). Parent's had duty to ensure their children did not have sex before marriage and for them (children) to understand their duties and roles such as cooking, drawing water, gathering food and fruits for daughters; cultivating, constructing a house, constructing a granary, thatching a fence and thatching a roof for boys. When the children are able to perform these duties when they were initiated, then the parents allowed them to get married. Young girls were taught how to behave once they reach puberty and bring home a boy who proposes them for a hand in marriage - Tumbuka Ngoni. Girls were taught on how to pull their labias (kukuna, kukhati, mukola mbavi) so that they attract and maintain their husbands not to have sex outside marriage. Tumbuka Ngoni. Women were taught on how to pull their labias (kukuna) so that they mantain their husbands not to have sex outside marriage -Tumbuka Ngoni. Sense of togetherness (9): The sense of togetherness makes people protect their beliefs and values including dressing – By believing that a particular are one and the same throughout, they protect their beliefs and values. In typical villages rich in Ngoni culture they do eat together at Limana level. This time was used is used to advise the youth, including on sexual matters. But also by eating together as a village it helped in checking the where abouts of some men and women who could disappers out of the eating and chatting sessions for -Ngoni. Women used to ask for sex in the morning in their own way that made men not to have sexual desires else where -Tumbuka Ngoni Marriage within the same culture (9): Tonga people used to marry fellow Tongas. It was advised that to marry someone with whom you share cultural values would strengthen the relationship. That way the cultural preventive measures are shared by the couple as they are same. It has been established that apart from being
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married by outsiders through force for example through attacks, there were no inter marriages before in the Tumbuka Ngoni cultures. Social distance (9): Social distance between male and female youth in the community more especially those that have reached puberty was encouraged “since blood has started boiling”- Chewa (2). Youths were not allowed to mingle with adults during ceremonies e.g. pa ukwati, kulonga ufumu. Chewa. Girls were not allowed to play with boys and vice versa. Girls were told that a boy should not in any way see their private partsTumbuka(2), Work and Business (9): Tonga men are reported to believe in working and fish business and single women are encouraged to do business to avoid temptations. In the suburban it has been reported that women do small to medium enterprise and utilize village banks (small lending institutions) to avoid risky behavior. Maturity as a measure for marriage (9): Despite claims that most African traditions approve their children to go into marriages while young, this study has found that some cultures in Malawi consider maturity as a critical before one is married. In the proper tradition of the Tongas, for example, people marry when they are old enough to make a concrete decisions and choice and at least when he is over 28 years. We usually abstain from having sex -Tonga. Men used to marry at an older age. Nthena (7): Somehow similar to syazi is the nthene tradition among the Mang’anja. The nthena traditional custom prevents husbands from having casual sex outside the known couples. In nthena, when a husband is rich, he is given a younger sister of the wife to marry so that he does not go away and have sex with others. This is done to safeguard the wealth and the life of the husband. Syazi (3): This is a tradition of giving a wife as a prize to a man because he takes good care of the wife or because his original wife does not have children. The prize wife could be a sister of the wife or any relative. This would help maintain the family and prevent men from indulging in extra marrital sex since the women are from the same families. The prize woman helped the main to be faithful. Thi is very common in the Tumbuka NgoniNgoni. HIV test (2): The modern communities have embraced the knowledge of going for test together before relations and get rested frequently. This has become an IK not only for the suburban culture but also for the Tongas and for individuals in the communities. Going to hospitals for Treatment(7): Despite the use of local medicine, going to hospital has always existed for a long time since the missionaries came to Malawi such that it has now become indigenous knowledge and practice for all the cultures to go to hospitals when one is sick. Even if some strongly uphold culture traditional, it has been common knowledge that most people recourse to going to the hospital after the traditonal medicine has not been succesful. Responsible drinking among Chewa (6) has been hailed as a way of preventing immoral behaviour. After work men go to drink as a way of interacting and instead of thinking about having sex. Sex objects: Among the Ngoni, it has been found that women can use chiguli (treated main cob to satisfy her sexual desire when a man is away. The cob is cooked in mmafuta a msatsi (cooking oil from castor beans) for it to soften. It is then cooked in porridge (la ufa) to make it sleepery. It is then taken back into the mafuta a msatsi then cleaned carefully and now its ready to be used by the woman to satisfy her sexual desire Avoiding Peer pressure: Avoid potential gatherings e.g. bars or gatherings where extramarital sex is common have been reported to have helped in HIV prevention among the Tongas.
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Family planning methods: Couples resume sex but men were taught to take withdraw prematurely before ejaculation out in fear of pregnancy Tumbuka Ngoni Changing bad IK (19): Some cultures are committed to change all IK that negatively affect development. This is a positive IK itself. For examples, Tumbuka reported that it is their traidition to fight all the traditions that derail development and HIV is not exempted. When installing chiefs beautiful girls were chosen to work for the invited chiefs and ended up sleeping with them but now whenever a chief is being installed the other invited chiefs are asked to bring their wives along with them. We establlished that among the Tonga, Chokolo practice was banned by the chiefs and this was a positive move on HIV prevention. The custom of Chokolo was abolished by the Chiefs by the year 2000 in the setting we studied. When a man dies these days, the wife has the right to choose who will look after her; these may be her own children. Tonga. Today Tonga men are told “Do not to marry your deceased relative's wife”. Furthermore, the habit of sending a wife back to her parents village to give birth and come back four or six months later is not common today- Tonga. Prevention of bad cultural practices for example Chokolo. (Chewa). The Chewas are also avoiding bad traditional, practices for example chokolo and fisi. Even traditional dances are no longer perfomed at night as it used to be before among the Tumbukas. Among the Ngoni’s kulowa kufa, fisi and kusasa fumbi are no longer practiced “unless done behind our knowledge as chiefs”. Norms for those who go to work outside countries. (20): In the Tumbuka Ngoni, men who wanted to go and work outside, e.g. to South Africa were told to do so after they have a child and to come after 3 years as part of family planning. They were told not to to have sex with another women as they could kill the child. Once husband is back from outside, the first two days could sleep in his parents house before having sex with the wife to get updates (malonje) on behaviour of his wife when he was away. When the man was away, his wife was monitored by the parents and relatives of the man so that to see if he was not sleeping with other men. This wourl help the parents give right feedback about the wife while he was away. If a man overstays, parents in collaboration with the husband would organize one of the the man’s well behaved brothers to be having sex with his in-law and have children to keep her company. “Tongas are migrant by nature we go out looking for greener pastures so that we can sustainably support our families”, it was reported “So we set up norms to safeguard the remaining members of the family”. Counselling for the Youth (20): The suburban believe one of the best ways to prevent the youth is to give them counselling without hiding anything. We found out that this can be done in many ways: (a) establishing counselling groups to offers counselling in churches, schools and youth groups, (b) establish specific counselling groups for girls, men, women, and youth, (c) revamping cultural groups who should visit fellow people in their homes or groups to give them counselling on how they are expected to behave as Lhomwes, Ngonis, Tumbukas and (d) training youth peer educators in each area to monitor behavior of fellow youth and organize counselling sessions for the targeted youth identified in the area. Literacy (8) Going to school or to be literate has now been become part of IK especially considering the period when western education was introducted in the courntry. In the past, girls were not educated and the only knowledge, skills and morals they were following were from their parents. Now education is opening them up and with the issue of gender equality they are even demanding for sex from boys -Tumbuka Ngoni. Traditional dances taken as a mere entertainment: People consider traditional dances as mere entertainment functions. Many pay less attention to the message the songs carry- Lhomwe
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(C) CHALLENGES TO IK FOR HIV PREVENTION Respondents were also required to identify challenges they face in trying to implement the IK. The following findings detail their responses. Westernization and modernization (56): It has been reported in the Sena culture that youth take up uphungu elder’s counselling as old fashion and the Lhomwe indicated that modernity has dissolved some values and beliefs. Flexibility and stereotyping of the Lhomwe culture has led to the loss of some Lhomwe values and the incorporation of other cultures such as poor dressing amongst girls. Girls now prefer going to modern dances and not traditional ones, and not respecting the six months waiting period, considering it outdated, educative traditional dances are dying slowly and replaced by band music which does not reach moral to the youth. It has been reported by the Yao people that westernization has really corrupted the youths and this has brought unruly behavior and degradation of their culture. “Good counseling is no longer being taken seriously since the youths have become corrupted by the outside culture. The youth are copying outside cultural traditions hence the degradation of their own” reported a respondent in the Yao. The Ngonis also bemoaned degradation of their culture. They said “the youths can no longer abide to our advice saying it is old fashioned and cannot be applied to the modern years or life (5). The interaction between boys and girls have changed alongside their knowledge on sex so you can no longer tell boys that akazi amaotcha or tell girls that amuna ndi dzilombo - Life style has changed. People no longer eat together as a village. “Modernization has transformed things. Now aunties are not taken seriously by the children; they are getting information from social the face book and pornographic pictures and videos and these kill what the children have been taught by their elders. Communal life is no longer in practice”-Tumbuka cultural custodian. The Tumbuka have observed that today people are no longer afraid because they know much more than they were supposed to know. “Modernization has spoiled our culture as people copy western life whether suitable or not for our culture” Tumbuka Ngoni (5). The cultural custodians, TAs and community leaders had this to say, “Modernization has spoiled our old good culture where sex could not be publicly talked in presence of children. Young people look at maintaining their virginity until they get married as old fashioned (out of fashion). The youths practice unprotected sex and believe nothing bad will happen- Tumbuka Ngoni. Girls/boys look at the one with pulled labia as old fashioned. Pre-arrangement on marriages are no longer popular among the youths. Nowadays young people have sex without any fear of parents dying neither boys getting burnt. Western culture has spoiled our people as now women talk to their fathers and brothers’ inlaws without fear and much respect. Young people or couples are not following what they have been taught. Too much mobile markets have exposed people to income leading to sexual activities. Videos, human rights and condom promotion have spoiled our people. Condoms promotion has influenced people to be loose” The Chitipa cultures maintain that westernization has made local dances fade out and people go to band dances at night where they can contract the virus. The suburban respondents reported that many youth cannot be involved in the initiation rites today. “Most girls refuse to come for chilangizi (counselling). Youths is not following chikhalidwe cha makolo (good traditional customs and practices) saying it is old school. Adoption of western culture is replacing initiation ceremonies into kitchen and dressing top-up, bridal showers. Too much exposure to mass and social media such as TV, radio and internet is encouraging people to adopt western culture such as bad dressing styles, unsafe relationships.
38
Ridicule and stigmatization (24): Most people are often being ridiculed when they talk about and try to promote IK. Chitipa culture (16) and sub urban (4) Lhomwe (4) Unfaithfulness (15): Among the Yao young spouses are left with no choice but to have other sexual partners if their spouses stay for long out of the country. It has been found among the Chewa that the main cause of unfaithfulness is simply “kuyenderana kuseli” among the spouses. It was further indicated that there is high level of unfaithfulness nowadays because people rush into marriage. They do not take time to search for a good spouse. Luck of satisfying each other sexually is another cause again emanating from rushing into marriage without knowing each other well. Among the Tumbuka Ngoni The Tongas reported lack of openness and being away to the lake to do business and leaving wife at home as encouraging extramarital sex. It was said that when one is faithful people ridicule them as having being bewitched. Kuyendayenda (not staying at home with spouse has been claimed as the main source of unfaithfulness among the cultures of Chitipa. In the suburban and other religious gathering, it has been reported that some women leave their husband for night prayers, legio, mvano, or dorica when they go to sleep with other men including church elders, pastors, priests, men of God, bishops and prophets. Open sex education (14): The Ngoni have noted that the modern primary and secondary schools curricula provide for actual information on sex and child bearing hence we can no longer tell the youths that mkazi amotcha and that men and women are the same in bed. In schools today youths are being taught openly about sex. The Tumbuka and Tumbuka NgoniTumbuka Ngonihave recognized that the teaching of sex and reproduction issues in Life Skills and Biology at primary and secondary school levels exposes the youth to all facts about sex and pregnancies and we can no longer instill fear in them about sex matters. The children are getting details at a very young age. “The youth are being taught Biology from standard four a situation that makes the youth believe they are more educated than the older people and believe that whatever they can hear from the elderly is old fashioned and baseless. “Previously Biology was only taught from secondary school level. Sex matters should only be taught to the youth at secondary level if the young ones are to heed to parental and elders’ advice” Tumbuka Ngoni. It has been noted in the suburban, Tumbuka and Lhomwe that educated women are less respectful to husbands because they think they are more equal and at times even superior than men especially after being oriented to gender and feministic movements .- Tumbuka Ngoni Dressing (13): Wearing miniskirts, tight trousers, leggings, high cut that shows underwear waist and pubic hair, wearing g-strings that leaving the buttocks loose and the “flashing the breast” make men fail to be faithful to their wives or partners. Ngoni and the Tumbuka Ngoni. Wearing revealing clothes in schools, colleges, markets even churches arouses sexual desires among men who cannot control for long – Chewa, University lecturer. The Tumbukas report that wearing properly is seen as old fashioned because of freedom dressing and modernization. “It is only married women who are dressing respectably these days and the problem is these men are really dogs (wanalume yawa, ni vintchewe nadi). They leave you and go for those who are dressed in miniskirts and trousers yet they can never allow you to dress like that” complained a member of ADC in the Tumbuka culture. The modern dressing has also reported to be responsible for rape case. All the ten cultural groups of Malawi seem to agree that dressing respectfully, the way it was done in the past and during the past encourage some moral deportment in terms prevention of irresponsible sex. Human rights education (12): While the promotion of human rights has advanced the dignity of the people in the country, it has been registered by almost all the cultures that the teachings of some human rights as advanced by the institutionalization of some human rights organizations has inhibited some useful IK. The Yao maintain that the emergence of human rights organizations is a very big challenge to their culture as the human rights teachings bring confusion to their (Yao) culture with good morals. The Tumbuka and Tumbuka Ngoni have observed that human rights make it difficult to apply some of the beliefs they had. They also hold that “Human rights- people don’t understand the rights properly and whenever you try to discipline your 39
child they accuse you of violating the child’s right such as child labour, respect for parents etc”. A tombola respondent said. “Human rights? - These days no one can discipline someone’s child even yours. Previously if an older person found any child doing wrong things the (older) person could even beat up that child to discipline them but not nowadays. Even for the virginity test, girls were tested by finger insertion while boys were checked if their foreskins were going up a lot but you cannot do that to the youths of these days” It was reported that too much freedoms and human rights has spoilt people’s behaviour. “Youths do things they want under freedom and democracy and it is difficult to control them. Youth are stubborn to teachers, guardians and parent in the name of freedom. Women are stubborn and disrespectful under the influence of gender and human right teachings.” Traditional practices (11): Negative chokolo is practiced among the Chewa was mentioned. In the Tonga, the practice of parading girls when they reach maturity gives the opportunity to entice young men to have sex. It was reported from the Tonga culture that some people are deep rooted in culture that they don’t mind the consequences of some of the traditional practices. Despite the ban on Chokolo there is high temptation for a brother to marry the widow. At the mphala boys still take advantage of being separated from the parents and indulge in having sexual relations before marriage and other deviant behavior because of peer pressure. In the cultures of Chitipa some negative traditions such as mwanseri, chokolo, fisi, kupimbira, chidyerano are being practiced secretly. However it is important to appreciate that most of the cultural practices have been replaced by modified bridal showers where the bride get some advice on good marriage practices Religion (10): Some traditional practices are not acceptable by some religious denominations. These inlude initiation rites traditionally approved polygyny.. Some churches discourage people from taking medications from hospitals and/or traiditional healers. Some churches discourage its followers from using condoms because they believe condoms encourage promiscuity. It was reported in the Tumbuka Ngoni that some youth were excommunicated from their church because they were found with condoms. Poverty (9) has been cited as a major cause of prostitution leading to HIV transmission among the Mang’anja. People today just want to be married to someone who is capable of feeding the family – Lhomwe. The Lhomwe have reported that poverty has weakened our togetherness and indigenous practices as we give in to donor and external supporters whose assistance is given on condition of eradicating some of our traditions such allowing homosexuality. Respondents in the Lhomwe groups reported that they were failing to protect their beliefs from foreign beliefs. Lack of knowledge and resources also make people enter sexual relationships they later regret on as one only discovers the spouse has bad behavior while already marriage– Tumbuka and Chitipa cultures. In Chitipa, it was reported that more people cross borders because of poverty where women fall prey to unprotected sex or into relationship with a man she does not fully know. Orphans and vulnerable children who lack support because of the dissolution of the chokolo tradition end up going to Tanzania to seek job and help and they become sex workers. Failing to abstain (9): According to the Chewas, people in their culture are failing to abstain from sex because they are not fully inculcated with the values of abstinence. The Tongas observed that despite giving advice to girls at the nthanganane initiation, the girls still practice sex before marriage. It is claimed that the IK on abstinence teaching have been diluted. Abstinence is ridiculed now because we have allowed westernized and casual life to be the standard norms of our life. “When you abstain and years pass by before you get married, people laugh at you, teasing you, saying that you are impotent” observed a cultural custodian in the Tonga area. In Chitipa culture it has been noted that people do not stop chidyenya (kusilira) . In the suburban it was reported that many of the youth say “you cannot buy a car without testing test driving it” meaning you can’t marry someone before having sex.
40
Strictness on medical intervention (9): The challenge is that the IK does not allow medical intervention in the examination of the circumcised individuals to find out whether the traditional way of doing it is effective in the prevention of the pandemic. (9)- Yao Poor Parenthood (8): The Tumbuka Ngonis have said poor parenthood is a serious challenge to promoting good morals. At puberty children are not sent to their grannies, uncles or aunties to receive good counsel because the parents believe such relatives do not have the desired knowledge as some are not well educated. Women and girls are not punished for pre marital or out of marriage pregnancies in the suburban culture. In the same setting children are allowed to attend bridal showers where they learn things they were not supposed to have heard. The children were reported as not ready and mature enough for such messages. Some parents even are encouraging their daughters to sleep with wealth men to help them fend for the family. Marriages without traditional counselors (ankhoswe) are common in the suburban culture and parents accept it as normal. Acculturation and intermarriages (8): The Ngonis have bemoaned the coming of people from other cultures to get married and settled in the area as contributing to the dissolution of their traidtional customs and practices “These people do not abide by our culture such that even their children do not inherit Ngoni cultural practices. Acculturation is one major challenge that is bringing traditions, customs, norms and beliefs in this district down- Yao. The Tumbuka Ngoni have also reported that too much intermarriage in the district that has spoiled the old good culture. Wealth (8): many wealthy people indulge themselves in ex marital relations and hence the spread of the virus – Chitipa, Suburban, Ngoni Disapproved Polygyny (7) also emerges as a challenge to approved polgyny and to HIV prevention “Polygamy was just okay in the past because women were very loyal. Men could go to (Theba) work in South Africa and come back and find all the wives waiting for them because they were afraid that they would fall pregnant. Now they can use use contraceptives. Nowadays mitala is not good because most women now are crooks” Tumbuka. It has also been reported in the tumbuka that the main problem of polygyny is that most men fail to take care of the wives and women go their own ways. It has been found among the Tumbuka Ngoni and the Chitipa cultures that polygamy is also bringing unfaithfulness as the men cannot sexually satisfy all the wives because it takes time for a man to take his turn for a particular woman. Decline or backsliding on religion morals (6): Not fearing God in all endeavors – as if you don’t have a soul.- Prayers are not taken seriously since God is not seen by face.. In other words, people do not put God ’s words into use - Chewa (6). Many people stopped praying because of heavy beer drinking. Integrated Cultures of Chitipa Problems in families (6): Spouses want to out new things in terms of fashion and styles. Tired of their spouses or partners want to try other things – Chewa. It was reported that “Some men do not allow their wives to take part in any organisations”- Sub Urban Cultures. Just because of some beliefs of “kuthunda or kulera mwana, husbands are denied sex by a wife who delivered. Many women are refused by their husbands to join organizations where they can learn good things – Chewa. As a result of all this, divorce is also on the rise. Migration and urbanization (6): When men go to South Africa and Zambia to work they also bring strange behaviours. Even without going outside the country, people go to live in town, adopt new behaviours and when they come back here they teach other people- Tumbuka (2). When in RSA, most men who have left wives back home, get married to other women in that country - Tumbuka Ngoni. When men who go away from their villages for green pastures, sometimes marrying there, their wives who are left behind without support turn to prostitution and can contract HIV..- Tonga. Men and women cross the Tanzania border to drink beer and indulge themselves in sex with rich men, many have got this virus through this- Integrated Cultures of Chitipa
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Taking advantage of dances (5): Many people especially the youth take advantage of traditional dances functions e.g. Tchopa as right places to indulge themselves in sexual activities.- Lhomwe. Unfortunately, Chilimika and Malipenga dances last for more than one week. So some of the dancers take advantage of fellow dancers and start sexual relationships which can lead to contracting HIV- Tonga. The dancing that people do in parties and top-ups are sexual dances that attract men. A lot of rest houses and bottle stores in the area which motivate people to drink irresponsibly and conduct unsafe sex practices. Most youth no longer take part in community youth meetings but in social functions such as discos- Sub Urban Insufficient and Lack of advice (5): There are no or few initiators and counselors (anamkungwi, ngaliba) to advise women- Lhomwe. Children are not advised by their parents. This role is more often left to aunties and uncles who sometimes talk everything or too little because they really do not know the child. Parents also do not have enough time to advise the children because the children spend most of their time in schools. Tumbuka. Parents also do not know how well they can talk to their children. They think that all the new things the children know are bad. –Tumbuka. Furthermore, young girls are not taught much at puberty initiation ceremonies e.g. for seven days as intensive as it used to be.- Tumbuka Ngoni Sex education through mass media (5): Radios are broadcasting programs which are not suitable for everyone- Tumbuka. Sex and sexuality taught in schools, radios expose youths to have sex.- Tumbuka Ngoni. Women/girls are publicly taught about sex and sexuality through radios. There is too much information on sex without audience selection.-.Tumbuka Ngoni (2). Radio programs that talk about explicit things claiming to be part of HIV prevention- Sub Urban Cultures Bad advice (5): Some initiators advise the children bad things at the initiation ceremonies such as Kusasa fumbi and jando. This has painted a bad picture about initiation ceremonies hence making people shun away from them. - Lhomwe Lack of respect from children (4): Children are no longer respecting their parent’s advices because they look at them as old fashioned- Lhomwe. Some people especially youth respond to advice by saying AIDS inabwerera anthu.- Ngoni. The youths don’t understand the culture so they have no respect for elders- Tonga. There is general stubbornness by children and the youth nowadays unlike in the past - Sub Urban Cultures Weakness of women (4): Women are easily convinced or enticed by men who just want to use them. Sometimes girls just want to try to test if men are indeed dangerous – Chewa. For ladies, it appears it is very difficult to get employment without offering yourself for sex. So abstinence can also disadvantage you. Most of the time, for a single woman to have ‘capital’ for a business she falls for a man - Tonga Campaign by NGOs (4): Many NGOs have been doing campaigns to stop people from using local herbs but modern medicine.- Lhomwe. We NGO empower the youth to abstain but we give condoms to those who cannot. As a result girls do not fear. They go to have sex with men because they know they cannot get pregnant. Condoms have made some youth to take sex as a hobby. Unfortunately for the girls when it breaks they get the virus and pregnancy. Besides, very few people use the condom consistently. Giving condoms anyhow by NGOs and government is promoting promiscuity – Tumbuka, Tumbuka Ngoni Democracy, freedom and modernity (4): has spoiled our children. Girls do not dress properly, love money too much, women call their husbands by their first names – Tumbuka Ngoni Poor prepared meals (3): by women make men find another women friend who can cook for him well. – Chitipa cultures Human Rights and the Law (3): People use human rights and freedom to do whatever they want Tumbuka. Youths are not afraid to have sex before marriage as they know the law will protect them. Regulations attached to bank loans on community banks leads to promiscuity to pay back the loan Suburban 42
Ignorance (3): District officials and partners working in the district are not aware of most of the cultural practices as community leaders and custodians of culture do not open up on cultural beliefs and practices happening in their areas. It becomes difficult to use culture in disseminating HIV messages and also to advocate for a stop in cultural practices that are fueling the spread of HIV.- Ngoni. Ignorance- people to understand and lack of knowledge of the indigenous knowledge by community based organizations - Cultures of Chitipa Peer Pressure (3) amongst the youths not sticking to parent’s advice- Chewa, sub urban; how to get top up gift leads to promiscuity – sub urban. Private parts enhancers: Use of virginity soap and penis enlargers is encouraging promiscuity- The SubUrban Cultures Implications of condoms (3): Some people still believe that condoms do not give sexual satisfaction as they still claim that “you cannot eat sweet wrapped in its case.” Some people don’t use female condoms claiming it makes a lot of noise. Lastly the introduction of condoms has made most partners unfaithful to each other encouraging multiple sexual partnerships Use of condoms (2): It has been reportedin th suburban that “In the past we were not using condoms. Today our children are contracting AIDS because of trust in condoms because the condom encourages sex relationships where the condom is used only on the first days. Later it is forgotten on the pretext of knowing or trusting each other even without HIV testing.. Sharing sharp objects (2): such as razors and scissors and still exists in some cultures such as Chewa. Children want to try out new things by taking parents’ sharp objects. Drunkenness (2): This makes one fail to make good judgment and control. –Chewa. There is also a tradition of men and women drinking beer even at night. This encourages promiscuous behavior. Chewa, Chitipa Cultures Discrimination and Stigma (2): People living with HIV are stigmatized and hence hard for them to go for HIV counseling and testing and disclose their status- Cultures of Chitipa Superstition (2): Bad luck stays when spirits are annoyed because some do not reveal all what the spirits want to hear . Also when a person who has offended the ancestors does not have enough money to pay to the spirit for the wrong doing.- (Sena) Death (2): Those who were involved in initiating young women in Litiwo are no longer alive and the tradition is fast dying out. The folk-tellers are gone and the talent of folk-telling is lost since the youth regard the talent as archaic - Yao Sport activities (2) are places where opposite sex relations develop and lead into unprotected sex, (Chewa). Sports was also identified as important in preventing youths from engaging in premarital sex. When one is injured during sporting activities nobody sponsors you leaving your poor parents taking care of you when they were supposed to work and fend for the other members of the family - Cultures of Chitipa Elderly accused of witchcraft (2): The elderly who are the pillars of traditions and beliefs are being accused of witchcraft hence they refrain from giving good counsel to the youths- Yao. Some say they don’t want to sit together in the community for fear of being be-witched - Ngoni Provocative dancing: Provocative dancing: The way women dance in some traditional dances e.g. Tchopa, promotes sexual activities- Lhomwe
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Development: Development always comes with negative things as well. People are exposed to different cultures now and it is difficult to guide them - Tumbuka. Gender Discrimination: The women are always the victims- Yao. Gender Equality: There are a lot of NGOs empowering the girl child and some of the things they are being taught have negative impact on indigenous knowledge – Tumbuka Unprofessional Circumcision: Especially the one at initiation ceremonies is done with contaminated equipment which can easily spread the disease. This has made a lot of people to stop going to initiation ceremonies. - Lhomwe No more belief in herbs: Many people no longer believe in herbs because there is little or no evidence to prove the effectiveness of the herbs-Lhomwe Involvement of very young girls and boys in initiation ceremonies (7): Some initiations involve young children who can hardly understand the messages they get from there and often times the messages are inappropriate. Consequently, youths behave recklessly–Yao (7) Few cultural custodians: It was reported that there are few culture custodians. Besides being few they have been discouraged to see culture as contributing in HIV prevention. So they lack courage to promote IK Lhomwe Lack of experience in traditional cultural practices by foreigners and the “educated: has posed a big challenge to implementing IK. There is apparent conflict of teaching in the community between those NGOs that come to show videos on behaviour change and those that use one to one counselling. The counselling may talk about this way while the video may also talk about a different approach and this confuse the recipients of the message Lack of understanding of women’s mood: The tradition of understanding the condition of a woman whether she is in the mood of having intercourse is no longer there. This is due to lack of IK counselling in the communities. Not understanding “who a woman is” has lead to a number of problems that alienate spouses to extramarital sex or lead to separation or divorce. Too much protocol during traditional initiation rites: There is too much authority and protocol towards the preparation for the initiates –ndowa – Yao (D) COMMUNICATING IK FOR HIV PREVENTION This section considers key holders or sources of IK, key communicators hereby called key players, appropriate approaches, media and channels for communicating IK for HIV prevention. Figures in this are (i) Appropriate Communication Approaches Participatory and face to face interpersonal communication has been proposed as the best IK approach for communicating primary HIV prevention (ii) Key Holders of IK for HIV Prevention Figures summarized in appendix D, gives findings on the key holders of HIV for primary prevention
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Ke y Holde rs of IK for HIV Pre v e ntion 89
Religious leaders
61
Youth groups
45
Dram a & arts groups
97
Wom en's groups
90
Support groups & PLWHA
59
Traditional healers & herbalis ts
93
Key Holders
Men's groups
40
Traditional mus ic performers
98
Vge elders , counsellors,custodians
70
Political leaders
71
Training institutions & profess ionals
80
Health & devpt comm ittees
75
NGOs, CBOs, depts .
85
Health workers & their orgs
101
Parents & guardians
112
Traditional & local leaders 0
20
40
60
80
100
120
No. Re sponde nts
Figure 1: Key holders of IK for HIV Prevention
From findings detailed in Figure 1, the study shows that traditional and community leaders indentified by 112 respondents (out of 146) are the main key holders of IK for HIV prevention. These are followed by parents and guardians (101); Village elders custodians and counselors comprising initiation rite counselors (angaliba, anankungwi, nkhalakale za mmudzi) (97), Women’s groups (97); men’s groups (93); Support groups and PLWHA (90); Health workers (80) such as HSAs community nurses probably because they experience the community life which include people values, traditions, knowledge and practices; NGOs, CBO and other departments (75) probably because they work and exit in the community; Training institutions and professionals (71) because of their studies and research in social cultural issues (71); youth groups (61) because of the knowledge and belief system they get from their communities and 45
guardians and youth groups as they are get some norms and values from the community. Traditional healers, traditional music performers (59) have be least preferred as fountain of IK for HIV prevention (iii)
Key Players or Communicators of IK for HIV Prevention Key Communicators of IK for HIV prevention Preachers ,pastors ,pries ts , prophets
50
Youth leaders , peer educators
55
dramatis ts , artists
31
Women's trad leaders ,couns ellors
59
Key Com m unicato rs
PLWHA, s upport groups , CBVs
60
THs, TBAs , herbalis ts
51
Vge men's leaders,couns ellors
59
Dancers , singers composers
40
Elders, couns ellors, custodians
61
MPs, councilors , govt officials
50
Teachers, trainers , facilitators
52
Health com, DACC, ADC, VDC
56
Com munity devpt facilitators
59
Health workers , staff & promoters
59
Parents and guardians
61
Chiefs (TA,GVH, VH), com munity leaders
63 0
10
20
30
40
50
60
70
No. of Respondents
Figure 2: Key Communicators of IK for HIV prevention
Findings as detailed in Figure 2, the research has shown that Community leaders and chiefs who comprise traditional authorities, group village heads, and village heads have been considered by the majority (61 respondents) are appropriate key players of IK for HIV prevention. This is probably because of the knowledge and authority they have in the community. These are followed PLWHA, support groups and community based volunteers (CBVs) (60) undoubtedly because of their commitment to communicate HIV prevention at community level; Elders, cultural custodians and counselors (61) probably because of their knowledge, experience in IK and the role they play in communicating the IK through initiation rites and other rites of passages; Health workers and staff (HSAs, community nurses, health promoters, clinicians, nutritionists); Women’s and men’s leaders and groups; Community development facilitators (59) respectively; Youth leaders and peer educators (55); Traditional birth attendants (TBAs), traditional healers (THs) and herbalists(51) and Religious preachers (50). Dramatists and traditional music dancers are considered least appropriate (iv)
Appropriate Media and Channels for Communicating IK for HIV prevention
46
Appropria te Cha nne ls & Media for Communica ting IK for for HIV Pre vention Drama & Art (story telling,fiction,poety)
41
Initiation rites
89
Religious institutions
77
Media and Channels
Sports, games, promos
40
Night & morning announcements
41
IEC materials & community media
25
Funerals
96
Rallies & open days
68
Traditional songs and dances
50 54
Talks, seminars, workshops, FGDs & meetings in vge /community
90
Door to door (household) education
97
One to one counselling & education
101
0
20
40
60
80
100
120
No.of Re sponde nts
Figure 3: Appropriate Media and Channels for Communicating IK for HIV Prevention
The figure shows that the majority of the respondents (101 of the 146) have identified One to one education and counselling as the most t appropriate channels for communicating IK for HIV prevention. Others put in the order of appropriateness are Door to door household education (97), Funeral event announcements (96) FGDs and meetings at village and community level (90); Initiation rites (89), Religious institutions (77); Rallies and open days (68), Talks, workshops or seminars (54); Traditional songs and dances (50); drama, arts and oracles (morning and evening announcements) (41) and sporting and competition activities (40). IEC and community media materials have been identified as the least appropriate. Summary of IK and Effective IK Communication for HIV Prevention Respect for parents’ and elders’ counsel (78 of the 146 respondents) is the most important IK for HIV prevention. This is followed by Abstinence, discipline and no premarital sex (59); Abstinence and fear of extra-marital sex (49), Initiation rites (50), Respect for husband (44), Enhancing Sexual attraction & Love for husband (34): Religious morality (34):, Parental control over children, Respectable dressing (27), Proper marriage procedures and arrangements (26)and Social activities and Sporting activities (23), Traditional communication between spouses on sexual matters (23), Sex education in private, Lobola (dowry) (23): Circumcision and Marriage Counselling and Conflict Resolution (23)Educative traditional dances and songs (22), Punishments for premarial and outside marriage sex (21). Value for virginity (20): Norms for those who go to work outside Countries(20), Counselling for the Youth (20), Changing bad IK (19) Kuzinga (13, Approved polygyny (12), Roles and responsibilities of children before marriage (12), Traditional groupings(12), Wife Inheritance (10): Sense of togetherness (9), Marriage within the same culture (9), Social distance (9), Work and business (9) Maturity as a measure for marriage (9), Literacy (8,), Responsible drinking (4) among Chewa (6). Going to hospitals for treatment (7) and Nthena and Syazi and traditions (7tradition(3).
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Impementing IK for HIV prevention has been challenged by Westernization and modernization, stigmatization, unfaithfulness, open sex education; sex modern dressing, human rights education, restrictive religious practices, poverty that has increases prostitution, failure to abstain, strictness on us of medicine, poor parenthood, intermarriages, disapproved polygyny, decline in religious morals, provocative dances to mention a few On communicating IK for HIV prevention, Traditional and community leaders have been identified as main holders (112). This is followed by Parents and guardians (101); Village elders custodians and counselors comprising initiation rite counselors (angaliba, anankungwi, nkhalakale za mmudzi) (97), Women’s groups (97); men’s groups (93); Support groups and PLWHA (90); Health workers (80) such as HSAs community nurses probably because they experience the community life which include people values, traditions, knowledge and practices; NGOs, CBO and other departments (75); Training institutions and professionals (71) Youth groups (61) and lastly Traditional healers, traditional music performers (59) On key communicators, Community leaders and chiefs who comprise TA, GVH, and VHs have been considered as most appropriate key player (61). This is followed PLWHA, support groups and community based volunteers (CBVs) (60); Elders, cultural custodians and counselors (61) Health workers and staff (HSAs, community nurses, health promoters, clinicians, nutritionists); Women’s and men’s leaders and groups; Community development facilitators (59) respectively; Youth leaders and peer educators (55); Traditional birth attendants (TBAs), traditional healers (THs) and herbalists(51) and Religious preachers (50). Dramatists and traditional music dancers are considered least appropriate. One to one education and counselling has been identified as appropriate media and channel for communicating IK for HIV prevention (101 of the 146 respondents. This is followed by Door to door household education (97), Funeral event announcements (96) FGDs and meetings at village and community level (90); Initiation rites(89), Religious institutions(77); Rallies and open days (68), Talks, workshops or seminars (54); Traditional songs and dances (50); drama, arts and oracles (morning and evening announcements) (41) and sporting and competition activities (40). IEC and community media materials have been identified as the least appropriate. 2.1.4 IK FOR HIV TREATMENT In collecting data on IK for HIV treatment, the research also considered some negative IK for HI treatment and challenges faced in implementing the IK for HIV and AIDS treatment. (A)
NEGATIVE IK FOR HIV TREATMENT
Before identifying the IK for HIV treatment, the research established that the following Ik is harmful to HIV treatment. Beliefs and myths (17): A belief still exists among the Lhomwe, Chewa and Tumbuka that when an HIV positive person sleeps with a virgin or an albino, he or she can be cured of the disease (8). Among the Sena, some people still believe that AIDS is tsempho and so there is no need for medical treatment but sexual cleansing. It has been reported that some people in the Chewa and Tumbuka cultures believe that AIDS is one of the diseases caused by witchcraft (6). Among the Chewa and Tumbuka, some people believe they can rape an infant to be cured of the HIV and AIDS. Traditional dances: Some traditional dances such as tchopa require special preparations which can take almost a week. Organizers leave their home and camp where the preparation takes places. This makes some AIDS patients break or stop in taking the ARVs.
48
Malume tradition: It has been found that in some Lhomwe ethnic groups, the malume (uncle) is the main determinant of most of the decisions in the nephew or nieces’ family. It was learnt that an uncle determines who gets treatment and the time one should receive the treatment. When a wife is sick, the husband cannot take her to the hospital or anywhere to seek treatment without the malume’s approval Chiulira: Reported amongst the Tumbukas, this is a practice whereby a woman who falls pregnant before start having a periods following the birth of another child, is taken away from the village is put in a temporary house away from anyone until she delivers. This hinders the woman from having a well-balanced diet and even accessing PMTCT services. Disapproved polygyny: Despite campaigns against the disapproved polygygny, some groups still accommodate and entertain the polygyny which is not approved by the first wife or other relatives. This promotes the spread of HIV and AIDS if the new wives have not been tested for HIV or are not well behaved -Lhomwe (3), Yao (5), Ngoni (6), and Tumbuka Ngoni (3). (B)
POSITIVE IK FOR HIV TREATMENT
The study has found that the following IK can help in HIV treatment. Use of herbs to cure diseases (121): Some herbs can cure AIDS related diseases and boost body immunity. Most of the names of the herbs were kept secret to the researchers as they are not given to patients freely but on cash basis. The following cultures reported to have such herbs Sena and Mang’anja, Yao (6), Ngoni (4), Chewa (8), Tumbuka (10), Tumbuka Ngoni (9), Tonga (16), Cultures of Chitipa (15) and the sub-urban cultures (9). However, names of some herbs that were revealed. These were nimu leaves (Lhomwe (9), Aloe vera - Lhomwe (3), Tumbuka, cham’mwamba- Lhomwe (5), nampwaphwa tree leaves -Lhomwe (2), mvunguti. (The tree cover is pounded and dried. The powder is put in the porridge of the patient) - Lhomwe (2), Jacaranda seeds Lhomwe, chambe-Lhomwe, pawpaw leaves-Lhomwe (2), nkhadzi Roots-Lhomwe and eating a lot of chisoso leaves- Lhomwe (2). It is believed that the sour taste of the herb is very vital for fighting diseases. The bulk for mwanga tree-Lhomwe, mpama tree leaves-Lhomwe, raw groundnuts-Lhomwe, kalongonda–Lhomwe, Eating a lot of bonongwe-Lhomwe, use of mulombwa- Lhomwe, mwana mphepo tree leaves - Lhomwe (see other from Chris book) It has been reported that most of the herbs are provided by the traditional healers used to heal different diseases with local medicine and using certain spiritual powers. This is commonly found in the Tumbuka Ngoni (10), Tumbuka (7), Tonga (5), Ngoni, Lhomwe and the Sena. Traditional Nutritional diet (68 ): Consumption of well-balanced diet from locally found food such as vegetables, beans, peas, fruits, soya, ground nuts, small fish, chicken, doves, goat meat etc has been reported to help in supplying the required balanced food for home based care –Yao (4), Tumbuka, Tumbuka Ngoni(8), Tonga, cultures of Chitipa (8), sub-urban cultures(3). Specifically, various nutritional remedies were reported to be used to improve the immune system of HIV infected and AIDS patients. Soy oil and flour, several wild fruits and juices of such fruits were reported to be used to improve the health status of HIV infected individuals. High fiber vegetables were also reported to be used to enable cleansing of the “body system.” Individuals infected with HIV are advised against drinking coffee and/or tea as well as taking processed sugar and refined maize flour. The most report plant perceived to have superior nutritional and medicinal values was the Moringa (Moringa oleifera). Moringa leaves are cooked into a sauce, with or without peanut butter. Laboratory analysis of Moringa leaves has shown that the plant’s fresh and dried leaves are rich source of different vitamins (A, B complex, C and E) and minerals (iron, selenium, calcium, magnesium, potassium). However, traditional 49
cooking methods where the leaves are boiled for very long time or the water in which the leaves are boiled are discarded, are thought to compromise the available nutrients. Different African leafy vegetables or indigenous and traditional plants were found to be used generally but also specifically to improve nutrition among HIV infected individuals. These local vegetables included Amaranthus species (bonongwe), Bidens pilosa or black jack (bonongwe), Beta vulgaris, Cleome gynandra, Curcubita maxima, Vigna ungiculata, Physalis pyruviana, and Thunbergia lancifolia, a vegetable sometimes cooked in matsukwa. Avocado pear leaves can also be made into a tea for the treatment of iron-deficiency anemia. It was reported also that certain foods (snacks) such as zitumbuwa (banana fritters), chigumuyoyo (in short chigumu) –baked from a mixture of water, maize flour with baking soda and chimimima-moulded from a mixture of ripe bananas and maize flour, wrapped in banana leaves and boiled in water. These snacks were reported to be of high nutritional value in terms of calories, minerals and vitamins. Matsukwa or ntombera is the sour white liquid obtained a few days of soaking milled maize kernels. The sour taste of matsukwa is used to improve the taste maize porridge, may be added to certain vegetables to tenderize. Matsukwa is thought to improve digestibility of the food. Another group of foods eaten were different types of boiled maize kernels. During the dry season when dried maize was plentiful but other fresh-foods in short supply, chingowe (water boiled dried maize kernels) is made. Other preparations are ntama (small pieces pounded maize boiled in water) and ntakula. Ntakula was when large maize kernels that failed processing in the mortar are boiled to be eaten as a snack or main meal. Thobwa, a fermented cereal gruel liked for its sweetness prepared in almost all regions on the country is, stomach-filling liked for its fermented aroma. Thobwa is made from boiled maize flour into which ground millet and or sorghum and added. The mixed is left to ferment for a few hours to days. Different wild edible fruits (WEFs) were reported to be used as snacks and supplement staple diets. These fruits include: masuku, matowo, bwemba, malambe and maula. The fruits are eaten whole, sucked, or made into juices. Farming and agricultural practices are another area where indigenous knowledge was found to be of value and could contribute towards ensuring improved nutrition and enhanced food security in households affected by HIV and AIDS. Establishing gardens, preserving and planting crops near Acacia trees was reported as an ageold practice. Scientific review suggested that these trees are nitrogen-fixing, hence the high crop yield among crops planted around the trees (Barany et al, 2001). Insect-based food and animal protein has also been claimed to help in boosting good personal diet. It is estimated that an HIV infected individual requires 10-15% more calories and 5-100% more protein than daily requirements (James and Schofield, 1990). There are specific food items that were identified as ‘traditional’ but of potentially high nutritional value. Flying ants (ngumbi) and mafulufute, caterpillars that feed on mopane (Colophospermum mopane) trees, i.e. (mphalabungu), grasshoppers (ziwala or zitete), nkhululu, mice (different species) and nsinjiro (peanut flour) contribute to the diet. The traditional cooking of sauces (ndiwo) in Malawi, unless the food is roasted, is almost always with onions and tomatoes. Lack of tomatoes especially is considered great want and poverty. Scientific evidence testifies to tomatoes and onions as having immunemodulating and other biological properties (sugar regulation) in the human body. Church Prayers (37): Praying for the sick or taking them to prayers sessions–Sena and Mang’anja, Yao (5), Ngoni (6), Culture of Chitipa (10), Sub-urban (3). People who have strong faith in some religious leaders especially the Pentecostals and Zion churches believe that they can get healed if they have faith-Lhomwe, Tumbuka Ngoni(7), Tonga (4), sub urban.
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Encouraging hospital medication: (16): Since the advent of Christianity and the colonization of our country that saw the introduction of health facilities, going to the health facility such as hospitals to get medicine or cure has been part of the IK for treatment. Through support groups and health education, people go to access ART from health facilities. Group therapy sessions and taking the patient to a health facility treatment is common means of treatment in all the cultures of Malawi. Traditional Spiritual and exorcisms therapeutic dances (13): Some diseases that are related to spiritual possession are claimed to be healed only through traditional spiritual exorcism apart from church prayers. In some cultures, the healing or spiritual exorcism is accompanied by specific dances that are therapeutic by nature for example, vimbuza music by the Tumbukas, Mizimu music drumming among the Chewa (2), Tumbuka (6), and Tumbuka Ngoni (4). Others included namtongwe for mutu wamtume or mutu wa magini where a person faiths and producing staccato wailing sound while trembling. Among the Lhomwe the ceremony is concluded by planting a banana tree in which the claimed to migrate and finally dies when the tree dies two after producing the banana which cannot be eaten. In other cultures the songs carry messages of goodness such as finishing ARV treatment-Yao. Some songs encourage people in the community to take care of the sick including those living with HIV and AIDS. Family care (25): This is the home based care provided by the family. This include taking unlimited care that shows love the patient such as bathing him or her or washing his/ her clothes, providing food to the patient. This also includes the psychosocial cure in terms of chatting with the patient and focusing on the positive things. Tumbuka Ngoni, Lhomwe, Ngoni, Chewa, Sena and Mang’anja Community moral and material support (13): This is the material and psycho social support the community gives to the patient. It has been found that the sense of togetherness to look after the sick relieves the patient worries hence prolonging one’s life - suburban cultures (3), Yao, Tumbuka(3), Tumbuka Ngoni (5). The community moral support is traditionally known among the communities and this helps in the treatment of HIV and AIDS Abstinence (5): Some people in the Yao, Tumbuka, none and the suburban still hold that abstinence is part of the treatment. They strongly believe that the HIV and AIDS cannot be treated PLWHA still do not refrain from casual sex Belief supporting the sick (3): The Yao are always supportive to those who are sick and there are no records during my chieftaincy about any tradition that is negative towards the caring and supporting for the sick. Yao (2), Tumbuka Ngoni. Support Groups (2): It has been found that referring PLHIV to support groups is helps to reduce stress among the PLWHA. Such groups promote positive living; advise each other on good nutrition and on behavior and actions to be avoided. Food security and Agricultural Practices (2): Several indigenous agricultural practices were identified as having potential to reduce under-nutrition and improve household food security. Moyo and Moyo (2013) reported how farmers in northern Malawi established “soil fertility by utilizing several indicators (Brachystegia species, soil color, soil feel and touch and other vegetation types.” The presence of Brachystegia (kaufiti) in a section of a garden is interpreted as evidence of soil fertility whole deep dark soil is evidence of high fertility. These attributes have potential to influence food security. Moyo and Moyo (2013) reports a change towards technologically-driven agriculture where hybrid maize farmers in the country are advised plants one seed, closely spaced at 30 centimeters apart and one crop per area of garden. The hybrid seeds are preferable for their early maturity and high yield but do poorly in resisting weevils. Contrast this to indigenous maize farming where local maize varieties were planted 90 cm apart allowing for intercropping (and diversification) and possibility of giving a chance to traditional edible 51
vegetables (e.g. bonongwe, chisoso, denje, limanda). Further, local maize varieties we reported to have better taste when eaten fresh (boiled or roasted) compared to hybrid varieties. Further the pith (stem) of local varieties without a healthy cob could be eaten as a snack; which could not be done for the hybrid varieties. Safety of drinking Water (2): Unsafe water is an important determinant contributing to the health of the general population but much more so among individuals infected with HIV. Unsafe water contributes to (chronic) diarrhea, one of the clinical features for AIDS definition. Some communities use Moringa seeds’ powder for flocculation of water. Moringa flocculants have been reported to remove up to 99 percent of bacteria within an hour of use. The University of Leicester has implemented a project using Moringa seed kernels to purify water in c community water-treatment in the country. From our study, it was not clear as to whether the practice of using Moringa seeds to treat water was local to Malawi or was introduced by Leicester University. Apart from using Moringa leaves to improve drinking water safety, Malawian women use different types of tree leaves to cover water when collected from wells and streams or rivers. Only specific types of tree leaves such as tsamba, tsanya and other (non poisonous leaves) are used. The leaves aid flocculation, prevent spillage as buckets or clay pots are balanced on the head. The upper side of the leaves also trap dust on the journey from the water source to home. (C)
CHALLENGES TO IK FOR HIV TREATMENT
Scarcity and cost of local herbs (45): Some of the trees are scarce or no longer existing. This has been reported in the all the cultures. It was revealed in the suburban that some local herbs such as aloe vera are expensive. Religious beliefs and traditions (43): It was found among the Sena, Ngoni, Mang'anja, Lhomwe (2), Chewa (2) Tonga and Chitipa cultures (4) that some churches such as the Fountain do preach that people should not go to hospitals. Most religious beliefs discourage its followers from local medicine as it is associated with witchcraft. It was reported among the Mang’anja of the religious belief that spirits will cure diseases as such some patients don’t take medical treatment. Some born again churches and prophets tell people to stop taking ARVs and or use of condoms example was cited of the ZCC churches - Tumbuka (11), Tumbuka Ngoni (12), Tonga, sub-urban. There are some born again Christians who are advised to stop taking medication but just trust in God and their religious (5) Belief in modern medicine (33): With the advent of ART, people no longer believe in local herbs for treating the AIDS- Mang’anja (14), Yao (6), Tumbuka, Tumbuka Ngoni. “People these days go to the hospitals because they are told in churches and seminars by the NGOs and government departments that those IK are old fashioned”- Tumbuka, Tumbuka Ngoni (7).Tonga, cultures of Chitipa, Sub-urban cultures. Stigmatization and Denial (35): It was reported that PLWHA groups are perceived negatively as groups of sick people who behaved carelessly to contract the HIV. As such, people do not want to join the groups where they could be treated effectively. The people are also discriminated against on a number of social and community privileges. (Sena, Yao (2), Chewa, Tumbuka (4), Tumbuka Ngoni (5), Tonga (4), cultures of Chitipa (4). It has been reported that there is still continued denial and typecasting when one is reported to have HIV and that youngsters are afraid to disclose their status and hence cannot get HIV treatment. Some end up committing suicide -Tumbuka (3) Ngoni, Lhomwe Traditional beliefs (18): There is strong traditional belief in Chitipa that AIDS is a curse and can therefore not be healed- Chitipa (18). There is strong belief that nothing traditional or local can treat HIV/AIDS. “We know that other people plant some trees but were told on radios and meetings that nothing cure HIV/AIDS” 52
- Tumbuka (3), Ngoni, Chewa, Tonga. There Is is strong belief in one medicine (4) in the communities that such one cannot take any other including the ARVs - Ngoni, Chewa, Tumbuka, Tumbuka Ngoni. No expiry date, expensive, overdose, side effects (36): It has been revealed that knowing the expiry date of the herbs discourage the “educated and civilized people” from taking the herbs. Most believe the herbs are expensive (5). Zitsamba zilibe muyeso weniweni ndipo overdose imaika patient pa chiopsezo (Herbs do not have exact prescription in terms of quality and this can harm the patient - Chitipa (17) suburban. Some people had observed that there is no limit to the intake of the herb and that the medicine given by the traditional doctors can sometimes have bad effects including killing the patient (14). Local food is regarded as old fashioned (12): Natural or locally prepared foods are regarded as old fashioned. Many people believe that it is a measure of being civilized when they prepare relish with cooking oil, mixed with various spices – Tumbuka (5), Lhomwe, Ngoni Alcohol consumption (26): Too much beer drinking that interferes with treatment of HIV and AIDSLhomwe (5), Yao (2) Chitipa cultures (11), Ngoni (8), Tumbuka (6), Suburban cultures. Religious teachings (17): Some religions promote that one can get healed of HIV even without treatment and they bring with them people who bear testimony in the fellowships- Mang’anja, Ngoni (6) and Tumbuka (2). Some Christian leaders have been reported to decry the use of traditional medicine as evil- Tumbuka Ngoni (5), Tonga, suburban cultures (2) No room for ARVs (12): It was reported that some people are strongly rooted in the herbs that they create no room for modern medicine including the ARVs. This was observed by the Sena, Ngoni (5) and the Chewa (6). Ineffectiveness of some herbs (11): Most herbs have evidence of being less effective after people had praised them. Mchape of the chisupe fame was cited as one of the examples. Cheating and Lack of trust (10): Most herbalists renowned for hoaxing and cheating people. This challenges credibility people used to hold for traditional healers. It has in fact been reported that most traditional healers lie that some medicine heals HIV (7). Some do not even accept it when their medicine has failed. “The other problem is that when these people know one type of medication and it really works they start cheating people that they know a lot of medication”._ Tumbuka (3), Tumbuka Ngoni, Tonga, Integrated cultures of Chitipa, Sub-urban cultures, In Rumphi, and the suburban, people have indicate their loss of trust in the tradition healers because of circular humanism campaign which refuse existence of witchcraft including discrediting the traditional healers. Negligence to take medication (14): Hiding and throwing away medicine has been reported in the Yao and Tumbuka and the Tumbuka Ngoni. Defaulter rate is high among the businesses people who often forget to take the ARVs medicine when going out of their homes to different markets to sell farm produce -Ngoni, Chewa. Not taking medicine according to instructions from traditional or medical doctors has been reported in the Tonga (4), and Chitipa cultures (5). Sometimes a patient chooses to ignore instructions on how to take the medicine. For example, most patients smoke or take alcoholic drinks while taking medicine despite advice from doctors or healers. People usually go to the traditional doctor after they have failed to get satisfactory help from the hospital. It is usually too late to be assisted –Tonga (4) Excessive alcohol consumption (14): Heavy alcohol consumption makes people forget time to take treatment (Mang’anja, cultures of Chitipa (10), suburban cultures (3) Unpleasant taste of the herbs (11): Most of the herbs have an unpleasant taste -Lhomwe (4), Ngoni (5), Chewa, Tonga. 53
Lack of faith in prayers (11): It has been reported that prayers need faith which is a difficult thing to have for people living with the virus -Yao (3), Ngoni, Chewa (4), Tumbuka Ngoni, Tonga (2). Long distance (10): to the herbalists or health facility where the patient can access the herbs or ART. Sena, Yao (2), Chitipa (4), suburban (3) Hiding HIV and ART status (9): Some unmarried women and men do not open up on their HIV status. Other people who are advised to start taking the ARVs delay taking the medicine saying they want to get married first- Ngoni (2). There is lack of disclosure of HIV status amongst couples in fear of divorce Tumbuka Ngoni (3), cultures of Chitipa (2). No cure, AIDS is a Curse: (8): “AIDS is a curse and cannot be healed, Integrated cultures of Chitipa (4). In other areas, People living with HIV refuse to take in medicine because they believe AIDS is a curse and one cannot be healed, - Chitipa (4). Continued prostitution (8): It has been reported by all the cultures that sleeping around when in actual sense you know that you are HIV positive or has HIV/AIDS is very rampart (8). The Chitipa cultures, supported by the by the Tonga report about girls who flock to the jetty or lake on the days when the ship docks to meet different men. The Yao have expressed concern about continued infidelity even among those on ART. Lack of balanced food (7): Lack of food to balance the diet even locally -Yao, Ngoni (4), Lhomwe, Ngoni, Lack of scientific medical research (6): Most district AIDS coordinating committees who participated in this research reported that lack of research on the local medicine does not give confidence Patient’s behavior and attitude (6): It has been reported that some PLWHA say bad words to the care takers e.g. describing the care taker as a witch. Some patients are selective on food (5) Decline in belief and trust (6): According to the Tumbuka and Ngoni, there is a general decline of belief in local medicine. Ignorance (4): Some patients overdose themselves to fasten the treatment only to find out that they are doing harm to themselves - Yao and Tumbuka (3) Lack of training for traditional healers (TH) and traditional birth attendants (TBAs) (4): Azamba are not trained on how best they can incorporate the IK in the advent of the ART and PMTCT services, yet women go to delivery secretly at TBAs clinic - Chitipa (2). Similarly most TH, though they have an association, do not get training to update their knowledge on the herbs. HIV patients hibernate (4): Apart from not being free to talk about AIDS especially those that are affected, it has been reported in the suburban that some patients withdraw from community and lock themselves in their rooms. Labor migration (4): Most men go to RSA for job and adhering to treatment becomes a challenge for both men and women as people do not disclose about the status -Tumbuka, Tumbuka Ngoni (3) Lack of resources (3): Due to the financial constraint, there is lack of proper food and resources to help provide good support and nutrition to supplement treatment endeavor- Chewa (2), Tumbuka Ngoni
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Most Polygamous families do not access HTC (3): It has been reported that some polygamous families in Tumbuka and Ngoni do not access HTC due to fear of stigma and hence to do no access treatment. Bad attitude by health workers (2): Some health workers have negative attitude towards patients and they also lack of comprehensive knowledge on HIV treatment. (Sena, Tonga) Government does not involve traditional healers (2): The government does not involve asing’anga in HIV/AIDS programs. Some time back donors for HIV/AIDS programs involved them but were later left out. Now the traditional healers lack the right information because they are not involved. -Tumbuka. suburban cultures, Traditional hearers sleep with patients (2): Some traditional healers take advantage of their patients and have unprotected sex with them so that local medicine can work -Tumbuka Ngoni. Use of same piercing instruments: Some traditional leaders use one needle or razor blade to prick patients. When the patients bleeds, they are told that they have been healed - Tumbuka Ngoni Poor care and support (2): There is notably a decline on the use IK to enhance care and support at the community level such as psychosocial support - visiting the PLWHA and the affected to provide the and psycho-social therapy or taking the patient to a health facility. Lack of mobilization: In has been noted that there is lack of promoters or mobilizers on adherence to ART, traditional medicine and good nutrition in the communities. Tumbuka Ngoni. Laziness to collect medication from the health facility or to consult traditional healers especially when they feel they look healthy (Sena) ARVs are used for brewing: People use ARV’s for brewing local beer, reported in the Tumbuka and Lhomwe People mix herbs and modern drugs: Some want rapid results and take herbs and medical help at the same time resulting in not knowing what is workable. Sometimes they suffer the side effects -Tonga. Lack of resources such as money to buy the herbs or consul the local healers has been reported by most cultures. Lack of empowerment among women: The Mangochi Napham Operations Manager in revealed that there is belief among the Yao that only men are given an upper hand in decision making. It is a man who decides whether a couple should go for an HIV testing, take or not the HIV treatment. Some CBOs have been reported to be selective when it comes to helping patients – Chitipa Sexual activity: It is alleged that among the Yao men are said to be sexually active; even when they are on ART or traditional treatment for STI. This hinders them from geeting better Late reporting of diseases: Late reporting of diseases to herbalist or medical people Sena and Mang’anja. Unprofessional ways of circumcising people: Unprofessional way of circumcising people lead to poor treatment of the circumcision.
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(D) COMMUNICATING IK FOR HIV TREATMENT (i) Appropriate Communication Approaches Results show that interactive interpersonal face to face communication is the most preferred approach for communicating treatment. (ii) Key Holders of IK for HIV treatment Figure 4 below gives details of the key holders of IK for HIV treatment as follows
Ke y holders of IK for HIV Treatment 105
Support groups & PLWHA
14
Youth groups
89
Parents & guardians
110
Traditional healers & herbalists
14
Traditional music performers
60
Key holders
Religious leaders
70
Training institutions, professionals
10
Political leaders
36
Health & devpt committees
13
Traditional music performers
100
Vge elders, counsellors,custodians
60
Educational dept and prof essionals
50
Trained health drama & arts groups
78
NGOs, CBOs, depts
100
Health w orkers & their Orgs
98
Traditional & local leaders
0
20
40
60
80
100
120
No of Respondents
Figure 4: Key holders of IK for HIV Treatment
Traditional healers and herbalists are considered (by 110 of the 146 respondents) as the main holders of IK for HIV treatment. These are followed by PLWHA and support groups (105), Health workers and their organizations (100); Elders and cultural custodians (100); Local and traditional leaders (98); Parents and guardians (89); NGO and CBO and relevant departments (78); Training institutions and researchers such as Universities (70); Religious leaders especially those that have healing powers. (iii) Key Players or Communicators of IK for HIV Treatment From figure 5 below the highest number of people (77) consider Parents and guardian followed by PLWHA, Support groups and CBVs (70), main key players in communicating IK for treatment. Other significant players in order of most appropriate include Traditional Healer, TBAs and herbalists (65), Health workers, (63); Elders, counselors and cultural custodians (63), Chiefs and community leaders (50); trained health drama /artists (40), Community development facilitators (36); Teachers and trainers (33) and Religious preachers/ leaders.
56
Key Communicators of IK for HIV Treatment PLWHA, support groups, CBVs
70
Youth leaders, peer educators
12
Parents and guardians
77
TH, Herbalists and TBA's
65
Dancers, s ingers com pos ers
9
Key P layers
Preachers ,pastors ,priests, prophets
29
Teachers , trainers , facilitators
9
MPs , councillors , govt officials
15
Health com , DACC, ADC, VDC
10
Dancers, s ingers com pos ers
12
Elders, counsellors , cus todians
63
Teachers , trainers , facilitators
33
Trained health artis ts and dram atis ts
40
Com m unity devpt facilitators, CBVs
36
Health workers, s taff & promoters
63
Chiefs , & com m unity leaders
50 0
10
20
30
40
50
60
No. of Respondents
Figure 5: Key Communicators of IK for HIV Treatment
(iv)
Appropriate Media and Channels for communicating IK for HIV Treatment
57
70
80
90
` M edia and Channels for Communicating IK for HIV Tre atment
59
Public Rallies and Open days
20
Sports , gam es, promos
68
Funerals
24
Night & m orning announcem ents
59
IEC m aterials & com munity m edia
28
Media and Channels
Churches
70
Ps ychosocial support: Vis iting the sick
20
Seminars
30
Initiation rites
66
Dram a & Art (story telling,fiction,poety)
68
Visits & HBC
70
FGDs & m eetings in vge /com m unity
60
Talks, speeches and lectures
80
Door to door - hous ehold education
50
Initiation rites
89
One to one counselling & education 0
10
20
30
40
50
60
70
80
90
100
No. of Respondents
Figure 6: Media and Channels for Communicating IK for HIV Treatment
From Figure 6 above, the highest number of respondents (89 of the 146) has identified One to counselling and education as the most appropriate channel for communicating HIV treatment. This is seconded by has been considered as the most shows in order of One to one counselling and education (89), Door to door household education (80); FGDs meetings in the community & Psycho social support visits to patients (70 respectively); Home based care (68), Funeral events (68); (Drama and Arts (66); Public talks and speeches (60); Public rallies, IEC materials and Community mass media (59). Summary of IK and Effective IK Communication for HIV Treatment Herbs have been identified by the majority of respondents (121 of 146) to be the best IK for HIV treatment at AIDS particularly booting the immune system. This is followed by traditional nutritional diet (68), prayers (37), Encouraging hospital medication (16) Traditional spiritual and exorcisms therapeutic dances (13): Family care (25): Community moral and material support (13): Support Groups (2) Secondary prevention abstinence (5), Isolating patients suffering from TB (4): Food security and Agricultural Practices (2): and Safety of drinking Water (2) IK for HIV treatment is challenged by Scarcity and cost of local herbs (45), Religious beliefs and traditions (43), Belief in modern medicine (33), Stigmatization and Denial (35): Traditional beliefs (18): No expiry date, expensive, overdose, side effects (36), Local food is regarded as old fashioned (12), Alcohol consumption 58
(26): Religious teachings (17): Negligence to take medication (14), Excessive alcohol consumption (14): Unpleasant taste of the herbs (11): Lack of faith in prayers (11): Long distance (10): Hiding HIV and ART status (9): AIDS has no cure belief, Continued prostitution (8), Lack of balanced food (7): Lack of scientific medical research (6): Patient’s behavior and attitude (6): Lack of training for traditional healers (TH) and traditional birth attendants (TBAs) HIV patients hibernate (4): Labor migration (4): Lack of resources (3) Most Polygamous families do not access HTC (3): Bad attitude by health workers (2): Government does not involve traditional healers (2): Traditional hearers sleep with patients. Use of same piercing instruments: ARVs are used for brewing: People mix herbs and modern drugs: Late reporting of diseases: Unprofessional ways of circumcising people: On key holders, Traditional healers and herbalists are considered (by 110 of the respondents) as the main holders of IK for HIV treatment. These are followed by PLWHA and support groups (105), Health workers and their organizations (100); Elders and cultural custodians (100); Local and traditional leaders (98); Parents and guardians (89); NGO and CBO and relevant departments (78); Training institutions and researchers such as Universities (70); Religious leaders especially those that have healing powers. The most appropriate key players of communicating IK for HIV treatment are Parents and guardian (77) followed by PLWHA, support groups and CBVs (70); Other significant players include Traditional Healers, TBAs and herbalists (65), Health workers, (63); Elders, counselors and cultural custodians (63), Chiefs and community leaders (50); Trained health drama /artists (40), Community development facilitators (36); Teachers and trainers (33) and Religious preachers/ leaders. One to counselling and education has been identified (89 of the 146) as the most appropriate channel for communicating HIV treatment. This is followed by One to one counselling and education (89), Door to door household education (80); FGDs meetings in the community & Psycho social support visits to patients (70 respectively); Home based care (68), Funeral events (68); (Drama and Arts (66); Public talks and speeches (60); Public rallies, IEC materials and Community mass media (59).
2.1.5 IK FOR CARE AND SUPPORT This section reports on the negative and positive IK for care and support and the challenges faced in implementing the IK for good care and support of the people living with and affected by the HIV and AIDS
(A)
NEGATIVE IK FOR HIV CARE AND SUPPORT
The following are some negative IK for HIV Care and Support Polygyny: Some men who marry more than one wife hence are not able to take care of all the wives in terms of providing the basic needs such as proper nutrition, housing and beddings that facilitate good care and support for people living with HIV –Ngoni, Chewa HIV patients are regarded as sinners: AIDS patients are perceived as total sinners. This is because HIV is associated with punishment from God on those who commit “adultery” acts. As such some people are shy to 59
go for HTC, or disclose their status a situation that makes them not get the required treatment, care and support –Chewa, Tumbuka, Chitipa cultures. . Religious readers stop patients from taking medication (4): Some religions do not allow patients to take medicine or sleep under mosquito nets. Tonga, Integrated cultures of Chitipa (3) People mix ARV with drugs (1): Some people are mixing ARVs with Indian hemp for addiction. Tumbuka Ngoni (B)
POSITIVE IK FOR CARE AND SUPPORT
The following IK has been found to promote care and support of the people living with HIV and AIDS. Community care (90): Communalistic life is a common long time tradition of most African societies. This includes doing things together including taking care of the patients. The study shows that taking care of the patient is an inherent duty and responsibility of the community. This can be done in several ways as organised by the village of community Taking the patient to the health facility - Sena, Mang’anja. The “There is love and harmony in our communities. When an individual is sick, we take the person to the hospital. Sick people are taken to the hospitals as well as traditional medicine practitioners” – Yao. The same kind of care is reported by the Tumbuka, none, Chetopa cultural groups. As social and community cohesion is said to be strong and popular among the Yao, it has been reported that a sick or vulnerable person among the Yao are perceived to be someone in need of community assistance through the provision of physical, mental, material as well as financial support. This is also augmented by their common religion, Islam which emphasises on giving alms and support to the vulnerable. The Lhomwe culture encourages people to take care of the sick and the elderly. “The belief is that if one pays no attention to vulnerable people in the society, he or she becomes cursed. He or she is going to give birth to an abnormal child or any curse which can bring death or a variety of bad lack to the family of the person who has done it”. (14)- Lhomwe. In the past the village head would organize community actions such asking all the people to work together. During weeding time for example, the whole village would work in one family’s gardens and rotate until all the gardens and cleared of the weed. The same applied to construction of a house, sharing food, supporting each other during funeral and of course caring for the sick. It was reported by a Lhomwe custodian that a village head person would produce a duty roster for people to look after the sick and this included bringing water, sweeping, washing clothes, bringing food or cooking. It was reported that the spirit of sharing and working together has declined tremendously after families started educating their children who after getting a job would start helping the family and make it independent by sending them money for preparing the garden, clothes and other basic needs the family would not share to everyone in the village. It was reported that the Ngoni people are strongly united (5). They live as one group. “We care for each other as one family”– reported by a TA in Ngoni’s unity can be traced from their history strong sense of oneness though they are dispersed after breaking away from Chaka Zulu in South Africa in the 19th century. Ngoni people believe in unity and caring for each other as one family. “We live close together as one family and when one is sick others are supposed to bring food for the sick at hospital or at home. We also share what we have with others who do not have. We share farm produce, animals like chickens or even goats. We care for the sick together”. It was learnt that within a Ngoni village there exist sub groups headed by Mkulu wa Banja who looks after the welfare of all families under him such that chiefs work in the villages through these Akulu a Banja. Within the sub groups, they take care of each other such as bringing together food to a sick person which helps those taking ARVs so that they do not sleep on an empty stomach. “ 60
The tombola and the Tumbuka Ngoni also highly uphold the communal life. “We help each other as a community, when one is sick; s/he is visited by everyone and with food or money” (6). In the tombola culture people maintain that when a person is it is not the responsibility for one person, but of everyone around so the whole community helps in care and support. Providing community home based care to chronically ill patients- Tumbuka Ngoni and Yao. As a community patients take courage in all the encouragements from their friends and this includes being HIV+ is not the end of it all- Yao., The patient is looked after by the whole community and not only the family- Tumbuka Ngoni. It was reported that the village support groups in Bolero provide better community support than the home based care. As a community the Tumbuka Ngoni provide communal work such as garden cultivation starting with one household until all the gardens are finished just like the Lhomwes; communal eating embracing those PLWHA where different food is provided and communal beer brewing and drinking. The communal eating helps patients to have sense of belonging and associating with others brings the psycho social therapy to the patients. In the Chitipa communities the care and support includes counselling and taking the patient health facilities and the CBO help families care for sick members by visiting the patients and provide some basic needs Among the Chewa, village groups such as women and youths provide psycho-social support to the sick. Volunteers within help in molding bricks for those that cannot afford to do by themselves. PLWHA are included in responsibilities of the community and incorporated in the community activities. In the sub urban care and support is provided by forming CBO and clubs (youth, women that can provide the care and support in the particular community, the CBO training households on care, support and counselling, providing clothing, money and other basic needs from well wishers, providing guardian to those who do not have, interacting with the sick to give social support. The women and youth organization also help around by visiting households that have HIV patients. In the suburban community, it was suggested that the community leader can facilitate and lead in establishment of the well supported clubs and organizations for care and support. The leaders can also be exemplary by initiating the care and support Social support (82): The PLWHA can be encouraged in a number of areas. Chatting socializing and cheering with them, bringing as testimonies or giving examples of people within the community who were diagnosed with HIV/AIDS before and are still living a healthy and happy life; encouraging them to walk or keep fit. Walk with him/her to the hospital if he can manage- Tonga. Praying with patients, taken to hospital, eating the food. This has been supported by all the cultural respondents for this study Proper and balanced food: (59): There is locally available food that make balanced diet which can be given to the AIDS patients. This includes local proteins, vegetables, porridge, thobwa, fruits, as advised by the community health workers or doctors. Home based care (26): Introduction of HBC- suburban cultures, The existence of HBCs has been adopted as part of the Lhomwe culture of late- Lhomwe, Frequent visits to houses nursing the sick- Mang’anja, Home based care providing psychological/moral support to the sick through the meetings organized together with them.- Chewa, Culture of extended families allowing every member of the family in taking a role by caring for the sick. For example, cooking, washing clothes, words of hope etc- Tumbuka. We still have home based care programs and they are working well- Tumbuka. Some people were assigned and committed to look after the patient without having sex in their homes- Tumbuka Ngoni. Taking the patient to health faculty, contributing money for the care, and interacting positively with the patient Encouraging good hygiene (23): Washing bedding and clothing and ensuring that they are clean all the time. Cleaning the patient environment -Tumbuka Ngoni, bathing, clean toilet to prevent new infections- To 61
Curbing discrimination and stigma (20): Eating together with the sick without any stigma-Yao, Discrimination and stigma is not encouraged among the Yao communities -Yao. Do not stigmatize and discrimination- Tumbuka Ngoni, Mphala – Meeting together without stigma with PLHIV at mphala where the communities discuss issues that affect them and eating together; Teaching young ones good cultural values. Do not discriminate him (13)- Tonga. Do not discriminate PLWHA (4) - cultures of Chitipa Spiritual support –Prayer (19): Prayers when one is sick- Mang’anja, Including the patients in prayersChewa, Praying for them (12) - cultures of Chitipa. Pray for him and encourage him as well. - Tonga., Praying for them. - Cultures of Chitipa. Pray with them to reduce their psychological issues- Tumbuka Ngoni. Cultural or Ethnic Groups Care and Support (17): People belonging to the same ethnic groups such as being Ngoni, tombola, Lhomwe, Sena can take to group themselves to provide unbiased care and support. This is encouraged on ground that people from the same ethnic background always have affinity to support each other e.g. in weddings, funerals. This can be encouraged in communities of mixed cultures such as suburban where the feeling of coming from the same area, culture enhances care and support. This also strengthen ties as people practice their IK in terms of values some of which cannot be taken away from people but can only be encouraged. Ngoni people live and eat m’malimana (groups) within their respective villages headed by Mkulu wa Limana also known as Mkulu wa Banja, Taking care of one another at Limana level, (limana or groups 9)- Ngoni. Another cultural group by the Ngoni is Lijaja. In those days they had a place in the village where all men were converging at one designated place for lunch and supper. Women would bring food to the Lijaja where men were seated together making hoes, baskets and mphasa. (Lijaja 6)- Ngoni For the Tumbukas Isangweni- isangweni is the practice where people were having their meals together, and for children, it was called ntcheni- Tumbuka. The Tumbukas also had a place where People were eating in one place which ensured that everyone had food to eat. They called it “kulya pa mphara”- Tumbuka The existence of Mbumba: There exists a Mbumba belief amongst the Lhomwe’s. This is a believe or a practice where by people from the same lineage live close to each other with the hope of helping each otherLhomwe. The existence of Mbumba: Amongst the Lhomwe’s people from the same blood lineage are considered to be Mbumba. This social unit is headed by a person who most of the times is a man whom the people have trusted to lead them. Mbumba therefore, bears the responsibility of taking care of any family member who is going through difficult times. Encouraging support and dependency from relatives (8): Relatives to be encouraged to be trusted by members of blood relations. In Tumbuka culture, people grow up trusting that relatives have to care for each other and there is always support for each other when one is ill. They usually go to see that person with giftsOrphans are always taken over by relatives and even when a person is bed ridden his or her children are cared for by relatives. Having extended families is a norm in the tombola culture. In the Suburban Cultures, Extended family tradition focuses on caring for everyone in the family Herbalists Care and Support (7): Herbalists support and care for the infected patients through the provision of shelter- Yao, Having a traditional healer in the villages also helps to get some help right in the village. - Tumbuka. Taking patients to traditional healer.- Tumbuka Ngoni(2), Washing patients clothes using munkwere (natural soap)- Tumbuka Ngoni, Use of local medicine- Tumbuka Ngoni, also trying to give the patient some herbs. – Tonga. The patient can also be given both herbs and medicine from the hospital - Tonga Farming and Business (6): Ngoni people are hard working in farming hence they do have staple food, fruits and vegetables. They also rear animals like hares, chickens, goats and cattle (6) - Ngoni
62
Administering medication (6): Encouraging the patients to have their medicine timely – Yao. Guardians also have to be following up prescriptions of patient given e.g. by witch doctor/herbalist- Chewa. The guardians have to ensure that the patient is taking his/her medicine at the right time (2). - Tonga. Patients also need to be reminded on their dates to go receive medication- The Sub-Urban Cultures. There is a need of watching patients while taking medication- The Sub-Urban Cultures Role Specification at Family and Mbumba level: (4): Role specification: Among the Lowe’s there is a concept of role specification in families and even at a mbumba level. This role specification entails that there already exist people who are responsible to take care of the sick or any other person who is going through tough times- Lhomwe. A woman is a custodian of most of the traditions hence she is better placed to give counsel to the husband about her condition- Yao. Women are on the forefront taking care of the sick as stipulated by the Ngoni culture- Ngoni Sexual Isolation (3): Total abstinence (tandulani mphasa) from sex in all communities when they had serious sicknesses like TB until treatment is over.- Tumbuka Ngoni Empowering PLWHA and Care takers Employing those who are infected by training them on good diet, information about diseases and how to control them, sharing experiences, exercises. This can be done by the NGOs, CBOs CBVs and health workers, support groups and clubs Traditional dance (1): Traditional dances e.g. Namtongwe are performed when one is sick as a way of entertaining the sick but it is also believed to be a prayer to gods to heal the sick individual.- Lhomwe
(C)
CHALLENGES TO IK FOR CARE AND SUPPORT
Discrimination (103): It has been reported that if you are visited by a home based care people, it means you are HIV positive and this increase stigmatization - Sena, Mang’anja, Lhomwe(6), Yao(4) Chewa (9), Tumbuka(4), Tumbuka Ngoni (13),Tonga(6). It has been reported that PLWHA still get discriminatory remarks when receiving coupons and at drinking joints. Ngoni (6), Chitipa(27), suburban. People do not want to eat with the sick - Sena, Yao (2), Ngoni, Chewa (2), Tumbuka(2), Tonga, Tumbuka Ngoni (6), and Chitipa cultures (3). The use of gloves makes patients fell discriminated -Suburban (2). HIV patients are regarded as useless people in society Chewa (3), and mostly their views are not heard in decision making - Chewa. Modernization (31): Modernization which has brought individualism as people now eat with their immediate family members at a table in their respective houses. People no longer care about what other family members of friends will eat whether they have food or not (urbanization) Ngoni(7),Tumbuka(8), Tumbuka Ngoni(12). Many youths amongst Lhomwe culture no longer believe in local knowledge. Lhomwe (3), Yao. Excessive beer drinking (16): Some care givers prioritise beer hence failing to the give patients the support they need Lhomwe (3) Yao, Ngoni (11), Chitipa cultures. Business days (14): People go to markets and bus depots to sell farm produce leaving behind a sick person with nobody to look after him or her –Ngoni (7) Tumbuka. Sometimes taking care of the patients is seasonal because as farmers, people concentrate working in the gardens during rainy seasons (5) Lack of HBC equipment and resources (28) such as food, basic needs makes it difficult to buy to take good care of the sick and the PLWHA – Sena, Mang’anga, Chitipa (6) (3) Tonga(2), Chitipa(7), Sub- urban culture(6), Poor support and care: Guardians (16): become frustrated when the sick are not following orders from doctors on their prescribed medicine. Yao (7), Tumbuka Ngoni, Tonga (2), Cultures of Chitipa (2), Sub-auburn culture (4), 63
Inadequate knowledge on caring for the PLWHA (14): In has been noted that most of the support groups have limited knowledge about care and support. They need to proper trainings – Tumbuka, Yao, Tonga (2), Tumbuka Ngoni, suburban cultures. Poor diet for patients (11): Lack of proper food is another major challenge.Yao(3), Tonga,. Inadequate food in the communities to provide to patients (PLHIV) Tumbuka Ngoni (7), Individualism (5): There is growing spirit of individualism in the communities as a result of copying the life of the “educated” or westernized. Consequently, there is a belief that everyone has his or her own problems including and needs – Sena, Yao, and Tumbuka (3). The death of communal life is mainly caused by business or work which makes one unable to partake in the HBC and psycho social support. - Chewa(2), Tumbuka(2),Tumbuka Ngoni. Reluctance to take patient to health facility (6): It is not priority for relatives to take a sick person to the health facility but to leave it to the spouse or the parents. Relatives intervene at the critical or terminal stage Lhomwe (3), Yao (2), Sena and Tumbuka Ngoni. It has been alleged that in some polygamous families spouses the sick pushing the responsibility to the other spouse –Lhomwe (2), Yao (4) Death of traditional dances; (9): There are less people these days that can perform some dances like Namtongwe, Lhomwe(4),and Yao (3) Tumbuka Ngoni (2). Lack of volunteerism spirit (2): People do not want to do voluntary work because the NGOs used to give them something else - Sena, Chewa, Scarcity of local medicine (6) that helps in prolonging one’s life after being found HIV positive – Chitipa Poor food preparation (4): Some meals are not well prepared and sometimes wrongly cooked. This makes the patient not to eat such type of meals – Chitipa Poor Communication (4): There is poor communication between support groups and PLWHA on how best to care for the PLWHA - Chitipa Hibernation (7): Most HIV patients do not take part in community development activities because they are not encouraged to do so by the community and because of stigma Poverty (16): Poverty is stopping people from taking proper care of the patients and some basic home based care needs are also expensive. Mang’anja, Lhomwe (9), Yao(2),Tumbuka, Tumbuka Ngoni, Sub-urban culture(2). Lack of disclosure of status: As a result people do not provide the support. Mang’anja, Ngoni, Tumbuka Ngoni (2). Denial (2): Guardians and patients alike are living in denial instead of accepting that their loved ones are suffering from the disease. Yao, Integrated cultures of Chitipa, Religious beliefs and readers (6): Religious beliefs have taken over and litiwo is no longer being practiced. Yao, Some church leaders discourage the use of local / traditional medicine Tumbuka Ngoni (5). Traditional hearers cheat patients (4): Herbalists have gone commercial and they are no longer gaining the trust form community members. Yao (2), Tumbuka Ngoni(2). 64
Beer drinking (5): Beer - Failing to take care of family members as elderly people in the family go for beer every afternoon when they are back from farms and they come back at night. Failing to take good care of those living with HIV. Ngoni, Chitipa cultures 4). Lack of resources (38) which can help me look after the sick effectively. These include good food, soap, proper clothing. Chewa (10), Tumbuka, Tonga(7), inadequate resources, NGOs to provide quality CHBC to the patients. Tumbuka Ngoni (5), kusowa kwa ndalama (mphwayi) zogulira zakudya ndi mankhwala a patients. Integrated culture of Chitipa(16), Sub-urban culture(3), Patient’s bad attitude (26): Some patients do not appreciate the love and care they are given perhaps because of losing hope or lack of training -Chewa(8), Tonga(4), integrated cultures of Chitipa(9), Suburban culture(5). Support groups have limited knowledge (2): Most of the support groups have limited knowledge about care and support, they need to be trained. Tumbuka (2). The sick are left to women (2): Gender equality- so many things are going wrong these days just because women are becoming big headed. They don’t want to listen to men. Tumbuka (2). Government does not involve traditional healers: Government does not want to work hand in hand with herbalists. Tumbuka. Migration(1): We have a lot of tenants here working in tobacco farms and they are bringing strange culture and mixing it with ours. Tumbuka. Traditional medicine is regarded as inferior and is scarce (20): People feel that traditional medicine is old school and primitive. Tumbuka,. Local medicine is not often used nowadays it is scarce Tumbuka Ngoni (20). Youths start engaging in sex at a tender age (4): Many youths start having sex at younger age as 14. Tumbuka Ngoni, Some girls don’t listen to advice, they go on and try to have sex. The fact that they are now grown up gives them reasons for trying it. Tonga, integrated cultures of Chitipa (2). Polygamy (1): Most people in polygamous families do not access HTC due to fear of stigma. Tumbuka Ngoni. Lack of scientific research (1): Most traditional healers do not know the real medicine for particular diseases. Tumbuka Ngoni. Local food is regarded as inferior (3): Natural or local foods like Millet Nsima are dying out due to introduction of other foods. Tumbuka Ngoni(3). Couples have unprotected sex (2): Some couples have unprotected sex before accessing HTC to avoid quarrels that one could have been unfaithful Tumbuka Ngoni (2). Scarcity of herbs: (10) kusowa kwa zitsamba (8), Scarcity of medication - Sub- urban culture(2). Drug overdose (2): Overdose (zitsamba zilibe muyeso weniweni zotsatira kudwaladwala, misala, kuphulika kwa chibelekero (chipapilo) Overdose (zitsamba zilibe muyeso weniweni zotsatira kudwaladwala, misala, kuphulika kwa chibelekero (chipapilo)- cultures of Chitipa (2). 65
CBO members are chased out of villages (4): CBO’s members being chased when counseling the effected and infected -cultures of Chitipa (2), Sub urban culture (2). Dependency syndrome (2): Patients depends a lot on guardians instead of providing for themselves when they get better -Sub- urban culture (2) Long distances to hospitals: Lack of transport. Especially when the hospital is far. For Ambulances, preference is only given to maternity cases. Most of the villages don’t have stretchers or bicycle ambulances these days. Tonga (2), cultures of Chitipa (13). (D)
COMMUNICATING CARE AND SUPPORT FOR PLWHA
(i) Approaches: Participatory or interactive face to face communication has been identified as the most effective in promoting care and support for people living with HIV and AIDS. (ii)
Key holders of IK for Care and Support for PLWHA
Table 5: Key holder of IK for Care and Support KEY HOLDERS
NO. OF RESPONDENTS
Support groups & PLWHA Traditional & local leaders Women groups
101 99 98
Parents & guardians Village elders, counselors,custodians Health workers & their Orgs Health & development committees Training institutions & professionals NGOs, CBOs, government departments Traditional healers & herbalists Religious leaders Political leaders Youth groups Trained drama & arts groups Traditional music performers
98 97 90 89 89 87 80 80 60 49 46 27
The findings which have been detailed from the highest show that PLWHA and support groups are primary key holders of IK for care and support. These are followed by traditional and local leaders (99); women’s groups, Parents and guardians (98 respectively), Village elders, counselors, custodians (97); Health workers & their Orgs90 Health & development committees (89) Training institutions & professionals (89) NGOs, CBOs, government depts87 Traditional healers & herbalists (80), Religious leaders (80); Religious leaders (80)
(iii)
Key Communicators and Players of IK for Care and Support
Table 6: Key Communicators of IK for Effective Care and Support for PLWHA
Key Players / Communicators
No. of Respondents
66
Chiefs & community leaders
58
Health workers, staff & promoters
54
PLWHA, support groups, CBVs
50
Women/girls leaders, counselors
33
Community development facilitators, CBVs
32
Preachers, pastors, priests, prophets
31
Youth leaders, peer educators
30
Teachers, trainers, facilitators
28
Parents and guardians
28
Elders, counselors, custodians
27
MPs, councilors, government officials
21
Health com, DACC, ADC, VDC
18
Trained dramatists, artists
14
Dancers, singers composers
13
TH, TBA, herbalists
12
The table shows that Chiefs & community leaders (58); Health workers, staff & promoters (54); PLWHA, support groups, CBVs (50); Women/girls leaders, counselors(33); Community development facilitators, CBVs (32); Preachers, pastors, priests, prophets (31); Youth leaders, peer educators(30); Teachers, trainers, facilitators; Teachers, trainers, facilitators(28); Parents and guardians (28); Elders, counselors, custodians(27)
(iv)
Appropriate Media and Channels for Communicating Care and support
Table 8 details channels and media that can be used to communicate care and support Table 7: Appropriate Channels and Media for Communicate Care and Support
Media and Channels FGDs & meetings in village /community
No. Respondents 78
Door to door - household education One to one counselling & education
72 71 70 62 60 58 52 45 40 26 15 12
Funerals Support: Psycho-social & materials Talks, lecturing, seminars, workshops, IEC materials & community mass media Night & morning announcements Rallies & open days Drama & Art (storytelling, fiction, poetry) Sports, games, promos Initiation rites Traditional Songs and dances
67
FGDs and meetings in village and community (78); Door to door – household education (72), One to one counselling and education (71), Funeral event (70) are the most appropriate ways of communicating care and support. Other significant means are, Psycho-social and material support (62); Talks seminars and workshops (60); IEC material and community mass media (58); Night & morning announcements (45) calling people to do a certain work in support of people affected and infected by HIV and AIDS. Open days, drama and art can also be used to communicate care and support.
Summary on IK and Communication for Care and Support Significant IK for care and support include community care (90): Social support (82): Proper and balanced food: (59): Encouraging Hygiene (23): Curbing Discrimination and Stigma (20) Spiritual support Prayer (19): Cultural or Ethnic Groups Care and Support (17): Herbalists Care and Support (7): Farming and Business (6): Administering medication (6): Role Specification at Family and Mbumba level: (4) Sexual Isolation (3): Empowering PLWHA and care takers. The IK for care and support is challenged by discrimination, lack of HBC equipment and resources, poor support and care from guardians, inadequate knowledge on caring for the PLWHA, Poor diet for patients, long distances to hospitals, drug overdose, individualism, scarcity of local medicine, reluctance to take patient to health facility, death of therapeutic traditional dances, , poor food preparation, poor communication, lack of disclosure of status:, denial, Religious beliefs, Patient’s bad attitude, Some patients do not appreciate the love and care they are given, Most traditional healers do not know the real medicine for particular diseases, patients over depend on guardians instead of providing for themselves when they get better, too much of the modernized food. Support groups and PLWHA (101) have been identified as most important key holders of IK for care and support. Others are traditional and local leaders (99); women’s groups, Parents and guardians (98 respectively), Village elders, counselors, custodians (97); Health workers & their Orgs90 Health & development committees (89) Training institutions & professionals (89) NGOs, CBOs, government depts87 Traditional healers & herbalists (80), Religious leaders (80); Religious leaders (80).
Key players include, Chiefs & community leaders (58); Health workers, staff & promoters (54); PLWHA, support groups, CBVs (50); Women/girls leaders, counselors(33); Community development facilitators, CBVs (32); Preachers, pastors, priests, prophets (31); Youth leaders, peer educators(30); Teachers, trainers, facilitators; Teachers, trainers, facilitators(28); Parents and guardians (28); Elders, counselors, custodians(27) Focus group discussion(FGDs) and meetings in village and community (78); Door to door – household education (72), One to one counselling and education (71), Funeral event (70) are the most appropriate media and channels of communicating care and support. Other significant means are, Psycho-social and material support (62); Talks seminars and workshops (60); IEC material and community mass media (58); Night & morning announcements (45) calling people to do a certain work in support of people affected and infected by HIV and AIDS. Open days, drama and art can also be used to communicate care and support.
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CHAPTER THREE: CONCLUSIONS AND RECOMMENDATIONS 4.1 OPINION ON THE ROLE OF IK IN HIV PREVENTION The research has found that almost all the respondents, 141 of the 146, respondents; representing 98%, accept that IK can play a role in HIV prevention, treatment, care and support. This includes 65 respondents (52%) and 65 respondents (about 46%) who strongly agree and agree respectively. Only three percent remains neutral or skeptical. This signifies that IK can be employed and help in HIV primary and secondary prevention. 4.2 IK AND COMMUNICATION FOR HIV PREVENTION 4.2.1 Positive IK for HIV prevention The following IK, as put in order of most preferred by respondents , can be used in HIV Prevention: Respect for parents’ and elders’ counsel(73), Abstinence, Discipline and No premarital sex (69; Abstinence and fear of extra-marital sex (56), Initiation rites (50), Respect for husband (44), Enhancing Sexual attraction & Love for husband (34): Religious morality (34); Others include Isolation from sex (28), Parental control over children; Respectable dressing (27); Proper marriage procedures and arrangements (26)and Social activities and Sporting activities (23); Traditional communication between spouses on sexual matters (23); Sex education in private, Lobola (dowerly) (23); Circumcision (23) and Marriage Counselling and Conflict Resolution (23); Educative traditional dances and songs (22); Punishments for premarial and outside marriage sex (21). Value for virginity (20): Norms for those who go to work outside countries(20); Counselling for the Youth (20); Changing bad IK (19); Kuzinga (13); Approved polygyny (12); Roles and responsibilities of children before marriage (12); Traditional groupings(12); Wife Inheritance (10); Sense of togetherness (9), Marriage within the same culture (9); Social distance (9); Work and business (9); Maturity as a measure for marriage (9); Literacy (8); Nthena (7); Responsible drinking (4) among Chewa (6); and Going to hospitals for treatment(7)
4.2.2. Challenges to Implemeting IK for HIV Prevention The following, put in the order from the most serious, are main challenges that need to be considered if Malawi is to implement effectively IK for HIV prevention: Westernization and modernization; Stigmatization of those who want to live by the positive IK; Unfaithfulness in the families; Open sex education through mass and class room media; Sexy modern dressing; Misunderstanding of freedom, democracy and human rights education; Restrictive religious practices; Poverty that increases prostitution; Failure to abstain; Strictness to use modern medicine; Poor parenthood; Inter-cultural remarriages that have dissolved individual traditional practices of good life; Disapproved polygyny; Decline in religious morals and Sexually provocative dances.
4.2.3 Communicating IK for HIV Prevention (A) Appropriate Communication Approaches Participatory interpersonal face to face communication has been identified as the most appropriate approach for communicating IK for HIV Prevention.
(B) Key Holders (Sources) of IK for HIV presention The following, put in th order from most important, have been identified and can be used as key sources of IK for HIV prevention. Traditional and community leaders (112); Parents and guardians (101); Village elders, custodians and counselors comprising initiation rite counselors (angaliba, anankungwi, nkhalakale za mmudzi) (97); Women’s groups (97); Men’s groups (93); Support groups and PLWHA (90); Health workers (80) such as HSAs 69
community nurses probably because of their experience the community life values, traditions, knowledge and practices; NGOs, CBO and other departments (75); Training institutions and professionals (71); Youth groups (61) and lastly, Traditional healers, traditional music performers (59).
(C) Key Players (Communicators) of Ik for HIV Prevention The research has shown that the following, put in order from the most appropriate, ought to be used as key communicators of IK for HIV prevention; Chiefs and community leaders who comprise TA, GVH, VHs (61); PLWHA, support groups and community based volunteers (CBVs) (60); Elders, cultural custodians and counselors (61); Health workers and staff (HSAs, community nurses, health promoters, clinicians, nutritionists); Women’s and men’s leaders and groups; Community development facilitators (59) respectively; Youth leaders and peer educators (55); Traditional birth attendants (TBAs), traditional healers (THs) and herbalists(51); Religious preachers (50). Dramatists and traditional music dancers are considered least appropriate. (C) Appropriate Media and Channels for communicating HIV Prevention One to one education and counselling (101) has been identified as the most appropriate media and channel for communicating IK for HIV prevention. This is followed by Door to door household education (97), Funeral event announcements (96); FGDs and meetings at village and community level (90); Initiation rites(89); Religious institutions(77); Rallies and open days (68); Talks, workshops or seminars (54); Traditional songs and dances (50); Drama, arts and oracles (morning and evening announcements) (41); Sporting and competition activities (40) and IEC and community media materials 4.3
IK AND COMMUNICATION FOR HIV TREATMENT
4.3.1
IK for HIV Treatment
The following put in order of most preferred have been found to be useful in promoting HIV treatment: Herbs that boost the immune system; Traditional nutritional diet; Prayers; Encouraging hospital medication; Traditional spiritual and exorcisms and therapeutic dances; Family care, Community moral and material support; Secondary prevention abstinence; Support groups: Food security and agricultural practices and Safety of drinking water. 4.3.2
Challenges to Implement IK for HIV Treatment
The following challenges need to be resolved if the Ik for HIV treatment is to be implemented effectively. Scarcity and cost of local herbs (45); Religious beliefs and traditions (43); Belief in modern medicine (33), Stigmatization and Denial (35); Traditional beliefs (18); No expiry date, expensive, overdose, side effects (36); Local food is regarded as old fashioned (12); Alcohol consumption (26); Religious teachings (17); Negligence to take medication (14); Excessive alcohol consumption (14); Unpleasant taste of the herbs (11); Lack of faith in prayers (11); Long distance (10); Hiding HIV and ART status (9); AIDS has no cure belief(9) Continued prostitution (8); Lack of balanced food (7); Lack of scientific medical research (6); Patient’s behavior and attitude (6); Lack of training for traditional healers (TH) and traditional birth attendants (TBAs); HIV patients hibernate (4); Labor migration (4); Lack of resources (3); Most Polygamous families do not access HTC (3):; Bad attitude by health workers (2); Government does not involve traditional healers (2); Traditional hearers sleep with patients; Use of same piercing instruments; ARVs are used for brewing; People mix herbs and modern drugs; Late reporting of diseases and Unprofessional ways of circumcising people: 4.3.3. Communicating IK for HIV Treatment The following can be used to communicate IK for HIV treatment: 70
(A)
Approaches
Interactive interpersonal face to face has be recommended as the best in promoting IK for HIV treatment (B) Key holders of IK for HIV Treatment Traditional healers and herbalists are considered (by 110 of the respondents) as the main holders of IK for HIV treatment. These are followed by PLWHA and support groups (105); Health workers and their organizations (100); Elders and cultural custodians (100); Local and traditional leaders (98); Parents and guardians (89); NGOs and CBOs and relevant departments (78); Training institutions and researchers such as Universities (70) and Religious leaders especially those that have healing powers . (C) Key Players of IK for HIV Treatment Parents and guardians (77) followed by PLWHA, support groups and CBVs (70) have been identified and can be used as key communicators of IK for HIV prevention. Other significant players include Traditional Healers, TBAs and herbalists (65); Health workers, (63); Elders, counselors and cultural custodians (63); Chiefs and community leaders (50); Trained health drama and artists (40); Community development facilitators (36); Teachers and trainers (33) and Religious preachers and leaders. (D) Appropriate Media and Channels One to one counselling and education has been identified (by 89 of the 146) as the most appropriate channel for communicating HIV treatment. This is followed by Door to door household education (80); FGDs meetings in the community and Psycho social support visits to patients (70 respectively); Home based care (68); Use of funeral events (68); (Drama and Arts (66); Public talks and speeches (60); Public rallies, IEC materials and Community mass media (59). 4.4
IK AND COMMUNICATION FOR CARE AND SUPPORT
4.4.1 Positive IK for Care and Support The following, put in order of the most important, are the pieces of IK that can be used to promote care and support. This includes Community care (90); Social support (82); Proper and balanced food (59); Encouraging Hygiene (23); Curbing Discrimination and Stigma (20); Prayers and spiritual prayer (19); Cultural or Ethnic Groups, Care and Support (17); Herbalists Care and Support (7); Farming and Business (6); Administering medication (6); Role Specification at Family and Mbumba level (4); Sexual Isolation (3) and Empowering PLWHA and care takers. 4.4.2 Challenges to Communicating IK for HIV Care and Support To effectively implement IK for care and support of PLWHA, the following challenges need to be eliminated. Lack of HBC equipment and resources, Poor support and care from guardians, Inadequate knowledge on caring for the PLWHA, Poor diet for patients, Long distances to hospitals; Drug overdose; individualism, Scarcity of local medicine, Reluctance to take patient to health facility, Death of therapeutic traditional dances, Poor food preparation, Poor communication, Lack of disclosure of status, Denial, Religious beliefs, Patient’s bad attitude, Some patients do not appreciate the love and care they are given, Some traditional healers do not know the real medicine for particular diseases, Patients over depend on guardians instead of providing for themselves when they get better and too much of the modernized food. 4.3.3.
Communicating IK for Care and Support
(A) Approaches Interpersonal face to face communication has been identified as the most appropriate approach for communication care and support.
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(B) Key holders of IK for Care and Support Support groups and PLWHA (101) have been identified by 101 respondents as most important key holders of IK for care and support. Others are Traditional and local leaders (99); Women’s groups; Parents and guardians (98 respectively); Village elders, counselors, custodians (97); Health workers and their organizations. (90); Health and development committees (89); Training institutions and professionals (89); NGOs, CBOs and government departments (87); Traditional healers and herbalists (80) and Religious leaders (80) (C) Key Communicators for Care and Support In order of the most appropriate, the main players for communicating care and support are Chiefs & community leaders (58); Health workers, staff, promoters (54); PLWHA, support groups, CBVs (50); Women leaders and counselors(33); Community development facilitators; CBVs (32); Preachers, pastors, priests and prophets (31); Youth leaders, peer educators(30); Teachers, trainers, facilitators; Teachers, trainers, facilitators(28); Parents and guardians (28); Elders, counselors and custodians(27) (D) Appropriate Media and Channels for Communication Care and Support Focus group discussion(FGDs) and meetings in the village and community (78); Door to door – household education (72), One to one counselling and education (71), Funeral events (70) are the most appropriate media and channels for communicating care and support. Other significant means are, Psycho-social and material support (62); Talks seminars and workshops (60); IEC materials and community mass media (58); Community or village and night morning announcements (45); Calling people to do a certain work in support of people affected and infected by HIV and AIDS and lastly Open days, drama and art
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CHAPTER FOUR: GENERAL IK COMMUNICATION STRATEGY 4.0 INTRODUCTION This strategy is a response to the need to include indigenous communication that will help communicate IK for HIV prevention, treatment, care and support. This follows a number of evaluations of the national HIV strategies in and the research on the Role of IK in HIV prevention, Treatment, Care and Support.. The strategy adopts a twelve point strategic communication model as follows: (1) Appreciation of situation and IK for HIV prevention, care and support in Malawi (2) Specification of strategic need (3) Identification of the main and specific objectives (4) Identification and specification of theoretical communication framework (5) Organization of appropriate IK for HIV preventions, treatment, care and support (6) Identification and segmentation of appropriate a target groups (7) Selection of appropriate communication approaches (8) Selection of effective communication techniques, media and channels (9) Selection and segmentation of appropriate key players (10) Identification of outcomes and key performance indicators (11) Recommendation of appropriate message development: encoding, motivation, positioning and pretesting (12) Definition of implementation process: including monitoring and evaluation, budgeting and mapping and structuring 4.1 SITUATION ANALYSIS AND BACKROUND Malawi still experiences a slow decline of disinfection, morbidity and mortality as Malawi’s HIV prevalence, at about 11 percent, is among the highest in the world. Further, an estimated 450,000 individuals are currently accessing life-saving antiretroviral therapy including women who are on treatment through the Option B+ initiative. Malawi government through various sectors including the NAC has invested immeasurable effort to mitigate the impact. However, more than two decades after all this effort, it is getting more evident that much of the undertaking for communicating HIV prevention in Malawi is grounded on workshop or classroom based imported knowledge, which is mostly offered through the “diffusion of innovation”, the “teach them” approach where mass media communication has also been exalted as the best approach to sell the knowledge. Experience on the slow decline of HIV prevalence in Malawi, however, has made people see the need to explore more. Faced by the current calls for people centered approaches in change and development initiatives, the obvious hypothesis is whether behavioral change communication approaches engaged and supported by the NAC have accommodated participatory bottom up communication and the use of what the indigenous people know and highly value in terms of perception and aspirations within their traditions, beliefs and practices. It on this basis that, through its reviews of the HIV prevention strategies and the engagement of qualified human resources, that NAC identified and hypothesized IK and IK communication as being instrumental in promoting tangible behavior change for primary and secondary prevention. Findings of the research NAC commissioned have proved the hypothesis true. 4.2 PROBLEM SUMMARY AND NEED Previous behavior change interventions have not focused more on IK for HIV communication and prevention. However, findings from the NAC research on IK for HIV communication, primary and secondary prevention, indicate that there is need to include IK and IK communication in all endeavors for HIV prevention, treatment, care and support if Malawi is to speed up reduction in HIV prevalence rate. 4.3 OBJECTIVES The strategy has main and specific objectives
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4.3.1
Main Objectives
The main objective of the strategy is to engage IK and IK communication approaches, media, channels, players and appropriate communication actions that can effectively help communicate the IK for HIV prevention, treatment, care and support 4.3.2
Specific Objectives
The strategy is designed to achieve the following specific objectives: (1) To specify primary and intermediary target groups for IK on prevention, treatment, care and support (2) To determine the appropriate communication approaches, key holders, key players, media, channels for communicating effectively IK for HIV prevention. (3) To assign appropriate communication approaches, key holders, key players, media, channels for communicating effectively IK for HIV treatment (4) To assign appropriate communication approaches, key holders, key players, media, channels for communicating effectively IK for care and support (5) To organize and encode appropriate IK themes and messages for HIV prevention, treatment care and support (6) To recommend the best strategic actions for advocating and communicating IK for prevention, care and support toward reduction of HIV prevalence in Malawi 4.4 THEORETICAL FRAMEWORK The strategy is founded on participatory empowerment communication that is designed to stimulate people to participate in identifying and using the most appropriate approaches, media, and channels and inspire their sense of ownership to undertake IK activities that will contribute to HIV prevention in Malawi. 4.5 STRATEGIC COMMUNICATION APPROACHES Participatory interpersonal face to face communication has been identified as the most appropriate approaches for communicating IK for HIV prevention, treatment, care and support 4.6 MAIN STRATEGIC ACTIONS The following strategic actions have been singled as appropriate: 4.6.1 Identification of target groups: primary and secondary 4.6.2 Participatory Advocacy and Partnership 4.6.3 Development of project plan and documents 4.6.4 Orientation of intermediary and primary target groups 4.6.5 Message development 4.6.6 Budgeting for the exercise 4.6.7 Implementation of communication of IK for HIV prevention, treatment, care and support 4.6.1 Target Groups As part of the strategic action, the document recommends that intermediary and primary targets should be identified if effective communication of IK for HIV primary and secondary prevention is to be achieved. Primary target groups : These are high risk groups comprising in and out of school youths both in local and suburban settings; the affluent working and business, the small scale business people living in the suburban and local communities, the local community that hosts much of the IK for HIV prevention care and support, the youth
Intermediary groups: These include the following that host, use and help in communicating IK for HIV prevention, care and support 74
(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l)
Traditional and community leaders such as chiefs, TAs, GVHs, VHs, suburban community leaders Elders, cultural custodians and community counselors such as initiation rite counselors Traditional healers (TH), traditional birth attendants, and herbalists Community health workers embracing the HSAs, nurses, clinicians, health promoters and educators CBOs and community based volunteers Support groups and PLWHA Health and development committees Religious and political leaders Drama and artists Traditional dance performers Religious and political leaders living in the community Training institutions facilitators such as teachers, lectures and researchers
4.6.2 Participatory Advocacy and Partnership This shall comprise the three level advocacies, namely; (a) Middle or lateral level advocacy: Meeting with district health and HIV committees and departments the DACC and DEC to present, sensitize, consult and interact on the implementation ideas and strategies of the IK; meeting the local community leaders and consulting them on how best the intervention can be implemented. (b) Top level advocacy: Consulting relevant authorities to harness their endorsement towards the development of a policy for advocating IK for HIV prevention care and support. (c) Lower level advocacy: Popularizing the intervention by seeking consent and support of the grass roots, village level leaders and change and development facilitators on how best to implement it in order to attain the desired goals. The partnership definition entails identifying exactly who the development partners and their roles will be and inviting them to all the necessary planning sessions. 4.6.3 Development of Project Plan and Document This shall include (i) The propose with detailed Log frames defining the objectives; strategic actions, outcomes, outputs, key performance indicators and means of verification. Processes and procedures including undertakers, partners and implementers (ii) Project document and charters 4.6.4 Orientation of Intermediary and Primary target groups This undertaking is designed to seek and endorse popular collaboration and support from intended key players. This will involve the meeting with the targeted intermediary or secondary target groups as implementers on the ground 4.6.5 Message Development The exercise shall entail: (a) Organizing the themes and messages which are also referred to as IK for HIV prevention, care and support (b) Message themes verification: Presenting the messages to the right carriers or facilitator hereby referred to as “key players” or communicators, for cleaning and refinement (c) Message testing: taking the themes and messages to a sampled group of recipients to verify the credibility, newsworthiness and effectiveness (d) Message motivation and positioning (e) Encoding of message into small publication like brochures for use by the intermediary or facilitators (f) Encoding the messages into appropriate media and materials for primary targets consumption. This could be posters, audio or video, CDs to be used in health facilities or households to support talks; messages 75
for jingles, commercials. Messages to be given to and delivered by traditional song composers, dancers, dramatists, story tellers, traditional counselors, elders, traditional leaders (g) Estimation of costing for the message development and productions (h) Production of the messages 4.5.6
Budgeting
This to include proposed budget for implementing the specific intervention in a given cultural target group 4.5.7
Implementing interventions on Communicating IK for HIV Prevention, care and support
For proper strategic actions, the intervention shall be considered in two ways: (a) Culturally centered projects: These are highly recommended because the research has shown that IK from one culture may not necessarily be the same as that of another culture. Targeting specific cultural grouping as found in the research, e.g. Tongas, Lhomwe, Tumbuka, to mention a few (b) National focuses projects: Targeting the general public of the Malawi society using the general media and channels such as mass media to accompany, sensitize or promote the interpersonal face to face implemented on the ground. The grassroots or community based implementation shall include the following activities (a) Local level participatory advocacy: Seeking agreement and support of the local and community leaders (b) Community mobilizations: For specified period involving open days, FGDs, door to door, one to one, testimonies, songs, dances, drama and various art (c) Targeted counselling: For youth, for women and men using various traditional counselling media including initiations (d) Promotional activities: Quiz and competitions for specific groups (women, men, youth) on songs with appropriate messages; IEC materials – posters and brochures The implementation shall focus on the three major areas namely, (a) Communicating IK for HIV prevention, (b) Communicating IK for HIV treatment (c) Communicating IK for care and support. The following sections strategizes implementation of the three areas (A) COMMUNICATING IK FOR HIV PRIMARY PREVENTION (i) Key Players and Their Specific Media and Channels Table 8: Key players and Specific Media and Channels for Communicating IK for HIV Prevention KEY PLAYERS
SPECIFIC APPROACHES , MEDIA, CHANNELS and PLACE
Chiefs (TA, GVH, VH), community leaders
Chiefs gathering, funerals, proverbs, announcements
Parents and guardians Health workers, staff & promoters Community development facilitators Health com, DACC, ADC, VDC Teachers, trainers, facilitators
Family talks, One to one, folktales, proverbs, testimonies FGDs, door to door, rallies, talks, IEC materials, theatre FGDs, promotions, IEC, community media, training leaders FGDs, meetings, training of development committees Talks, lessons in class/ assemblies, counselling, promotions, quiz, competitions, clubs, theatre Rallies, guest speakers, sponsoring promos for prevention FGDs with ADCs, VHCs, VDCs, village groups, One to one
MPs, councilors, government Elders, counselors, custodians
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Dancers, singers composers Men's leaders, counselors in community THs, TBAs, herbalists PLWHA, support groups, CBVs Women's traditional leaders, counselors Dramatists, artists Youth leaders, peer educators Preachers, pastors, priests, prophets
Educative songs, dances done in the village community Door to door, one to one, initiation rites, development gathering Village and committee meetings, talks on open days Talks, door to door, open days, testimonies Village meetings, talks, door to door, initiations Community festivals, open days, in schools, market Youth clubs, Open days, door to door, chiefs gatherings, Preaching, talks, door to door, one to one counseling
(ii) Key Holders of IK for HIV prevention The research identified the following as key holders of IK for HIV prevention. They are detailed in order of preference from the most preferred to the least. Table 9: Key holders of IK for HIV prevention Key holders
No of Research respondents who identified the Key holders
Traditional and local leaders Parents and guardians
112 101
Village elders, counselors, custodians
98
Women's groups
97
Men's groups
93
Support groups and PLWHA
90
Religious leaders
89
Health workers and their orgs
85
Health and development committees
80
NGOs, CBOs, depts. Training institutions & professionals Political leaders Youth groups Traditional healers & herbalists Drama and arts groups Traditional music performers
75 71 70 61 59 45 40
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a.
Main Themes or Messages of IK for HIV Prevention The following IK is placed in the order from the most preferred to the least. IK Theme Respect for parents’ and elders’ counsel Abstinence, discipline and no premarital sex Abstinence and fear of extra-marital sex Initiation rites for good behavior and life skills Respect for husband Enhancing sexual attraction Love for husband Religious morality Isolation from sex in relationship Parental control over children Respectable dressing Proper marriage procedures and arrangements Social activities and sporting activities Traditional communication between spouses on sexual matters Sex education in private, Lobola (dowry) Marriage counselling and conflict Resolution Circumcision Educative traditional dances and songs Punishments for premarial and outside marriage sex Value for virginity Norms for those who go to work outside countries Counselling for the youth Changing bad IK Kuzinga tradition Approved polygyny, Traditional groupings: Roles and responsibilities of children before marriage Traditional groupings Wife Inheritance Sense of togetherness, Social distance; Work and business Maturity as a measure for marriage; Marriage within the same culture Literacy Responsible drinking among Chewa Going to hospitals for treatment Nthena and Syazi and traditions
(B) COMMUNICATING IK FOR HIV TREATMENT (i) Key Players and specific Media and Channels
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No of Respondents that voted for the IK 73 69 56 50 44 34 34 34 28 28 27 26 23 23 23 23 23 22 21 20 20 20 19 13 12 12 12 12 10 9 for each 8 6 7 7
Table 10: Key Players and Specific Media and Channels Key Players (Communicating) Chiefs and community leaders
Number of Respondents 50
Health workers, staff and promoters Community development facilitators, CBVs Trained health artists and dramatists Teachers, trainers, facilitators Elders, counselors, custodians Dancers, singers composers Health com, DACC, ADC, VDC MPs, councilors, government officials Teachers, trainers, facilitators Preachers, pastors, priests, prophets Dancers, singers and composers TH, herbalists and TBA's Parents and guardians Youth leaders, peer educators PLWHA, support groups, CBVs
Specific Media, Channels, Place
63 36
Open days, FGDs men, women & youth & development leaders FGDs, seminars, Door to door, talks, IEC materials Training, promotional events, change programs, IEC media
40 33 63 12 10 15 9 29 9 65 77 12 70
Theater, stories, poems, in villages, schools, public places Talks, lessons, lectures, workshops in community Initiation Rites, One to One / door to door counselling Songs dances with messages on Treatment at village level FGDs with men's groups & individuals at TA, GVH or VH Rallies, support promos & mobilizations at community level Talks, lessons, counselling, promos, quiz, clubs, theatre Preaching, talks, door to door & one to one counseling Songs and dances at community level on treatment Meeting with groups & people at village level Advice to family members on proper treatment & adherence Peer education, school events, assemblies and classes FGDs, visits, counselling with men's groups
From Table 11 above, key players for communicating IK for HIV treatment, considered in the order from the most preferable are parents and guardians (77); PLWHA, support groups and CBVs (70); traditional healers, TBAs and herbalists (65); health workers, (63); elders, counselors and cultural custodians (63); chiefs and community leaders (50); trained health dramatists /artists (40); community development facilitators (36); teachers and trainers (33) and religious leaders and preachers. (ii) Key holders of IK for HIV Treatment Table 11: Key holders of IK for HIV Treatment Key holders Traditional healers and herbalists Support groups and PLWHA Health workers and their Organizations Village elders, counselors,custodians Traditional and local leaders Parents and guardians NGOs, CBOs, departments Training institutions and professionals Educational departments & professionals Religious leaders Trained health drama & arts groups Health & development committees Traditional music performers Youth groups Traditional music performers Political leaders
No of Research respondents who identified the Key holders 110 105 100 100 98 89 78 70 60 60 50 36 14 14 13 10
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(iii) Main IK Themes and Messages for HIV Treatment Table 12: Main IK Themes and Messages for HIV Treatment IK Themes and Messages Herbs for booting the immune system Traditional nutritional diet Prayers Family care Encouraging hospital medication Traditional spiritual and exorcisms therapeutic dances Community moral and material support Secondary prevention abstinence Isolating patients suffering from TB Support groups Food security and agricultural practices Safety drinking water
(C)
No of Respondents that proposed the IK 121 68 37 25 16 13 13 5 4 2 2 2
COMMUNICATING IK FOR CARE AND SUPPORT
(i) Appropriate Players and Specific Media and Channels for communicating Care and Support Table 13: Appropriate players, Specific media and channels for Communicating care and support KEY PLAYERS
No of Respondents
MEDIA, CHANNELS AND TECHNIQUES
Chiefs and community leaders
58
Health workers, staff, promoters
54
Talks at chiefs place, advocating for psycho- social and material support for PLWHA Talks, FGDs to various groups on HBC and support therapy
Community development facilitators, CBVs Health & development committees, DACC, ADC, VDC TH, TBA, herbalists
32
Trainings and workshops on IK for proper care and support
18
Talks, trainings, FGDs with group leaders on care and support
12
PLWHA, support groups, CBVs Women/girls leaders, counselors Religious leaders and preachers Trained dramatists, artists Teachers, trainers, facilitators Dancers, singers composers MPs, councilors, government officials Youth leaders, peer educators Elders, counselors, custodians Parents and guardians
50 33 31 14 28 13 21
FGDs with various groups on traditional medicine at village/ household level Forming groups, visit homes, testimonies FGDs, counselling on HBC FGDs with women leaders and groups, door to door, one on one Preaching and promoting IK care and support Plays & arts on care & support done at community or village level Lessons, counselling, promos, quiz, competitions, clubs Songs and dances with messages on care and support, Rallies, guest speakers, sponsoring promos for care & support
30 27 28
FGDs, meetings, promos on care support in community or village Talks, counselling to families & groups on support and care Teaching family members on HBC and support for each other
From Table 14 above, key communicators of care and support put in the order of most appropriate are as follows: Chiefs and community leaders (58); health workers, staff, promoters (54); PLWHA, support groups, 80
CBVs (50); women leaders and counselors(33); Community development facilitators; CBVs (32); preachers, pastors, priests and prophets (31); youth leaders, peer educators(30); teachers, trainers, facilitators(28); parents and guardians (28); elders, counselors and custodians(27) (ii)
Key holders of IK for Care and Support (put in the order of the most appropriate)
Table 14: Key holders of IK for Care and Support KEY HOLDERS
No of Research respondents who identified the Key holders
Support groups & PLWHA Traditional & local leaders Women groups Parents & guardians Village elders, counselors,custodians Health workers & their Orgs Health & development committees Training institutions & professionals NGOs, CBOs, government departments Traditional healers & herbalists Religious leaders Political leaders Youth groups Trained drama & arts groups Traditional music performers
(7)
101 99 98 98 97 90 89 89 87 80 80 60 49 46 27
IK or Messages themes for HIV care and Support IK Themes and Messages Community care Social support Proper and balanced food Encouraging hygiene Curbing discrimination and stigma Spiritual support prayer Cultural or ethnic groups care and support Herbalists care and support Farming and business Administering medication Role specification at family and mbumba level Sexual isolation Empowering PLWHA and care takers.
No of Respondents that proposed the IK 90 82 59 23 20 19 17 7 6 6 4 3 2
4.5 Strategic Action Process and Summary The strategic action processes will be included in the project documents and may vary from culture or ethnic group focused project to national focused project. Budgets can also vary depending on the coverage of the project.
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James, W.P.T. and Schofield E, C. (1990). Human Energy Requirements: A manual for Planners and Nutritionists. Oxford: Oxford University Press. Food and Agriculture Organization. Sutherland, J.P, et al, (1993). “Moringa oleifera at Pilot or Full scale”. in Pickford, J. et al. eds. Water, Sanitation, Environment and Development: Proceedings of the 19th WEDC Conference, Accra, Ghana, Sept.1993. Loughborough University of Technology Press, 1994: 109-111. Sundu Y. (2013). “Waist beads Resurfacing” The Nation, Blantyre: Nations Publications Limited, July 12, 2013 Barany, M. et al. (2001). “Non-timber Forest Benefits and HIV/AIDS in Sub-Saharan Africa” Journal of Forestry, 36-41 Moyo, B H Z and Moyo, D Z, (2012). Indigenous Knowledge Perceptions and development practice in northern Malawi. The Geographical Journal, doi: 1111/geog.12056 Wenger, E. (2007). “Communities of Practice: [http://www.ewenger.com/theory/ on January 14, 2014].
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Accessed
from
Anonymous, (2000). “Traditional medicine practice and practitioners are accorded formal status in the Nigerian national health system and will contribute towards the fight against HIV/AIDS. The Guardian, December 6. World Bank, (2001). Indigenous Knowledge Program for Development. Washington DC. Mpaso P. (2013). “Do waist beads make women sexually attractive?” The Nation, Blantyre: Nation Publication Limited, September 8, 2013 Chimango LJ. (undated). “Woman without Ankhoswe in Malawi”. accessed on 26th February 2014. from http://www.jlp.bham.ac.uk/volumes/15/chimango-art.pdf Hangartner-Everts E. (2013). Integrating Indigenous Knowledge in Education and Healthcare in Northern Malawi: Pregnancy Through Toddlerhood. College of Education and Human Services. http://corescholar.libraries.w right.edu/cgi/viewcontent.cgi?article=1000&context=cehs_student Ibik, J.O, (1966). The Law of Marriage in Nyasaland. PhD thesis, University of London. Chimango LJ. (1974). Traditional Law in Malawi: Cases and Materials. Law Department: University of Malawi Ibik JO. (1970). Restatement of African Law: Malawi. The Law of Marriage and Divorce. Sweet and Maxwell, London. Malekebu, B E. (1952). Unkhoswe wa aNyanja. Oxford University Press. Williamson J, (1955). Useful plants of Nyasaland. Zomba: The Government Printer. 168 pp. (Reprint: Williamson, J., 1975. Useful plants of Malawi. Zomba: University of Malawi. 82
Chiotha S. The Role of Indigenous Knowledge in Primary Health Care and Sustainable Utilization of Natural Resources in Malawi: Opportunities and Information challenges. Briggs, J, Moyo B. (2012). The Resilience of Indigenous Knowledge in small-scale African Agriculture: Key Drivers. Scottish Geographical Journal 128: 64-80. Moyo BHZ. (2008). The use and role of indigenous knowledge in small-scale agricultural systems in Africa: the case of farmers in northern Malawi. PhD thesis, Department of Geography, University of Glasgow (http://theses.gla.ac.uk) Chambers R. (1993). Challenging the professions: Frontiers for rural development intermediate. Technology Publications, London. Sinclair, F. L. and Walker, D. H. (1999). “A utilitarian approach to the incorporation of local knowledge in agro-forestry research and extension” in Buck LE, Lassoie JP, Fernandes ECM eds. Agro-forestry Research and extension. London: Lewis Publishers, 245-75. Moyo, B. H. Z. (2009). “Indigenous Knowledge-based Farming Practices: A Setting for the contestation of Modernity, Development and Progress”. Scottish Geographical Journal 125: 353-60. Tietjen, A, M. (1985). “Infant Care and Feeding Practices and the Beginnings of Socialization among the Maisin of Papua New Guinea” in L.B. Marshall (ed.), Infant Care and Feeding in the South Pacific (pp. 121-136). New York: Gordon and Breach Science Publishers. Munthali, A. (2007). “Childrearing and Infant Care Issues: A Cross-cultural Perspective”, in P. Liamputtong (Ed.) Beliefs about Pregnancy, Childbearing and Newborn in a Rural District in Northern Malawi (pp 142-153). New York NY: Nova Science Publishers, Inc. Bwanali A, L. Empowering indigenous languages in HIV and AIDS communication accessed from www.worldbank.org/afr/ik
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APPENDICES Appendix A: Questions Guide for Desk Review / Secondary Research
RESEARCH ON THE ROLE OF IK IN HIV COMMUNICATION AND PREVENTION SECTION A: IDENTIFICATION Title of Literature: ____________________________________________________ Author (a) / Editor(s) _________________________________________________ Date and Place of Publication: ___________________________________________ How the Literature was identified: ________________________________________ Date accessed _______________________________________________________ Culture being depicted_________________________________________________ SECTION A: THE ROLE OF IK IN HIV PREVENTION, TREATMENT, CARE AND SUPPORT 1. Whether IK can help in HIV prevention, treatment, care and support? Tick appropriate answer Strongly Agree Agree Neutral Disagree (a) (b) (c) (d)
Strongly Disagree (e)
If you answers are a, b, c, go to question 2 2. Discuss the indigenous traditions, customs and practices, beliefs, norms and values in the culture/ area that help in (a) HIV and AIDS Prevention _____________________________________________________________________________________ _____________________________________________________________________________________ (b) HIV and AIDS Treatment _____________________________________________________________________________________ _____________________________________________________________________________________ (c) HIV and AIDS Care and support _____________________________________________________________________________________ _____________________________________________________________________________________
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3. (i) Any indigenous traditions, customs and practices, beliefs, norms and values that negatively affect HIV prevention, treatment, care and support in the culture being discussed. No Yes (ii) If Yes, mention them (a) HIV prevention _____________________________________________________________________________________ _____________________________________________________________________________________ _________________________________________________ (b) HIV and AIDS treatment _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ (c) HIV and AIDS care and support _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ SECTION B: INDIGENOUS COMMUNICATION APPROACHES, PLAYERS AND BEARERS OF KNOWLEDGE 4.
Identification and discussion of indigenous communication approaches and techniques (media and channels) that can enhance
(a) HIV and AIDS Prevention _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ (b) HIV and AIDS Treatment _____________________________________________________________________________________ _____________________________________________________________________________________ (c) HIV and AIDS care and support (impact mitigation) 5.
Key holders of indigenous knowledge for HIV prevention, treatment, care and support in the culture under discussion _____________________________________________________________________________________ _____________________________________________________________________________________ 6. The key players in communicating IK for HIV and AIDS, prevention, care and support _____________________________________________________________________________________ _____________________________________________________________________________________ 7 The indigenous communication approaches and techniques negatively affect HIV and AIDS prevention, care and support _____________________________________________________________________________________ _____________________________________________________________________________________ SECTION D: RECOMMENDED STRATEGIC ACTION FOR THE COM STRATEGY 85
The best IK elements recommended for HIV and AIDS prevention, treatment, care and support (a) The actual Knowledge _____________________________________________________________________________________ _____________________________________________________________________________________ (b) The Bearers of Knowledge _____________________________________________________________________________________ _____________________________________________________________________________________ (c) Key players (who should communicate) what and through which media and channels _____________________________________________________________________________________ _____________________________________________________________________________________ (d) What _____________________________________________________________________________________ _____________________________________________________________________________________ (f) Media, Channel and How _____________________________________________________________________________________ _____________________________________________________________________________________ When _____________________________________________________________________________________ _____________________________________________________________________________________
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Appendix B: One of the questions guides for the FGDs or KII- primary research
RESEARCH ON THE ROLE OF IK ON HIV COMMUNICATION AND PREVENTION Introduction Thank you very much for accepting to participate in this study which is designed to identify the role of local knowledge - concerning traditions, customs, practices, knowledge, perceptions, beliefs, norms and values for HIV prevention , treatment, care and support. Individual contributions to this discussion will be kept confidential, i.e. readers will not be able to link the comments you made to you as a person. However, if you want your groups’ identity to be known, we will be pleased to do so. The discussion is in three parts, Part one is about the role of local knowledge. Part two is about the role indigenous communication approaches and techniques. The last part seeks your recommendations on the best strategic actions to be undertaken on the right local knowledge, who to give it, where, when, how or through which and channels of communications
SECTION A: IDENTIFICATION Name of culture: _____________________________________________________ Traditional Authority __________________________________________________ Group Village Head / Area _____________________________________________ Name of Focus Group (optional)_________________________________________ Level of Focus Group _________________________________________________ Date ______________________________________________________________ Time ______________________________________________________________ Name of data collector ________________________________________________ SECTION A: THE ROLE OF IK IN HIV PREVENTION, TREATMENT, CARE AND SUPPORT 4. Do you think local knowledge can help in HIV prevention, treatment, care and support? Tick appropriate answer Strongly Agree Agree Neutral Disagree Strongly Disagree (a) (b) (c) (d) (e) If you answers are a, b, c go to question 2
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5. Could you please tell me the various local traditions, customs and practices, beliefs, norms and values in your culture/ area here which can help (c) HIV Prevention _____________________________________________________________________________________ _____________________________________________________________________________________ (d) HIV and AIDS Treatment _____________________________________________________________________________________ _____________________________________________________________________________________ (c) HIV and AIDS Care and support _____________________________________________________________________________________ _____________________________________________________________________________________ 6. (i) Are there any local traditions, customs and practices, beliefs, norms and values in your culture/ area here that negatively impact on HIV prevention, treatment, care and support? No Yes (ii) If Yes, mention them, and explain how you believe these may affect HIV (a) HIV prevention _____________________________________________________________________________________ _____________________________________________________________________________________ (b) HIV and AIDS treatment _____________________________________________________________________________________ _____________________________________________________________________________________ (c) HIV and AIDS care and support _____________________________________________________________________________________ _____________________________________________________________________________________ SECTION B: INDIGENOUS COMMUNICATION APPROACHES, PLAYERS AND BEARERS OF KNOWLEDGE 4.
Discuss local communication approaches and techniques (media and channels) that can enhance
(d) HIV Prevention _____________________________________________________________________________________ _____________________________________________________________________________________ (e) HIV and AIDS Treatment _____________________________________________________________________________________ _____________________________________________________________________________________ (f) HIV and AIDS care and support (impact mitigation) 5. Who are the key holders of local knowledge for HIV prevention, treatment, care and support? _____________________________________________________________________________________ _____________________________________________________________________________________
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6.
Who are or can be the best key players in communicating local terms for HIV and AIDS, prevention, care and support _____________________________________________________________________________________ _____________________________________________________________________________________ 8 What are the local communication approaches and techniques negatively affect HIV and AIDS prevention, care and support _____________________________________________________________________________________ _____________________________________________________________________________________ SECTION D: STRATEGIC ACTION FOR THE COM STRATEGY Apart from the above information you have given what in you cultural area here are the best IK/Local elements that should be used in promoting HIV prevention, treatment, care and support (e) The Knowledge _____________________________________________________________________________________ _____________________________________________________________________________________ (f) Bearers of Knowledge _____________________________________________________________________________________ _____________________________________________________________________________________ (g) Key players (who should communicate) what and through which media and channels _____________________________________________________________________________________ _____________________________________________________________________________________ (h) Who _____________________________________________________________________________________ _____________________________________________________________________________________ (i) What _____________________________________________________________________________________ _____________________________________________________________________________________ (f) Media, Channel and How _____________________________________________________________________________________ _____________________________________________________________________________________ When _____________________________________________________________________________________ _____________________________________________________________________________________
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Appendix C: Communicating IK for HIV Prevention, Care and Support
Microsoft Office Excel Worksheet
Appendix D: Research Findings from the Specific Cultural Groups of Malawi FINDINGS ON IK AND COMMUNICATION FROM SPECIFIC MALAWI CULTURAL ETHNIC GROUPS This section presents findings on IK for HIV prevention, treatment care and support in the ten major cultures where the research was conducted. 1.0
THE SENA
1.1 Background The Sena people are largely concentrated in the Southern part of Malawi especially in the Lower Shire Valley. They are mostly distributed in the districts of Nsanje, Chikwawa and some parts of Mwanza and Thyolo. The Sena practice a number of economic strategies ranging from small scale fishing in the shire river Highlands as well as cultivating cotton, which is sold as the cash crop. The Sena people came into Malawi in the late nineteenth century. Their original home is the South Bank of Zambezi bordering with Mozambique, particularly in a town called Sena. The Sena migrated mainly because of the socio-economic, ecological and political factors which included low laying areas of the Shire valley provided a conducive environment for madimba (dambo) gardening, availability of labor along the Shire Valley, availability of land, conducive environment for cotton cultivation, availability of water and prolonged drought and famine in Sena land. The Sena have patrilineal descent and practice virilocal marriage system. In this instance, after marriage arrangements the wife moves out of her parent’s home village and lives in the husband’s home village. The Sena also practice the Lobola marriage system. In this instance, the prospective husband pays a bride price to the parents of the wife. This is mostly in form of cattle. When this is not available, he pays a certain amount of money equivalent to the number of cattle one was expected to pay with. The Sena people do practice chokolo (widow inheritance). The one who inherits the widow also inherits the all the property as well as the children. However, in the wake of HIV/AIDS, chokolo has received a lot of criticism. Alongside chokolo, is another form of marriage called Nthena. This happens when a husband has successfully taken care of the family (including the father-in-law), and as a token of appreciation, the in-laws family give him a sister to his wife. However, the children of Nthena are not of the same status as that of the original wife. Furthermore, the Sena people do practice polygamy. The wives can build houses adjacent to each other but do not usually have a communal meal. Senas are essentially patrilineal and inheritance is patrilineal. When a clan leader dies, power goes to the deceased`s brother or his son. The village consists of the paternal grandfather with his married sons and grandsons to whom he acts as a leader. The paternal grandfather acts as Nkoko wogona (Senior Authority Figure) who sorts out and rectifies matters in times of disputes. The seas believe in spiritual possessions mainly among the patrilineal societies than the matrilineal societies. These spirits that possess people are usually of the deceased ancestors. In the case of these spirits, people refer to them as matenda a mizimu (disease of spirits). This necessitates the rituals as therapeutic. Their manifestation into the society usually has a purpose and they are dealt with accordingly. To them, the following signify signs of possession: Hysteria-loss of consciousness, loss of appetite, nightmares, shivering, 90
rigidity and contraction of the limbs and raving. Their spirits can be good or evil. Good spirit like Malombo is great healer who once lived and would like to possess someone within the social structure. Evil spirits like chikwangwali or chiwanda when alive was consuming human flesh. Therefore when that person dies, his or her spirit has a propensity to consume human flesh. The sickness caused by the chikwangwali is thought to affect the reproductive system. When a woman continually has miscarriages (spontaneous abortions), members of the community believe and suspect that the chikwangwali might be feasting on the fetus. It is also believed within the community that the chikwangwali may cause also female sterility, infant mortality. At times the husband may get suspicious and call for a diviner. This research was conducted in TA Malemia in GVH Magulugulu and Mbeta. The section below presents findings on knowledge for HIV prevention, treatment care and support in the major Sena culture. 2.0 IK FOR HIV PREVENTION, TREATMENT, CARE AND SUPPORT Before identifying positive IK among the Senas, efforts were made to understand IK that negatively contributes to HIV prevention, treatment care and support. Some challenges to implementing the positive IK were identified 2.1 PREVENTION 2.1.1 Negative IK to HIV Prevention Belief in spirits (Kupita moto, nyumba etc) (9): Senas believe that anything happening to a person is a result of how one relates with the spirits. Certain activities in this case sex must be done all the time to please the ancestors. When bad luck happens, it is a result of unhappiness of the spirits, to reverse these then one has to do sex to clear the bad spirits. Similarly when one has got anything new e.g. a bicycle then one must does sex to ask the spirits to keep it well.
Late night daces leading to sex (6): There is a tendency that during the day is usually hot and it cools in the evening and they use such to do a number of activities e.g. dances under the trees etc and these provide room for sexual activities.
Youth taking up uphungu as old fashion (4): Most youth no longer have counselors as it used to be, they perceive them as old fashion. Video that shows sex (4): There are now so many video places that operate as businesses and are not censored as they show sex, so when parents and community counselors try not to discuss sex the youths would have already been introduced to sex through videos. Market days being used as sex days especially in the evening (their markets are usually not patronised in the morning but in the evening) (3): The Sena land markets are almost empty in the morning but in the evening. This coupled with alcohol, dances and videos facilitate sexual activities. Human rights (3): There is a lot of human rights education which portrays bad side of some IK that used to help in preventing sexual activities among the society so with the general knowledge of human rights, people no longer believe in some IK Lack of parenting culture as such kids do things their own way (3): Most parents do not care of the day to day activities of their sons and daughters. Early marriages (2): It is perceived that most boys and girls do not see the net benefits of education so they engage in early marriages for survival. Sexual intercourse normalized for boys and girls (sex for fun)(2): Most boys and girls now take sex as a casual activity because their friends have done it already as opposed to the past when fear was used to keep away youths from sex. For example, they used to tell girls that they will die if they get pregnant or the chief will die if they get pregnant. Now having seen their friends pregnant but no death has occurred to both the girls and the chief then they take sex as normal. Parents forcing their kids to marry earlier (2). Girls are forced so that the parents may get material support while boys are usually forced when they are orphans so that they must not feel the pain resulting from orphan hood.
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Conflict between videos and community counseling (2). While counselors advice kids on how bad sex is, videos show how good it is and how enjoyable it is. Drinking alcohol excessively as Mozambicans bring cheapest liquor compared to traditional ones: Alcohol is being consumed even by kids as it is perceived to be cheaper especially ones coming from Mozambique.
2.1.2 Positive IK for Prevention Maseseto (6) –Girls initiation which emphasizes on the need to delay pregnancy. Use of nsatsi and beads to girls that have started “periods” how to satisfy a man in bed. Sexual cleansing with own wife (6): .Nowadays there is a tendency that most people do cleansing with their own wife as opposed to sometime back when people could just choose anyone. Cleansing using traditional medicine (3): Those who do not have marriage are advised to do cleansing using traditional medicine 2.1.3 Challenges to IK for Prevention Human rights education (5): Communities think that human rights inhibit people from practicing some traditions which are feared to be violation of the rights. Conflict between videos and community counseling(4): while counselors promote abstinence and inflict fear on doing sex , videos show people enjoying sex Youth taking up uphungu as old fashion (3): Youth no longer regard traditional counseling as important. Incomplete cleansing (3) the belief that bad luck may stay when spirits are annoyed because some those that are hired to do cleansing on behalf of the other) do not reveal all what the spirits want to hear and when the offender does not have enough money to pay for all that need to be cleansed . 2.2 TREATMENT 2.2.1 Negative IK to HIV Treatment Religious beliefs (5) some churches such as Fountain churches do preach that people should not go to hospitals. People believe that HIV is tsempho (3) so there is no need for medical treatment but sexual cleansing. Hiding of medication (2) some people hide their medicine from their relatives and loved ones so that they should not know that they are positive. Late reporting of diseases (3) some people report late to clinics. They usually go when they are terminally ill. PLWHIV groups are stereotyped and called “groups of sick people. As such some may not join. 2.2.2 Positive IK for Treatment Taking of medication (10): On treatment they noted that people are usually drinking medicine from the hospital. Believing in spirits (7): Some groups and individuals believe that spirits help in healing e.g. when one has hysteria, loss of appetite, loss of consciousness etc. Collecting medication for each other in turn (4): most people give each other turns in collection of medication. Prayers (3): belief in prayers alongside medication. God does favor. Clinical referrals (4 ) They refer people to hospitals when community based efforts seem to fail and this helps in treatment uptake Group therapy sessions (2) group therapy sessions are conducted in PLWHA groups 2.2.3 Challenges to IK for Treatment Distances to ART clinics (5): most people on Art walk long distances to collect medication. 92
Discrimination (4) to someone discovered to be on treatment Health worker attitude towards patients (4): Some health workers that provide ART shout at patients especially when they miss the date for drug collection and when they come late with patients. They do this even without understanding why one has missed the date. Laziness to collect medication (3): Some patients especially when they feel they look health become lazy to collect medication. Illiteracy (3): Some patients do not understand the prescriptions due to illiteracy. Lack of comprehensive knowledge on HIV treatment (2) some patients do not understand how ARVs work as such this compromises treatment utilization Stopping treatment (2): Some patients who believe heavily in traditional medicine stop taking drugs.
2.3 IK FOR CARE AND SUPPORT 2.3.1 Negative IK to Care and Support Mind your business syndrome (4): There is a belief that no one needs the other since everyone has his or her own medication and that some people refuse to take care of others if they are not related. Discordant partners (2): Some people continue sexual cleansing even when a person is positive. People hiding their sick ones (2): When visited by home based care people it means you are HIV positive and this increase stigmatization. 2.3.2 IK for Care and support Tradition of community taking patients to clinic (8): There is generally a community arrangement that when a household has a patient that require to go to the hospital, other community members do join to carry the patient to the hospital HBC (3) communities form HBC groups to support each other Food distribution (2) food distribution to people who are in need was cited as being positive 2.3.3 Challenges to IK for IK that Challenges Care and support Long distances to hospitals: (7) Discrimination (6): people who are known to be positive fell discriminated against and this poses a challenge to care and support as well. HBC visits (5) when HBC group visit the sick people make conclude that the one being visited is HIV positive. Lack of HBC materials (4) most HBC groups do not having working materials and equipment e.g. Gloves and basic drugs Lack of volunteerism spirit (3): A respondent said, “masiku ano anthu safuna kumapanga zaulele chifukwa amabungwe anawazoloweza kuwapatsa kenakake” (people do not want to do voluntary work because the NGOs used to give them something else) Drop outs from HBC groups (3) since most of the patients look health and are usually not terminally ill HBC volunteers stop being active hence dropping out. Late reporting of diseases to hospitals or health centers (4): Some households report late when they have a patient at home. 3.0 COMMUNICATING IK The following section presents the findings on effective IK communication. 3.1 COMMUNICATING IK FOR HIV PREVENTION (a) Key holders of IK for HIV prevention For the whole community: Health workers staff and organizations (4); NGOs (8), parents (2), chiefs (2), min of education, local leaders (3), church leaders. For men: chiefs, NGOs/AIDS service organizations, parents, Min of Health through, clinics For women: parents, hospital staff. 93
For youth: hospital staff, chiefs, NGOs, youth clubs and community volunteers. (b) Key Players of IK for HIV prevention For all: chiefs (3), teachers (3), parents (3), health workers, staff, organization (3), churches, radios, video people, politicians, CBOs, women. For men: church leaders, chiefs, dramatists, HSAs, parents. For women: NGOs (2), women in their groups, HSAs, churches, drama groups. For youth: Health workers, hospital staff, chiefs, youth clubs and community volunteers. (c) Approaches, Media and Channels For All: Chiefs gatherings, chiefs rallies, public rallies by politicians; inviting someone to advise and counsel, Parents counseling their kids, counseling by parents, IEC through community members, Religious functions/preaching, dramas/arts, dramas, markets, at clinics, documentaries, programs that have songs alongside. For men: Traditional leaders, meetings organized by hospital people, at churches, one on one for parents. For women: njole (dances for women), public rallies, in churches, one to one counseling For youth: In school classes and assembly, one to one, drama (d) Time and Place For all: Afternoon and evening in markets, mostly afternoons were preferred timing for chiefs rallies 2 o’clock after noon for chiefs rallies, 2 o’clock pm when schools are closed, any other time for churches and initiation ceremonies, drama with p/a systems, mornings for clinic based initiatives (kusikelo etc). For men: In the homes anytime for parents, 2 o’clock afternoon for chiefs and H.S.A rallies, at funerals for chiefs as well. For women: Mornings for clinic based initiatives, School ground afternoon. For youth: Afternoon was preferred for all organized community gatherings whether by the chiefs and the place being at community grounds and in clinics for health staff. 3.2 IK FOR HIV TREATMENT (a) Key holders For All: Health workers (5) PLWHIV meetings, chiefs rallies, chiefs, trained volunteers, Min of health, NGOs 4, afternoons when schools are open. For men, women and youth: health workers and staff (b) Key Players For All: Health workers, HSAs, Biomedical NGOs, HIV patients as key players, chiefs, HBC, Min of Health/Clinical people, Drama people. For men: Health personnel that work in the community, volunteers For Women and youth: health staff (3) NGO, CBO. (c) Approaches, Media and Channels For All: Health workers (3), Door to door, chiefs rallies (3), One on one, in support groups, dialogue group meetings and through songs, village health committees, meetings3, positive deviance presentations, HBC, PLWHIV Exchange visits. For men: During antenatal services, through rallies to reach men, For Women: One to one counseling: For Youth: At antenatal clinics by HSAs, at organized meetings by chiefs. (d) Time and Place For All: Mostly afternoons were preferred timing for chiefs rallies, drama with PA systems. Mornings for clinics, homes and clinics, church activities, throughout, For men: Morning at growth monitoring places: For women: Mornings for clinic based initiatives (kusikelo etc), at the clinics during visits, For Youth: Afternoon was preferred for all organized community gatherings whether by the chiefs and the place being at community grounds and in clinics for health staff.
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3.3 CARE AND SUPPORT (a) Key holders For All: Health workers (3), NGOs (2), confined meetings of fewer people, Social welfare, Chiefs, AIDS service organizations, NGOs and departments3, HBC, churches, parents, at funerals. For Men: Heath personnel. For Women: Chiefs, churches: For Youth - community members themselves, chiefs and home based care groups. (c) Key Players For All: Chiefs (2), health workers (3), NGOs, church leaders and business people, volunteers. For Men: Volunteers, Chiefs. For Women: Chiefs, religious leaders, volunteers, and HSAs: For Youth: In public rallies, markets, churches. (c) Approaches, Media and Channels For all: In churches5:s, door to door by HSAs (2), NGOs and departments(3), dialogue groups and in Schools, drama by volunteers, trainings, at initiations, at funnels. For men: drama, through church sessions, through songs that preach about caring one another. For women: Rallies, church gatherings. For youth at antenatal clinics by HSAs, at organized meetings by chiefs. (d) Time and Place For all: In schools in the afternoon, public rallies in the afternoon(2), afternoons were preferred for all organized meetings by chiefs, at churches in the morning, extension workers all time as well as business people, at funnels, homes where there are sick people, HSAs, At health facilities. For men: Weekends to allow farming activities to take place, at chiefs rallies to use chiefs influence. For women: Afternoon 2 o’clock. For youth - afternoon was preferred for all organized community gatherings whether by the chiefs and the place being at community grounds and in clinics for health staff.
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2.0
THE MANG’ANJA CULTURE
2.1 BACKGROUND The Mang'anja people are part of the Maravi group of people that previously occupied central and southern region of Malawi, southeast Zambia and northwest Mozambique. The name Mang'anja is related to a lake or any large body of water, meaning to say that the Mang'anja people are lakeshore dwellers. The homeland of the Mang'anja extended from the southern shore of Lake Malawi to lower shire. The Mang'anja were harmonious and peaceful, loving people with non-military chiefs, due to this weakness they experienced numerous invasions. In the late 18th century, the Mang'anjas was invaded by the Yao and the Ngoni people. The invasion led them to migrate to the western and central highlands. In the early 19th century, they were also invaded by the Lhomwe people; this then led them to migrate to the lower shire. Presently, lower shire is the only place where the Mang'anjas are living in large numbers. There was also another invasion by the Sena immigrants from Zambezi in the 19th century. The invasions which the Mang'anja people experienced influenced their lives, most of their beliefs and traditional dances are from the people who invaded them. The section below presents findings on knowledge for HIV prevention care and support in the major Mang’anja culture where the research was conducted and sampled. This research was conducted in TA Katunga In GVH Salumeji. 2.2 IK FOR HIV PREVENTION 2.2.1 Negative IK for Prevention NGOs have strongly de-campaigned IK (3), e.g. the Nthena tradition. Human rights education: (3) has made youth have a platform where they can discuss dehumanizing effects of some traditions leading to them to report what was not reported. Traditions (6) like kupita kufa, Bzade, Gule wamkulu are negative to IK for HIV prevention. Most of these traditions are practiced among the Sena who stay within the man ganja culture. Dances that are usually done at night (6) usually the Mang'anjas have dances at night and those facilitate sexual activities within cross generation. Some people do not believe in the new knowledge (3) and continue doing kusatsa fumbi/kulowa kufa even after mobilization. Most people still don’t use condoms (5) because they believe sex must be unprotected for it to be complete. “Nanga tikagwilitsa chimenechija? Ndekuti mwasinthana magazi ngati” (Can we use that one (condom)? No it means you haven’t exchanged blood” Heavy alcohol consumption (5) by both males and females lead to more sex without protection. 2.2.2 Positive IK for Prevention Initiation rites (8) when the girls are at the age range between ten and sixteen; they undergo puberty initiation (5). Most initiations take place at the church or at an organized house, where some Christian instructions are offered. The novices or initiates are taught domestic chores, tradition customs related to sexuality and reproduction. They are instructed with elder women of the village and ceremony usually takes or goes on for two to three weeks. The initiation also instills sense of fear of pregnancy especially for girls. Parent's duty (4): before marriage, it is the parents’ duty to ensure their children understand their duties. They make sure that their daughters know; how to cook, to draw water, gathering food and fruits, and smearing the floor. On the other hand, sons have to know; how to fish, to hunt, to cultivate crop, constructing a house, constructing a granary, thatching a fence and thatching a roof. When the children are able to perform all the above mentioned duties and they are initiated, then the parents allow them to get married. Parents stop doing sex (2) a tradition which promotes the fact that when kids go out of the house for some days parents stop doing sex to protect them. 96
Construction of a special house for new couples (3). They mentioned the tradition as better for prevention as it gives them ample time to know each other better sexually. Nthena (3): when a husband is rich, he is given a younger sister of the wife to marry so that he does not go away and do sex with others- this is usually done to safeguard the wealth). Demobilization of kusatsa fumbi after initiation. (5) NGOs and government departments have strongly de-campaigned the traditions Use of a traditional medicine (3) called phundabwi instead of Kulowa kufa. HIV testing (4) has become is almost everywhere
2.2.3 Challenges to HIV Prevention Poverty 8 was cited as a major challenge and driver of prostitution leading to HIV transmission. 2.2 TREATMENT 2.2.1 Negative IK for HIV Treatment Belief that spirits will cure diseases (6): There is a rooted belief in spirits as such some patients don’t take medical treatment. Religious beliefs (3) are becoming more prominent that some people believe they can be healed just by prayers. Late reporting of cases to hospital (2) They also cited this as major challenge 2.2.2 Positive IK for Treatment Caring a husband who returns home. A husband divorced and returns home, no matter how long the women still regards him as a husband on return and takes care of him. Women are not allowed to work outside home when there is sickness at home Rushing to hospitals whenever sick. Believing that one can get healed if he/she takes medication blessed by God. Use of some herbs 4 to cure some diseases. Some herbs are used to cure diseases e.g. Moringa, neem. Believing in ART without fail (5). Most patients on treatment comply 2.2.3 Challenges to Treatment Heavy alcohol consumption (5) makes people forget time to take treatment. Poverty (3) is a challenge as people say that ART makes people become hungrier so in lean periods of food people don’t take ARVs. Fellowships (4) promote that one can get healed of HIV even without treatment and they bring with them people who bear testimony in the fellowships. 2.3 CARE AND SUPPORT 2.3.1 Negative IK for Care and Support Saying bad words towards the sick. Mudaziputa dala bii. Iye akamvayi. 2.3.2 Positive IK for Care and support Frequent visits to houses nursing the sick (5) a tendency of visiting the sick at household levels and at clinics Prayers when one is sick (3) people pray for each other when one is sick Giving proper food (4) when one is sick they bring food for the patient Taking the sick to the hospital (5) when one is sick and cannot walk they take the person to the hospital 2.3.3
Challenges for Care and support 97
2.4
Poverty (3) stops people from doing the practices properly. Hiding sicknesses: 3 some households don’t reveal that their relative is sick in fear that the perceived witches of the community will finish them off COMMUNICATING IK FOR HIV PREVENTION
2.4.1 IK for HIV Prevention (a) Key holders For All: Health workers (3), NGOs, Local leaders, teachers, church leaders (2), Support groups through CBOs. Chiefs (2), radios, parents, health personnel, Support groups, Youth friendly groups. HIV and AIDS counselors. Mbona is a snake which is worshiped by the Sena people when they want rains and as well as other things. Men and women take part in this practice when performing these rituals. Girls go through initiation ceremonies when they reach puberty stage known as samba. Boy’s rites Nyau dancers. Wedding rites are performed by parents to their children, parents at household level, Azukulu, Uncles (eni mbumba). Gule wamkulu dancers, For Men: NGOs, Local leaders (2), teachers, support groups, HIV and AIDS counselors; Counselors. Parents, Drama people, Chiefs, HSA. Nyau is a traditional dance practiced by the Mang’anja and is a better channel to communicate massages through the songs they sing. Men take part in this practice when performing these rituals. Uncles, men gathering at funerals (Mphala or Pasiwa). For Women: Health workers (3), Support groups through CBOs, Support groups, Chiefs, HIV and AIDS counselors. Women take part in this practice when performing these rituals. Grannies, elderly women and girls as well as theNankungwi For Youth: Health workers (HSAs (2), local leaders(2), political leaders (2), church leaders(2), counselors /phungu, radios, youth friendly groups, HIV and AIDS counselors, counselors/phungu. Nyau is a traditional dance practiced by the Mang’anja and is a better channel to communicate massages through the songs they sing, young girls, dancers, boys and girls, adzukulu. (b) Key Players For All: Support groups, Church leaders (2), parents, Chiefs (5), HIV and AIDS counselors, nyau dancers, nankugwi, women and girls, uncles and nyau dancers, parents, Adzukulu, Uncles and, HIV and AIDS counselors. For Men: church leaders (2), chiefs (2), parents, nyau, traditional doctors, and uncles For Women: Church leaders, HIV and AIDS counselors, initiation counselors, special counselors for girls. They have some designated persons assigned to teach or train girls on various things called phungu wake wa mwana, married women, nankugwi, women and girls, mothers and aunts. For Youth: HSAs (2) chiefs (2) and parents (2) HIV and AIDS counselors, nyau, girls, boys. (c) Approaches, Media and Channels For All: public rallies using p/a system(2), using churches when advising for marriage, in schools, drama2, and counseling send off and female and male counseling, face to face communication, churches. posters, , lectures, open days, through nyau performances for instance kang’wingwi and makanja, nyau initiation ceremonies, gule wamkulu is performed at weddings, through music and ritual dance performances. through chinamwali initiation ceremonies, dances and music, counseling, through chinkhoswe, at the grave when giving a speech., installation of a chief, funerals and initiation ceremony. For Men: counseling, rallies, posters, community rallies, church gathering(2, funnels, drama, initiations. nyau dances at funerals and other functions. every chief performs regular ritual offerings to the shrine to ask for rains. at the simba. at the grave. dancers
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For Women: using churches when advising for marriage, rallies, churches, posters, dzoma, initiation was cited as the right approach, nyau, they participate in ritual offering when asking for rain, nankugwi, women and girls, through chinkhoswe, send off. at cooking places at the funeral. Women sing songs and clap hands. For Youth: use sports bonanzas(2), initiations, rallies with p/a system, peer group meetings, wedding, in schools, drama, face to face communication, lectures, open days, posters, at the funeral, dancers. Initiations, rallies with PA system, peer group meetings, weddings. nyau dances at funerals and other functions, girls, at the simba for boys, counseling. (d) Time and Place For All: At chief’s place on a rally, At morning assemblies in schools, When doing marriage counseling. mornings for churches, afternoons for rallies, in the evening for homes. In homes especially for married people, In schools for youths, throughout the year especially during summer season; during holidays. For Men: At chief’s place on a rally, Afternoons for rallies, In the evening for homes; mornings for churches (2). In homes especially for married people, in homes, initiation times when schools are closed. Throughout the year especially during summer season For Women: When doing marriage counseling, afternoon for rallies, in the evening for homes. Mornings for churches, in homes especially for married people, in the house where initiation takes place. For Youth: at the clinics and Saturdays afternoon activities, at morning assemblies in schools, mornings for churches. In schools for the youths, afternoon for most activities, throughout the year especially during summer season, during holidays 2.4.2
COMMUICATING IK FOR TREATMENT
(a) Key holders For All: Health workers(3), Drama groups, Church leaders, Chiefs, Pastors, parents, trained community volunteers, HIV and AIDS counselors, nyau dancers such as Makanja. Traditional doctors, Chiefs village elders and men. Gule Wamkulu is performed at weddings, installation of a chief, funerals and initiation ceremony. For Men: Church leaders (3), chiefs, health workers, HIV and AIDS counselors, hospital people. Village elders, perform when chief is sick. For Women: Pastors, chiefs, health workers (2), HIV and AIDS counselors. parents, NGOs. For Youth: Health workers (2), Drama groups, Pastors. Trained community volunteer, HIV and AIDS counselors (b) Key players For All: Health workers, parents, chiefs 4, church leaders. Trained community volunteers and HSA, HIV and AIDs counselors, nyau dancers, traditional doctors, chiefs, uncles and men For Men: Health workers (3), chiefs (2), church leaders, HIV and AIDs counselors, nyau dancers, traditional doctors For Women: health workers (2), chiefs, church leaders, trained community volunteers, HIV and AIDS counselors. Parents, elderly women also participate in the ritual dances and songs. For Youth: Health development committees (3) chiefs, church leaders, trained community volunteers, HIV and AIDs counselors, nyau dancers. (c) Approaches, Media and Channels For All: During counseling sessions (2), public rallies (2), through nyau performances for instance Kang’wingw’i and Makanja, nyau initiation ceremonies, Gule wamkulu is performed at weddings, dances and music(2). Through the music they sing and the massages they say during the performances. Through music, speech at the graveyard, funeral installation of a chief, funerals and initiation ceremony. Drama at churches, face to face communication at clinics, door to door, visiting support groups and CBOs For Men: In public rallies, churches, door to door, visiting support groups and CBOs. At the health centers during antenatal services, through performances at weddings, party functions and other activities. Uncles and
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Chiefs, For Women: During counseling sessions, face communication at clinics, visiting support groups and CBOs. Door to Door by HSA (usually referred to as adokotala a mmudzi). For Youth: Rallies organized at the chiefs place presentations made by health workers2, Rallies, Dramas, face to face communication at clinics. Visiting support groups, through initiation ceremonies for girls. At the Simba (d) Time and Place For All: During counseling sessions, In Public rallies, Afternoons for rallies, Mornings for churches, In the evening for homes, twice a month, throughout the year especially during summer season. The rituals are performed at the mountains and rivers, in the villages during holidays. For Men: In Public rallies. Afternoons for rallies, in the evening for homes, mornings for churches, twice a month, morning during antenatal services, at funerals, weddings and development meetings. 2.4.3 CARE AND SUPPORT For Women: during counseling sessions, in the evening for homes, mornings for churches, afternoons for rallies, For Youth: Afternoon, mornings for churches, twice a month, during day and night for girls (a) Key holders For all: chiefs(4, health workers (4), local leaders(2), extension workers, nyau dancers and village elders. traditional doctors, village elders and men. nankungwi and women. political leaders, church leaders, For men: chiefs4, political leaders, church leaders(2), health workers, extension workers, parents. For women: health workers(3),church leaders, church leaders, local leaders, local leaders3. parents. women are the ones who sing the songs for nyau dancers. married women. For youth: chiefs (4), churches(2), and parents (2), health workers2. They are bonafide dancers. girls. (b) Key Players For all: chiefs (5), health workers. They recommended if all extension workers would be the carriers of this information as they are trusted, traditional doctors, nankungwi, women and girls, church leaders, For men: chiefs (2), church leaders, health workers. They recommended if all extension workers would be the carriers of this information as they are trusted, parents: For women: health workers(3), they also recommended chiefs to disseminate the message, community leaders parents, women, church leaders, For youth: chiefs(2), they also recommended chiefs to disseminate the message, churches(2), health workers 3. girls. men and the youth, parents. (c) Approaches, Media and Channels For All: Health workers advising guardians. Use of drama to demonstrate how care should be provided. Face to face discussions, Advice at antenatal care, church rallies or gatherings, Rallies for chiefs and home visits for extension workers as they are believed to be alangizi. Through Nyau performances for instance Kang’wingw’i and Makanja, Gule Wamkulu is performed at weddings. Traditional doctors, Chiefs village elders and men, through chinamwali initiation ceremonies, songs and counseling massages, funerals and initiation ceremony, nyau initiation ceremonies, dances and Music, counseling, bridal parties, announcements at funerals, installation of a chief For Men: Health workers advising guardians, church rallies and gatherings, rallies for chiefs and home visits for extension workers as they are believed to be alangizi. Face to face communication, door to door, chiefs rallies, uncles and chiefs. For Women: Use of drama to demonstrate how care should be provided. Advice at antenatal care, Church rallies/gatherings, rallies, chief, rallies dramas at churches, church. For Youth: Rallies (2) rallies, for chiefs, rallies. Church meetings or when visiting the sick, Use of drama to demonstrate how care should be provided. Face to face discussions, church meetings or when visiting the sick, songs, dances and counseling massages, at the Simba, adzukulu.
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(d) Time and Place For all: at the chiefs’ place and in homes when visiting the sick, morning for antenatal services and for prayers, afternoon for public rallies. at the time people are receiving any type of help. in village savings and loan groups, throughout the year especially during summer season, during holiday in summer season. For men: at the chiefs’ place, afternoon for public rallies. At the time people are receiving any type of help. in homes at the time people are visiting patients. For women: homes when visiting the sick, morning for antenatal services and for prayers, in village savings and loan groups. at the time people are receiving any type of help, throughout, during day and night. For youth: afternoon 3, at the chief’s place. At the time people are receiving any type of help. during day and night.
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3.0
LHOMWE CULTURE
Background The Lhomwe are one of the four largest ethnic groups living in Malawi. They are located primarily in the southeast section of Malawi with the largest concentration being in Phalombe district. Others live in Mulanje, Thyolo, Chiradzulu, Zomba, and Liwonde. Smaller numbers are scattered throughout the southern region of Malawi. In Mozambique, the Lhomwe are found almost entirely in the Zambezia Province. The Lhomwe are originally from what is now Mozambique to the east of Malawi. In 1996, a source indicated that the majority lived in Malawi. However, current sources now indicate that the population in Mozambique is about double that in Malawi. The total population reported in current sources is also considerably less that the population reported in 1996. The migration of large numbers of Lhomwe to Malawi had taken place before the arrival of missionaries, white traders, and colonialists in the latter part of the nineteenth century. There was also a large influx of Lhomwe into Malawi in the 1930's because of tribal wars in Mozambique. A more recent contributor to the Lhomwe migration to Malawi was Mozambique's long civil war. Perhaps many have now returned since the stabilization The Lhomwe are Bantu people as are most of the people of southeastern Africa. The Lhomwe are part of a larger cluster called the Makhuwa (Macua)-Lhomwe Group. Together the tribes of this cluster make up almost 40% of the population of Mozambique. In the past Lhomwe women made distinctive scarification marks on their cheeks, but this custom is dying out. The Lhomwe are a rural people with only 5-10% living in urban areas. They are primarily subsistence farmers. Many of them love to hunt though wild game is scarce. Political situations: Mozambique's muddy political history has not greatly influenced the rural dwelling Lhomwe people, except to continue scattering the peoples over the area and into Malawi. Neither the Portuguese culture nor Marxist teaching was seriously embraced by these people. In Malawi, the three main parties are somewhat aligned along regional lines. The Lhomwe identify mainly with the ruling party which is the predominant party in the Southern Region. Customs: Lhomwe customs are centered on work and play. The men build the houses, the barriers to protect the gardens, and the grain bins to store the maize. They also like to make grass or reed mats. In the past the men have been skilled hunters, but there is little game remaining to be hunted. The major tasks of the women are cooking and caring for the children. Also they enjoy making clay pots. The young girls start helping their mothers at an early age often carrying their younger siblings on their backs when they can barely do so. The Lhomwe enjoy working together as evidenced by friends and neighbors working together cultivating one another's fields. Religion: The religious leaning of the Lhomwe vary greatly with the degree of penetration of Christianity. The Baptist Union in Mozambique has had a strong influence in areas surrounding its churches. However in general, the Lhomwe are animists who still worship ancestral spirits. Though most Lhomwe would consider themselves Christians, the traditions of the ancestors greatly influence their daily lives. Recent analysis has led to a classification of religion for the Malawi Lhomwe as Traditional Religion. In Mozambique, it is reported that Traditional Religion, Christianity and Islam are found among the Lhomwe. Christianity: Universities Mission to Central Africa began work at Magomero in Southern Malawi in 1861. As the Lhomwe are one of three major ethnic groups in that area, they were among the first to receive a Christian witness in Malawi. Many of the Lhomwe who came into Malawi from Mozambique in the 1930's were Roman Catholic such that the Catholic Church in southeastern Malawi was sometimes called "the
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Lhomwe Church." The section below illustrates the IK that Lhomwes have. The research was conducted in TA Kaduya in Phalombe district. 3.1 IK FOR HIV PREVENTION 3.1.1 Negative Ik for Prevention Mitala (4) Lowe men believe in marrying many wives a behaviour which put one on the risk of contracting HIV. Lowe men can have more than one wife a practice which is very bad in as far as HIV and AIDs prevention is concerned. Traditional Dances (4): Serebwede dance: This is a kind of a traditional dance which is mostly performed by women. They way women dress when performing this dances e.g. showing their breasts off, is considered be an enticing factor for people to indulge themselves in sexual activities. Traditional Dances: Other traditional dances e.g. Serebwede, promote sexual activities due to the way girls dress. The way women dress when performing some traditional dances e.g. Serebwede encourages sexual activities. Women who perform this dance show their breasts and thighs, Traditional Dances (Tchopa): During Tchopa preparation, people take advantage of the preparation period and venue as ideal time to indulge themselves in secret sexual activities more especially men. Initiation Ceremonies (3): Some initiation ceremonies encourage sexual activities. Men are sometimes told to indulge themselves in sexual activities as a way of showing that they are real men. Girls are also told to indulge themselves in sexual activities to avoid being barren. Some initiation ceremonies e.g. Jando promote sexual activities and also use improper materials for circumcision which can easily spread the virus. Kugwa mdothi ceremonies: In these ceremonies, girls are advised to sleep with a man in order to have a smooth body Chokolo (3): This is a practice where a brother marries the wife of a deceased brother. This poses a threat of one contacting HIV virus in a scenario that the spouses were HIV positive. Chokolo: This is a practice where a brother marries the wife of a deceased brother. This poses a threat of one contacting HIV virus in a scenario that the spouses were HIV positive, Some Lhomwe’s still believe in Chokolo: This is a practice where a brother marries a wife whose husband has died but was related to the late husband. This practice is considered a bad practice in such a way that it poses a high risk of transmitting the disease from one person to another. Kulowa fisi (3): Kulowa Fisi: This practise where a family which is failing to bear children hires another man to sleep with the wife, Kulowetsa Fisi: This practise where a family which is failing to bear children hires another man to sleep with the wife. Kusasa fumbi (2): Kusasa Fumbi: This is a practise where Lowe boys are told to indulge themselves in sexual activities with girls once they are released from the initiation ceremony. This is the case because it is believed that once they do this they get cleansed, Kusasa Fumbi: This is a practise where boys are encouraged to have sex with girls whenever they come out of the initiation ceremony. Prohibition of sex talk in marriage (1): The prohibiting of sex talk in marriages: Talking about sex amongst spouses is considered a taboo amongst the Lowe. This leads to unsatisfying of each other in the family which leads to one having many sexual partners. Loose Marriages (1): Loose Marriages: There are no proper procedures which people use to enter into marriage. This makes it easy for men to marry many wives and marry several times as well. Husband borrowing (1): Husband Borrowing: Some women exchange husbands as a way of showing friendship amongst them. The existence of the Mbuyache concept: An uncle makes all decisions for Lowe 103
women including who should get married, to who should the girl get married to. This has in one way or the other promote the spreading of the disease because many women are pushed into marriages which puts them on the risk of marrying people who will not respect them. 3.1.2 Positive IK for Prevention Initiation ceremonies (11): Initiation ceremonies: Kugwa mdothi ceremony (a ceremony for adult women) teaches women to take care of their families. (9), Chimwanamaye: This is a practise where women can exchange husbands for some days as way of showing friendship, Some initiation ceremonies still use the unprotected ways to circumcise boys
Traditional Dances (7): Traditional Dances e.g. Manganje: The songs people sing when performing this dance are aimed at telling people to prevent the disease. (7)
Dressing (3): Dressing: Women are encouraged to dress in a modest manner e.g. putting on Clothes which covers legs and breasts; This includes putting on zitenje, blouses which exposes breasts, their husbands and themselves by dressing well. This promotes fidelity amongst families
Respect and faithfulness (2): Lhomwe women believe in respect and faithfulness to their husbands. This reduces infidelity amongst spouses, having one wife.
Openness (1): Openness amongst spouses
The six months waiting period (1): The six months waiting period: Lhomwe men used to wait for six months without having sex with anyone including their spouse after one’s wife had given birth for fear of killing the newly born baby.
Kusempha Mtundu (1): In the past, there existed a belief amongst the Lhomwe’s that when a man marries in a village and before five years the wife dies due to sexual transmitted diseases e.g. Kanyera, the man was chased from the village as a way of cleansing the community because the man was believed to have polluted the village and the clan. This belief prevented people from having multiple sexual partners for the fear of being chased from the community.
Kulowa Fisi (1): Kulowa Fisi: This practise where a family which is failing to bear children hires another man to sleep with the wife.
Sense of togetherness (1): Sense of togetherness: By believing that Lhomwe’s are one and the same throughout, they protect their beliefs and values in so doing they resist other foreign cultures e.g. modern dressing etc.
Believe in religions (1): Lhomwe’s believe in their religions. Majority of the Lhomwe’s from this area are Christians a denomination which also take a very integral part in as far as issues pertaining to HIV and AIDS prevention are concerned.
Men believe in sleeping with older women (1): Some men believe that by sleeping with older women one can get cured of the disease
3.1.2
Challenges to IK for HIV prevention
Modernity (10): Modernity has dissolved some Lhomwe values and believes. Flexibility of the Lhomwe Culture has led to the loosing of some Lhomwe values and the incorporation of other cultures such as poor dressing amongst Lhomwe girls, going to modern dances and not traditional ones, and not 104
respecting the six months waiting period, considering it out-dated, Traditional dances like Manganje are now seasonal dances and no longer daily dances.
Initiation ceremonies (7): Some initiators advice the children bad things at the initiation ceremonies such as Kusasa fumbi and jando. This has painted a bad picture in as far as initiation ceremonies in the area are concerned hence making people shun away from it.
Circumcision (5) at initiation ceremonies is done unprofessionally and with material which can easily spread the disease. This has made a lot of people to stop going to initiation ceremonies.
Traditional dances (4): People consider traditional dances as mere entertainment functions. Many pay less attention to the message the songs carry, Many people more especially the youth amongst the Lhomwe take advantage of traditional dances functions e.g. tchopa as right places to indulge themselves in sexual activities, Provocative Dancing: The way women dance in some traditional dances e.g. Tchopa, promotes sexual activities., Some traditional dances promote sexual activities due to the way people dress and the way they are prepared. Dances like Tchopa are prepared in such a way that people spend days preparing. Due to this other people take this opportunity to indulge themselves in sexual activities.
People no longer believe in herbs (2): Many people no longer believe in these herbs due to the fact that there exists no evidence as to prove the effectiveness of the herbs, Many NGOs have been doing campaigns to make people stop using local herbs but hence use modern medicine.
Poverty (2): Poverty: Due to poverty, these days’ practices like these can no longer have the influence they used to have because people these days are just after securing a husband who is capable of feeding the family, Poverty has weakened the sense of togetherness amongst the Lhomwe’s up to the extent that Lhomwe’s are failing to protect their beliefs from other foreign beliefs. Culture custodians (1): There exists few cultural custodians to promote some of these believes, Children in the area no longer respect their parent’s advices because they look at them as old fashioned.
3.2
IK FOR HIV TREATMENT
3.2.1 Negative IK for Treatment Polygyny (9): Lhomwe people believe in marrying more than one wife a practise which promotes the spreading of the disease, Mitala: Lhomwe’s believe in having more than one wife. This practise affects treatment in such a way that by having many wives, one risks contacting and also multiplying the virus if one is already HIV positive, Lhomwe men believe in having more than one wife. This is poses a threat to treatment in such a way that if one is infected, there is a risk of infecting other people or contracting more viruses, Other people in the community still believe that AIDS is Kanyera (an old sexually transmitted disease) hence the need to use local means of treating the disease only. (7). Too much beer drinking (5) Religions (2): Some religions prohibit people to go to hospital when they are sick. Other religions also believe in miracle healings, believing in religious healings The malume practise (2): One’s uncle determines who gets treatment and also the time one should receive treatment. When a wife is sick, the husband cannot take the sick wife either to the hospital or anywhere to
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seek treatment unless the uncle says so, there is a belief amongst other Lowe’s that when an HIV positive individual sleeps with a virgin, he can be cured of the disease Tradition Dances (1): Tradition Dances: Tradition dances e.g. Tchopa requires special preparation which can take almost a week. Organisers leave their home and camp where the preparation is taking place. This makes even people to stop their medication (those who are on ARVs). Lack of glove usage (1): Not using gloves when taking care of a patient: Lowe’s believe that a patient must be taken care of in the same way any other person is treated in the community. Due to this, some people do not even use protective material such as gloves when taking care of the sick for fear of being deemed as pompous and selfish. Belief of sleeping with virgins (1): Some believe that by sleeping with a virgin one can get cured 3.2.2
Positive IK for HIV Treatment
Use of herbs (34): Use of nimu leaves (9), Use of Aloe Vera (3), Use of cham’mwamba(5),Use of nampwaphwa tree leaves (1),Use of naphwanga tree leaves (1),Use of mvunguti. (The tree cover is pounded and dried. The powder is put in the porridge of the patient)(1), Use of Jacaranda seeds (1),Use of chambe (1),Use of Masamba a Peyala (2),Use of nkhadzi roots (1), Eating a lot of chisoso( It is believed that the sour taste is very vital in as far as fighting against diseases is concerned)(2),Use of mwanga tree ( The cover ), Use of mpama tree leaves (1), Eating raw ground nuts (1), Eating lot of kalongonda (1) Eating a lot of Bonongwe (1), Use of Mulombwa (1),Use of mwanaphepo tree and leaves Belief in prayer (1): Lhomwe’s believe in praying to gods through practises like namtongwe. Sense of togetherness (1): Sense of togetherness relieves the patient worries hence prolonging one’s life. 3.2.3 Challenging Ik for Treatment De- campaigns by Health NGOs (9): De- campaigns by Health NGOs: Both the government of Malawi and non-governmental organizations have been doing campaigns in the area which are aimed at making people to stop using herbs but instead use modern medicine. They claim that there is no tangible evidence to prove that these herbs really help (9) People no longer believe in herbs with the coming of herbs (5): The coming in of ARVs people no longer believe in local herbs because of the existence of ARVs (5) Scarcity of trees (3): Some of these trees are scarce Herbs have unpleasant smell (2): Most of these herbs have an unpleasant taste (They are bitter), Majority of these herbs have a very unpleasant taste. Other people cannot afford some of these local herbs or medicine e.g. People drink due to poverty Reluctant to use (1): People are now reluctant to use these herbs due to the fact that they are widely considered to be herbs for HIV and AIDS patients. Sense of Togetherness (1): Togetherness is a seasonal thing most of the times it is there during hunger. 3.3
CARE AND SUPPORT
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3.3.1
Negative IK for Care and Support:
Belief that you can contact HIV by interacting with patients (6): There also exists a belief amongst some Lhomwe’s that by contacting with HIV and AIDS patients, one can also contact the disease, There exists a belief amongst Lhomwe’s that AIDS is a curse from the gods. This makes people become reluctant to support AIDS patients (5). Beer drinking (3): Lhomwe’s believe in beer drinking.. Because of this, sick people are not well supported because the care givers prioritise beer to patients. Lhomwe’s believe in drinking beer too much. This poses a threat to sick people due to the fact that care givers are most of the times drunk and also spend a lot of time to drinking places. Polygyny (3): Lhomwe men believe in polygyny: This becomes problematic when one becomes sick. Everyone refuses to take care of the sick pushing the responsibility to the other spouse. Lhomwe’s believe that only women are the ones who should be taking care of the sick. This puts a lot of pressure on women who already have a lot of roles to play in a family e.g. taking care of the children. This in the end leads to poor caring of the sick. Majority of Lhomwe’s believe in Mitala which brings about problems when one becomes sick. Men dump responsibility of patients to women (2): Men easily dump their wives and opt to stay with the one who is not sick. Women also refuse to take care of sick husbands arguing that it is the responsibility of the other wife. Loose marriages (1): Loose marriages: Lhomwe’s lack proper marriage procedures. This makes it easy for people to dump their spouses and marry another person, loose marriages: Lhomwe’s do not have proper marriage procedures. This becomes problematic in such a way that when one falls sick in a family, either a wife of a husband can easily dump the spouse without any fear because there was no proper way which was followed to consider the people a family, this becomes problematic when one becomes sick. Everyone refuses to take care of the sick pushing the responsibility to the other spouse. Belief that AIDS can be contacted when you are promiscuous (1): Believing that AIDS is a disease for promiscuous people make people become reluctant to take care of the sick in the community. 3.3.2
Positive IK for Care and Support
Care and support: Taking care of the sick and the elderly (14): Lhomwe culture encourages people to take care of the sick and the elderly. The belief is that if one pays no attention to vulnerable people in the society, he or she becomes cursed. He or she is going to give birth to an abnormal child or any curse which can bring death or a variety of bad lack to the family of the person who has done it. (14) The existence of Mbumba (3): The existence of Mbumba: There exists a Mbumba belief amongst the Lhomwe’s. This is a believe or a practice where by people from the same lineage live close to each other with the hope of helping each other, The existence of Mbumba: Amongst the Lhomwe’s people from the same blood lineage are considered to be Mbumba. This social unit is headed by a person who most of the times is a man whom the people have trusted to lead them. Mbumba therefore, bears the responsibility of taking care of any family member who is going through difficult times e.g. someone who is sick. Role specification: Amongst the Lhomwe’s there is a concept of role specification in families and even at a Mbumba level. This role specification entails that there already exist people who are responsible to take care of the sick or any other person who is going through tough times. The existence of HBCs (1): Lately, HBCs has been adopted as part of the Lhomwe culture of late. 107
Traditional dances (1): Traditional dances e.g. Namtongwe are performed when one is sick as a way of entertaining the sick but it is also believed to be a prayer to gods to heal the sick individual. 3.3.3
Challenges for Care and support
Poverty (9): Poverty amongst Lhomwe has greatly contributed towards the dissolution of the sense of togetherness amongst the Lhomwe’s. (9) Youth don’t believe in knowledge (1): Many youths amongst Lhomwe culture no longer believe in local knowledge. Lack of practical evidence (1): Lack of practical evidence on some of the mythical believes: There is no practical evidence to some believes e.g. death to people who do not take care of their friends in bad fortune. This has removed the fear people had. Myth about AIDS (1): There is a belief that everyone who suffers from HIV and AIDS is prostitute. This belief makes people become reluctant to help HIV and AIDS patients. Lack of culture custodians (1): The unavailability of culture custodians have contributed negatively towards care and support in such a way that there exists no individuals in the society who can communicate old knowledge on how to take care of the sick. Freedom and Human rights (1): Freedom and Human rights: Freedom fighters have contributed negatively towards role specification amongst Lhomwe. The coming in of CBOs (1): The coming in of CBOs has weakened the communal life amongst the Lhomwe. People these days now depend on the CBOs to take care of the sick in the community and they are very few individuals. Business and work (1): Work and various businesses amongst the Lhomwe’s have weakened the sense of togetherness. Traditional dances (1): There are less people these days that can perform some dances like Namtongwe. 3.4 COMMUNICATING IK The following section presents the Findings on IK Communications 3.4.1 Communicating IK FOR PREVENTION (a) Key holders For All: village chiefs (8), custodians of culture e.g. the elderly and initiators (Anankungwi) they are being trained about HIV prevention Church Elders (7), Azamba (local mid wives) are being trained these days, Community health workers (6), community leaders and committees (5), they attend different trainings pertaining to HIV prevention, They receive a lot of training on prevention), Parents, eni Mbumba (They are considered the top counsellors at a family level and are highly respected), CBOs. For men: community health workers, old people, initiators (anankungwi), village chiefs; For women: agogo, church elders, village community workers: For youth: community health workers, elders, parents VDC, HBC. (b) Key Players For All: village chiefs (7), church elders; community health health workers (6), village organisations e.g. HBCs (5), initiators (2): CBOs (2) ADC, Political Leaders (They command a lot of following), parents, local musicians, radio announcers: For men: Community health workers, church elders, cure custodians, village chiefs: For women:
Village chiefs, Church Pastors, Village health workers; For youth: village chiefs, HBC, VDC. 108
(c) Approaches, Media and Channels For All: Through village meeting such as AIDS opening days ( a lot of people attend to these meetings) (9), Religious groupings (6), through traditional dances e.g. manganje (this dance happens more often and command a large following) (6), through drama, through drama, through drama, door to door, one –to- one, one-to-one (this should be used to target the youth who rarely attend village meetings), at funeral (posonjola: this is a kind of ceremony which happens a day after burial. during this meeting, people talk about a variety of things and a lot of people attend to this ceremony), social functions e.g. weddings, through mass rallies e.g. political rallies, through village courts, through music, through local music, through poems, through poems, through posters, at school. For Men: Religious gatherings, through village meetings, pa mbumba by eni mbumba, by using one-to-one approach, For Women: through drama, through choirs, through poems, in schools, village meetings, at church/ mosques: For Youth: through drama, through choirs, through poems, in schools, village meetings (d) Time and Place For All: after 2 o’ clock ( most people are back from the garden and are free) (5), from June to November (people are free from garden work), July- November (many garden work is done), after harvesting (people are free from gardening activities and food fetching activities, Saturdays ( many people are free), Saturdays (many people are free), Saturday (many people are home and free), Saturdays or Sundays (most people are free), December and January (there are a lot of entertainment hence there is a need to remind people about preventing hive), January (there are a lot of entertainment hence there is a need also to remind people about HIV prevention), anytime. For Women: Saturday morning (people are mostly at home and free), Friday afternoon (it is mostly a half day and people are free), October (many people indulge themselves in various bad activities because of hunger more especially women) For Youth: march (farmers have a lot of money after selling tobacco hence there is a need to remind them about prevention), December (there are a lot of social activities. there is a need to remind people about prevent contacting hive and aids because this is the time when people indulge themselves in various malpractices). 3.4.2 COMMUNICATING IK FOR HIV TREATMENT (a) Key holders of IK for HIV Treatment For All: Health Community Workers, Health workers, Village Health Workers, Community Health workers, Community Health workers, Village Health Workers, Village Health Workers, Traditional Healers (Many people believe in these people), Village Birth Attendants (Azamba), Traditional Healers (Asing’anga), Local healers (Asing’anga), There is no one locally who is knowledgeable about HIV and AIDs treatment, Traditional healers (They are being trained these days and are now very knowledgeable about HIV treatment), Church Elders, ADC, CBOs, Village chiefs, Village birth attendants (Azamba): They are very knowledgeable about HIV and AIDS issues because they are trained, Traditional healers (They know herbs which can be used to treat the disease), HBC volunteers, Village health Workers only For Men: Village Herbal Doctors, Village Chiefs, Community Health Workers, and CBOs For Youth: There exist no knowledgeable persons in the village apart from village health workers (b) Key Players For All: People Living With HIV and AIDS, Traditional Healers, Village chiefs12, Community health Workers, ADC3, Religious leaders, Village Health Workers 6, ( They attend various training pertaining to HIV treatment), Village Church Elders, Culture custodians, Religious leaders, CBOs,, NAPHAM, village community workers. For men: village chiefs, church elders, community health workers, for women: village health workers, village chiefs, and teachers. For the youth: village health workers only 109
(c) Approaches, Media and Channels For All: one -to-one (when it’s done by village health workers), at drinking places, church places, pa mjigo, through drama, through traditional dances, through poems, through initiation ceremonies, public gatherings, through drama, through poems, use of posters, at funerals (posonjola), village meetings, during initiation ceremonies, church elders, through village meetings, through drama, through poems, through traditional dances, religious gatherings, through drama, through music, through village gatherings, through drama, through poems, through music done by local people, through radios, at work places, village meetings, church places, through drama, through poems, For men: through village meetings, at church, door-to-door, at school; for women: through drama, through music, by using local musicians through traditional dances, through village gatherings; for youth: through drama, through music (by using local musicians e.g. Joe gwaladi), through traditional dances, through poems, at school places, at church (d) Time and Place For All: Any time, June – November (People are free from gardening activities), Saturdays (Many people are free), From 2 O’clock in the afternoon (Most people are free), December and January (there are a lot of entertainment hence there is a need to remind people about preventing HIV), Any time of the day and any time of the season, Any day in the morning, April (People have food and free from garden work), Afternoon hours (most people are free), In September, October, December (there a lot of village meetings), Afternoon hours any day, From June to November (Many garden work is done), Any time, There should be no specific times. For men: After 2 O’ Clock, During March (Much garden work is done). For women: From 2 O’clock in the afternoon (Many people are free by this time), every after two months (To avoid making it boring; For Youth: Once every two months (To avoid making the message boring) 3.4.3 COMMUNICATING CARE AND SUPPORT (a) Key holders For All: Community organisations e.g. Teachers Living Positively (TILIPO), traditional leaders (3) e.g. VH, s); Custodians of culture e.g. the elderly. They are also involved in caring for the sick; Health workers (It is their field of expertise); CBOs (They exist to care and support PLWHA), Village chiefs, Community Health Workers(CHWs); HBCs, Women, Old people, Women, Village health workers, Village Health Counsellors, Women ( They are the ones who take care of the sick in the community), Culture Custodians e.g. Old people or Anankungwi (they know the traditional way of taking care of the sick), Church elders, Health Counsellors, Women, Women, Village Health Workers, ADC, Village Chiefs, Village HBCs, VDC, CBOs, Old people, Church Elders, Village Health Workers, For Men: Women, Old people, Village volunteers, Village chiefs For Women: Women (They are the ones who take care of the sick), Community Health Workers (They are knowledgeable about taking care of the sick), Old people (They are mostly home and are very kind and patient people), Pastors (It is part of their job to promote love in the society), Village chiefs (It is part of their job to make sure that sick people more specially AIDS patient are well taken care of and also are not being discriminated).For Youth: Women, VDC, CBOs (b) Key Players
For All: Religious Leaders, Village Chiefs, Community Health workers, Village Chiefs, CBOs, Village Health Workers, Church Elders, VDC, Women, Community Health Workers, Village Chiefs, Women, Old people, Village Chiefs, Local artists e.g. Joe Gwaladi, Community health workers, Women, Culture custodians, Village chiefs, Village health counselors, Village Health Workers, Women, Village Health Workers, Culture Custodians, Village community Workers, Village chiefs, Church Elders, Village Health Workers. For Men: Women, Village Health Workers For Women: Pastors (Many people believe and respect them in the community), 110
Chiefs (They are respected by everyone in the society hence making it easy to communicate with various people in the society), Community Health Workers (People trust these people that they are knowledgeable about HIV and AIDS issues); For Youth: Village Health Workers, Women (d) Approaches, Media and Channels For All: Through Music done by local artists, through drama, through initiation ceremonies e.g. kugwa mdothi (done to girls who are about to get married), through drama, through traditional dances, through poems, through initiation ceremonies, through village groups e.g. youth groups, women groups’ etc, through village meetings, at a bore hole, at church, village meetings, at a bore hole (many women are found in these places), church places, village social functions e.g. weddings, village meetings, through village counselors, through eni mbumba, through initiation ceremonies, through drama, through poems, through village gatherings, face to face, village meetings, through traditional dances, through drama, through local music, village meetings, church places, school places, For Men: Door-to-Door, Through Drama, At village Meetings, Through Music For Women: At church ( Many people belong to various religious groups and they attend services), During Village Meetings( People attend village meetings more especially the ones called by the chief for fear of being labeled as a rude person), Door-to-Door ( Many health related issues in the area are communicated through door-to-door approach and people are used to this), By using local celebrities e.g. Muli (They command a lot of following in the areas), Through Drama (People love drama in the area but also HIV and AIDS messages are considered boring hence making the use of drama one of the best ways of communicating the message), Through Music ( People prefer listening to music most of their times more especially music by local artists) For Youth: At church, During Village Meetings, Door-to-Door, Through Drama, Through Poems (d) Time and Place For All: Any time, Anytime, 9:00 (People are fresh), 1:00 (People find themselves doing nothing), May – November (Many people are free from gardening activities), December and January (There a lot of social functions hence there is a need to remind people not to abandon the sick in the community), Any time of the day, Any day in the afternoon especially from 2 O’clock because many people are free, Any month of the year, Any time but in the afternoon, Any time in the afternoon, During Hunger free months e.g. April, June or July, Any time people are free, Any time, For Men: any time. For Women: Every morning hours (people are at home), From 2 O’clock (Majority of people are home and not doing any work), December, January and April (There are a lot of social activities and entertainment during these months. There is a need to remind people to take care of the sick in their homes instead of enjoying too much). For Youth: There should not be any specific time.
4.0
THE YAO
4.1
BACKGROUND 111
Mangochi is a district rich in cultural sentiments ranging from social, religious, political, economic and all other aspects that are sowed in human societies. The society is complex due to different religious groupings or denominations and such sentiments have different implications on the society. The Yao are dominated by Islam and Christianity follows and the emergence of Pentecostal churches have really brought a social, religious as well as political turn around amongst the Yao. This research was done in TA Mponda in San Mkawa, Mgunda Mapiri, Koche villages. Partners that that also contributed information to this research were SAFAIDS, Save the Children, Manet+, C-Change, Napham, SSDI Com, Manaso, MSF, Dignitas and Unima departments 4.2
IK FOR HIV PREVENTION
4.2.1 Negative IK for Prevention Polygamy (5): This is one of negative traditions that promote the spread of HIV and AIDS. It starts from the traditional leaders themselves. Traditional sexual feasts (4): The traditional sexual feast commonly known as Lyogo- marks the day that boys initiates are getting better and it is an all-night feast comprising of dances and songs. There is a mixture of boy and girl initiates and a sexual feast is expected to be performed. Here, every man goes for a woman of his choice regardless of whether one is married or not. ‘ Initiation ceremonies (4): Messages given to the young initiates at jando and nsondo do not suit them. They are very inappropriate Circumcision (3): Due to lack of proper equipment. Traditional belief that if you undergo circumcision you become immune from acquiring HIV. Labor migration (3) amongst the Yao men and now women are getting involved. Labor migration, Labor migration, Religious beliefs (2): Religious beliefs such as ‘matarasimu’ are one negative IK and these involve the cursing of an individual through the official Muslim writing that spells a bad omen on individuals. Religious cerebrations such as Eid-Ul-Fitr and Christmas promote unruly behavior Traditional dances (2): Mjiri – traditional dance that involve ladies and gentlemen and it leads to promiscuous behavior. M’bwiza- a dance that involve both males and females and mainly done in the evening and promotes untidy sexual activities. Kusasa fumbi: This is performed by the young initiates so as to show their manhood after coming out of the ‘ndagala’ initiation rite. Namchisamchisa: All-night celebration that marks a week before the initiates come out of jando where different activities take place including sexual related ones Kulowa fisi as sexual feast during the time where a man is assigned to a woman whose husband is infertile and not able to make her pregnant. Unfaithfulness within the married couples. Excessive alcohol consumption Prostitution is high among the Yao and this promotes high number of HIV cases in the district. 4.2.1 Positive IK for HIV Prevention Circumcision (10): They cited circumcision as one of the cultural activity which could help in the HIV prevention. Traditional dances (7): such as Likwata , a Yao traditional dance for women, contains HIV prevention related messages. Mchomanga (a Yao traditional dance). Mjiri – a traditional dance involving both males and females. Beni – traditional Yao dance Msondo (6): Girls initiation Litiwo (4) counsel given to young ladies before getting into marriage where they are told dos and don’ts for the sake of their marriages. 112
Obedience and respect among the youth (2): Amongst the Yao, the youths are expected to heed the counsel of their parents. Respect and decency amongst the Yao youths. Religion (2): Religion – Muslim largely acculturated in the Yao traditions and beliefs Use of herbal medicine (2) Woman isolation: a woman is isolated from her husband who cannot handle the pressure of waiting for her to heal after giving birth Magical traps: Snare or trap (a woman is magically trapped by a husband who goes away for a long time so that the woman should not be engaged in sexual activities with other men. It is believed that the man and the woman may get locked or stuck to each other after the sex. Counselling : Counseling from the elderly to the younger generation
4.2.3 Challenges for Care and support IK does not allow the intervention of medical examiners for the circumcised (9): The traditional circumcision does not allow medical intervention in the examination of the circumcised individuals to find out whether the traditional way of doing it is effective in the prevention of the pandemic. Initiations involve infants who don’t understand messages associated with it (7): Girls and Boys initiations involve infants who can hardly understand the messages they get from there and often times the messages are inappropriate. Consequently, youths behave recklessly. Acculturation and westernization (2): It was reported that acculturation is one major challenge that is bringing traditions, customs, norms and beliefs in this district down. Westernization has really hit our youths and this has brought unruly behavior among them Culture degradation (2): Degradation of our culture. The youth are copying outside cultural traditions hence the degradation of their own. Human rights are a challenge (2): The rising and emergence of human rights organizations is a very big challenge. The teachings of different organizations are bringing confusion. The elderly being accused of witchcraft (1): The elderly who are the pillars of traditions and beliefs are being accused of witchcraft hence they refrain from giving good counsel to the youths Youth regard fork-telling as archaic (1): Those who were folk-tellers are gone and the talent of folktelling is lost since the youth regard the talent as archaic. Litiwo is phasing out (1): Those who were involved in initiating young women in litiwo are no longer alive and the tradition is fast dying out. Youth do not heed to counseling (1): Good counseling is no longer being taken seriously since the youths have become corrupted by the outside world Discrimination against women (1): The snare/trap is gender discriminatory since women are always the victims. Unfaithfulness (1): Young spouses are left with no choice but to have other sexual partners if their spouses stay for long in SA. Polygamy (1): Polygamous marriages. 4.3
IK FOR HIV TREATMENT
4.3.2
Negative IK for HIV Treatment
Polygyny 5): This is helping the disease to spread further and it is blocking the effort for HIV and AIDS treatment. Polygamous couples stress each other and if they are on treatment the effectiveness cannot be the same. In the polygamy, when a husband or wife has the virus, there is likeliness that a second wife may leave the relationship or may start cheating. Usually, the one living with HIV and AIDS is stigmatized or sidelined and the treatment gets ineffective.
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Unfaithfulness and Promiscuity (4): Prescribed medicine is not taken on daily basis due to other traditional beliefs as such treatment becomes inefficient. Unfaithfulness amongst the Yao is rising and those on ART are in danger of acquiring more viruses from their unfaithful partners. The tendency of promiscuity due to poverty is rampant among the Yao and it leads to more HIV untreated cases. Promiscuity leading to unfaithfulness and those on treatment does not follow medical rules instead they keep sleeping around.
Excessive alcohol consumption (2) among the youth has become a negative norm and tradition that hinders treatment of those on ART Unprofessional ways of circumcising people (1). Labor migration (1): While on ART, some people go outside the country to work and suspend the treatment. Impatience with the sick (1): A tendency of being impatient with the sick that lead to stress hence the medication cannot be effective. Ignorance (1): Sick people over dose themselves to fasten the treatment Restricted foods(1): There is some food variety that may help infected persons they are not accepted among some Yao of Muslim faith Lack of knowledge for herbal medicine (1) on how to prepare herbal medicine. Discrimination (1).If you participate in HIV and AIDS issues, you are likely to be discriminated against and taking the treatment is not effective. Male superiority (1): There is a belief amongst the Yao according to the Napham Operations Manager that give men an upper hand in decision making and women are subjected to all what men decide. Women are not allowed to decide on health issues about the whole family and it is only men who decide whether the couple should go for an HIV testing or not. Youth don’t understand women (1): The tradition of understanding the condition of a woman whether she is in the mood of having intercourse is no longer there hence the youth are finding themselves in trouble Too much protocol in preparing initiates (1): There is too much authority and protocol towards the preparation for the initiates –ndowa Initiators demand money from initiate (1): Those who initiate young ladies in litiwo demand a lot of money and this scare would be initiates from undergoing the tradition
4.3.3 Positive IK for Treatment Use of herbal and traditional medicine (6): Traditional medicine has been and is still popular and effective among the Yao communities. This is done by traditional herbalists Prayers (5): Prayers play an important part in HIV and AIDS treatment, though this depends on an individual’s faith.(5) Providing balanced meals (2): Provision of balanced diet that improves immunity, provision of herbal drugs or medicine as well as community life amongst the Yao that may help reduce stress experienced by those who are suffering from the pandemic. Taking the sick to the hospital (2): Guardians help the sick finish their medication as well as providing them with proper food and taking the sick to the hospital. Restriction of sexual activities during menstruation (2): A man is not allowed into his wife when she is menstruating .A woman wears a red cloth symbolizing that she is not in a position to have intercourse with her husband Traditional dances (1): Traditional dances that carry messages of the goodness of finishing ARV treatment. 114
Moral support (1): Moral support is traditionally known among the Yao communities and this helps in the treatment of HIV and AIDS Community provides support Litiwo initiation gives young women to get counsel so they should be given words of wisdom on how to take care of themselves and their spouses Religious ceremonies (1): Ndowa religious ceremony equivalent to litiwo where young women are advised what they are supposed to do when they enter into marriage No treatment except for abstinence (1): The respondent strongly suggested that HIV and AIDS is a disease sent by God and there is no way there could be any treatment unless people refrain from their wrong doing
4.3.4 Challenges to IK for HIV Treatment Herbal medicine phasing out (6): Herbal medicine is becoming unpopular, unprofessional, lacks hygienic measures, and may lead to over dosage. Lack of faith in prayers (2): Prayers need faith which is a difficult thing to have for people living with the virus. Poverty (2): Economic status is a big challenge to the people in rural areas where HIV and AIDS is growing very fast. Poverty is one major factor hindering HIV treatment hence polygamy is tolerated Religious tensions (2): Religious tension is becoming a challenge towards issues to do with HIV and AIDS treatment. There is always tension between faith based organizations and those who believe in traditional medicine. Both sides do not tolerate to be underrated and this does not help those who are need of support from either sides Religious leaders mislead patients not all prayers are effective and people living with the virus start the ART very late because their religious leaders might have told them they are healed completely. Lack of balanced meals because of poverty Lack of knowledge on herbal medicine in recent generation Delays in taking the sick to the hospital (1) since the herbalists believe they can treat those suffering from HIV Religious beliefs (1)that stop sick people from going to the hospital or taking medication by saying prayer is the only solution.. Stigma and discrimination (1): Communities are the one bringing stigma and discrimination Sexual activities hinder patients from getting better (1): Among the Yao men are said to be sexually proactive and this could hinder those on ART getting better. Illiteracy (1): Lack of knowledge or illiteracy among many Yaos is another challenge Patients disregard advice (1): Those living with the virus do not take advise to refrain from promiscuity despite the fact that they are on ART Long distances to health facility (1): Hospitals are far away and it becomes a challenge for people to access proper medication. Fake herbal medicine (1): Environmental degradation leads to fake herbal medicine 4.4
IK FOR CARE AND SUPPORT
4.4.1
Negative IK for Care and Support
Discrimination (3): In the early years of the disease, people were discriminatory and stigma was present Discrimination is becoming the order of the day among the Yao communities. Sick people are discriminated against in development activities because they are living with the virus. Polygamy (polygyny) (2): This leads to abandonment of the infected spouse and to go to live with other women including prostitutes
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Delays in taking patients to the hospital (2): The sick person is not taken to the hospital for HIV testing in good time. Instead traditional healers are invited to cast out the bad spell. Sick persons are taken to the hospital when the condition worsens. Use of foreign language: The tradition of faith based organizations of using foreign language does not have or have less effect on the sick people. Traditional beliefs which hold that when someone is sick, it is caused by some relatives who bewitch others due to jealousy. Stereotyping the sick: Sharing is becoming a problem. PLWHA find it tough to find resources to help themselves and some who have plenty stereotype the sick people
4.4.2 Positive IK for are and support Provision of balanced meals (6): Provision of proper and balanced diet food, regardless the fact that someone is living with the virus. Taking patients to the hospital (5): There is love and harmony amongst the Yao communities. When an individual is sick, they rush with the person to the hospital. Sick people are taken to the hospitals as well as traditional medicine practitioners. Spirit of togetherness (4): A sick person among the Yao is perceived to be someone in need of community assistance through the provision of physical, mental as well as financial support. Social cohesion is popular among the Yao communities and communal life is a strong tradition. This includes looking after the sick and vulnerable people. It was reported that the Yao are passionate people who come together in times of happiness and sorrow Provision of mental, moral and physical support (4): There is love and understanding amongst the Yao. Provision of moral, psychological and material support is common and emphasized in the Muslim religion which is common among the Yao. Praying for the sick (2): Yao communities believe in community prayers to be effective in times of sicknesses or any calamity. Prayers become part of the psycho-social support. Three quarters of the Yao communities are Muslim and they are known for being prayerful Looking after patients (2): Patiently looking after sick people and listening to their part of the story. Being close to the sick and talk about cheerful stories make them feel loved Care from herbalists (2): Herbalists support and care for the infected patients through the provision of shelter. The Yao are supportive: The Yao are always supportive to those who are sick and there are no records during my chieftaincy about any tradition that is negative towards the caring and supporting for the sick. Eating together with patients without any stigma Encouragement from friends: The patients take courage in all the encouragements from their friends and this includes the common words that being HIV+ is not the end of it all Discouragement of stigma: Discrimination and stigma is not encouraged among the Yao communities Litiwo women’s’ counsel prior to getting into marriage or during first pregnancy includes advice on care for patients Women giving counsel to the husband: A woman is a custodian of most of the traditions hence she is better placed to give counsel to the husband about sick condition 4.4.3
Challenges to IK for Care and Support
Frustrated guardians (4): Guardians become frustrated when the sick are not following orders from doctors on their prescribed medicine, when the sick become angry and speak ill words, when the sick are not following orders from doctors on their prescribed medicine, when after staying in the hospitals for longer periods more especially when the sick become angry and speak ill words. Lack of balanced meals (3) is another major challenge. Food scarcity – fish is no longer available as it used to be – and this has been why sick people are not well cared for
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Lack of knowledge and resources for caring for the sick (2): Lack of proper equipment, resources and knowledge, leave care givers in danger of contracting the virus. Lack of proper materials and equipment to take good care of the sick Poverty (2) makes care givers unable to provide proper diet to the sick. Traditional beliefs (2) that if one is sick it is a result of witchcraft and patients are left unattended or are taken to witchdoctors instead of hospitals for proper care and support. Traditional belief that uncles should be the last person to decide whether the sick should be taken to the hospital or not Denial: Guardians and patients alike are living in denial instead of accepting that their loved ones are suffering from the disease. Isolating the sick: Some community members become unwilling to help ailing people, lack of resources as well as the fear that one could become infected through any contact during the time of caring for the sick person. Discrimination: Some people still discriminate towards PLWHA Lack of proper messages: Lack of proper messages to be given to the sick Stress among the sick: Stress is becoming too much for the sick due to other traditions and the sick may end up being helpless and hopeless Restrictions to administer herbal medicine: Medical personnel does not allow guardians to administer herbal medicine to the sick while in hospitals Delays in taking the sick to the hospital: Some take time to take the sick to the hospital Male superiority in society : Traditionally, men have more power that women and they are allowed to do anything without taking into consideration whether the wife is sick or not Religious beliefs: Religious beliefs have taken over and litiwo is no longer being practiced Westernization and Integration of IK: There is an integration of IK and some elements of western life have become a tradition amongst the Yao youth and this has caused negative perception towards spirit of communal care and support. People disassociate with old ways of giving counsel: They are ashamed of being associated with old ways of giving counsel to young couples. Lack of trust in herbalists: Herbalists have gone commercial and they are no longer gaining the trust form community members Labor migration : Labor migration and ignorance on how exactly HIV can be contracted
4.5 COMMUNICATING IK 4.5.1 Communicating IK for HIV Prevention (a) Key holders For All: Religious leaders such as Sheikhs and pastors (7), traditional leaders (8) such a TAs, GVHs, VHs (6); initiation counselors (5), politicians(2), prominent figures of the development committees (2), head of the clan such as uncles, the elderly, herbalists(3) TBAs (2) traditional musicians. For Men: Medical personnel, faith based leaders, CBOs, for women – traditional leaders, faith based leaders, CBOs, women’s groups. For youth - traditional leaders, TBA, Youth to youth counseling (mchanda ni Mchanda), faith based leaders, Key informants such as the elderly, CBOs, health workers. (b) Key players For all: CBOs (6), Development committees (6)- ADC, VDC; religious leaders (6), government ministries(2) TAs (3); civil society organizations(2), the elderly and folk tellers(2); initiation counselors (3), herbalists (2); THs (3); TBAs; HSAs(3); youth groups; For men - TAs, faith based leaders, health workers. For women traditional leaders, family members, health workers. For youth-HSAs, CBOs TBAs youth clubs. (c) Approaches, Media and Channels For all: church services, hymns and dances with messages relating to HIV and AIDS (6), funerals (3), VDC (3) meetings, development gatherings and meetings (3), one-on-one conversations, verbal approaches by the 117
villages during any of their meetings with the communities; initiation and cultural ceremonies (2) since they pull large crowds; traditional dances and ceremonies with messages concerning HIV and AIDS and related issues; drama, leaflets, political rallies, night criers. For men: Traditional dances with HIV and AIDS messages; drama; one-on-one conversations; debates: For Women: Drama, traditional music, one-on-one conversation, religious sermons. For Youth: Drama, Poems and songs with HIV and AIDS messages, door to door visits, one-on-one conversations, Sporting activities. (d) Time and Place For all: any time according to the communities’ schedule i.e. during initiation ceremonies, cultivation season, prayer sessions that will help tackle the issues to do with HIV and AIDS prevention on daily basis, Funerals; people should be told about the cause of the death and through prayer gatherings, Most of the times such as community meetings are done at the headquarters of the T.A and mostly in the afternoon. For men-any time depending on the occasion. For women - any time according to what is happening on a particular time and place. For youth-any time according to the purpose of the gathering to the right audience. 4.5.1 COMMUNICATING IK FOR HIV TREATMENT (a) Key holders For all – CBOs who are always in contact with all issues to do with HIV and AIDS at community level (6), development committees (7); THs (10); healthy workers(3); The elderly who are experienced in herbal medicine, herbalists(3); traditional leaders; TBA(); teachers and initiation counselors. For men: Health workers, traditional leaders, faith based leaders, political leaders and CBOs: For Women: Health workers, CBOs: For Youth: Health workers, TBAs, THs, CBOs, youth groups, traditional leaders (b) Key players For All: CBOs(9), ADCs, VDC(3), healthy workers (6), religious leaders/faith based leaders (4); partners such as dignities, PSI Malawi and other health providers, traditional authority counselors, T.A.(2), counselors(2), village head (3), herbalists (2), TBAs (2), initiation counselors (2) , teachers, (2), uncles and aunties through talking with their nieces and nephews. For men: health workers, CBOs, traditional leaders, counselors, family members. For women –TA, traditional counselors, CBOs, For Youth -youth organizations, CBOs, health workers, traditional leaders, and faith based organizations. (c) Approaches, Media and Channels For all: Drama(3) plays on a local level, traditional dances and music(2) such as beni, likwata, and even during the time when the new initiates are coming out; distribution of leaflets; through the use of pictures, mega phones, community groups (involving those infected so to let them share various experiences). Through poetry (2), preaching, church gatherings, mosque gatherings, folk-telling (2), folk-telling, night criers, Area ADC and VDC meetings; CBOs meetings; one-on-one conversation. For men: Traditional music, folktelling, preaching during faith based gatherings, drama, sporting activities. For women: drama, traditional music, poetry: For youth - youth through sporting activities, preaching and other religious gatherings, health meetings (d) Time and Place For all: Throughout the year since healthy workers do not have a specific time they are expected to respond to healthy issues, Any time that suits the occasion and event. E.g. the village counselors could say a word about HIV and AIDS during development meetings and gatherings, Any time and place that will suit their occasion or event, Any time depending on the schedule, Any time depending on the message and the audience, During community health gatherings, community development gatherings as well as religious gatherings, During community health gatherings, community development gatherings as well as religious 118
gatherings. For men - any time depending on what is happening; For women: - any time according to the event and audience at a particular place; For youth: - any time and place that may suit the occasion 4.5.2
COMMUNICATING CARE AND SUPPORT
(a) Key holders For All: Traditional leaders (6), community faith groups (5); CBOs(5), ADC(6), VDCs(2), HSAs; community support groups(2); Uncle or someone who is responsible for the welfare of the clan; the elderly (2); community birth attendants (2); TBA(4); THs(2), traditional healers/herbalists(3), sorcerers(2). For men Family members, THs and health workers. For women: health workers, TAs, CBOs. For youth -family members, traditional leaders, religious leaders, CBOs. (b) Key players For all CBOs (7), ADC (5), HSA(2), health workers, health development partners PSI Malawi, Dignitas, faith-based organizations(3), community leaders, community counselors, VDCs(3),Village Community counselors, traditional herbalists, TBA(3). For Men: C.BOs, ADC, VDC, HSAs. For Women - CBOs, health workers, traditional counselors: For youth - health workers, CBOs, religious leaders, traditional leaders, and youth clubs (c) Approaches, Media and Channels For all: Traditional drama (7), traditional poetry on HIV and AIDS messages (5), story- telling, folk-telling(2), faith based gatherings(7), initiation counseling, music with HIV care and support messages(4), development gatherings(3), health committees meetings, music with HIV care and support messages, night criers(3), traditional drama, One-on-one conversations, initiation ceremonies(2). For Men: drama, initiations rites, community development meetings, community health committees, poetry, story- telling. For Women: drama, poetry, sporting activities, traditional music. For youth - traditional music with HIV and AIDS support and care messages, drama, poems, ADC meetings, religious meetings. (d) Time and Place For all: Throughout the year, any time depending on the message and the audience (3), Any time that suits the function, schedule, and nature of communication, during religious meetings, cultural meetings as well as area development committees. For men: - any time depending on the nature of the audience: For women:any time and place depending on the purpose of the occasion. For youth: any time depending on the purpose of the occasion.
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5.0
THE NGONI CULTURE
5.1 BACKGROUND The Ngoni, originally known as the Ngoni, emigrated from South Africa and changed their name from Ngoni to Ngoni after crossing the Zambezi River. Currently, Ngoni people are found in the northern (called Tumbuka Ngoni in this report), central and southern regions of Malawi. There are two basic groups of the Ngoni, the northern Ngoni known as the Jere, currently being led by Inkosi ya Makosi M’mbelwa and the central and southern Ngoni popularly known as the Maseko Ngoni. Within the three regions the Ngoni people are geographically distributed as follows: Jere Ngoni of Mzimba under paramount chief M’Mbelwa; Jere Ngoni under Zulu and Mlonyeni in Mchinji; Maseko Ngoni of Dedza under Paramount Chief Kachindamoto and Kachere: Maseko Ngoni of Ntcheu under Inkosi ya Makosi Gomani: Maseko Ngoni of Thyolo under Paramount Chief bumble: Maseko Ngoni under Masula in Lilongwe; Maseko Ngoni under Simoni Likongwe in Neno; Maseko Ngoni in TA Kanduku in Mwanza. This research focused on the Maseko Ngoni in Ntcheu district under Inkosi ya Makosi Gomani. Traditional Authority Njolomole was identified as being one of the areas rich in Ngoni culture and convenient to the study. In the area of TA Njolomole, focused group discussions were conducted with 8 Area development committee members, a group of 5 elder men, a group of 5 elder women and a group of 6 youths comprised of 4 boys and 2 girls. Amongst the key informant interviews (KII) were TA Njolomole, one GHV. The following are the finding research has managed to unearth cultural practices among the Ngoni that may help in HIV prevention, treatment, and care and support. The study also revealed some underground practices among the Ngoni that may spread HIV and interfere with employing cultural approaches in HIV Prevention, treatment, and care and support for PLWHA. 5.2.1. Negative IK for prevention Beer drinking (10): Beer plus a woman by your side, people fail to use a condom when they are drunk, Beer drinking is part of the Ngoni culture. (Beer and women) Kulowa fisi (Letting a hyena come to the family) (8): In a family when they do not have a child (chiwiya) they consider getting another man (Fisi) to impregnate the woman, (8) Chidyerano (6): chidyerano / chimwanamaye – two families that are friends go out for a sex spree by exchange wives or husbands. They cook special beer for the two families and once they are drunk they do exchange the wives for a night, (chidyerano / chimwanamaye 6) Longer periods at funerals (6): Women were supposed to spend a month at a funeral house as husbands were allowed to go back to their respective homes. Some men took advantage of this period and to have sex with other sexual partners, When there is a funeral women stay at the funeral house for a month which result in men begin looking for sex from other women and girls from other villages and others go to bottle stores to get their bodies relieved by sex workers (kukhuza maliro 5). Kudika Mimba (6): kudika mimba – No sex after the woman is 6 months pregnant. Kudika chikuta – No sex for 6 months after the woman has given birth (mimba and chikuta means 9 months of no sex), (kudikira mimba or chikuta 6).
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Mchenzo (6): During wedding ceremonies, youths do not sleep in their parents’ homes as they spend a night dancing and drinking beer in a pre-wedding day celebrations. Most youths and even men and women use the mchezo as meeting points with sexual partners, (Mchenzo 6). Bulangete la Mfumu (5): Bulangete la Mfumu – when a Traditional Authority or GVH has gone to a village to settle disputes he is given a girl or woman to cook for him and sleep with him over night (mfumu singagone yokha), (bulangete la mfumu 5) Polygyny (5): Ngoni people believe in Mitala – having more than one wife. Having more wives is a symbol of being a real Ngoni. (Mitala 5) Kolowetsa dzuwa (1): kolowetsa dzuwa – girls go to the river to prepare themselves for marriages through genital mutilation where they handle each other private parts, fluids and blood without any gloves. Zizimba (1): Zizimba - Women end up sleeping with Asing’anga as a solution to barrenness in their families. Kusasa fumbi ; kusasa fumbi – in the past years but now things have changed people are no longer doing this practice 5.2.2. Positive IK for HIV prevention Advice from elders (35): Boys were told by their parents and elders that girls amaluma and amaotcha. (Akazi amaotcha 5), Both boys and girls were told to fear each other by saying amuna amaluma and akazi amaotcha, (Amuna ndi zilombo (5), As Ngoni we do have special advise to a boy and girl when getting married on how they can satisfy each other in bed to avoid the other partner seeking extra marital sex partners, (Mlango for both boys and girls (5), As Ngoni people we have songs that talks about abstainance and prevention sexually transmitted diseases ; that includes HIV and AIDS, (Ngoni Songs for prevention 8), Girls were taught that if a man touches her briests her mum would die, (Amuna mzilombo 6), Youth were told that if they sleep with a man or woman before mariage their parents would die. This was to let the youths abstain and only start having sex when they get married, (Chinamwali for both 5), Boys and girls used to stay away from each other as girls were told that amuna ndi zilombo amaluma and boys were told that akazi amaotcha or amapana. Initiation ceremonies (12): Chinamwali – advising girls that they should stay away from men saying men aare ruthless animals (ndi dzilombo), (Chinamwalli 5), When a girl has come of age she is told not to have sex before marriage or else risk killing her parents by doing so, (mlango for girls7). Use of objects to satisfying sexula desires (5): Men using Mpolowoni so satisfy their sexual desires when ever they are not with their wives. mpolowoni is an indiginous tree which men carry with them when they go out of their homes for bussiness trips or to see relatives and friends. (mpolowoni 4), Njulira – a way of having oral and non penetrative sex among the Ngoni, there is a lot of caresing for the man and woman then the man will put his penis along the thighs of the woman until he releases semen. Mostly used when the wife is expecting or has just given birth. Break from sex (3): When a woman has given birth they are not supposed to have sex for 6 months but the man is not supposed to have sex with another woman because ammusempha mwana obadwayo hence the child can have stunted growth or even die, (msempha 2), When a man has sex outside mariage after the woman has given birth, amamusempha mwana obadwayo. The child would grow stentedly and at times the child may even die.
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Games (1): Men used to play games like fuwa which is like bawo with 32 holes and can be played by not less than 10 people at a time and one game takes more than a day to end. Men were busy with this game during the afternoon and evening hours hence no time to go and meet extra mariatal sex partners. Kulowa kufa (1): kulowa kufa, fisi and kusasa fumbi – but now it is no longer in practice unless it is being done behind our knowledge as chiefs. Longer periods at funerals (1): Women stay for a month at a funeral house before they go to their respective houses hence some husbands go to beer centers to look for sex workers or go to other villages to meet other sex partners. Togetherness (1): In typical villages rich in Ngoni culture they do eat together at limana level. This time was used (or is used if it it still prcacticed in some areas) is used to advise the youth. But also by eating together as a village it helped in checking the where abouts of some men and women who could snick out of the eating and chatting sessions for sex with other sexual partners. Dresing (1): Mavalidwe a Chingoni – women used to wear nyanda (it was made from chikopa) and men used to wear Njobo (kuboola chinkho ndikuvala). Men were always taking with them the Chishango and whenever the woman bends or nill down the man was supposed to put the chishango behind the woman to avoid other men from being rustful over her. Use of sex objects (1): Women were using chiguli (maize cob) – they cook iti mmafuta a msatsi for it to soften then they cook it in porridge (la ufa) to make it sleepery and they take it back into mafuta amsatsi and then it is ready to be used by the woman to satisfy her libido (sexual desire) when the man is away. Tarditional songs (1): Nyimbo za chingoni:Usamayenda ndi usiku koma usana Udakwata mkazi wa chindoko. 5.2.3. Challenges to HIV Prevention Education (7): Education – our education at primary and secondary schools provide for actual information on sex and child bearing hence we can no longer tell the youths that mkazi amotcha or that men and women are the same in bed, In schools today youths are being taught plainly about sex, (Education 7). Religion (6): Religion – there are a number of traditional practices that are not acceptable by our religion like chinamwali cha ku mtsinje, (Religion and Tradition practices 6). Migration (6): Coming of people from other cultures, getting married and getting settled in our area. They do not abide to our culture such that even their children do not inherit Ngoni cultural practices, (inter marriegies 6). Youth do not listen to advice (6): People especially youth respond to advice by saying AIDS inabwerera anthu, Youths say life has changed hence they cannot abide to our advice saying ndi zakalekale, Youths consider advice from parents as old fashion ideas (zakalekale) that can not be applied in these so called modern years or life, (Advice is old fashion 5). Individualism (2): Life style has changed. People no longer eat together as a village, Some say they don’t want to seat together in the community for fear of being be-witched
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Drasing (1): Today’s dressing where by girls put on miniskirts and tight trousers resulting in men failing to be faithful to their wives or partners. Knowledge about sex (1): The interaction between boys and girls has changed alongside their knowledge on sex so you can no longer tell boys that akazi amaotcha or tell girls that amuna ndi dzilombo. District officials and partners (1): District officials and partners working in the district are not aware of most of the cultural practices as community leaders and custodians of culture do not open up on cultural beliefs and practices happening in their areas. It becomes difficult to use culture in disseminating HIV messages and also to advocate for a stop in cultural practices that are fueling the spread of HIV. 5.3. IK FOR HIV TREATMENT 5.3.1 Negative IK for HIV Treatment Beer drinking (8): Excessive beer drinking interferes with taking of ARVs on daily basis as others forget but also with the beer medication does not work well and people experience more side effects such as swollen face. (Mankhwala sakumagwira bwino ntchito mthupi chifukwa lidapipima ndi mowa), Beer drinking among the Ngoni which result in people forgetting to take ARVs which is leading to poor adherence and they do not use condoms when drunk. Women are main victims as men and even youths have sex with them taking advantage of their drunkenness, (Beer and ARVs 8). Religion (7): There are some religions with ethics that force people to stop ARVs and have faith in the words of their leaders that they will be healed of HIV and AIDS, (Religious beliefs 7) Polygyny (6): Having more than one wife Business People forget to take with them the ARVs when going to different markets to sell farm produce or do business other business Men shun hospital medication (1): Some men do not go to hospital for medication when they test positive because of a perception that they will not marry other wives when people realize that they are HIV positive. Belief in traditional medicine (1): Belief in traditional medicine others stop taking ARVs and replace it with traditional medicine. People do not open up for HIV status (1): Unmarried women and men do not open up on their HIV status or some do not take ARVs saying they want to get married first.
5.3.2 Positive IK for treatment
Pandemic: Respondents could not identify any positive IK that could help in HIV and AIDS treatment arguing that the disease (pandemic) has no cure and that the community does not have any knowledge on how to treat the disease. Nursing patients: Kudika matenda – Ngoni people are fond of using traditional medicine (zitsamba) alongside hospital medication, mostly on TB treatment and ARVs, Using traditional herbs as treatment for opportunistic infections and immunity boosters i.e. aloe vera, cham’mwamba, masamba agwafa, ntangala za malambe Use of herbs (1): Using traditional herbs alongside hospital medication, mostly on TB treatment and ARVs
AIDS has no cure He argued that HIV and AIDS has no cure so there is nothing traditionally that can heal like traditional medicine or church prayers.
Prayers (1): praying to God for good health and treatment.
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Urine drinking: Drinking your own urine alongside ARVs as part of the treatment, Having unprotected sex when drunk yet they are told not to have sex without condom to avoid infecting others and reinfection, (Beer drinking 5).
People do not finish medication (1): Others when they regain health status they stop drinking ARVs thinking that they have been healed.
5.3.3Challenges to treatment Fake prophets (6): The coming in of self acclaimed pastors and prophets who ask people to stop taking ARVs so that they join their ministries and they will be healed of HIV and AIDS, (Pastors and traditional doctors 6). People believe in herbs (5): Some people consider the herbs or immune boosters like cham’mwamba and dululu as treatment and they stop taking ARVs and going to hospital when they are sick, (Use of Tradition herbs 5). Lack of faith : Lack of faith in God People make fun of ARVs : People make fun of those who are on ARVs whenever they have healthy bodies. People stop ARVs when they get well: Some people stop taking ARVs once their body has reacted positively to the immune boosters. Some assume that they have been healed whilst others opt for taking the immune boosters only. Kuyamikilidwa (1): kuyamikilidwa i.e. mwanenepatu. Some people get carried away with comments like ‘ma ARV akuyanjani’ and stop taking ARVs. 5.4 IK FOR CARE AND SUPPORT 5.4.1 Negative Care and Support
Beer drinking (11): Beer – Some guardians and relatives do not have time to take care of the sick and remind the patient to take ARVs hence no adherence to treatment. They patronize beer joints on daily basis, (Beer drinking 11). Polygyny (8): misika (business) among the Ngoni. People go to markets and bus depots to sell farm produce leaving behind a sick person with nobody to look after him or her, (misika 7), Men have more than one wife hence they cannot manage to take care of all the wives by providing basic needs in terms of proper nutrition, housing and beddings that facilitate good care and support for people living with HIV.
Church massages (5): The way how some people preach in church depicting those with HIV and AIDS as sinners. (Church massages 5).
Discrimination (1): Saying discriminatory remarks about people with HIV when receiving coupons and at drinking joints.
5.4.2 Positive IK among the Ngoni. Care and support. Sense of togetherness (27): Ngoni people live as one hence when one is sick others are supposed to bring forward food for the sick that is at hospital are at home. We also share what you have with others who do not have like farm produce, animals like chickens or even goats, (care for the sick 7), Ngoni people live and eat malimana (groups) within their respective villages headed by mkulu wa limana otherwise known as mkulu wa banja, Taking care of one another at limana level, (limana or groups 9), lijaja – In those days we had a place in the village where all men were converging at one designated place for lunch and supper. Women would bring food to the Lijaja where men were seated together making hoes, baskets and mphasa. (lijaja 6), Ngoni people 124
believe in unity and caring for each other as one family. Within their respective villages they do have sub groups headed by mkulu wa banja who looks after the welfare of all families under him such that chiefs work in the villages through these akulu a banja. Within these sub groups they take care of each other i.e. bringing together food to a sick person which helps those taking ARVs that they cannot sleep on an empty stomach, Ngoni people take care of each other as one family. (Unity 5). Farming (6): Ngoni people are hard working in farming hence they do have staple food, fruits and vegetables. They also rear animals like hares, chickens, goats and cattle. (Farming 6). Women look after the sick (1): Women are on the forefront taking care of the sick as stipulated by the Ngoni culture. 5.5 Challenges Care and support Modernization and individualism (7) which have brought individualism as people now eat with their immediate family members at a table in their respective houses. People no longer care about what their other family members of friends will eat whether they have food or not (urbanization). (Modernization and individualism . People do not disclose their status: People are not op Beer drinking): Beer - Failing to take care of family members as elderly people in the family go for beer every afternoon when they are back from farms and they come back at night. Discrimination: There are still some elements of discrimination i.e. some say ‘chokani akachilombo inu’ 5.6 COMMUNICATING IK 5.6.1 PREVENTION (A) Key holders For all: traditional leaders as custodians of culture, traditional counselors, (6) traditional doctors - Religious Leaders (5, Head of family group (6); health workers like HAS (5), Chairpersons of markets or business areas, (CBOs (7), (youth club 6), ADC members, community role models (Azibambo ndi azimayi achitsanzo), chiefs, community volunteers, traditional leaders, For men: chiefs, religious leaders, health workers, youth clubs, community based organizations; for women’s chiefs, – health workers, CBOs members, youth groups, church leaders; for youth: advisors and custodians of culture in the villages (alangizi achikhalidwe akumudzi), chiefs, teachers in both secondary and primary schools, you For all: traditional leaders as custodians of culture (7), traditional clubs or organizations, religious leaders, health workers (akuchipatala), community based organizations KEY PLAYERS counselors (5), traditional doctors - as, religious lea (5), (youth clubs (5), CBOs (6), mkulu wa banja / limana (limana 5), (health workers 5), chairpersons of markets or business areas, role models mabanja a chitsanzo, For men: chiefs, religious leaders, health workers i.e. health surveillance asistants and nurses, youth clubs, community based organizations. For Women: Chiefs, achipatala – health workers i.e. HSAs and Volunteers, anamkungwi, CBO members, Youth Groups, Church Leaders
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For Youth: Chiefs, Role Models - mabanja a chitsanzo, Advisors and custodians of culture in the villages (alangizi achikhalidwe akumudzi), Teachers in both secondary and primary schools, Youth clubs, Community Based Organizations, Religious Leaders, Health Workers (achipatala), 5.6.2 APPROACHES, MEDIA AND CHANNELS For All: Traditional dances e.g. ingoma, weyuni, nsindo, mkwenda. (5), Drama and poems, Poetry and drama, Drama and poems, Traditional weddings, traditional weddings, Traditional events, Traditional events, e.g. chinamwali, choirs. Development rallies, Through chiefs, Chiefs Traditional courts during hearing of cases or disputes, Funerals preaching in churches). For Men: Community or public rallies, Traditional dances, Drama, Initiation Ceremonies – zinamwali, In churches through choirs and preaching. For Women: Using Ngoni traditional dances, Ngoni traditional music, Drama and poems, Misonkhano – community rallies, In churches, During funerals. For Youth: Drama, Traditional dances, Community rallies, In churches through choirs and preaching, Initiation camps or ceremonies (zinamwali through anamkungwi), 5.6.3 TIME AND PLACE For All: When settling disputes at Chiefs traditional, Chiefs traditional, Chiefs traditional courts traditional courts (bwalo la a mfumu), In church during sermons and meetings like with youth and church elders (3), During funerals but it should be done with caution to avoid people think that the deceased has died of HIV and AIDS, Market days in markets, Beer halls with communities, Sports grounds during weekends(2), Utilizing places where people are receiving coupons and fertilizer(2). Misonkhano – community rallies and open days at school or village ground, For Men: At hospitals in the morning before they start giving medication, Community rallies in the afternoon when people are back from farms, At Chief’s traditional court (bwalo a mfumu), In churches on worship days. For Women: a bwalo la mfumu – at chief’s traditional court in the afternoon after 2pm, In churches during services. For Youth: Community rallies in the afternoon when people are back from farms, Youth centers or village youth meeting centers i.e. schools, At Chiefs traditional court (bwalo a mfumu), In churches 5.6.4TREATMENT (a) KEYHOLDERS For All: Traditional Leaders, (5), HTC counselors (5), Health Workers(4), e.g. Doctors, Nurses, Those living with HIV(4), Those who take care of People Living with HIV and on ARVs(3), mkulu wa banja / limana, HSAs(1), Families that have been affected with HIV and AIDS, Community Based Organizations, Community Based Organizations, Religious Leaders(2), Health Surveillance Assistants, Community Volunteers, Youth Groups, Chiefs, District HIV and AIDS Committee (DAC) members, For Men: Health Workers (achipatala) – Doctors, Nurses, HSAs, HTC counselors, Traditional Leaders, Religious Leaders, Community Based Organizations, Youth Groups
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For Women: Chiefs, Health Workers – i.e. HSAs, HSAs and Nurses, Religious Leaders, Support Groups, Community Based Organizations(1), Youth Groups.
For Youth: Health Workers (achipatala) – Doctors, Nurses, HTC counselors, Traditional Leaders, Village counselors (alangizi a chikhalidwe mmidzi), Those living with HIV, Community Based Organizations, Religious Leaders, Youth Groups Key Players For All: CBOs, health surveillance assistants (2), HIV counseling and testing counselors(2), religious leaders, guardians to those living with HIV, , chiefs(2), health surveillance assistants, community volunteers, youth groups (5), faith based organizations (5), nongovernmental organizations working in respective areas(5), those living with HIV(3), traditional leaders(3), health workers(1), – doctors, nurses, groups, (DACC) members, mkulu wa banja / limana, For Men: Traditional leaders, religious leaders, health workers (achipatala) – doctors, nurses, health surveillance asistants, hatch counselors, community based organizations, youth groups. For Women: Chiefs, health workers – doctors, nurses, health surveillance asistants, support groups, religious leaders, and community based organizations and youth groups, nongovernmental organizations. For Youth: traditional leaders, health workers – doctors, nurses, health surveillance asistants, HTC counselors, village counselors (alangizi a chikhalidwe mmidzi), those living with HIV, community based organizations, youth groups, religious leaders
(b) Approaches, Media And Channels For All: Sermons or preaching in churches(5), Drama, songs and poems(6), Open days (should be organized like traditional days), Open days or community rallies – misonkhano (5), Traditional dances i.e. ngoma and msindo with treatment messages (6), Door to door visits(2), During initiation ceremonies, IEC materials like posters having pictures of people from our culture i.e. dressed in Ngoni regalia(2), For Men: Door to door visits by CBO members and HSAs, Open days, community rallies, In churches – songs or preaching, Posters having good pictures of people, Traditional dances i.e. ngoma and nsindo. For Women: Door to door visits, Community rallies – misonkhano, Traditional dances i.e. Ngoma, Drama, songs and poems, Preaching in churches For Youth: Door to door visits by Youth groups and CBO members, Open days (i.e. during World AIDS day) – should be organized with total involvement of community leaders not just people from the district disseminating messages during the activity, IEC materials like posters having pictures of people from our culture, Traditional dances i.e. ngoma and msindo, Drama, songs and poems, in churches – disseminating songs or preaching.
(c) TIME AND PLACE For All: During traditional healing of cases or disputes and chiefs traditional courts, in churches during sermons, In churches during sermons, preaching and songs preaching, songs and announcements (5), At political rallies or gatherings, Public rallies at schools or village grounds, In churches through preaching 127
and songs(3), Community rallies in the afternoon at village grounds and schools, Hospitals in the morning – health talks, Hospitals, health posts and dispensaries – during antenatal clinics(2), At football grounds during the weekends, Sports grounds during weekends(2), For Men: Community rallies at schools or village grounds in the afternoon, Sports grounds during football matche and churches. For Women: At hospitals / health centers – dispensaries, Public rallies at schools or village grounds in the afternoon (tikachoka kumunda), during healing of cases or disputes (ma bwalo a mafumu), In churches through preaching. For Youth: Community rallies at schools or village grounds in the afternoon, During traditional court healing of cases or disputes (ma bwalo a mafumu), In churches during prayers, Sports grounds during weekends.
5.5.2 CARE AND SUPPORT (a) Keyholders For All: Traditional Leaders(3), Volunteers(3), Health Workers – HSAs(5), Youth Groups(4), Community based Organizations (5), Support Groups(4), mkulu wa banja, chiefs, Those living and affected by HIV and AIDS(4), NGOs and FBOs(2), Guardians to those on ARVs, NGOs like NAPHAM, eni banja / mkulu wa banja, For Men: Support Groups, Community Based Organizations, Traditional Leaders, Health Workers – HSAs, Volunteers, Guardians to those living with HIV and on ARVs, For Women: Support Groups, Chiefs, Health Workers – HSAs, Volunteers, Community Based Organizations, Youth Groups For Youth: Support Groups, Community Based Organizations, Health Workers – HSAs, Volunteers, Those living with HIV and AIDS, Guardians to those living with HIV and on ARVs, Traditional Leaders
(b) Key Players For All: health workers – nurses (6), church / religious leaders(4) traditional leaders(4), NGOs and FBOs, Support Groups(3), CBOs(2), Those living and affected by HIV and AIDS, NGOs like NAPHAM, Counselors, HSAs, Community Counselors (6), DACC members, For men:traditional leaders, support groups, church leaders, health workers – hsas and community counselors / volunteers, youth groups, community based organizations: For women: chiefs, health workers – HSAs, volunteers, counselors, support groups, youth groups, community based organizations, church leaders, NGOs: For youth: taditional leaders, church leaders, health workers – hsas and community counselors / volunteers, those living with hiv, support groups, youth groups, community based organizations (c) Approaches, Media and Channels For All: During healing of cases or disputes at traditional courts (6), drama, poems and songs(3), traditional dances i.e. ngoma and nsindo(4), in churches in their sermons and during their crusades end evangelism meetings(3), open days during world AIDS day and candle light memorial(3), community campaigns – 128
misonkhano during World AIDS day, Community rallies in schools and ground, Door to door visitations by support groups youth groups and CBO members, For Men: Community rallies in schools and grounds, Door to door visits by achipatala and CBO members, Drama and poems, Traditional dances i.e. ngom. For Women: community rallies in schools and grounds, during healringof cases or disputes at chiefs and traditional courts, door to door, visitations by support groups and CBO members. For Youth: Open days and community rallies in schools and grounds, during healing of cases or disputes at traditional courts, door to door visits by support groups youth groups and CBO members, drama, poems and songs,traditional dances i.e. ngoma and nsindo (d) Time and place For All: chiefs traditional courts - in the afternoon when people are back from their farms(3), schools or village grounds – in the afternoon(3), at church during church meetings and preaching(4), songs (choirs) and preaching, community campaigns in school or village grounds – in the afternoon, after 2pm when people are back from their farms, For Men: schools or village grounds – in the afternoon, after 2pm – since at that time we are back from farms, chiefs traditional courts - in the afternoon as well, in churches during church meetings, songs (choirs) and preaching. For women: chiefs traditional courts - in the afternoon when people are back from farms at this time, schools or village grounds during weekends when there are football matches – in the afternoon, in churches; songs (choirs) and preaching For Youth: schools or village grounds – in the afternoon-when people are back from their farms and during the weekend, chiefs traditional courts - in the afternoon when people are back from their farms, in churches during church meetings, songs (choirs) and preaching.
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6.0
THE CHEWA CULTURE
6.1 BACKGROUND The Chewa are said to have originated from Zaire and emigrated to northern Zambia and central Malawi where they now live. They are primarily located in Zambia, Zimbabwe, with the bulk of the population in Malawi. It is said that they established their first kingdom in Africa around the year 1480. Chewa is today regarded as a member of the Bantu-speaking people of Malawi1. In the 17th century, the Portuguese recorded having had contact with the Chewa clans, the Banda and Phiri and they have well documented records of their contact with the Chewa between 1608 and 1667. The Chewa are closely related to people in surrounding regions such as the Tumbuka and the Senga. They are historically also related to the Bemba, with whom they share a similar origin in the Democratic Republic of Congo. An alternative name, often used interchangeably with Chewa, is Nyanjas. Their language is called Chichewa and according to historian Chirambo, the Chewas and the Manganja are one and this explains the relationship between the Undi and Lundi kingship of Malawi. The Chewa distinguish themselves from the other cultures by their distinct language, specials tattoos, possession of masks and secret societies and agricultural techniques.he nyau masquerade and dance. The Chewa speak Chichewa, Chinyanja or Banti, which is one of the widely used languages of Malawi. This research was conducted in Dowa and Kasungu districts which are largely dominated by the Chewa. In Dowa it was conducted in TA Chiwere in in GVH Gawa Madzi apart from the FGD at district level with DACC and the DAC. It was also conducted in Kasungu district in the TA Chilowamatambe in Gideon groups. 6.2
Negative IK FOR Prevention Traditional practices (14): for example chidyelano, and fisi Immorality (5) such as rape with the view that “nkhwani umakoma wa nthete”. Traditional dances (3) especially those happening at night e.g. dusha, vimbuza, nyau. Others are sexy such mbwiza-opposite sex at night till you fall. gule wamkulu-where youths are involved in sexual activities in the name of watching the dance in most cases at night. Puberty initiation rite (2): Akazi akaswa mbano- puberty, have the desire to try sex. It is believed that when a girl reaches puberty she needs to be “tried” if she is mature
Games (2) some youths play for example a local game known chibisalirano where youths play hide and seek with opposite sex common at night. In addition, they also play cards where the one who finishes last is asked to strip clothes off so that the others should play with private parts. Kachere, chitelera, makhanya (sankha amene ukonde) commonly among youths, letting opposite sex to feel for each other
Night dances : mchezo (night dance) provoking promiscuous behavior Bulangete la mfumu: A young girl asked to sleep for a night with a guest chief in a village, preferably a virgin. Kuveka chilemba: Girls are asked to gather at chiefs house the whole night Associating AIDS with witchcratf (1) -HIV is not contagious but associated with witchcraft. Cultural beliefs: “kulimbitsa mwana/kuika ku malo, a belief where a man is chosen to have sex with a mother who has just delivered. Polygamy (polygyny):The act of marrying several wives which is practiced in most villages Early marriages: Early marriages among youths ending up marrying already effected opposite sex. Drunkenness (1): Drunkenness among youths
6.2.1 Positive IK for Prevention Faithfulness (8): Marriage where partners are faithful to one another. Good dressing (6): Good dressing is encouraged amongst women.
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Abstinence (5): Abstinence from sexual activities of of paramount importance Daylight traditional dances (5): Daylight traditional dances for example gule wamkulu wamasana” giving people something to do to refrain from sexual activities. Social distance (3): Social distance between male and female youth in the community more especially those that have reached puberty since blood has started boiling. Youths not allowed to mingle with adults during ceremonies e.g. pa ukwati, kulonga ufumu. Responsible alcohol consumption (2): Responsible drinking keeps people busy instead of doing sexual activities. It is urgued that those who don’t drink resort to women as a hobby Religion and prayer (2): Fearing God in all activities. Prayers which form the basis of and controls everyday activities. No sharing of objects (2): Children told not to use parents’ razors, scissors. Kusabwerekana lumo, zingano, miswachi. Sports and games (1): Use of sporting activities for example bawo
6.2.3 Challenges for Prevention Traditional activities (7): Some traditional activities/dances allow men and women to mingle at night especially e.g. mankhanya (kuvina motoilana). Sexy dressing among women (5). This arouses sexual interest; this is common among women wearing revealing clothes in front of men. Unfaithfulness (3):“kuyenderana kuseli” Men committed to wives who are not faithful. “Mtima wa nzako ndi tsidya lina” those faithful on the face are not true by heart. Failure to abstain (3): Kukanika kudzigwira mbanja. People are failing to abstain from sexual activities especially among youths. Not all people can abstain, hence indulge in sexual activities Religion and prayers not taken seriously (3): Not fearing God in all endeavors – as if you don’t have a soul. Prayers are not taken seriously since we do not see God with our eyes. Put don’t put God’s words into practice. Cultural practices (2): Some culture practices even if not displayed are practiced in underground. It happens secretly a proof to this is that peole do not know the cause of death, chokolo Temptations: There are trials and temptations in the family, spouses want to know new things. Desire for new things : Children want to try out new things by taking parents razor’s and scissors Husbands are denied of sex-in the family husbands are denied sex after the wife has just delivered in the belief commonly known as ‘kulera mwana’. Thus if they have sex weeks after birth then the baby won’t grow. Divorce: is also on the rise among different married partners Sporting activities harbouring sexual relationships: These have become places where opposite sex relations develop Testing to see if men are dangerous: A feeling of trying to test if men are indeed dangerous Drunkenness hence fails to make good judgement and control. Peer pressure amongst youths not sticking to parents advice. Sharing of sharp objects risks contractionof HIV/AIDS Women used as sex objects. They are easily enticed by men who just want to use them 6.2 IK FOR HIV TREATMENT 6.2.1 Negative IK for Treatment AIDS associated with witchcraft (5): Belief that some sickness is associated with witchcraft. Sleeping with albino or mikuzi (3): Belief that sleeping with albino (2) or azimayi a “mikuzi” treats the disease. Poverty (2): Due to the financial constraint, there is lack of proper food to support treatment. Herbs are bitter (2): That sour medicines are associated with cure it is not always the case (2). Rape: Raping infants with the hope of getting cured 131
Denial: Total denial that one is affected Unfaithfulness: kudziiwala kwa odwala (having multiple partners) Lack of knowledge about HIV/AIDS. Discrimination of infected members in the community Religious restrictions of people by some other churches to seek help from herbalist, arguing their prayers alone can heal e.g. “Akapolo a Yesu church”. No cure of AIDS: Anyone has ever been treated of HIV and AIDS. vimbuza it is just a waste of time
6.2.2 Positive IK forTreatment Herbal treatment (8): Herbal garden where people grow different types of herbs for example mulinga. Prayers (6) for instance, zion ya nyenyezi, Traditional dances (2): Vimbuza by beating drums Taking the sick to the hospital 6.2.2 Challenges for Treatment Lack of faith in prayers (4): Patients do not believe in prayers already lost hope. Failure of traditional medicine (4): Some herbal medicine is not reliable. Failure of traditional medicine “zisamba” to heal. They have no formula of mixing. Zisamba has no proper prescription and sometimes poisonous Incompatibility of herbal medicine (3): Some herbal medicine not compatible to patients. No proper care of HIV/AIDS hence some medicines are fake. Witch doctors just want to satisfy themselves knowing that it won’t work. Vimbuza healing is seasonal (3): Vimbuza (mizimu) imayendera nyengo/nthawi. Nthawi ina imagwira nthawi ina ayi. Sometimes it is total lie to cure a disease. Through vimbuza some are sucked blood, sometimes burnt by fire in the process. In addition, spirits ‘azimu’ sometimes refuses requests. Complications due herbal medicine: Too much of the herbal medicine attracts other complications, no preservatives, no limit or specific time. Silence among patients: Culture of silence, where one who falls sick do not stand out to tell friends and relatives about the situation. Sleeping with herbalists or witchdoctor, more especially women Caution taken when caring for the sick: If one is not properly protected when caring for the sick, the disease may be passed on. Herbs are bitter some believe they are poisonous ince it has no proper formula on preparation. Offerings made to the spirits: People lose a lot of resources because the so-called ancestral spirits are too demanding asking for more e.g sugar, tea leaves etc. mizimu kusemphana Lack of enouch food and diet for the PLWHA False beliefs: Not all beliefs are real. Only restricted to those who strongly believe 6.2.3 Negative IK for Care and Support Stigma and discrimination (12): No greetings, gossiping, pointing fingers at patients. Sidelined in community development activities. Not taking their views in decision making. HIV patients are regarded as useless people in society. They are at times shouted at like “zake”. People believe that an HIV patient is a dead man walking –“akuyenda okufa ifa” Patients are talkative (2): Kuzazula Kwa odwala (talkative). Talkative patients are not taken good care of. Disregarding patients’ views: Any contribution made by patients is considered useless and does not carry weight. HIV is associated with sin: Sick patients are looked at as total sinner, associating it to the punishment that is coming from God. Perception that HIV can only be contacted through sex: People think that HIV can only be contacted by sex alone; other ways are taken out of the box. Lack of counsel: Lack of proper counsel to patients. 132
Lack of proper diet Not following up on patients (1): Not following up on state of the disease by relatives and friends Taking care of patients is seasonal (1): Sometimes taking care of the patients its seasonal because are farming Too many tasks assigned to the patient (1): A patient is given a lot of activities beyond physical level Patients are selective towards food (1): Choice of food/selective
6.3.1 Positive IK for Care and Support Preparation of balanced meals (7): Preparing necessary food for the patient. Washing for the sick (5): Washing bedding and clothing. Showing love to patients (5): Showing them love Including PLWHA in community works (5): Including him/her in social responsibilities of the community. Incorporating them in community activities. Selecting them to lead in activities of the village, they have to be as active as possible. Putting their ideas first in community decision making. Doing things together e.g. sleeping, eating Encouraging and including the sick in prayer (4): Encouraging in prayers Encouraging the patient on the improvement of the condition and also in spiritual life(2). Psychological and moral support (2): Home based care providing psycho-social moral and finacial support to the sick through the meetings organized together with them. Village groups e.g. women, youths provide psycho-social support Volunteers provide support (2): Volunteers within help in moulding bricks for those that cannot afford to do by themselves. Kumuzilira nyumba – if necessary Advising paitents: Advising the patient not to drink alcohol Respecting patient’s rights: Respecting the patients’ rights giving freedom Listerning to patients: Listening to him/her even if she is on the wrong. Providing shelter to patients: Provide good shelter Sharing materials: Sharing house materials Following up on patient;s prescriptions: Follow up prescriptions of patient given e.g. by witch doctor/herbalist Taking the sick to the hospital: Seeking medical attention if situation worsens Exchanging clothes: Swapping clothes Extended families: Culture of extended families allowing every member of the family in taking a role by caring for the sick. For example, cooking, washing clothes, words of hope etc 6.4.1 Care and support Financial constraints (10): Financial constraints hence lack of resources for caring e.g. good food, soap, proper clothing. HIV is incurable (8): Since they are aware that HIV is incurable hence lose hope Discrimination and stigma (3): Stigma and discrimination oscillating from family members, the infected patients are also pointed fingers at when wondering about HIV/AIDS are regarded as sick even in the head, therefore cannot say anything tangible. Group members sideline the sick Patients are talkative (3): Patients are mostly short tampered and talkative. Patients are talkative (kuzazura). “odwala kuzazuka”-shouting Bad perception among patients (2): Bad perception of HIV/AIDS patients thinking that everything good for instance good food is for them only not the whole family/community hence tend to monopolise. Patients do not appreciate the love and care. Patients too weak to work (2): some work may not be suitable for the patient’s physical state. Due to their physical state, do not effectively contribute more especially hard labour. Household activities are neglected (2): Household activities e.g. farming are affected since most of the time is dedicated to the sick. Difficult to take care of the patient since at times the care givers are in the garden. 133
Lack of knowledge among guardians (1): Guardians have little or no knowledge on how to go about the care, therefore lose hope fast. Volunteers are laughed at (1): In some instances volunteers are laughed at when caring for the sick. Sharing of sharp objects (1): Sharing of sharp objects Lack of faith (1): Lack of faith by patients Patients are too demanding (1): “kulawantha”- very demanding on resources and food but not making good use out of it Resistance to take medicine (1): Resistance to take medicine and sometimes forget
6.5
COMMUNICATING IK
6.5.1
Communicating IK for HIV Prevention
(a)
Key holders
For All: traditional leaders, atsogoleri adambwe, church clergy, DACC, PLWHA and gvh, vdc, religious leaders, care givers, youths, ngo’s, radio one, school teachers, youths(3), Family level with relatives, Azamba(2) village counsellors, akulu ankhole: For men: Akulu a nkhole (kudambwe), traditional and religious leaders, counsellors and friends.For women: chiefs, home-based care (HBC), church priests, village and initiation counsellors, For youths village counsellors and church leaders. (b) Key Players For All: T/A, T/A , Adambwe, Church clergy(2), PLWHA, development committees, DACC, care givers, youths(2), healthy personnel, parents, radio one, NGOs, initiation counsellors, traditional and community leaders, religious leaders(2), For men: traditional and community leaders, akulu ankhole, religious leaders, counsellors, friends. For women: chiefs, church priests, HBC, traditional and initiation counsellors.For Youth: groups, community and village counsellors (c) Approaches, Media and Channels For all: Community and primary school meetings targeting the youths, church sermons(2), Community meetings for the whole village, drama, songs, sporting activities, door to door, visiting and cheering the sick sick, when charting (mchezero), traditional dances, funerals where most people gather(2), audio-visual interaction, community meetings(2), parents advising children and the youth, traditional dances For men: community meetings, church sermons (2), when drinking. For women: FDGs meetings, religious gatherings, door to door, songs, traditional hospital, chinamwali For the youth: drama, poetry, folktales, preaching, face to face / one to one (d) Time and Place For all: weekend evenings, funerals, religious services, at chiefs meeting place for meetings, Both at the deceased house and grave yard when burying the dead, weekend nights for audio-visual interactions, Mwana akatha msinkhu and during school holidays, during weekends at community ground(2) , Community ground weekends, early in the morning or weekend at chiefs house , Wednesday at 8pm for HBC on school premises, Sunday after church services, door by door, during holidays, month end community meetings, For men: kudambwe mostly at night during weekends, weekend evenings/ pa mphala (settling disputes), Weekends and day evenings, every day when meeting friends; For women: Weekend (Saturday afternoon), Sunday, Friday at mosque, Daily- door to door to reach out to those who don’t participate in women groupings, daily basis rural hospital, initiation rite on school holidays; For youth: During holidays on the ground, When giving payments “swahala” to small chiefs month end, During business meetings on weekends, Sporting activities in weekends 6.5.2 TREATMENT 134
(a) Keyholders For All: traditional doctors (2), TBAs (2), traditional leaders, traditional and initiation counsellors, village healthy representatives, NGO’s, relatives, religious leaders, PLWHA (8), caregiver – parents and guardians, youths and HBC. For men: specially trained men, religious leaders, chiefs: For women: women groups, religious people, traditional and community leaders (3); For the youth: Gule or dambwe leaders, tradional leadesrs – chiefs, youth reps (b) Key Players For all: Traditional healers, TBAs(3), traditional leaders- TA(4), GVH, VH; religious leaders(2), initiation counsellors, radio one, health NGOs, PLWHA, patients, care givers, community health workers(2), village counsellors; youth; home based care groups: For men: men, chiefs, religious leaders, For women: women groups, religious leaders; For youth: Akulu ankhole, youths, chiefs (c) Communication Approaches, Media and Channels For all: positive living trainings, community meetings(2), at health facility when treating patients, face to face discussions, advising girls, listening to radio, film shows, drama, church sermons, intiation rites, drama, youth chats, HBC For men: face to face, one to one or FGDs, counselling, church; For women: face to face, “pa mtondo”when making flour or pounding maize, FGDs meetings; For youth: songs, drama, riddles, dances, preachings counselling by elders and parents (d) Time and Place For all: Community meeting place under a tree during weekends, under chiefs tree in the afternoon; weekend evenings for serious discussion on one to one, during treatments to patients, home counselling when a girl reaches puberty, Every day during free time more especially at night, weekends at community halls, during health campaigns, weekends after church, weekend door to door, at home when eating. Once a month at chiefs’ places, holiday time, youth groups, chattings and social events, when one falls sick. For men: door to door during weekends and evenings, evenings of weekdays, after church services. For Women: During bank ya nkhonde meetings, women groups, door to door, week ends, at water sources, For youth: Weekends afternoon and evenings, Kudambwe madzulo, anytime a patient visits a herbalist. 6.5.3
IK FOR CARE AND SUPPORT
(a) KEYHOLDERS For All: HBC volunteer, PLWHA (8) relatives, social welfare, youths, traditional leaders (12), Village health representatives(5), village cousnsellors(4), relatives of patients, village healthy staff and counsellors, NGOs, NAC, religious leaders, wmen groups, radio one, elders (akulu ankhole), women For Men, Mens groups, religious leaders, Akulu ankhole, traditional leaders (7); For women: care givers, Mkulu wa nkhole (ku dambwe), womens leaders, PLWHA, CBVs. For youths, TBAs, Care givers, PLWHA, elders, initiation counsellors, parents, NGOs, youth groups. (b) Key Players For all: HBC volunteer, relatives, social welfare, youths, traditional and community leaders, parents and guardians, relatives, community or village health worker or reps; elders, village or initiation counsellors, religious leaders, youth clubs; women groups, radio one.
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For men: Religious and teaditional leaders, mens groups; chiefs, akulu ankhole: For women: care givers, PLWHA, support groups, volunteers, women’s leaders; For Youth, youth, TBAs chiefs, care givers, relatives, youth groups. (c) Approaches, Media and Channels For all: HBC training, OVC training, CBCC, children’s corner; interactive audio-visual shows, drama(2), community meetings, funerals because almost all villagers members are present; discussing face to face with fellow men and women, advising youths kudambwe, church sermons, video shows, radio, face to face, development meetings, religious funerals, womens’, songs, dances, initiation, rites, women’s group. For Men: Macheza, because that’s where a lot of people gather, one to one/ man to man, religious prayers, political rallies, kudambwe. For women: counselling for to each other, song, women church groupings. For youth: games, songs, drama, poetry, story telling, youth groups and FGDs, one to one, door to door. (d) Time and Place For all: During dry season, weekend, when chatting at home, campaign initiatives, during holidays, kudambwe, sundays after sermon, month and weekends, when the village is meeting, weekend evening, village meeting to receive swahala, kumphala kwa fumu, at church on weekends when most people attend, women gathering places for developmental activities mostly on month end, when one is sick/ training care givers. For men: Evening, during work, at the gardens, weekends, after church, during holidays and week ends because there plenty of free time: For women church gathering at church on weekends, at water source. For youths: different games e.g. bawo at home, when helping the sick at their home, community youth meetings, when meeting up with friends to play on the ground in the afternoon.
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7.0
THE TUMBUKA NGONI
7.1 BACKGROUND The Tumbuka Ngoni culture was born out of intermarriages between the Ngoni and the Tumbukas. The Tumbuka Ngoni are mainly found in the northern part of Mzimba district particularly in chief Mbelwa’s area. The district comprises of a number of TA from the Ngoni people. The head of these TAs is Paramount Chief Inkosi ya Makosi M'Mbelwa IV who has his headquarters at Edingeni. Ngonis used to pierce their ears as part of their identity during wars between the Ngonis and Tongas. Once dead they are buried while seated. Ngoni are renowned for taking beer called utchwala. Ngoni also take part in the practice of polygamy. This involves the marrying of many women e.g. 8 wives for instance. They also like cattle raring. They like eating meat at every occasion. Tumbuka ngonis like their own traditional dance called ingoma which is usually performed on very special occasions like cerebrations, weddings, funerals and during initiation ceremonies of chiefs. They also involve themselves in the dressing Ngoni outfits called vikhumba (animal skin specifically from lion or leopard, carry chishango (shield) with a spear when dancing. Lion’s skin is put on by the Inkosi Ya Makosi alone and during his crowning ceremony. Ngoni’s greet indirectly e.g. “mwafumbana wuli mose? One answers that tadapila tose no kaheni meaning they are all fine. They believe in marrying through paying of Lobola (dowry) Dowry is given to brides’ parents as a token of appreciation for raising and mentoring the wife to such a good and respectful woman. Once the woman is married she is taken as part of her husband’s family and her husband’s people shall be her people as in Ruth chapter 1:15-17 or chapter 1:16 in the Bible. A day before the wedding day when the bride is brought to her husband she is first welcomed in the cattle Kraal to be handed over to the husbands’ family where she brings “Pfuko” some kind of Tobacco in an animal skin as a sign of coming in peace. The bride is also given a spear in the cattle kraal to choose a cow that should be slaughtered on their wedding and all the wedding processes begins. Once the husband dies the wife will not return to her parents, she is taken care of by the husband’s family. Ngoni’s believe and give respect to the first wife and she can participate in any chieftainship unlike the second wives if in polygamous family Inkosi ya Makosi is the pramount chief. The senior chiefs are Mpherembe and Mtwalo. Below the senior chiefs, there are the following traditional authorities (T/A’s): Mzikubola, Mzukuzuku, Mabilabo, Kampingo Sibande and Jalavikuwa. Sub Traditional Authorities are Chikoma Harry Mkandawire and Levi Jere. The next in the hierarchy are Inkosana Chimtengo and Mkhuzo. The least in the hierarchy are Kapopo and Ngonomo. This research was conducted in M’mbelwa district council. The research was firstly conducted at the district with district staff. The rest of the research was conducted in the Traditional Authority M’mbelwa at his headquarters in Edingeni. The TA with his communities was very thankful that M’mbelwa district was chosen to be one of the district to participate in the research. 7.2. IK for HIV Prevention 7.2.1 Negative Ik for HIB prevention Prevention Wife inheritance (10)without HTC. Polygamy (9) Syazi (8) (prize wife could be a wife’ younger sister or a niece) given to a couple has an influence on HIV spread as there is age gap between a girl and a man. Msubigzo (4) when men go to RSA for work ht parents arrange or request a younger brother to be having sex with his in-law (to keep her company and prevent her from having sex with other men rather than the family members). Men’s parents identify a relative to have sex with their daughter in-law without husbands’ knowledge. Musubizyo arranged temporary man by husbands parents to have sex with the wife once husband is in RSA for work so that woman is kept busy as they are usually young and just married. 137
Once a couple has no child parents arrange a man (brother, friend) to have sex with the wife without husband knowing.
Unfaithfulness (3) and lack of proper communication within the family. Most men go to RSA for work and marry other women from there and their wives have extra marital families.
Secret friends (3): Secret friends (Visiki) encourage people to have unprotected sex outside marriage. Visiki – Secret friends during exchange of gifts people end up having unprotected sex and one man hanged himself and died because his wife had sex with another man during secret friends. Visiki (secret friends) – time for exchange of gifts between families with beer celebrating and end up having unprotected sex.
Sharing of objects (2): Use of one razor (knife during application of local medicine). Use of one lazer blade at funerals. Chiphongo (2): When a couple has no child husbands relatives arrange that woman should have sex with a younger brother friend to get pregnant. Dilution of culture by health workers: Health care workers has spoiled or diluted the culture by accepting couples to have sex after delivery of a baby as early as 1 month. Mbulu: When women reach menopause refuse to have sex with their husbands in fear of Mbulu (abdominal swelling that is believed to be due to sperms at menopause). Poverty: Poverty levels have led to many girls and women having sex before marriage and outside. Pregnancies out of wedlock: Dowry is becoming expensive hence boys just impregnate girls and marry them without following proper channels. Kulizga ng’oma: Kulizya ng’oma – initiation for girls when they reach puberty and they are taught how to do sex by elder women. Mixing of cultures: Cross bordering with Zambia has affected the communities with different cultures. Freedom of dressing : Freedom of dressing
7.2.3 Positive IK for HIV Prevention Discouraging pre-marital sex (18): Sexual debut was encouraged for young people till they get married. Youths when found having sex were beaten up or killed in bring bad cough and bad luck in the community. Youths were well disciplined. They were taught that once they had the bush as they would sex their parents would know and parents would die, girls would die while pregnant (mapinga) while boys would get burnt. Girls / boys could chat with their fiancé in small house (gowelo) in company of other friends without even having sex. Girls were counselled at puberty by aunt or grannies not to have sex with boys because their parents will die and they will die during delivery once they get pregnant. Chichezya- Once dowry has been paid to brides‘ parents girls and boys could sleep in one room without having sex. Girls or boys having sex prematurely could die and it was a taboo for girls to seduce boys. Girls or boys could chat with their fiancée openly and in company of other peers. Youths were taught not to engage in premature sexual activities due to bad effects that could befall them like parents dying. Family ties (extended families) support system helps children not to indulge in sexual activities. Dowry (15): Dowry (Lobola) payment to the brides’ parents when getting married helped both couples to be faithful because once one is found having sex ouside marriage the dowrly (cattle were returned to husbands family and if it was man he could loose his cattle). Dowry to the bride was paid by men’s parents showing committment and respect that they have on the first wife and do not entertain divorce. 1st wife is more respected by grooms parents as the parents are committed to pay dowry for her and divorce is not entertained. Dowry could be paid inadvance (kujalira) that made both boys and girls to be faithful to each other till they grow and mature to get married without disappointing their parents. Parents are committed to pay dowry for their son to his first wife and she is treated with so much respect. Husbands parents pay lobola.(dowrly) to the wifes‘ parents and she is repected where as no parents would pay cattle for the second 138
wife. Parents commitment to pay the dowry to brides parents helped men not misbehave as a man who leaves the wife for the second wife parents could not pay lobola and no respect for the second wife. Extra marital sex was discouraged (10): When woman is pregnant men were told not to have sex outside marriage because they wuold kill the wife with Mapinga (dying during delivery). Women used to ask for sex before working up in their own way that made men not to have sexual desires else where. When women are pregnant men are not supposed to have sex outside marriage as they would kill the wife with Mapinga (death during delivery of a baby) Both men / women were tuaght to abstain from sex within and outside in fear of wife dying with nose bleeding, weakness, Mapinga (dying during delivery of a baby) (no sex when woman is 5 – 7 months pregnant). Men/women were told to abstain from sex once wife is breastfeeding the child in fear of killing the child with Moto (causing fever for a child and die) till the child stops breast feeding. Once couple has a baby women are not supposed to cook instead relatives or husband should stay home and cook for the wife till the child is 2-3 months they have sex and take local medicine. Pregnant women would die with pregnancy once husband has extramarrital sex. No sex for couples when the woman is breast feeding a baby till the baby stops breast feeding. Couples resume sex but men were taught to take sperms out in fear of pregnancy. Men would lose cattle to the wifes/ family if he also had extra marital sex. Women are told not to shave their private parts when the husband is away in order to stop them from having extra marital sex. Wife inheritance (6): Wife inheritance helped to keep the deceased woman from sexual desires as she could get sexual satisfaction from inherited husband. It also help young children of the deceased not to indulge in sexual activities for their food and other needs rather well looked ater by the man who inherits the mother (5) Disciplined youths (6): Youths were disciplined by beating once done something wrong including havingsex. Girls were taught on how to behave and fear boys for 7 days were kept indoor. Young girls were taught how to behave once they reach puberty and bring home a boy who proposes them for a hand in marriage. Boys / men were taught not to show their underwear. Majaha- two boys could go to one village to look for a girl and chose one to marry then ask his parents to agree on dowry. (boys could go a village and meet girls parents if they have girls that they could marry away from their village. Labour migration (6): Men were told to go to RSA for work once they have a child and come after 3 years as part of family planning but no sex as they could kill the child. Once husband is back from RSA first two days could sleep in his parents house before having sex with the wife to get updates (malonje) on behaviour of his wife when he was in RSA. Once men go to RSA for work their wives were monitored not to have sex with other men and men sleeps in their parents homes for the first days on arrival to get feedback on behavior of his wife while away. Women were monitored by parents in-laws not to have extra marital sex once their husbands are in RSA for work. Once husbands return from RSA for work they sleep in their parents‘ home to get updates on their wives‘ behavious wneh they were away. When men go to RSA to work and bring worth to the families as their mission not sexual relationships. Promicuity was punishable (6): When a man is found having sex with another mans‘ wife pays 1 Bongwani (1 cow) or just touching her breasts to the husband for local medicine. When a woman is found having sex with another man she pays 1 Thokazi (1 cow) to her husband and usually she is divorced and her parents returns cattle to the husband. Once a women was caught having sex with another man pays (chaludengere) 1 cow or goat to the husband and sometimes gets divorce or not. Bongwani – (A cow) paid as a penalty when found having sex with somebody’s wife or husband. Once one in a family was caught having sex outside marriage was charged with a penalty. Bongwani – (A cow) paid as a penalty when found having sex with somebody’s wife or husband. Women respected their spouses (5): Women were taught how to respect their husbands when called should respond (baba/wawa meaning dad) that impressed men and encouraged them to be faithful to their wives.
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Submissiveness (4): Both men and women used to be very submissive to each other. Girls, women were taught to be respectiful and submissive to theri husbands once married. Women were trained and taught to be respectiful to their husbands including elder in-laws and elders in the communities. Syazi (4): Syazi (prize wife given) helps in maintaing the family and prevents men fro having extra marrital sex since women are from the same families. Syazi (prize women given to man because he takes good care of the wife) encouraged men to maintain their behavior not to indulge in extra marital sex. Syazi- prize wife given to a couple when husband is a good man or do not have a child so husband should marry Syazi rather than having extra marital sex. Syazi helped men to be faithful to the family. Wife inheritance helped the families to care and protect the deceased womn from having sex from other men rather than young brothers or elders. Polygamy (3): Polygamy is good as it lessens womens burden to work and keeps men within the family no sex outside the family, when one has a child he can have sex with another wife within polygamy family. Polygamy was good to keep husbands and wives within the families since if they indulge in extra marrital sex they would pay a cow as a penalty for the offence. Polygamy was good for the Ngonis as it restricted them having sex within the family not outside family. Proper dressing (3): Boys, girls, and women were taught to dress nicely in with long dresses, skirts not short. Girls were told to dress with long dresses or wrappers (dressing code was good) Dressing code for girls, women (mini skirts, suppergets) is putting men and boys at risk of havig sex with girls. Social distance (3): When a girl was found with a boy more than twice day or night were forced to marry each other in fear that they will impregnate each other and bring shame to the family. Boston Moyo tells his story how he married Iness Mtonga, I was forced to marry Iness because her parents found me chatting with her in my gowelo (small house) without having sex, we were told to marry each other instantly. Now we have been married for 3 years, we have one child and we are expecting another child. Women were trained not to talk to their fathers and brother in-laws and all elders that led them to keep distance from getting used to the extent of having sex with them despite being given money (kuwongozya). No existence of inter-marriages (2): Use of kakuna (2): Girls were taught on how to pull their labias (kakuna, kukhati, mukola mbavi) so that they attract and maintain their husbands not to have sex outside marriage. Women were tuaght on how to pull their labias (kukuna) so that they seduce and mantain their husbands not to have sex outside marriage Secret sex education (2): Sex education was not taught publicly like now. There were no awareness on sex and sexuality. Arranged marriaged (2): Pre-arranged marriage where parents could choose a bride to be for their son and would start monotoring and shaping her to be good wife for her future husband. Parents choose a bride and mentor her while young for their son. Sex withdrawal (2): Couples were taught on withdrawal method during sex when a child is young. Men could sleep in another room once the woman is breast feeding in fear of impregnating her. (no sex outside marriage) Traditional dances (2): Ingoma dance / khonyo during cerebrations kept both men and women busy not to indulge in sexual activities. Ingoma dance makes the communities busy not to have time for extra marrital sex.
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Virginity checks : Men were taught on how to check virginity for girls on wedding day (first day to have sex) this helped in sex debut. Chiphongo:(fisi)- brother to husband or freind has sex with man’s wife once they are failing to have a child in that family. Abstinance: When married couples were taught to abstain or being faithful to each other during marriage counselling. Verasangawani: cattle that parents charge to majaha to pay for the bride. Polygamy: Women gave consent for their husbands to marry another wife and they could even help to chose a good wife or their younger sister and this encouraged men to be faithful to the wives he marries. Chiusya Nyama: when a wife dies her parents provide another wife (sister, niece, cousin) to the deceased husband to marry and as consolation. Msubizgo: Once man is in out of the country for work, his parents arrange for his young brother to be having sex with his in-law and have children to keep her company. Chapamusana: This is a punishment imposed on a man for impregnating a woman out of wedlock Chipongozi: daughther in-laws were taught never talk with her father in-law, elder brothers to her husband and other men once married. 7.3.3 Challenges to IK for HIV prevention Human rights (13): Videos, human rights and condom promotion have spoiled our people, Condoms promotion has influenced people to be loose. Nowadays women due to democracy they just call their husbands by their first names (this demotivates men). Modernization and westernization (7): Modernization has spoiled our culture as people copy western life whether suitable or not for our culture. Modernization has spoiled our old good culture that sex could not be publicly talked in presence of children. Western culture has spoiled our people as now women are freely talking to their fathers and brothers’ in-laws without fear. Loss of belief in old ways (7): School / education have spoiled both women and men not to be submissive to each other. Education has changed people’s beliefs and attitudes not to believe in old values. Cultural values are no longer valued by young people and old ones due to education as most children go to school. Sex and sexuality taught in schools, radios expose youths to do sex. Women/girls are publicly taught about sex and sexuality through radios. Too much information on sex without audience selection. Nowadays young people have sex without fear of parents dying neither boys getting burnt. Unfaithfulness (4):Nowadays when men go to RSA marry other women and women behind have sex with others. Men marry other women once in RSA for work. Polygamy (3); Polygamy is also bringing unfaithfulness due to sexual dissatisfaction. Polygamy brings too much problems as the women are not sexually satisfied since men have sex in turns. Virginity taken as old fashioned (3)Young people look at maintaining their virginity till they get married as old fashioned (out of fashion). Arranged marriages are phasing out (3): Pre-arrangement on marriage for the children is out of fashion nowadays. Girls do not accept pre-arranged marriages. NGOs are stopping pre-arranged marriages. Pre-marital sex (2); Youths are not afraid to have sex before marriage as they know the law will protect them. Girls are taught on how to give good sex to husbands when they grow and this makes they start having unprotected sex as they want to experience. Initiation ceremonies phasing out (2): Young girls are not taught much at puberty ceremonies for 7days as intensive as it used to be. When girls are kept indoor for 7 days this exposes her to many boys/men that she is ready for sex. Wife inheritance (2); Wife inheritance is not good because you might not know the status of the deceased woman. Widows unwilling to be inherited. Women refuse to be inherited once their husbands die because they have some information on HIV during ante-natal visits to the health facilities. 141
Disregarding advice: World has changed and young people or couples are not following what they have been taught. Mobile markets: Too much mobile markets have exposed people (men, women, girls and boys) to disposable income leading to sexual activities. Parents counsel their own children: Nowadays parents advise and counsel their own children at puberty without sending them to aunt or granny as they regard them not to have adequate knowledge on sex and HIV. Poor parenting: Poor parenthood Intermarriages Too much intermarriage in the district that has spoiled the old culture. Traditional dances taken as old fashioned: Now cerebrations are done in bar places than ingoma dance is looked as old fashioned. Lack of resources to marry a Ngoni woman.
7.4 IK for HIV TREATMENT 7.4.1 Negative IK for Treatment Religious leaders advising followers to stop medication (11): Some religious leaders are telling people to stop ARVs because they have prayed, some churches also discourage the use of Condoms, these churches are mainly ZCC, Last church Stigma and discrimination (4): Stigma and discrimination. Stigma and discrimination by isolating PLHIV, TB patients. Stigma and discrimination . Stigma and discrimination People don’t disclose their HIV status (3): Lack of HIV disclosure amongst couples in fear of divorce. Most people do not disclose about their HIV status or go for HTC. Lack of disclosure of one’s HIV status in a family. Loss of trust in Vimbuza (2): Most people do not believe in Vimbuza nowadays. People do not believe in Vimbuza nowadays they regard & condemn as old things, evil spirits and fake. Wife inheritance (2): Wife inheritance. Labor migration (2): Men go to RSA to look for work (job) encourage HIV spread as they leave young wives and men also marry South Africans. Most men go to RSA for job and adhering to treatment becomes a challenge for both men and women as people do not disclose about the status. Churches that advocate for polygamy (1): Some churches like Last Church advocate for Polygamy as they regard it as not sin before God. Divorce (1): If one is diagnosed with HIV in polygamous families they divorce each other especially if it is a woman who is HIV positive. Intermarriages (1): Too much intermarriage. Syazi (1): Syazi (prize wife given to a man) Traditional healers marrying young girls (1): Parents could let the traditional healer marry a young girl once he heals her despite age differences and number of wives he could have. Use of condoms (1): Condom use encourages having unprotected sex as people get used. Disposal of herbal medicine (1): Patients are not supposed to throw the local medicine after use and once healed traditional healers are demanding too much money from patients where as in the past it was very cheap even free. Too many opportunistic diseases (1): Too many diseases nowadays. No treatment (1): HIV has no treatment. Loss of belief in local medicine (1): People do not believe in local medicine any more. Lack of commitment among guardians (1): People are less committed to look after patients. Lack of resources (1): Lack of resources like fertilizers, water pumps to use and grow our local foods for the patients due to deforestation, land degradation etc. 7.4.2
Positive IK for Treatment.
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Use of herbal medicine (18): Traditional healers used to heal different diseases with local medicine. Used to have local medicine to heal ailments called nzakaka. Communities used to treat some medical ailments with natural medicines like Mzakaka. Local medicine like Muthuthula, kabeza treats ailments including diarrhea. Natural remedies or local medicine like tea leaves helps to heal diseases as believed by Zion Churches (ZCC). Chanusi (local medicine) used to help people prophecy for medicines for patients with different diseases. Sira - local medicines that used to treat boys between 13-15years once they reach puberty and were taught not have sex before marriage. Use of local or natural traditional medicine to heal diseases like Gonorrhea. PLWHA are given natural remedies like moiling Provision of natural foods (8): Providing natural local foods (food without preservatives) like millet porridge, sorghum nsima etc. Religious Beliefs (7): People had strong faith in some religious leaders especially the Pentecostals and ZCC, with faith they get healed. Traditional dances (5): Vimbuza (drum beating and dancing) helps patients to prophecy medicine and patients could get healed. Communal eating (5): Communal eating with sick patients including PLWHA helps reduce stress for patients and instills sense of belonging. Providing shelter (4): Providing shelter, food, water to a patient. Providing shelter Chatting with patients (4): Chatting with the patient to reduce stress. Chatting with the patients with focus on positive things. Chatting and spending some times with a patient. Chatting with patients Isolating the sick (4): Sick patients were isolated to have fresh air away from the communities especially those with TB, measles etc. Isolation of patients with some diseases to stop further spread of diseases. Used to isolate chronically ill patients with faithful and committed old people to look after them. Isolation of TB, HIV patients was helping in healing process as people could be committed to take care of the patient till recovery. Caring for the sick (2): Providing care to ill patients. Bathing the patient Taking patients to the hospital (2): Taking the patient to the hospital. Patient is taken to hospital for medical checkup. Support groups (2): Referring PLHIV to support groups is helping to reduce stress. Referring PLHIV to support groups is helping to reduce stress. Abstinence (2): Total abstinence encouraged once someone is sick and isolated in the family. If HIV positive they believe not having sex often. Counseling (1): Counselling was good and adhered to by patients. Encourage them to use condoms once having sex for PLWHA Faithfulness (1): Faithfulness to each other. Normal births (1): Women used to deliver babies without complications of caesarian section.
7.4.2 Challenges to IK for HIV Treatment. Loss of belief in local medicine (10): Most people do not believe in traditional medicine to heal some ailments with the coming of health facilities. Religious leaders discourage the use of local medicine (8): Some religious leaders are discouraging the use of traditional medicine as evil by Christians. Some religious leaders are discouraging the use of local medicine by their Christians. Some church leaders discourage the use of local / traditional medicine. People believe more in religious leaders, Some religious leaders are stopping PLWHA from taking ARVs due to inadequate or poor counselling to patients. People do not believe in current prophecies of current pastors or preachers. Some church leaders discourage the use of local / traditional medicine. Scarcity of local herbs (7): Local medicines are scarce now due to deforestation and too many diseases now than before. Modernization (5): Modernization has spoiled us and encourages the use of health facilities than local medicine.
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Disregard of local foods (2): Natural or local foods are regarded as old fashioned foods. Introduction of new foods that we buy from shops has made people to look at local and natural foods as old fashioned. Sharing of objects (2): Some traditional leaders especially in ZCC use one needle to prick patients once they are bled they are told that they have been healed. Lack of disclosure of HIV status (2): HIV disclosure amongst couples is a challenge. Adherence to treatment becomes a challenge as some people do not disclose about their HIV status even to the spouses. Stigma and discrimination (2): Stigma and discrimination. Most people in polygamous families do not access HTC due to fear of stigma. HIV has no cure (1): HIV has no cure (medicine) and local medicine is not healing. Traditional healers are not authentic (1): Nowadays traditional healers are "fake" do not know real medicine. Traditional healers take advantage of patients (1): Some traditional healers take advantage of their patients and have unprotected sex with them so that local medicine can work. Local medicine is difficult to measure (1): Dosage for local medicine is not significant. Unprotected sex (1): Some couples have unprotected sex before accessing HTC to avoid quarrels that one could have been unfaithful. Premarital sex (1): Many youths start having sex at younger age as 14. Opportunistic diseases (1): Too many diseases nowadays than before.
7.5 IK for care and Support 7.5.1 Negatives IK for Care and support Stigma and discrimination (14): Isolation of sick patients is regarded as Stigma and discrimination for PLWHA feel self-stigma when people talk about HIV at Mpala or Sangweni or Kukhati. Some people refuse to eat together with PLWHA neither using same utensils. Some people do not want eat with patients due to diarrhea. People do not respect PLWHA’s views. Bad attitudes among guardians (3): Bad attitudes for some people to care for sick patients. Negative attitude by some community members against PLHIV that they do not want to eat with them in one plate (communal). Negative attitude by some community members against PLHIV that they do not want to eat with them in one plate (communal). Lack of resources (3): Lack of resources to provide natural (local) foods e.g. fertilizer to cultivate maize, money to buy sugar for porridge etc. Inadequate food to provide for PLHIV. Some patients needs or demand good food that the guardians cannot afford. Inadequate information on HIV (2): Inadequate information on caring for PLHIV. Perception that HIV is a punishment: Some people feel HIV is a punishment from God so let the patients be punished. Labor migration: People have a tendency of going to RSA for work hence nobody to look after sick people and promiscuity is encouraged. Lack of disclosure: Lack of disclosure of HIV positive status to each other especially when one accesses HTC alone and when husband was away to RSA. Lack of knowledge: Lack of knowledge on how to care for PLWHA Using medicine for brewing alcohol: ARV’s are used for brewing local bear (Kachaso) Mixing medication with drugs: Some people are mixing ARVs with Indian hemp for addiction. 7.5.2 Positive IK for Care and Support. Communal eating and drinking (12): Communal eating helps. Communal gardens cultivating staring with one taking turns and drink beer eat different foods. Eating food with a patient at communal. Communal eating for community members with PLWHA. Variety foods are prepared by all households in the (family) community. Communal eating helps patients to have sense of belonging. Communal 144
farming within family and other community members. Communal eating at mphala. Communal eating helps patient to associate with others. Communal eating helps patient to associate with others.
No stigma (8): Do not stigmatize and discrimination. Involve PLWHA in all development activities. Playing with them. Sharing leadership positions with PLWHA. Chatting, sharing stories with a patient. Mphala – Meeting together without stigma with PLWHA at mphala where the communities discuss issues that affect them and eating together. Teaching young ones on good cultural values. Involvement in developmental, church activities. Share stories and laugh with them.
Providing balanced meals (6): Providing proper local food to patients like Millet porridge, drink etc. Provide high nutritive food. Providing natural good food to our patients. Provide the food that the patient needs and demands. Provide natural food. Providing good local food to patients.
Taking the sick to the hospital (6): Escort the patient to the hospital for medical attention. Taking patients to the health facility whenever sick. Referral to health facilities. Taking patients to health facilities for medical attention.
Counseling (4): Provide good counselling. Counselling Provide material support (3): Provide soap for bathing and washing. Providing soap for bathing and washing for PLWHA
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Communal gardening (3): Communal gardening starting with one farm then moves to the next in return the owner provides nsima with chicken and mostly with Thobwa (millet drink and local beer). Communal gardening starting with one farm then moves to the next in return the owner provides nsima with chicken and mostly with Thobwa (millet drink and local beer). Communal gardening starting with one farm then moves to the next in return the owner provides nsima with chicken and mostly with Thobwa (millet drink and local beer).
Abstinence (2): Total abstinence (tandulani mphasa) from sex in all communities when they had serious sicknesses like TB until treatment is over. Some people were assigned and committed to look after the patient without having sex in their homes.
Shelter (2): Providing shelter to patients. Providing shelter and food Praying with the sick (2): Pray with them to reduce their psychological issues. Praying with the patient as families, friends. Traditional healers (2): Taking patients to traditional healer. Isolation of the sick: Isolation of sick patient Encourage the patient in prayer: Discuss with a patient about the Bible in bringing hope. Support groups (1): Introduce PLWHA to support group members. Showing love to the patient: Provide care by chatting with the patients not shouting. Tolerating the patients: Patients should be tolerated in whatever she/he says. Advising them to take medication: Encourage them to take medicine and take them to hospitals. .Use of herbs: Use of local medicine Cleaning up for patients: Washing patients clothes using munkwere (natural soap) Home based care: Providing CHBC to chronically ill patients. Providing CHBC to chronically ill patients. Spirit of togetherness : The patient is looked after by the whole community and not only the family
7.5.3 Challenges for Care and support. Modernization (13): Modernization has made people to be confined to be eating with their own families not at communal. 145
Scarcity of local medicine (10): Local medicine is not often used nowadays it is scarce. Modern medicine has displaced local herbs (10): Modern medicine has disturbed the use of local medicine. Most people do not believe in traditional medicine to heal some ailments with the coming of health facilities. Most people do not believe in traditional medicine to heal some ailments with the coming of health facilities. People nowadays do not believe in local or traditional medicine. Stigma and discrimination (8): Stigma and discrimination for PLHIV. Religious leaders discourage the use of local herbs (7): Some church leaders discourage the use of local / traditional medicine. Lack of resources (4): Inadequate resources, NGOs to provide quality CHBC to the patients. Lack of farm inputs to produce local foods. Lack of farm inputs to produce local foods for the patients. Lack of proper natural food for the patients due to poor resources. Inadequate food (3): Inadequate food in the communities to provide to patients (PLHIV). Inadequate food in the homes (poverty levels is high). Inadequate food to provide to patients as nowadays food is bought. Stigma due to lack of information (3): Inadequate information on HIV hence stigma and discrimination for PLHIV. Local foods phasing out (3): Natural or local foods are regarded as old fashioned foods. Natural or local foods like Millet Nsima are dying out due to introduction of other foods. Introduction of new foods that we buy from shops has made people to look at local and natural foods as old fashioned. Guardians can’t afford good food (2): Some patients demand good food that guardians can’t afford to provide as they are poor. Poverty levels contribute to low food insecurity and uptake. Sharing of objects (2): Some traditional leaders especially in ZCC use one needle to prick patients once they bleed they tell them that they have been healed. Lack of disclosure of HIV status (1): HIV disclosure amongst couples is a challenge. Premarital sex: Many youths start having sex at younger age as 14. No access to HTC: Most people in polygamous families do not access HTC due to fear of stigma. Traditional healers lack knowledge: Most traditional healers do not know the real medicine for particular diseases. Guardians lack commitment: No commitment from people to look after sick patient. Traditional healers take advantage of patients (1): Some traditional healers take advantage of their patients and have unprotected sex with them so that local medicine can work. Traditional healers are fake: Nowadays traditional healers are fake do not know real medicine Unprotected sex before HTC; Some couples have unprotected sex before accessing HTC to avoid quarrels that one could have been unfaithful. Use of condoms: People do not abstain from sex when one is sick they use condoms instead. Time constraints: Time constraints for people. Opportunistic diseases: Too many diseases nowadays than before. Patients do not disclose their HIV status: Adherence to treatment becomes a challenge as some people do not disclose about their HIV status even to the spouses.
7.6
COMMUNICATING IK
7.6.1
Communicating Prevention
(A) Key holders For All: Health care workers (HCWs) (9), CBOs (7), Youth clubs (7), Traditional leaders(6), NGOs like Word Alive (5), Religious leaders (5), Community Volunteers (5), Support groups, Support groups, Support groups, Support groups, Teachers, Teachers, Teachers, Teachers, Politicians, WVI. For Men: Government, Health care workers (HCWs), Traditional leaders, Religious leaders, For Women: NGOs, Teachers, Support groups, Health care workers (HCWs), Government, For Youth: Youth clubs, 146
NGOs, Teachers, Church leaders, Traditional leaders, Support groups, CBOs, Health care workers (HCWs), Government. (B) Key Players For All: Youth clubs(7), CBOs (5), Traditional leaders, (5), Religious leaders (5), Health care workers (HCWs) (5), Health committee (3), Volunteers(3) , Volunteers, Volunteers, Support groups, Support groups, Support groups, Support groups, Teachers, Teachers, Teachers, Teachers, NGOs like Word Alive, NGOs, NGOs, NGOs, Politicians, Communities, WVI. For Men: Health care workers (HCWs), Health committee, NGOs, Traditional leaders, Religious leaders, CBOs; For Women, NGOs, Church leaders, Support groups, CBOs, Health care workers (HCWs) Teachers, For Youth: Youth clubs, NGOs, Church leaders, Traditional leaders, Support groups, CBOs, Health care workers (HCWs), Teachers (C) Approaches, Media and Channels For All: FGDs meetings (2) any gatherings, funeral (4), church gatherings(2), Mphala or Sangweni – meeting place for men, boys where they eat together and discuss issues and teach manners to the young ones, Kukhati – Meeting place for women meet and eat, teach young girls about sex debut, mainstream HIV Prevention in other programs, Girls counselling ceremony, drama(3), Songs (2), traditional dances, public address system, radio programs through mzimba radio, radios, posters, community mobilization, market places using mega phones, no application of salt once in monthly periods. For Men: radios, posters, drama, community mobilization, meetings, market places using mega phones, funerals, mphala or sangweni – meeting place for men, boys where they eat together and discuss issues and teach manners to the young ones. For Women: any gatherings, community mobilization, market places using mega phones, funerals, meetings, kukhati (meeting place for women meet and eat, teach young girls about sex debut, no application of salt once in monthly periods), drama, choirs, songs, radio e.g. Mzimba radio, chikaya radio from Zambia, magazines; For Youth: radio e.g. mzimba radio, chikaya radio from Zambia, magazines, songs, meetings, drama, choirs, poems, debates. (D) Time and Place For All: at any meetings, all gatherings, at mpala (a place where families gather men and women separately and eat, chat, share experiences and those who have committed sin are advised), dry seasons are the best, during market places, market places with mega phones, chiefs meeting places, young people should be targeted from 7 years and above, girls puberty initiation ceremony (counseling ceremony – chinamwali), youths should start being taught about culture at puberty, market places (kabwandire), churches, church, school, in schools, football clubs, development activities, in communities, after farm harvest, afternoons, mother groups, funerals, sports clubs, football grounds. For Men: Market places (kabwandire), churches, schools, football clubs, development activities, all gatherings; For Women: In communities, any gathering ceremonies, health facilities, churches, funerals, market places (kabwandire), development activities, all gatherings: For Youth: in communities, at school, at any gathering ceremonies (youth clubs), mpala, (men), churches, funerals, young people’s should start to be taught about HIV at 7–10 years and above. 7.6.2 COMMUNICATING IK FOR HIV TREATMENT A) Key holders For All: Health care workers(5) Religious leaders(4), traditional leaders(3), NGOs(3), politicians(2),youths, Youths, CBOs (3), CBVs and support groups (5) Community Volunteers, Support groups.
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For Men: Families, health care workers (HCWs), Health committee, Traditional leaders, Religious leaders, NGOs, CBOs. For women: NGOs, Support groups, CBOs, Health care workers (HCWs), Government. For Youth: Youth clubs, NGOs, Church leaders, Traditional leaders, Support groups, CBO Health care workers (HCWs), government B) Key Players For All: Health care workers (HCWs) (5), Traditional leaders (3) Religious leaders(4); NGOs(3), Volunteers, Volunteers and Support groups(7), Government(2), youths(2), CBO(2): For men: Health care workers and committee, NGOs, traditional leaders(3), politicians, CBOs. For women: NGOs, Support groups, Teachers, Marriage counselors, CBOs, health care workers (HCWs), Government; For youth: Youth clubs, NGOs, church leaders, traditional leaders, support groups, teachers, health care workers (HCWs), government (C) Approaches, Media and Channels For All: Drama (3), dialogues, traditional dances, FGD meetings (5), funeral(4), church gatherings, songs, songs, initiations 4 ceremonies for chiefs, initiation ceremonies for chiefs, initiations, kukhati – meeting place for women meet and eat, teach young girls about sex debut, no application of salt once in monthly periods, mphala or sangweni – meeting place for men, boys where they eat together and discuss issues and teach manners to the young ones, community mobilization, market places using mega phones, meetings, funeral gathering, church gatherings, community mobilization, community mobilization, community mobilization, market places using mega phone. For Men: Radios, Posters, Drama, Church gatherings like Wumanyano, Madodano etc, Community Mobilization, Meetings, Mphala or Sangweni – meeting place for men, boys where they eat together and discuss issues and teach manners to the young ones; For Women: Drama, Choirs, Radio e.g. Mzimba radio, Chikaya radio from Zambia, Songs, meetings; For Youth: Drama, Choirs, Poems, Debates, Radio e.g. Mzimba radio, Chikaya radio from, Zambia, Magazines, Songs, Meetings. (D) Time and Place For All: All gatherings, At any meetings e.g. ADC, VDC, During market places, TA meeting places, Radios, Cinema (mobile showing HIV films), At Mpala (a place where families gather men and women separately and eat, chat, share experiences and those who have committed sin are advised), Girls puberty initiation ceremony (counseling ceremony – chinamwali), Market places (kabwandire), Churches, Church, Schools, Football clubs, Development activities e.g. VSL, Youths should start being taught about culture. For Men: Market places (kabwandire), Churches, Schools, Football clubs, Development activities e.g. VSL, gatherings; For Women: Communities, At any gathering ceremonies, Health facilities or outreach, Churches, funerals; For Youth: communities, at school, at any gathering ceremonies, health facilities or outreach, mpala, churches, funerals, young people’s should start to be taught from ten years of age. 7.6.3 COMMUNICATING CARE AND SUPPORT (A) Key holders For All: Health care workers (8); traditional leaders (9), religious leaders (4), NGOs (4), family member at Mpala (3) youths; CBVs, support groups and PLWHA (8), CBOs (2). For Men: Government, Health care workers (HCWs), NGOs, traditional leaders, Religious leaders, health committees, CBOs, For women: Health care workers (HCWs), NGOs, Health committee, CBOs; For Youth: Youth clubs, NGOs, church leaders, traditional leaders, teachers, support groups, health care workers, government. (B) Key Players For All: Health care workers (HCWs) (6), traditional leaders (3), religious leaders (4), NGOs(4) youths(3), Government (2), CBVs, CBOs, Support groups and PLWHA(7); For Men: Health care workers (4) traditional leaders, Religious leaders, CBOs, For Women: NGOs, Support groups, CBOs, Health care
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workers (HCWs), Teachers, Government, For Youth: Youth clubs, NGOs, Church leaders, Support groups, Health care workers (3) teachers, government. (D) Approaches, Media and Channels For All: meetings, meetings, discussions, one on one dialogues, dialogue sessions, dialogue sessions, radios, radios, church festivals, church festivals, church gatherings, church gatherings, drama, drama, drama, drama, songs, songs, initiation ceremony for girls, public address system (mega phones), initiation ceremony for girls, community mobilization, community mobilization, public address system (mega phones), market places using mega phones, funerals, mphala or sangweni – meeting place for men, boys where they eat together and discuss issues and teach manners to the young ones, kukhati – meeting place for women meet and eat, teach young girls about sex debut, no application of salt once in monthly periods. For Men: Radios, Community Mobilization, Posters, Meetings, Market places using mega phones, Funerals, Mphala or Sangweni – meeting place for men, boys where they eat together and discuss issues and teach manners to the young ones. For Women: Radios, One on one dialogue, Market places using mega phones, community Mobilization, Funerals, Church festivals, Kukhati( Meeting place for women meet and eat, teach young girls about sex debut, no application of salt once in monthly periods), Any gatherings., For Youth: drama, choirs, poems, debates, songs, meetings radio e.g. mzimba radio, chikaya radio from, Zambia, magazines. (E) Time and Place For All: at any meetings, during school times(4), during market places(2), churches, funerals (4), outreach clinics, mpala, in families, health facilities, churches, churches, football grounds, during market places, outreach clinics, market places, mpala, in families, health facilities, development activities, youths should start being taught about culture. For Men: at any gathering, market places (kabwandire), churches, schools, OPD at health facilities, outreach, football clubs, and development activities; For women: kukhati, (meeting place for women), funerals, in communities, market places, market places (kabwandire), churches, development activities, all gatherings; For youth: meetings, in communities, market places, at schools, health facilities, mphala, church(es) gathering, funerals, young people should start to be taught about HIV from 10 years of age .
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8.0
THE TONGA CULTURE
8.1 BACKGROUND Tongas have a culture somehow similar to other tribes who live along the lakeshore. There are several migration traditions attributed to the coming of the Tonga. For instance, some people claim they came via the watershed between Lake Tanganyika and Lake Malawi. Others claim that they came from present day Zambia. Whilst other traditions claim that they came from the East and crossed the lake via rafts, This is because the Tonga were among some of the ethnic groups that came into Nyasaland (present day Malawi) between 17th and 19th centuries. The Tonga were primarily a fishing people with cassava as their staple food. Through mission education, they were able to earn higher wages during colonial times and worked primarily as porters, skilled or semi-skilled workers, and armed auxiliaries during the attack on Kimaurunga. The Tonga had adopted the Ngoni custom of marriage payment of cattle, with kin liable for further payments if a child or wife fell ill. Males could not divorce their wives without a hearing of public repudiation, while she and her family, however, could dismiss him without formality, unless he had a wealthy or otherwise powerful family. The kin of a woman dying away from home could also demand burial permission and heavy payment from the husband. Marriage is the most important factor integrating otherwise independent groups of kinsmen. Marriage serves not only the end of ordered procreation but has emotional, domestic, economic and political functions. The marriage goes through a processes which attracts certain payment at every stage. The Tonga political system is basically a system of overlapping networks of kin groups and kin interests. The Tonga believe in a Supreme Being, hence God is portrayed as the creator, the source of all life/death, and giver of rain. In addition to that God is denoted with names such as Chiuta, Leza, Mlengi, Mulungu and Chata. These names indicate that God is a supreme spirit. In addition to that they also indicate the ultimate source of moral good, hence God's moral attributes. Apart from God, the Tonga also believe in supernatural powers (i.e. ancestral spirits) which are believed to be the custodians of morality. They also have a mediating role such as receiving petitions from the living and direct it to God. Furthermore, the Tonga also believes in mystical powers i.e. spirits that can posses’ people, witchcraft as well as sorcery. However, names like Mwatimara or Tamara denote the existence of witchcraft. In addition to that, the Tonga also believe that a witch incarnates or turns into a peculiar creature (ndondocha) to travel in disguise. The Tonga are renowned for performing Chioda women dance, kanchoma, performed by both sexes) Mangolongondo -predominantly performed by men, Visekese predominantly performed by women; Chilimika by both sexes; Mtangala by girls and women; Ndelitha or accordion by both men and women; , Maskawe by both men and women possessed by the spirits, and malipenga predominantly performed by men 8.2 IK FOR HIV PREVENTION 8.2.1 Negative Ik for Prevention
Traditional dances (5): Chilimika dances where children and women stay away from home for more than one week. (5)
Chokolo (4): Chokolo – This practice is also responsible for the spread of HIV. When marrying, you don’t consider what killed the person, Chokolo tradition (marrying your late brother’s wife), There are rare cases where some people still practice ‘Chokolo’ secretly, Some people still practice Chokolo secretly. They just pretend as if they are helping their in-law whilst in actual sense they are married.
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Business and work (4): When a woman goes to buy fish (usipa) for her to be served first she has to sleep with a fisherman, Women who go to wait for 2 – 3 days for fish also have sex with people on the sand, Some women especially those buying and selling fish from the lake get trapped in the habit of selling their bodies to get favours from the fishermen, Some fishermen have a habit of deserting their friends at the lake just to have sex with the friends’ wives. Arranged marriages (3): Arranged marriages: This usually happens with Tongas living in South Africa. They just ask for a Tonga girl to be sent to them without knowing each other’s characters. This can also promote infection of HIV, You sometimes accept to have sex because you have been promised marriage and you are afraid of being dumped if you refuse him. This way you can easily contract HIV, Getting married to people you do not know well. Marrying people from different cultures you have just known for a short while. This never used to be the case in those days. Prostitution (2): Prostitutes are spreading HIV, since people from different cultures start arriving in here, prostitution has skyrocketed here in Nkhata bay hence the increase in HIV infections. Once lovers, always lovers (2): M’bulo Umala Cha (once lovers, always lovers) Some people continue having a secret sexual relationship with a boyhood lover even after they are married. Church activities (2): Overnight prayers. Sometimes used condoms are found within Church yard, there are some pastors who send women to Church seminars in exchange for sexual favors. Sex before marriage (2): Young girls today have sexual relationships before they are married. This is promoting the spread of HIV; People diagnosed with HIV don’t stop sleeping with different partners. Human rights (2): The coming of freedoms did not teach our children how to use these freedoms. So, they are practicing bad habits like having sex, thinking that it is their right. That way they contract HIV, Traditional doctors taking advantage of women wanting children. Beer drinking (1): Young men who drink beer engage in sexual activities with prostitutes sometimes. If the prostitute is HIV+, they infect their wives or girlfriends in the village. Kupempha mwana (1): Transition of kupempha mwana (when a woman is a month pregnant, her parents come to ask to take her to their home to give birth and she only come back four months after the baby is born, making the man to go and look for sex elsewhere). Way of disseminating information (1): Change in the way of disseminating information about HIV/AIDS has youths to wanting to try new things, including use of condoms. Tradition practices (1): Mbiliya: This is when a man is rewarded with his wife’s younger sister when they feel that his wife has grown old. This can promote HIV infection. Dressing (1): Indecent dressing by girls, it encourages rape.
8.2.3 Positive IK for Prevention
Traditional gatherings (7): At ‘Nthanganane’ (a house where young girls and unmarried women are advised and taught the Tonga culture) we are advised not to have sex until you are married, At Nthanganane (girls house) young girls and unmarried women are also taught how to conduct themselves to prevent diseases. People should be faithful to their spouses. At mphala, the youth are advised by the elders on how to behave to become good citizens. Prevention of diseases is also tackled here. (5)
Chokolo (4); the ban of the Chokolo practice was one of the positive moves done by the chiefs, the custom of Chokolo was abolished by the Chiefs. When a man dies these days, the wife has the right to choose the children to look after her. Faithfulness by partners (4): By being faithful to one partner, Tongas are faithful to their spouses / They are also encourage to abstain from having sex when they are not married, Tonga women are usually faithful. This is because for you to marry one, you pay a price (Lobola). So to attract suitors they ought to be well behaved., If you avoid sleeping around and if you are married stick to your partner and be faithful Belief of marrying when you are old (4): In the proper tradition of the Tongas, people marry when they are old enough to make a concrete choice. At least when he is over 28 years. We usually abstain from having sex. Men used to marry at an older age.
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Parents had control over children (4): In those days, parents had control over their young children’s movements. Children were monitored wherever they were and were given what time to be back home. But these days’ children are exposed to bad things. For instance life at the beach, people have sex on the sand. Young boys and girls see this thing and would want to try them, Parents used to and still encourage their children to have one partner and be faithful Work, business and farming (3): Tongas are migrant by nature. So we go out looking for greener pastures so that we can sustainably support our families, Men usually believe in working and fish business, Single women are encouraged to do business to avoid temptations. Hospital visitation (2): They also encourage us to go to hospitals. They say the hospital have always been there since long time ago Abstinence (2): Avoid having sex with people you don’t know, In the Tonga tradition young girls who were not yet grown up were not allowed to have sex. But when they had just reached adolescence they were called to be advised by the elders on how to look after themselves and one of them was to encourage them to start having sex only when they are married. If we revert to this tradition again Girls counselling and advice (2): Girls are advised by Nankungwi when they are grown up, when a girl has just grown up, she was summoned by an older woman called Nankungwi to advise her about how to take care of herself. Traditional dances (2): Many families have stopped sending their children to Chilimika dances Openness and good communication between partners (1): Being free to discuss and do everything together with your wife (Kumasukilana) HIV testing (1): Partners going for tests together Polygamy (1): Reduction in the rate of polygamy has also helped in reducing HIV/AIDS. Church activities (1): Tongas find pride in taking part in church activities. This usually promotes faithfulness and one is always busy when participating in such church activities thereby distracting one from indulging in bad behaviors which can promote HIV transmission. Use of condoms (1): At first, in those days, we were not using condoms. Today our children are contracting AIDS because of trust in condoms. Avoid public places (1): Avoid potential gatherings e.g. bars or political gatherings where you are moved by mob psychology where you just copy what others are doing which might lead to HIV transmission... Dressing (1): Young girls were taught to dress properly. Fork tales told by Grannies (1): Fork tales told by Grannies were used as a platform for advising the young children indirectly. Girls are not allowed to walk aimlessly (1): Young girls are not allowed just to walk aimlessly. Betrothed (1): Girls were sometimes betrothed (kutomeredwa). Sending women to their mother (1): The habit of sending a wife back to her parents to give birth and come back 4 – 6 months later is not common.
8.2.4 Challenges to IK for HIV Prevention Village gathering (6): Some girls, despite all the advice at Nthanganane, still go on and practice sex. Work, business and farming (3): The men who go away for green pastures sometimes go on to marry there. So their wives who are left behind without support, turns into prostitution, and can contract HIV, turning the children into victims, for ladies, it is very difficult to get employment without offering yourself for sex. So abstinence can also disadvantage you, working away from home and spending nights at the lake means very few days only at your house. Faithfulness between partners (2): When you are faithful to your spouse people laugh at you, they say that you have been bewitched by your spouse; you could be faithful but not knowing what your husband does at the lake. Traditional practices (2): Some people are deep rooted in culture that they don’t mind the consequences of some of the traditional practices e.g. Chokolo 152
8.3
Untimely sexual relationship (2): The emotions you feel sometimes because of maturity tempts you to have a relationship secretly, in rare cases, young girls, knowing now they are grownups got trapped in sexual relationships. Dressing (1): Copying dressing of the tourists. Especially miniskirts. This attracts men and can also promote rape, The youth believe that anything that is new is cool, including wearing leggings, Prostitution (1): When a man is separated from his wife for months, he can easily resort to hooking up with prostitutes for pleasure. And accidentally he can contract HIV, Girls indulge in sex (1): The fact that the girls when they reach maturity are paraded in the village gives the opportunity to young men to entice them to have sex. Youth neither do nor respect culture (1): The youths don’t understand the culture so they have no respect for elders. Lack of openness and communication (1): Not all families are open to each other so this makes partners not to trust each other. Traditional dances (1): Unfortunately, Chilimika and Malipenga dances last for more than one week. So some of the dancers take advantage of fellow dancers and start sexual relationships which can lead to contracting HIV. Church activities (1): In other churches to be sent to seminars, you have to offer yourself to a priest. Abstinence (1): When you abstain and years passing by before you get married, people laugh at you. Teasing you, saying that you are impotent. Lack of source of capital (1): Most of the time, for a single woman to have capital for a business can become a problem. Traditional gatherings (1): Sometimes at mphalas, when the elders are away. Some youths can become naughty. Just like what we call youth groups today, there were cases of peer pressure resulting in indecent behaviour. IK FOR HIV TREATMENT
8.3.1 Negative IK for Treatment Disagreement about treatment (2: Arguing about where to take the patient first: whether to the traditional doctor or hospital. This makes it difficult to make the right decision and it also takes time before you take the patient for help, the practice by some traditional doctors of admitting patients at their households encourages patients and guardians to start relationship that can spread HIV.
Herbalists and false prophets (2): The herbalists and false prophets who just claim that they can cure HIV/AIDS are the ones hindering HIV treatment, When prophets has prayed for you and go to hospital for testing and found that you are HIV-, you stop taking your herbs forgetting that all along for you to be in that state is because of the herbs you have been taking. The results at the hospital are negative because of the increase in immunity because of the herb. The disease returns again afterwards and it is too late to be saved. Lack of trust in herbs (2): Lack of trust in cultural herbs, when you don’t want your fellow Christians to think that you believe in traditional medicine, you are afraid that they will excommunicate you. Some herbs have bad effects (2): Traditional doctors not experimenting on new herbs and believing in only the old knowledge they have, the medicine given by the traditional doctor can sometimes have bad effects. That includes killing you. Negative attitude towards herbs (1): Negative attitude towards herbs because they are usually too bitter. Chokolo (1): Chokolo. Some people still practice it secretly. Prostitution (1): Prostitution. A lot of girls flock to the jet on the days when the ship docks. This is where they meet different men. Herbs are expensive (1): The traditional doctor charges a lot of money for his services. 153
Spreading the virus (1): Sleeping around when in actual sense you know that you are HIV positive or has HIV/AIDS. People do not follow medical instructions (1): Not taking your medicine according to instructions from traditional or medical doctors. Tendency by some patients who chose not to follow the traditional prescriptions of taking the herbs. Herbalist cheat patients (1): Traditional doctors who pretend to know all the herbs for each and every disease. A traditional doctor would always pretend that he has a remedy for any disease hence issuing wrong herbs sometimes. Some patients are difficult (1): Patients who are stubborn make it difficult for the herbalist to help them. Lack of faith (1): Lack of trust in God by the patient. Tradition doctors hide information (1): Traditional doctors don’t share information about their medicine. Use of sharp objects (1): Some traditional doctors use one razor blade on several people; this can promote the spread of HIV.
8.3.2 Positive IK for Treatment Use of herbs (21): There are herbs which can help to bring back body immunity. (16), Traditional doctors can sometimes cure diseases, which in the village are regarded as HIV/AIDS. (5) Prayers (4): Prayers also can cure HIV, Prayer by pastor and sometimes yourself (spiritual healing) Aloe vera – heals fever, running stomach and many diseases, Some preachers claim that they can cure HIV/AIDS, But there is a prophet who also claims that he can cure AIDS. Proper diets (1): Beliefs in some particular diets also helps. For instance drinking 2 litres of water every day for seven days can heal many diseases. If you feel you are not cured, start taking a glass of squeezed lemon juice for 42 days and you get cured. No cure for AIDS (1): there is any IK in our culture that can cure HIV/AIDS completely. But many diseases that are associated with HIV/AIDS can be cured. Belief in hospitals (1): Since I was born I have also seen that the Tongas up to day also believe in medicine from the hospital. 8.3.3 Challenges on Treatment Church beliefs (4): They discourage their followers to take herbs or medicine when they are sick. The Christian faith is a hindrance if you go to a traditional doctor, At Church (Ecumenical Counselling Committee), we learn to plant a particular herb for diseases Fake prophets (2): Prophets who stop people from taking herbs or ARVs lead to the death of their believers, there is an influx of false prophets who just swindle people but cannot cure AIDS. No measure for traditional dosage (2): The dosage of traditional medicine is not properly measured. I think there is need for research on that, When using herbs, the dosage is sometimes not proper. It is usually worked on assumption. Herbs are expensive (2): All the people who claim that they cure sell their price at a higher price, when you put all your trust in traditional doctors you do not know well, you waste a lot of money trying to get healed because they charge too much money. Scarcity of herbs (1): Some herbs are difficult to acquire whereas others like Ginger or Garlic are expensive to buy. Herbs have no expiry date (1): Not knowing the expiry date of the herbs. People access hospitals when herbs have failed (1): People usually go to the traditional doctor after they have failed to get satisfactory help from the hospital. It is usually to let to be assisted. Poor handling of patients (1): The handling of patients at traditional doctor is not professional and sometimes the place is not hygienic. 154
Some herbs do not work (1): We try different types of herbs but in the end it never works until you go to the hospital. Most of the people who believe in herbs or prayers when they come to the hospital for HIV test, they are found to be HIV+ Confusion (1): Other people get confused because they are threatened that the priest is a Satanist. People mix herbs and medical drugs (1): When you want rapid results, it becomes a challenge because you take herbs and medical help at the same time resulting in not knowing what is workable. Sometimes you suffer the side effects. Lack of faith (1): For one to be healed by prayer you have to believe first and this does not happen all the time. Herbalist is liars (1): Every problem you take to a traditional doctor, they would always pretend to have a solution. They would never say I don’t know the remedy for your problem. Herbs have unpleasant test (1): Herbs are usually very bitter. This leads to patients not taking it accordingly and loss of appetite Patients refuse to take medication (1): Sometimes a sick person can refuse to take herbs because he has been introduced to modern medicine (medical help). Patients ignore instructions (1): Sometimes a patient can choose to ignore instructions on how to take the medicine from the herbalist. People get hurt while hunting for herbs (1): When looking for the herbs in the thick bushes, you would sometimes get hurt. Herbs takes time to heal patients (1): For a patient to feel better he was supposed to sleep beside a fire. So it was a hard job to keep the fire burning all the time. Information for making herbs is hidden (1): The information for making (producing) this drug is just limited to few people. Especially those in Support Groups can access it.
8.3.4 and support
Negative IK for Care
Stigma and discrimination (7): Stigma and discrimination when it is not your child. My wife would not want to care for someone who is only related to me, when there is stigma, in some places, people don’t share the same toilet with an infected person. Do not discriminate: Many people still discriminate against HIV/AIDS patients, don’t blame the patient, thinking that he did contract it deliberately. Work, business and farming (3): Some people forget about the patient. They would leave the house early in the morning to either the garden or business leaving the patient with no food and come back late around noon, The habit of going early in the morning to the garden, leaving a sick person with no food, Guardians have the habit of leaving the patients alone. Sometimes you leave a patient and go to watch football. By the time you come back you find that he is hungry or maybe shit on the bed. Women are the ones who take care of patients (2): In our culture usually it is the woman tasked with duties of caring for the sick. This is bad, Always leaving the women in the forefront when there is a sick person Care and support (2): Sometimes we don’t give 100% care, speaking with patient with love. If you don’t have or afford what he wants, speak with him nicely. Religion (2): Some religions don’t allow you to take medicine or sleep under mosquito net, if it is a wife, sleep in a different room. Belief in witchcraft (1): Belief that a patient has been bewitched. Some herbalists stop patients from taking nutritious food (1): Choosing what type of food to eat, Traditional doctors can stop a patient from eating particular foods. Violent patients (1): When the patient is foul mouthed and violent. Teasing patients (1): Tendency by those looking after the patients, who usually tease the patient about his condition. 155
Tendancy of not taking patients to hospitals (1): Not taking him to the herbalist or doctor when necessary
8.3.5 Positive Ik for Care and support Discrimination and stigma (13): Do not discriminate him. (13) Proper diet (8): Make sure that you give the patient proper food.(7), We must give the patient additional supplement of nutrition Hygiene (5): Personal hygiene, make sure he is always clean and clean the toilet to prevent new infections, Bath him, make sure he is always clean, including his clothes should be clean as well, Dirty clothes can start new infections, If she is a woman, discourage her from getting pregnant. Care and support and encouragements (4): Show love towards the patient, Encourage him. Make him forget his sickness. One way of doing that is by praying with him. Both a man and woman as parents are supposed to care for the patient equally. Use of herbs (3): Give him herbs or medicine from the hospital, The HBC should also help the patient, the guardian as well as the patient is supposed to have the up to date information about the disease. Patient must take medicine (2): Make sure he is taking his medicine at the right time. Take patients to hospitals (2): When you see that the situation has gone beyond your capability, take him to hospital, Take the patient to the hospital and when back, follow the doctor’s instructions. Use of mosquito nets (1): Make sure that he sleeps under mosquito net. Care for people with AIDS (1): In the Tonga culture, when you have a child suffering from AIDS and not showing love, people laugh at you, so you are encouraged to love your sick child. Prayers (1): Pray for him and encourage him as well. 8.3.6 Challenges for Care and support Resources are expensive (5): Food, soap and body oils can be expensive, For one to get all the necessities you need money, so sometimes you can manage to all give necessary case of people of resources Lack of equipment (3): People caring for the sick lack resources like fertilizers to produce food. Sometimes you use bare hands when bathing him even if he has sores, just to demonstrate that you care Loans are not enough (3): Loans given to the patients as a group are not enough; the guardian has to know in time when there is a change in the types of drugs. Any change in most cases have bad side effects, In terms of loans, sometimes a patient may die before finishing paying back the loans. This will lead to the other member paying for him (group loans). Patient’s behaviour and attitude (3): The patient’s behaviour can be erratic. Sometimes he just shouts at you, When you take him on a trip, he can start making problems like ‘I want a particular type of food’ you cannot afford. Proper Diet (3): Usually a diet for the patient is demanding and in the village many people are poor, Lack of enough food stuffs and long distances to the hospital, There were enough fruits but we did not know the importance of balanced diet to the patient. Lack of transport (1): Lack of transport. Especially when the hospital is far. For Ambulances, preference is only given to maternity cases. Most of the villages don’t have stretchers or bicycle ambulances these days. HBC personnel (1): HBC personnel sometimes lack the knowledge of HIV/AIDS care. Discrimination and stigma (1): Not discriminating against him. Lack of knowledge (1): Lack of knowledge on how to care for an HIV/AIDS patient. Old people are tasked to look for patients (1): When you are very old and tasked to look after the patient. Work, business and farming (1): Working away from home and spending nights at the lake means very few days only at your house to take care of the sick. 156
Patients refuse to take medicine (1): Sometimes for reasons best known to him, a patient may refuse to take his drugs or eat food. Girls do not listen to advice (1): Some girls don’t listen to advice; they go on and try to have sex. The fact that they are now grown up gives them reasons for trying it. Lack of proper information about AIDS (1): The way the HIV/AIDS was presented to man at first makes it very difficult for people caring for the HIV/AIDS patient. It brings with it stigma. For instance, many people would not want to associate with patient because they consider the patient as someone who is promiscuous or they are afraid of getting infected.
8.4 COMMUNICATING IK THE TONGA 8.4.1 Communicating IK for HIV prevention (A) Key holders For All: Traditional leaders, parents, religious leaders, initiators, NGOs, Community leaders, Church, MPs, Chief, Village leaders, Traditional leaders, Parents, Religious leaders, Parents, Religious leaders, Initiators, NGOs, Community leaders, Church, MPs, Chief, Village leaders. For Men: church, Chief (7), Elders of the village, For Women: chiefs, Church, Health workers For Youth: chiefs, youth leaders, NGOs, Everyone is responsible (B) Key Players For all: Chiefs(4) , traditional and community leaders(5); youth(4), teachers(5), CBO(3)s, parents(4), DACC(3), NGOs(5), religious groupings; everyone is responsible, youth, women organization, teachers(4), churches teachers, women organization(3),For Men: Chiefs Church, CDC; For Women: chiefs, church, youth groups, radio, women organizations. For Youth: Youths, chiefs, women (C) Approaches, Media and Channels For All: one on one chat with traditional nurses, songs, interactive sections, drama, group discussions, sermons, school, use of megaphone, during bridal showers, top-ups, village meetings, funerals, radios, peer groups, television, radios and television, newspapers, community meetings, school, use of megaphone, during bridal showers, top-ups, village meetings, funerals, radios, peer groups, songs, interactive sections, drama, group discussions, sermons, school, use of megaphone, during bridal showers. For Men: Church sermons, Funerals, Village meetings, For Women: Village meetings, Church, Funerals, Face to face. For Youth: During church sermons, Drama, Songs, Poems, posters. (D) Time and Place For All: church day, any celebration, Special day for HIV campaigns, traditional ceremonies, beer joints, DACC campaigns, Saturdays and Sunday in the afternoon, Church day. For Men: Church during prayer time, Home church (mphakati), For Women: Anytime and anyplace For Youth: Village meetings, Youth gatherings, Women gathering 8.4.2
Communicating IK for HIV Treatment
(A) Key holders For All: Women and girls, Traditional leaders (5), Traditional healers(7), CBOs(3), health workers(8), NGOs(5), FBOs, health workers(8), HBCs; Volunteers and Support Groups – PLWHA (8), parents; women and girls, FBOs, HBCs; For Men: Chief, elders of the village, church, health workers, For Women: Chief, Elders of the village, Women for their caring heart; For Youth: Elders of the village, health workers, Chief, Youth (b) Key Players For All: PLWHA (10) CBVs and support groups (9), traditional and community leaders (10); health workers (6), religious leaders (5), women’s groups; For Men: Chief, traditional healers, PLWHA, men’s groups; For 157
Women: women’s groups, Youth, Health workers, leaders of the community (political, religious, NGOs); For Youth: church, chief, political, leaders, youth (d) Approaches, Media and Channels For All: One on one(6), FGDs(10), drama(3), church day(4), traditional ceremonies, Radios and TV, Church day, , Counseling, NGO meetings, during bridal shower and top-up, funeral, For Men: One on one, FGDs, funeral, village meetings, mphakati; For Women: FGDs, One on one, Door to door, women’s clubs For Youth: village meeting, political rallies, songs, church announcements/sermons, drama (d) Time and Place For All: Anytime (8), any social gathering, church sermons and announcements, For Men: Church during sermons, confidential places in the village. For Women Anytime and anyplace necessary, For Youth:Sports times, entertainment centers, church youth meetings . 8.4.2 Communicating Care and Support (a) Key holders For all: women, health workers, HBC, NGOs, traditional and community leaders (9), TH, PLWHA and CBV (9), FBOs. For Men: Health workers, traditional healers, home based care volunteers, Traditional and Community leaders, FBO; For Women: Health workers, women’s, groups, HBC groups – PLWHA; For Youth: youth groups, health workers, schools, community leaders (b) Key Players For All: Traditional and community leaders(7), CBV and PLWHAS, women and youth groups, health workers (7), parents, HBC, NGOs; For Men: men’s groups, traditional and community leaders, CBVs and PLWHA; For Women: Women for their caring heart among PLWHAs, CBVs, health workers For Youth: traditional leaders and health workers, parents, youth leaders (c) Approaches, Media and Channels For All: Door to door, FGDs at chiefs place (5), HBC meetings; Events example campaigns, One on one, Community, Funerals (3), Church, visits to PLWHA, giving material and moral support; For Men: chiefs gatherings and men’s groups, health workers meetings, CBVs meetings; For Women: Village meetings, women’s groups meetings, HBC meetings with PLWHA, church, funerals; For Youth: youth groups meetings, songs, drama, visits to the sick. (d) Time and Place For All: Any time, CBO centers, church meetings, community based child care center CBCCC, Community ground, Wherever and whenever convenient, For relatives any time: For Men: chiefs places, door to door, men’s clubs, funeral, churches, rallies; For Women, homes, women’s groups, HBC groups, churches, waters sources, maize mill places, anytime and anyplace; For Youth: Community ground at any time
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9.0
SOME CULTURES OF CHITIPA
9.1 BACKGROUND There are more than fifteen different and integrated cultures in Chitipa. This research reached two big culture groups Lambya and Sukwa 9.2
IK FOR HIV PREVENTION
9.2.1 Negative IK for HIV Prevention Vibwaila (done at night) men and women involve – taking appreciation from female side after Lobola ceremony. Chidyelano with apongozi men and women invited to drink. Zilabu – kumwa mowa mwaichidwa. Polygamy. Women after giving birth they take long to go back to their homes, so a girl is given to husband to cook for him by the end she becomes a wife again. Chidyerano with apongozi, they invite friends, men and women at night to eat and drink beer then sex. Vibwaila. Vimbuza dance at night Zilabu – zikulimbikitsa ziwerewere, vibwaila. Chokolo. Imphyana (chokolo, chihala). Chidyerano – kumwa mowa ndi mpongozi nkwitana amuna ndi akazi ena kukamwa nawo usiku (chiwerewere). Mitala. Vibwaila (kuzimya matamba ang’ombe) mwambo wa token of appreciation ku chimuna men and women involved and it happens at night (chiwerewere) Chidyelano – Apongozi drinking at night while friends of different sex invited. Zilabu drinking while night and dances (chiwerewere) vimbuza done at night. Kuzinga makato a ng’ombe (token of appreciation. Miyambo, Imphyana(chokolo)., kupimbira. Mbingha, juzinga makato a ng’ombe or vibwaila, chidyerano, zilabu, kulowa kufa, Mbirigha (token of appreciation, magule ausiku e.g. ngwanya, dansi ya magitala, vimbuza, ndolo. Miyambo ya fisi (kwazimila): kutofoka mapazi ang’ombe/ lobola, men and women drink beer and eat the whole night chiwerewere; Chidyerano – apongozi with apongozi (amuna/akazi drink beer together with the invited. Zitabu – kumwa mowa usiku onse. 9.2.2 Positive IK Prevention. Abstinence and no premarital sex Faithfulness to one partner Polygamy gives satisfaction to man, get tested before he marries other wives and no going for rampage. Youth forming clubs to be busy with activities other than idling Faithfulness to one partner kupimbira helps to avoid multiple partners, Forming groups (youth) to avoid indulging themselves in bad behaviours e.g.. Kukana miyambo (impliyana). Counselling and advice on HIV/AIDS. CBO Not using same piercing equipment Stopping the negative traditions such as vimbuza that encourage night relations and sex, chidyerano, chokolo, imphyana (mitala, vibwaila),
Praying and religious (kuiputa)
9.2.3 Challenges for Prevention Ignorance- people to understand it is difficult. People are crossing the border to search for money because of poverty. Meet wealth people indulge themselves in sex hence the spread of the virus. Lack of resources and knowledge. Being Scorned 159
Negative chokolo, fisi kupimbira, chidyerano, Poor preparation of food OVC increasing Over drinking Westernization and modernization; IK fading out Sexy dressing be amaitengera ku zilabu kumapanga chiwerewere Discrimination of PLWHA Lack of health staff Lack of IK and skills for prevention. Culturally enshrined traditions which they do not want to stop. Modernisation: Local Gule fading out people go to modern bands where they contract the virus. If a woman has given birth they stay long so men fail to wait in addition a girl given to help the husband is taken as a wife Negative chokolo (Imphyina), kwingilirana (fisi), isakulwa (token of appreciation), zilabu (open throughout the
chokolo, tsakulwa (shazi token of appreciation), kwingilirane (fisi) posowa mwana, kupimbira, kukolwa 9.3
IK FOR HIV TREATMENT
9.3.1 Negatives Ik for Treatment. HIV/AIDS belief it’s a curse no intervention so better die. Disclosure problem. Compliance. Spiritualpeople church members refuse to go to hospital Patients refuse to take medicine because AIDS is a curse Kusala odwala – no food given, no access of medicine, ena amati mankhwala achikuda ndi oyipa, no enough knowledge of zitsamba No enough knowledge zitsamba, ena amati amankhwala achikuda ndi oipa. Kusala odwala – no food given. No access of medicine People discourage each other from taking traditional medicine- herbs Over drinking .Zilabu – zizolowezi zomwa mowa mwauchidakwa kukhulupirira kumagonetsa kachilombo, kusamwa mankhwala because Aids sachira, kumwa zitsamba zokhalitsa zopanda muyeso. Denial. Kuyendayenda (misika/mowa). Kuledzera (kachilombo kamagona/kamafa) Many are shy to come on the open in order to be counseled. Denial. Others believe AIDS is a curse there is no intervention. Other miyambo hinder element of faithfulness; women go for other men while waiting for her turn (mitala). Spiritual people don’t go to hospital. Churches stop followers to go to herbalists Delivering at TBA where care and treatment is not enough or unavailable: Night prayers that prevents people from being faithful Herbs are kept for long and there is no expiry date. Some people generally believe that herbs are bad and therefore they do not take them. Over drinking; some people believe that if they are drunk the virus can die 9.3.2 Positive IK for Treatment
Herbs that help to heal some diseases and boast immune system: These include. Moringa, matukutu for headache and shingles; mufifi for ring worms and shingles; Avocado pears leaves for body pains and fever and increasing blood; chiwangalume, malupalala for headache; naonga, golwa, namatetemunyere, intheke for stomachache and namaoka, mpheta matete (mutu, m’mimba) Prayers for spiritual and moral support and also to provide actual healing for those who believe Good home based food such as mphetapheta, naonga, namayoka, maluluzga, mpheta, guava, madzi a mpunga, kuotcha nthochi mango, garlic, ginger, kwata which also heal some dieseas such as headache and visiting and give nutritious food e.g. bonongwe, kholowa 160
Supporting patients by giving shelter by circles of hopes Taking patients to hospital. Empowering them to have income generating activities to buy nutritious food and basic needs Community action therapy by the community or village to visit the sick and provide psycho-social and moral support.
9.3.3 Challenges for Treatment. Scarcity of most drugs due to deforestation Accessibility- little herbs are accessible to the masses Pastors stopping patients to take drugs. Kumwa zitsamba zokhalitsa (expired) Lack of standardized dosage makes other people believe you can start swelling (kutupikana) and the pregnant women to experience difficulties at delivery or mentally disturbed Over drinking mwauchidakwa kwa odwala. Long distance to take the patient to health facility. Some herbalist are fake, they give herbs and a person continue to be sick Some herbalists lack proper knowledge of the medicine / herbs and they end up cheating “AIDs a curse. You can die even if you take medicine. Some religious groups discourage people from taking herbs Lack of money to buy food and to travel to hospital It was alleged that some CBO and volunteers are selective when it comes to help patients. Night prayers increase chances of further infection and promiscuous behaviour has been noted. 9.4 IK FOR CARE AND SUPPORT OF PLWHA 9.4.1 Negative Ik for Care and support Discrimination and isolation Poor communication from the care takes, health staff “ kuondaku mwasala pamg’ono kufa Lack of resources and food to care for PLWHAs Not disclosing HIV status Lack of indigenous herbs Lack of on home based care The patients refusing support or medicine. Ndafa kale Not taking the sick to hospital Drinking heavily of forget the patient at home Pastors stopping people to take medicine Failure to cool well for the patient 9.4.2
Positive IK for Care and support.
Kuhala; support from new husband Support group and relatives give food and care right from their home Taking them to the hospital when they are sick. Prividng balanced diet and better places Chatting with the sick as organized by the chief Praying with the patient as organized by the religion groups and the support group Contributing money for food as organized by the chief Proving and cleaning sleeping place
9.4.3
Challenges for Care and support.
No cash to buy nutritious food, no transport to hospital, psychosocial support focus one side; monogamy only not spread. Zitsamba kusowa, patients chasing guardians. 161
Odwala kulankhula zoipa kwa omusamalira monga ndiwe mfiti. Transport money to take patient to hospital. Ana a masiku ano sanvera za chikhalidwe, miyambo ya mdera, kusowa ndalama ya chakudya cha odwala. Kukana ndi kusankha zakudya. Lack of skills and knowledge, kusowa ndalama ya transport. Kusowa zipangizo e.g. gloves. Odwala kukana owathandiza. Odwala kulankhula zoipa kwa omusamala e.g. ndiwe mfiti, ana amasiku ano samvera za chikhalidwe miyambo ya mdera. Transport money to take patient to hospital, kusowa ndalama ya chakudya cha odwala kukana ndi kusankha zakudya. Chitukuko china sichigwiridwa, kusowa kwa ulangizi ndi zipangizo, kusowa ndalama zopitira kuchipatala kusowa ndalama zogulira zakudya zamagulu. Kusowa kwa zipangizo and skills (gloves), odwala kusamwa mankhwala chifukwa amakhulupirira kuti sangachire Kutopa kupita ndi odwala kuchipatala, kusowa kwa ndalama (mphwayi) zogulira zakudya ndi mankhwala a patients. Kusalidwa (posasamalika pa zakuday, pogona) Kusowa kwa transport (chipatala kutakika), kusowa kwa ndalama zogulira zakudya. Odwala kukana kumwa mankhwala. Kusowa ndalama zogurira zakudya, kusowa ndalama ya transport kuchipatala ku boma, kusala odwala. Kusowa kwa transport yaku chipatala. Kusowa kwa ndalama ya zakudya zoyenera. Palibe ukadaulo akwanira othandizira odwala maphunziro akufunika. Nthawi zina odwala amathamangitsa yekha omuthandiza. Zitsamba zikusowa. Transport yaku chipatala kusowa. Scarcity of the herbs. No standardize dosage resulting to swollen of limbs and also uterus eruption. AIDS is a curse patients not taking medication. Zizolowezi zomwa mowa mwauchidakwa. Odwala ena amakhulupilira kuti kachilombo kamagona kufa. Kusowa ndalama zogulira zakudya zabwino. Kusowa zipangizo ndi ulangizi. Kuthandizira odwala. Kusowa ndalama. Kusowa kwa zipangizo ndi knowledge posamalira odwala. Kusala odwala. Kusowa kwa ndalama yopitira kuchipatala ndi kugula zakudya zoyenera. Odwala ena ukali wosafuna kuthandizidwa. Kusowa kwa zitsamba. Overdose (zitsamba zilibe muyeso weniweni zotsatira kudwaladwala, misala, kuphulika kwa chibelekero (chipapilo). Zizolowezi zomwa mowa, no time to take care for the sick – CBO’s members being chased when counseling the effected and infected. Kusowa kwa zitsamba. Lack of skill and knowledge those providing services. Kusowa kwa ndalama zogulira zakudya, kusowa transport ya kuchipatala. Zizolowezi zomwe mowa mwauchidakwa (zilabu) no time for the sick. uvinda (denial). Lack of skills and resources e.g. gloves. Transport problem to go to hospital with patients because its far. Scarcity of zitsamba. No cash to buy nutritious food. Lack of material. No enough knowledge and skill. CBO members are selective (poor families are sidelined) Transport money to take patient to hospital, kukana ndi kusankha zakudya. Odwala kulankhula zoipa kwa omusamala e.g. ndiwe mfiti. Kusowa ndalama ya chakudya cha odwala. Ana a masiku ano sanvera za chikhalidwe, miyambo ya mdera Challenges on using IK for care and support: Kulephera kupita kuchipatala chifukwa cha ndalama, kusowa kwa ndalama zogulira chakudya. Kusowa zipangizo zosamalirira odwala, kusowa kwa zitsamba monga naonga Mayendedwe kuvuta popita ku chipatala chifukwa chosowa ndalama. Kusowa zakudya za magulu. Kusowa kwa zitsamba. Zilabu kumwa mowa mwauchidakwa no time for the sick
9.5 COMMUNICATING IK 9.5.1 Communicating Prevention (A)
Keyhoders
162
For All: Local leaders, Community health workers, VDC, CBO members, Youth leaders, Religious leaders, Faith leaders, Traditional leaders, youth leaders, DACC members, Health workers, Women group leaders, Advisors of VA, Local leaders., Community health workers, VDC, CBO members, Youth leaders, Religious leaders For Men: Local leaders. Community health workers. VDC. CBO members. Youth leaders. Religious leaders For Women: Local leaders. Community health workers. VDC. CBO members. Youth leaders. Religious leaders For Youth:Local leaders. Community health workers. VDC. CBO members. Youth leaders. Religious leaders. (B) Key players For All: Youth, Local leaders, Religious leaders, VDC, CBC members, Community health workers, Traditional leaders, Religious leaders, CBO’s members, Youth leaders, Local leaders, Community health workers, VDC, CBO members, Youth leaders, Religious leaders. For Men: Local leaders. Community health workers. VDC. CBO members. Youth leaders. Religious leaders. For Women: Local leaders. Community health workers. VDC. CBO members. Youth leaders. Religious leadersFor Youth:Local leaders. Community health workers. VDC. CBO members. Youth leaders. Religious leaders. (C) Appropriate Media, Channels and Approaches For All: Meetings, workshops, open days, print media, community radios, community festivals, debates, video shops, kukambirana, Kulangizana, Posters, Drama, Meeting, churches, funeral, ceremonies, festivals, songs, magule, kukambirana, kulangizana, Open day mega phones, Songs, Drama, Posters, Radio, Churches, Schools, hospital (health talks), funeral ceremonies, kukambirana, kulangizana. For Men: Debate, songs, drama, posters, radio, churches, schools, hospital (health talks) funeral ceremonies, kukambirana and kulangizana. For Women: Debate, songs, drama, posters, radio, churches, schools, hospital (health talks) funeral ceremonies, kukambirana and kulangizana For Youth: Debate, songs, drama, posters, radio, churches, schools, hospital (health talks) funeral ceremonies, kukambirana and kulangizana. (D) TIME AND PLACE For All: Kummadzulo, kum’mawa, chiefs courts, community grounds, Kum’mawa, Kumadzulo, chief courts, community grounds, Kum’mawa, Kumadzulo, chief courts, community grounds For Men: chief courts and community grounds: For Women: Kum’mawa, kumadzulo, chief courts and community grounds; For Youth: Kum’mawa, kumadzulo, chief courts and community grounds 9.5.2 Communicating Treatment (A) Key holders For All: Local leaders, CBO’c, members, youth members, VDC, religious leaders, Community health worker, traditional leaders, religious leaders, CBO’s members, youth members, Local leaders, Youth leaders, Alangizi a m’mudzi, Extension/community workers: For Men: Local leaders; Community health workers. VDC. CBO members, Religious leaders; For Women: Local leaders. Community health workers. VDC. CBO members. Religious leaders; For Youth: Local leaders. Community health workers. VDC. CBO members. Youth leaders. Religious leaders. (B) Key Players For All: Community health workers, religious leaders, VDC, CBO’s members, Local leaders, Religious leader, CBO members, health workers, teachers, youth leaders, Local leaders, Youth leaders, Alangizi a m’mudzi, Extension/community workers. For Men: Local leaders. Community health workers. VDC. CBO members. Religious leaders; For Women:; Local leaders. Community health workers. VDC. CBO members. Women
163
leaders. Religious leaders; For Youth: Youth leaders. Religious leaders
Local leaders. Community health workers. VDC. CBO members.
(C) Approaches, Media and Channels For All: Magule, zisudzo, songs, meeting, churches, schools, kumaliro, kulangizana, kukambirana, Debate, Songs, Drama, Posters, Radio, Churches, Schools, hospital (health talks), funeral ceremonies, kukambirana, kulangizana, Debate, Songs, Drama, Posters, Radio, Churches, Schools, hospital (health talks), funeral ceremonies, Kukambirana, kulangizana. For Men: Meetings, funeral ceremonies, churches, schools, counseling, discussions, songs, debates, dances, posters, radios and televisions; For Women: Debate, songs, drama, posters, radio, churches, schools, hospital (health talks), kukambirana and kulangizana: For Youth:Debate, songs, drama, posters, radio, churches, schools, hospital (health talks), kukambirana and kulangizana (C) TIME AND PLACE For All: Kum’mawa, Kumadzulo, chief courts, community grounds, Kum’mawa, Kumadzulo, chief courts, community grounds, Kum’mawa, kumadzulo, chief court, community grounds. For Men: Kum’mawa, kumadzulo, chief courts and community grounds For Women: Kum’mawa, kumadzulo, chief courts and community grounds For Youth: Kum’mawa, kumadzulo, chief courts and community grounds
9.5.3
COMMUNICATION CARE AND SUPPORT
(A) Keyholders For All: Health and extension workers, CBC members, local members, UDS, workers, teachers, local leaders, youth leaders, village cousellors, parents, support groups and PLWHA (9) traditional leaders and village custodians (7), For Men: local leaders, community health workers, development committees, CBO members; religious leaders: For Women:, local leaders, community health workers, VDC, CBO members. religious leaders: For Youth: Local leaders. Community health workers. VDC. CBO members. Youth leaders. Religious leaders (B) Key Players For all Local leaders, village and community counsellors; extension community workers, religious leaders, youth leaders(2), community health workers, community and local leaders(5); community health workers, ADC, VDC, NGOs. religious leaders, CBC members, community health workers, VDC, CBC members, youth leaders; women groups, HBC groups – PLWHA (6) : For men: Local leaders, community health workers, VDC, CBO members, religious leaders, mens groups: For Women: Local leaders, community health workers. VDC, CBOs, CBV, PLWHA and support groups (3) members. religious leaders For Youth: Local leaders. community health workers. VDC, CBOs, members. youth leaders. religious leaders. (C) Approaches, Media and Channels For All: Songs, drama (2) , posters, community radio, churches, schools, hospital (health talks), funeral, traditional dances, meetings, FGDs and counselling; door to door, debate (4); debate, songs, For men: FGDs, meetings, funerals, churches, schools, counseling, discussions, songs, debates, dances, posters, radios and televisions: For women: Debate, songs, drama, posters, radio, churches, schools, hospital (health talks), kukambirana and kulangizana.: For youth: debate, songs, quiz, drama, posters, radio, churches, schools, hospital (health talks). (D)
Time And Place 164
For All: churches, chief courts (2), community grounds,), chiefs courts (5); For Men: chief courts and community grounds; secluded places, family: For Women: Kum’mawa, kumadzulo, chief courts and community grounds. For Youth: Kum’mawa, kumadzulo, chief courts and community grounds.
10:0
THE SUB URBAN CULTURE
10.1 BACKGROUND The suburban communities that were sampled and reached in this research were Biwi and areas 18A and 18B in Lilongwe. In Blantyre the research was done in Ndirande and Chilimba suburban settlements. Ndirande is one of the well-known township in Blantyre Malawi for violence, theft, unsafe sex behavior in short everything goes. It is one of the most highly populated areas with people from all ethnic groups in Malawi. The township faces many developmental challenges such as poor housing, lack of land for farming, poverty, high number of orphans and those that are vulnerable. Areas 18A and 18B are renowned for immoral behaviour in terms of promiscuous behavour. Most of the respondents agreed that there is need for IK in these areas if we are to help reduce HIV infection in the urban areas 10.2
IK FOR HIV PREVENTION
10.2.1 NEGATIVE IK FOR PREVENTION Traditional practices (14): Kuyamwa magazi by traditional healers who claim to be draining HIV/AIDS blood,Kusula ana which traditional healers sleep with those that are barren, Kuchosa ziwanda by some prophets, Kuchotsa kusabeleka, Chokolo, Kulowa kufa(2), Mwambo ochosa mafupa, Kulawa nnamwali (men who have passion for virgins), Kuguga (men who leave their wives who have reach menopause stage for those that are younger Social activities (7): Bridal shower encourages those that are not married to practice unsafe sex, Weddings, Parties, Disco, Top-ups Initiation ceremonies (6): Initiation ceremonies especially jando and nsondo, Chinamwali (youth now our days don’t understand advise cleary, Advise given during initiation ceremonies, Circumcision, Chilangizi for girls encourages young girls to do bad things after the ceremony for they are taught bad things especially about Zokoka (2) Use of condoms (2): Use of condoms instead of abstinence, Introduction and distribution of condoms especially in primary schools encourages and motivates people to practice sex Cobweb relationiships (1): Network relationships Youth groups (1): Youth groups encourage each other on dating and use of condoms instead of abstinence Beer drinking (1): Too much drinking (black berries)and smoking encourages/motivates people to do bad things, Chisecret Church activities (1): Overnight prayers Competition (1); Women nag their husbands to buy good things as a competition when he fails they go for some else, Competition of doctors and tradition healers on healing Use of TBAs (1): Use of traditional birth attendants Technology (1): Watching porn movies in video shows 10.2.2 Positive IK for HIV Prevention Social activities (13): Bridal shower(3), Dressing top-up(2), Kitchen top-up, Weddings, Parties, Disco, Top-ups(2) (Kitchen. Dressing,), Chisecret Abstainance (6): Emphasis on sex after marriage, Abstinence among youth, Emphasis on one partnet to discourage promiscuity, Girls not to date men, Emphasis of not having out of wedlock children for example making those found pregnant wear dog intestines, To stop promiscuity to reduce kanyela diseases which is caused by mix of different blood through sexual intercourse
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Initiation ceremonies (5): Chilangizi by mainstream churches, Chinamwali by some church and ethnic groups, Jando to be practiced in town, Initiation ceremonies (advice given help young people to shape their future, handle themselves during period Traditional practices (4): Zokoka, Chitomelo, Chinamwali/chilangizi, Chilangizi cha atsikana Groups and organization (4): Women groups, Youth groups, Women organisations (mvano, catholic women organization, dorica), To establish counseling groups in communities Christianity and religion (3): Christian teachings (one man one woman), Prayers by Pentecostal churches, Overnight prayers Village banks (3) Bank ya mmudzi Value of virginity (2): Value of virginity helps youth to preserve themselves for marriage, Keeping virginity till marriage Use of condoms (2): Use of condoms Going for VCT (1): Getting tested frequently.
10.2.3 Challenges for Prevention
Youth shun tradition (5): Youth are not following chikhalidwe cha makolo saying its old school, Youth tend to say “you cant buy a car without test driving it” meaning you cant marry before having sex, Stubbornness of children, Most youth are sidelinig chinamwali these days, Most girls refuse to come for chilangizi, Most youth no longer take part in youth meetings Use of condoms (3): Condom does not satify and sweet sadyela mpepela attitude, People who don’t use female condoms claimimg it makes a lot of noise, Due to introduction of condoms most partners are unfaithful to each other and it encourages people to have multiple sex partners Dressing (3): Adoption of western culture which is replacing initiation ceremonies into kitchen and dressing top-up, bridal showers, Change of dress code to min skirts and leggings, The way women are dressing Media programs (3): Radio programs that talk about explicit things claiming to be part of HIV prevention, Too much exposure to western culture through TV and magazines, Media for example radio, TV which is encouraging people to adopt western culture Use of virginity soap (2): Use of virginity soap and men enlargers which is encouraging promiscuity Peer pressure (2): Peer pressure, Peer pressure on how to get top up gift leads to promiscuity Parental advice (2); Parents encouraging their children to sleep around with wealth men, Marriage without traditional counselors (ankhoswe) Social activities (2): Attendance of children at bridal showers, The dancing that people do in parties and top-ups are sexual dances that attracts men Men refuse their wives to attend to other activities (2): Some men don’t allow their wives to take part in any organisations, Most women don’t come because their husband don’t allow them\ Infidelity practices (2): Chisecret encourages other women to conduct in unsafe sex to get money to buy expensive gift for their asiki, Women leave their homes claiming their going for overnight prayers when they are going to sleep with other men Punishment (1): Girls not being punished for out of wedlock pregnancies Cobweb relationship (1): Network relationships Modernization (1): Most of cultural practices have been replaced by western lifestyles eg top-ups. Bridal shower where young girls/women dance and share explicit things Village loans (1): Laws attached to bank loans on bank ya mmudzi leads to promiscuity to pay back the loan Religion and Christianity (1): Church doctrines, Coming of prophets and Pentecostal churches which are stopping people from taking their medication
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10.3
Beer drinking (1): A lot of rest houses and bottle stores in the area which motivates people to drink irresponsibly and conduct unsafe sex practices Education (1): Life skills subject taught in primary schools IK FOR HIV TREATMENT
10.3.1 Negative IK for Treatment:
Religion and belives (7): Islam way of cleaning corpse, Churches that encourage people to seek for healing instead of counselling, When people stop taking medication after being told by prophets or Pentecostal pastors, Church teachings on healing, Use of prophets when you don’t have faith, Those who are born again they stop taking medication, Pentecostal churches encourages people not to take medication Westernization (2): Due to adoption of western culture people have neglected herbal medicine, People only prefer western medicine these days Scarcity of herbs (2): Though herbs are local there cannot be available always, Scarcity of Chisomo plants Lack of cooperation and counselling (2): Lack of cooperation in the community, Hiding from counselors Beer drinking (2): Drinking beer claiming to be Ngoni culture while taking medication, Most patients smoke cigarettes and chamba while taking medication Herbs have limitless priscription (1): Traditional healers have no limit on quantity of medication to take Drug resistance (1): after people stop taking medication through advise given by prophets People mix herbs with hospital medicine (1): Use of nsupa by traditional healers instead of just giving medication Fake herberlists (1): Traditional healers who claim to have medication People don’t like herbs (1): Most people don’t like using aloe vera for its bad test
10.3.2 Positive IK for HIV Treatment
Religion and Christianity (4): Spiritual healing by prophets and Pentecostal churches, Use of prayers (works for those who believe), Use of herbs such as chamwamba, aloe vera, avocado leaves and garlic to boost the immunity, Prayer; prophets are healing people
Use of herbs (6): Use of herbs such as Aloe vera to heal wounds and skin rashes, Chamwamba and moringa to boost immunity, Use of herbs such as moringa leaves to boost immune system, Use of herbs such as aloe vera, Use of herbs such as Chisoso to boost immunity, bonongwe ofila to increase blood, moringa (leaves or seed) to boost immunity, Use of Chisomo plants like tea leaves and aloevera to heal wounds and diarrhea prevention, Use of herb such as tomato leaves to stop diarhoea, drinking aloe vera, mixing herbs with coca cola, Using herds such as guava leaves and other herbs to increase level of blood in the body Fruit juices (5): Making energy drink usinglemon juice, ginger juice, garlic juice and sugar/honey, Using lemon grass to clean the body through urine, Eating appropriate food, Use of local food such as local chicken, Chigwada chotendela, Chimera to boost immune system, Use of mtolilo, avocado pear leaves and bonongwe ofila to increase blood level in the body Councelling (2): Counseling, Counseling it’s the only solution for once found positive the person is psychologically affected
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Hospital visitation (2): Sending them to hospital for treatment and counselling Traditional beliefs (2): Not to add salt in relish when menstruating to avoid mtsempho, Not to sleep in same bed with husbands during period Support and care (2): Befriend the infected person to encourage them, Visiting them frequently to make them have a feeling of belonging and support
10.3.3 Challenges to IK for HIV Treatment. People shun counselling and hibernate due to their status (5): Most people don’t accept their new status and start taking treatment, Most people don’t go for counseling for they are either ashamed or shocked, Most people don’t go for counseling for they are ashamed and some don’t go for their medication to avoid being noticed by people, Most people who are infected are not open and ready to be friends with anyone and share their experiences, Some patients lock themselves up in their rooms
10.4
Religion and Christianity (5): People go for church prayers instead of counselling, Churches that encourage people not to go for medical treatment and use of herbs, Prophets encouraging people to stop taking medication, People who don’t worship God conduct in bad sexual activities, Prophets encourage people not to take their medication Poverty (4): Poverty motivates girls to sleep around hence kanyela continues, It’s expensive to use aloe vera and local food example local chicken that’s why most people prefer ARVs, Lack of transport to send patients to hospital Herbs are scarece and expensive (2): Scarcity of chamwamba and aloe vera plants, Aloe vera is expensive People prefer herberlistd (2); People preferring only traditional healers (2) People have abandoned tradition (2): People have abandon tradition ways of healing to western medicine but no one gets healed from mtsepho from western medicine that’s why AIDS can’t be healed because its partly associated with mtsepho hence there is a need for integration, Traditional healers putting a covenant on medication (zizimba) Negligence by medical staff (2): Hospital staff (doctors) neglecting traditional medication. There is need for integration, Negligence of youth Peer pressure (1): Peer pressure Lack of knowledge (1): Lack of knowledge on use of local things example use of lemon grass Lack of discousions and debate (1):Most people are not free to talk about AIDS especially those that are affected Herb have no limit (1):There is no limit on intake of herb medication Beer drinking (1): Drinking and smoking chamba, When people are drunk they forget to take their medication, Taking medication and alcohol at the sametime IK FOR CARE AND SUPPORT OF PLWHA
10.4.1 Negatives IK for Care and Support
Stigma and discrimination (18): Relatives lock patients in their rooms, Not to participate in any community development,No sharing of clothing especially for younger girls, Not allowed to take part in any community development projects, Avoid passing by their houses,Talk back to them in a bad tone or use or blame them for their fate, Not allowed to get a loan over fear that they might die before payment, Avoiding those who are infected and affected, Lack of marriage partner due to discrimination , Not to register for coupons instead other member of the family, Mostly they are not called to attend any community development activities for they are considered weak, Guardians let go of their responsibilities to take care of those who are sick 168
Lack of training (1): Lack of training on care and support people abandon their relatives to avoid getting contaminated Patient hibanation (1): Most HIV patients do not take part in community development activities but they choose not to because nobody stops them Patients behaviour (1): Patients throwing away food
10.4.2 Positive IK for Care and support
Love and care (13): Due to the love that elderly people have on their relatives they don’t use gloves, Encouraging them in any way, Loving them, Chatting with them and counsel them, Befriend them to, Always be patient, HBCs take care of patients properly than regular people, Escorting them to hospital, Women organizations help around by visiting households that have HIV patients, Reminding them their dates to go receive medication, Watching them while taking medication, Encourage patients to eat their food, Provide guardians for those that don’t have
Hiegine (11): Provision of clean and usable toilets, Provision of clothing, Provision of clothing from well wishers, Cleaning their homes(5), Washing their clothes (2), Building shelter Proper diet (10): Provision of good food(6), Providing food that is appropriate and advised by the doctor, Providing good food to patients especially vegetables to increase blood levels in the body, HBCs provide food and cleaning (2), Family contributing money to pay for hospital bills Assisting patients financially (2): Employing those who are infected to share experience, Community contributes money to take care of patients Training (2): CBO training on care, support and counselling, Local NGOs are teaching people on HBCs
CBOs (1): Formation of CBOs that focus on HIV/AIDS patients
Extended families (1): Extended family tradition which focus on caring for everyone in the family
10.4.2 Challenges to IK for Care and Support
Poverty (9): Poverty leads to people not eating proper food, Food is not always available, Due to poverty food and clothing is not always available, Inadequate food, Lack of good shelter (2), Lack of medication, Hygiene, Scarcity of medication Lack of equipment (7): Lack of gloves(5), Lack of resources, Use of plastic bags instead of gloves Patience behaviour (5): Patients throwing away food, Their always in bad mood, Some pour water on their guardians when giving them medication, Accusing guardians for bewitching them, Some patients are rude when they are being counselled, Patients sometimes throw food at guardians Poor care and support (5): Guardians let go of their responsibilities to take care of those who are sick, Most people don’t give contribution money, Lack of quality care, Lack of support from relatives, Most people are not willing to give Forms of discrimination (2): Use of gloves makes patients fell discriminated, Use of gloves when taking care of them make them feel discriminated Lack of training (2): Most NGO teaching on HBCs is not effective, Lack of effective CBOs training Gander equality (1): Gender issues (men don’t take care of their wives) Dependency syndrome (1): Patients depends a lot on guardians instead of providing for themselves when they get better (dependency syndrome) Patients hibernation (1): When people are visiting them they lock themselves up in their rooms
10.5 COMMUNICATING IK 10.5.1 Communicating IK for HIV Prevention A)
Keyholders
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For All: parents, Chiefs, traditional and community leaders (7), parents(3), religious leaders(5), initiators, (2) NGOs (3), MPs(2), initiators; For Men: church, chief, elders of the village, For Women: Chief, Church, health workers, For Youth: Chiefs, elders; youth leaders B) Key Players For All: Chiefs anc community leaders (6); teachers (4), NGOs and CBO (6), parents (7) development committee (9), religious groups, everyone is responsible (4); youth groups, womens organizations,. For Men: chiefs, church, development committees; For Women: Chiefs, church, schools, youth groups, Radio, Women organizations; For Youth: Youth, Chief, Women C) Approaches, Media and Channels For All: Door to door (9) One on one chat with traditional nurses, Songs, Drama, FGDs, Sermons, School talks and lesions, during bridal showers, top-ups, village and community meetings, community radios, peer groups, Radios and TV, Use of megaphone, peer groups, Songs, FGDs, For Men: church sermons, funerals; For Women: Village meetings, church, funerals, face to face; For Youth: during church sermons, drama, songs, poems, posters, youth groups, D) Time And Place For all: church day, Any celebration, Special day for HIV campaigns, traditional ceremonies, beer joints, DACC campaigns, Saturdays and Sunday in the afternoon, Anytime and anyplace, Saturdays and Sunday in the afternoon, Anytime and anyplace, Church day. For Men: Church during prayer time, home church (mphakati), For Women: Anytime and anyplace; For Youth: Village meetings, Youth gatherings, Women gathering 10.5.2 Communicating IK for HIV Treatment (a) Key holders For All:Women and girls, CBOs, Hospital staff, NGOs, FBOs, Health sectors, Min. of Health, Hospital staff (community health), HBCs, CBOs, HSAs , DACC, NGOs, Volunteers, Chiefs, Women and girls, CBOs, Hospital staff, NGOs, FBOs, Health sectors, Min. of Health, Hospital staff (community health), HBCs, CBOs, HSAs , DACC, NGOs, Volunteers, Chiefs, Hospital staff (community health), HBCs, CBOs, HSAs , DACC, NGOs, Volunteers. For Men: Chief, Elders of the village, Church, Health workers, For Women: Chief, Elders of the village, Women for their caring heart; For Youth: Elders of the village, Chief, Youth (b) Key Players For All: Those who are infected, Chiefs, Village/community leaders, Church, Health worker and CDC, Women , Chief, Those who are infected, Chiefs, Village/community leaders, Church, Health worker and CDC, Women , Chief, Those who are infected, Chiefs, Village/community leaders, Church, Health worker and CDC, Women , Chiefs; For Men: Chief, Women and men, CDC; For Women: Women for they are active, Youth, Health workers, Leaders of the community (political, religious, NGOs); For Youth: Church, Chief, Political, Leaders, Youth (c) Approaches, Media And Channels For All: One on one, Drama, Church day, Traditional ceremonies, Radios and TV, One on one, Drama, Church day, Traditional ceremonies, Radios, TV, Radio, Counseling, NGO meetings, During bridal shower and top-up, One on one for those who have a patient in their homes, One on one, Drama, Church day, Traditional ceremonies, Radios and TV, One on one, Drama, Church day, Traditional ceremonies. For Men: One on one, Village meetings, Mphakati, Funerals; For Women: village meetings, one on one For Youth: Village meeting, Political rallies, Songs, Church announcements/sermons, Drama (d) Time and Place For All: Anytime, anyplace, anytime, anytime, any celebration, Church sermons and announcements, anytime, any celebration, Church sermons and announcements 170
For Men: Church during sermons; For Women: Anytime and anyplace necessary; For Youth: times, entertainment centers, church youth meetings.
Sports
10.5.2 COMMUNICATING CARE AND SUPPORT A) Keyholders For All: Women, Health workers, HBC, NGOs, Chiefs, Community leaders, FBOs, HBC, Health worker. For Men: Health workers, HBC, NGOs, Chiefs, Community leaders. For Women: Health workers, Chief, HBC B) Key Players For All: Women, Youth, HAS, CBOS, Relatives, Health sectors, NGOs, Min. of health For Women: Women for their caring heart and activeness, health workers; For Youth: health workers, PLWHA C) Approaches, Media and Channels For All: Interpersonal, Community meetings, door to door, Events example campaigns, One on one, Community meetings, Funerals, One on one, Church, Funerals: For Men, community leaders,PLWHA For Women: Village meetings, Church, Funerals, PLWHAs; health workers, door to door D) Time and Place For All: Any time, CBO centers, Church meetings, CBCCC (community based child care center), Community ground, whenever it is convenient, for relatives any time. For men: after work; evening; For Women and youth: after work, or schooling the evening; in the evening or Community ground at any time
11.0
THE TUMBUKA CULTURE
11.1 BACKGROUND Most of the Tumbukas in Malawi live in Rumphi district is in the northern region. The Tumbuka tribe has a very rich culture such that even in these times when some tribes are being diluted by other external factors, the tumbukas still follow their cultural practices. This research study was carried out in the area of traditional authority Chikulamayembe, popularly known as Themba la mathemba Chikulamayembe. This is around a place known as Bolero and it is to the North-west of the Rumphi boma in Kalawilira, Bongololo and Nkhozo villages. To collect data at district level, FGD was conducted comprising District AIDS coordinator, the District health environmental office, the district welfare officer, the District labour officer and the DOP and key informants interviews with partners such as REAP, Life Concern and Eva Demaya were conducted. Data was also collected at local community level, the KII with the themba himself and other cultural custodians, GVH bongololo and FGDs with the ADC and VDC in Kalawirira village and the youth in Nkhodzo village. 11.2
IK FOR HIV PREVENTION
11.2.1
Negative IK for HIV Prevention
Beer drinking (10): A lot of people here just drink beer so that they should hide behind the drunkenness when prostituting. (10)
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Mitala (8): Polygyny has turned out bad because most men fail to take care of the women and this makes women seek assistance and pleasure from other men. (8) Entertaining Chiefs (6): When installing a new chief there is a tendency of picking young beautiful girls to serve the invited chiefs and they end up sleeping with them. Chokolo /dowry (6), Mbirigha- this is chokolo cha akazi. When a wife dies, a female relative takes over the widower Women trainers (5): There are also some women in the villages; who are just known of training girls in things like elongating labia. These women are entrusted with the girls and usually build a close relationship with the girls and they take advantage of this and find boys for the girls so that they should get some monetary gains from these relationships.(5) Business and work (3): In rest houses and bar they employ very young and attractive girls and men always get tempted to sleep with them, Parents are busy making money and don’t have time to advise their children, A lot of men go to work in South Africa and they usually have other women there and even the wives they leave here sleep around with other men and when they meet they do not even go for testing. Traditional practices (3): Kupimbira is when a family is constrained financially and it goes to a richer man to ask for assistance and the rich man offers help in exchange for a girl. This practice is very bad for the man can take the girl at a very tender age so that he can guard her before making her a wife and usually makes her a wife while still very young. Sometimes some couples even offer an unborn child, Shlazi- this is a token of appreciation, if a married woman is being treated so well by the husband, her parents offers a sister to be the second wife to the “good man, Chijula mphinga- When a man wife dies but they wife’s side was very happy with how the two were living the wife’s side offers another woman as a wife to the widower. Dressing (3): Girls are now dressing less respectifully. They are putting on very tight trousers, some clothes which look like pyjamas, miniskirts, skirts with long slits, spaghetti tops and not covering their breasts. The girls these days do not even put on petticoats and you can see through how their legs are, Boys also sag their trousers and show their under wears and I don’t know what girls like about this, People here, especially women do not dress respectably and as a result, rape cases are on the increase Technology (3): There are youths here who have sophisticated phones and youth like downloading pornographic materials and end up trying them, Youths here like going to video shows and this is where they watch uncensored movies and in the end want to try what they watch., Ma gig- there are usually discos at the boma and Bolero and this is where a lot of people drink and have sex. Vimbuza (2): This is a special healing that is accompanied by drums and songs and attracts a lot of people and it usually happens at night. This is where people meet and have sex, Zimbuza is a spiritual dance and it is still be done at night and people still have a chance to be having sex Village banks (2): Many women involve themselves in relationships with men so that they can be funding them to pay back their loans, Village banks- some women borrow money from a number of village banks and when they have pressure to repay the loans they sleep with men in exchange for money. These loans also give women autonomy and their husbands feel diminished and they end up going different directions in search for better relationships Vibwaira (2): This is when women go to visit women in another village and sleep over there. There are usually dances at night and a lot of women take this as a chance to have sex with other men, Vibwaira: Soon after harvest women like to go and visit another village in a group and mostly there are dances at night which
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are mostly accompanied by sexual activities, A lot of married young men here go to work in South Africa and mostly the women left behind end up having affairs with other men. Chimwanamaye. (2): In Bowe, a place bordering Mzimba, there has been two or three cases were couples were in conflicts because of chimwanamaye. They exchanged spouses and things did not go well and this practice also spreads HIV, The parts which are bordered by Mzimba have adopted a practice from Mzimba which is called “chimwanamayi”. This is where two best friends can exchange spouses Kulowa fisi (2): This is not very common but sometimes some people do it. When a woman is failing to conceive, the man seeks help from another man to make his wife pregnant, Fisi- some people hire a man to help when a family is failing to have a child Farming (2): Tobacco farming- the problem with tobacco farming is that the men get a lot of money at once and they usually use it for prostitutes, they think that is great pleasure, Tobacco farming- Mostly men get more money at once when they sell their tobacco and most men get to prostitutes for pleasure and even some tobacco farm owners like sleeping around with their tenants wives. Lies to children (1): In our culture we don’t tell our children the whole truth, we just try to scare them with some stories but they need to know the truth, School children here are at high risk and they are highly dangerous. They want to live a sophisticated life so all they care about is money. Even if I approach a school girl now she can say “a Themba muli walala” meaning Themba you are old. They think that old people have more money. Political rallies (1): There is a tendency of political parties taking women to meetings where they spend nights there and this encourages promiscuity. Smoking Indian hemp (1); A lot of people here smoke chamba ad you know what happens when someone abuses thie drug. Celebrations (1): Celebrations- there are a lot of celebrations that happen here and the obvious thing to happen there is sex. Sometimes women do what they call “zipongo” and they visit each other and sleep over at a friend’s house. Some women just take this as a way of running away from home to meet men. Church trips (1): Churches send youths to retreats and this is where youths have a lot of sex. Even in choirs that is where they meet their mates and have sex. Basera (1): Basera; when a man is seen that is treating his wife very well the wife’s side can give him a sister to the wife to have as a second wife as a token of appreciation, The local organizations which are here sometimes organize discos and this is where people usually meet to have sex. Family planning methods (1): Every woman is using family planning methods and we wish if it was a rule that only married women should have access to family planning methods Education (1): Schools are also teaching a lot of things which are not suitable for young primary school children. Youth are not afraid of AIDS (1): Most youths are never afraid of HIV. Pregnancy and family planning methods has increased sexual activies Belief in Christianity (1): Most people here are Christians and do not like that there are NGOs who give out condoms but these NGOs only give condoms to youths who cannot abstain.
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Believing in traditional healers (1) most of whom still use one blade for several people. Lack of openness (1): Kusamasukirana- Couples in the rural area are not free with each other and when men meet prostitutes they get carried away with what they do to them. People are just learning to be free with each other. Sharing of strong information by women (1): They share local concoctions like “munowa” which increases libido in women and they say it helps the man the sleep with to enjoy the sex. When they use this and their husbands cannot satisfy them they normally look from other stronger men and men with bigger penises and women who use these do not like condoms. Some use some medicine to tighten their vaginas and these sometimes cause thrush which allows HIV transmission. Lack of sexual satisfaction by women (1): Most men in the villages don’t understand their women sexually and mostly do not satisfy their wives in bed “amawasiya akazi awo mmalere”. This makes women to go to younger men. The problem is most men loose their libido as they grow due to financial pressure. 11.2.2
Positive Prevention.
Advice from elders (8): Previously girls were usually called together and advised by elders and they were really very desciplined.(8) Kadumuliro (5): Kadumuliro, this is a place where people were burnt to death if they were found having sex with someones spouse or found pregnant before marriage. This place is just by ths road you used when coming here, Kadumuliro- When unmarried girl was found pregnant she and the man responsible for the pregnancy were taken to kadumuliro an tied in bundles of firewood an burnt. Even if people were caught having sex with someones wife or husband they were killed at kadumuliro. This made people to be afraid of any misbehavious, Our forefathers had a judicial valley called “kadumuliro but it was stopped by Chirambo who was a nephew to the then Themba. People who were found guilty of ommitting adultery were bundled in firewood and burnt to death. I belive that this was good if we could just change the severity. Dressing (5): Girls used to dress decently,In the past a woman nakedness could not just be seen anyhow, and women were dressing to cover up most of their bodies., Girls and women used to dress appropriately not like these days when girls are walking almost naked and tempting men, When a man passed away the widow was always putting on a doek which was called Chithawezi and men were always keeping off, this could help these days only that people would argue that what about tif a woman dies what will a man put on. This issue about rights has disturbed culture, Men wee so disciplined- people were just putting on a small cloth around the wasewe used to call “Sambi” but you could not hear that a man has raped a girl. Mitala (3): Mitala- mitala is one wy of lessening promiscuity. People hate mitala but in actual fact if men have one wife they go around having a lot of girls and it is even more dangerous than mitala. In the villages mitala is not considered as multiple concurrent partenership, it is a normal thing. If you look at the prevalence in islamic cultures or among Jews you will find that HIV prevalence is low because of polygamy. The prevalence rate in Rumphi is at 6.7% while for the whole Malawi is 10.2%, Mitala has two sides the good part of it is that when a man as two wivs he wont have time to go around looking for other women, Mitala. Polygamy is good because no man can have only one woman. If he has one wife he goes around sleeping with other women. Descipline (3): In Adolescents, there ued to be discipline, they were being threatened; boys were being told that their private parts coud get burnt if they slept with anyone, and the will be having terrible back aches, People were disciplined and respected their parents especially their mothers,The youth use to be very obidien to their elders not the way things are these days
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Punishment (2): We have a system where by when women report to the chiefs about a missing husband when found the husband is arrested by the chief and given a punishment, There is a punishment which is given by the chiefs to all those who are caught and accused of committing uldeterly. Faithfuness to one another (2): People in the gone years were afraid of fornication, afraid of getting pregnant out of wedlock and afraid of getting sexually transimitted infections, People believed that when people were fornicating the whole village could be affected by illnesses like (chikhoso) unstoppable coughing Abstainnce (1): There is just a few things that would positively affect HIV prevention. The main one is that during the past times people used to absain from sex up until when they got married, There are no specific Ik but some of the things which were bad were changed and now they are helping in the preventon of HIV/AIDS. For example; Chief installation (1): When installing chiefs beautiful girls were chosen to work for the invited chiefs and ended up sleeping with them but now whenever a chief is being installed the other invited chiefs are asked to bring their wives along with them. Vibwaira (1): Vibwaira: this is a tradition that after a month in marriage, women from the brides side go to visit where the girl is staying with the husband. It was usually occuring at night but now it is rohbited and only done during the day. Tradition dances (1): Even traditional dances are no longer perfomed at night as it used to be before. Delayed marrieges (1): If we look back into the past people were delaying in getting married but now things have totally changed, things are bad now. Back then people were reahing eighteen years before getting into sex but now people are starting at eight. Back then people could get married not knowing what to do in marriage. Social distance (1): There also used to be social distance. Girl could not play with boys and viceversa. Girls were told that a boy should not in any way see their private parts. Lack of education (1): Back then girs were not educated and the only rules they were following were from their parents but now, education is opening them up and with the issue of gender equality they are even demanding for sex from boys. Parents had power over kids (1): Back in times parents had power over their parents they could even undress their child to see if she ad sex but now with the children`s rights you cant do that. Myth by old people(1): Some old people could even just come up and say that i am not feeling well these days and i know its not normal sickness, someone has done something bad and someone could always come up and confes that s/he wa fornicating or a girl ws pregnant.. Choice of a good spouse (1): In our culture we believe that when you want to marry you do not just pick anyone anyhow. You need to know the person and wheres/he comes from. This helps to choose a good spouse who you has known that has good behaviour. Advice for girls (1): Girls are advised a lot, when they start their period they are taken by aunties, if there is an elder sister ans may be inlaws and is advised for about seven days but boys are never advised but only if they have done something bad, Girls were sleeping in one house and it was called Nthanganene or Mphara ya wakazi. This was kind of securing the girls and it was indeed helping
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Sense of togetherness (1): Long ago people used to eat together because they used to live like a community and their children were sleeping in one building. For girls their house was called nthanganenge and boys Mphara. This is where the children were getting advised by elderly people. This was helpful because there ws no difference between an orphan and the other children. Sex isolation (1): Girls and boys were waiting till getting marriage to have sex. Hey could visit each other nd spend the night in one room but never have sex. 11.2.3
Challenges to IK for HIV Prevention.
Modernization and development (4): Development always comes with negative things as well. People are exposed to different cultures now and it is difficult to guide them, Modernization has transformed things. Now aunties are not taken seriously by the children; they are getting information from Facebook, videos and these kill what the children have been taught by their elders, Mostly the challenge being faced by these is westernization. The coming of videos and all have seen people watching pornographic movies., People go to live in town, adopt new behaviours and when they come back here they teach other people Human rights (3): Human rights make it difficult to apply some of the beliefs we had, Human rightspeople don’t understand the rights properly and whenever you try to corret your child they accuse you of violating her or his rights, Human rights- These days no one can disciplines someone’s child. Previously if an elder person found any child doing things that were not right that elder person could even beat that child up but not nowadays. Even for the virginity test, girls were tested by finger insertion while buys were checked if their foreskins were going up a lot but can you do that to the youths of these days? Mitala (3): Mitala- polygamy was just okay in the past days because women were very loyal. Men could go to (Theba) work in South Africa and come back and find all the wives waiting for them because they were afraid that they would fall pregnant but now they just use contraceptives. Nowadays mitala is not good because most women now are crooks. The challenge about polygyny is that the women these days are big hearted. They challenge men. Some young women even challenge that when i am fed up I will marry a fellow woman but we have never seen it here (woman marrying woman), As regards mitala, the problem is that most men fail to take care of the wives and women go their own ways and other men now are afraid of mitala. Education (3): Even schools are now teaching primary school children biology. The children are getting details at a very young age, School- Just because the youth are educated and most of the older people are uneducated, the youth think that the things they hear from the older people are old fashioned and baseless. The youths these days do not listen to elders Dressing (2): Girls think dressing properly is old fashioned, Freedom of dressing, it is only married women who are dressing respectably these days and the problem is these men are really dogs (wanalume yawa, ni vintchewe nadi) They leave you and go for those who are dressed in miniskirts and trousers yet they can never allow you to dress like that. Gander equality and NGOs (2): Gender equality is another thing. There are a lot of NGOs empowering the girl child and some of the things they are being taught have negative impact, We are one of the NGOs that empower youth, we tell them to abstain but for those who cannot abstain we give them condoms. These condoms somehow have a negative impact because it is like the girls have nothing to fear and can go ahead and have sex without getting pregnant or getting infected. We give out a lot of condoms and some are given to some youths who distribute to peers in the villages and this makes the youths to be more free to get the condoms. Most of the youths have nothing to do and they take sex as a hobby.
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People are knowlegable (2): These days, people are no longer afraid, they know much more than they were supposed to know, These days the parents do not know how to talk to their children, they think that everything that is new is bad. Advice from parents (2): Children were never advised by their parents but by their aunties and uncles and this allowed freedom to talk about anything. How can a father talk to his son openly about sex, There are no (zilangizo) these days because girls have to attend school. Tradition believes (1): The only challenge which was there was that the people were so used to these traditions and some people still try to cling to them. Business and work (1): Parents are busy with different activities to make money and care less about what their children are doing. Judicial system (1): The judicial valley cannot work well with the human rights that we have today Media institutions (1): Radios are broadcasting programs which are not suitable for everyone. Individualism (1): These days its every man for himself and this hinders the “living as a community” life Migration (1): There are a lot of men who go to South Africa and Zambia to work and they also bring strange behaviours. Use of condoms (1): Even girls these days are not afraid of sex because they trust in condoms and if it breaks they get infected. The problem is the government and NGOs because they just provide contraceptives and condoms to anyone and these things are promoting promiscuity Religion (1): People are more religious these days and many religions forbid mitala. 11.3
IK FOR HIV TREATMENT
11.3.1
Negative Ik for Treatment
Fake prophets (8): Prophets who pray for people and tell them to stop taking ARVs (7), Pastors cheat people to have cured them by prayers and my two sisters died because of the same. I tried to talk to them but when people believe in their pastors so much it is difficult to change their mind Beer drinking (5): Beer drinking (5) Religion (3): Religion- some religious leaders pray for people and tell them to stop taking ARVs. So just because this person was on ARVs, s/he survives for a while but when it resurfaces, it is Worse, My dad also died because of that, these churches are very bad, We had a death last year because of that same thing, There were also some youths who were excommunicated from their church because they were found with condoms at Kawaza, Bolero and we also met the church leaders on this. Sex with kids (3): Some people believe that if you have sex with a toddler, a lame person or an albino you can get cured of AIDS and this has seen rape cases increasing, Some people believe that when you sleep with a girl who has yet reached puberty then you get healed, Some believe that if you are HIV+ and you have sex with a small girl like of the age three to five or with a crippled girl then the virus goes
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Stigma and discrimination. (2): Stigma and discrimination. We have a case of a girl who is discriminated (see attached case study). The girl’s parents died of AIDS. She is now 14years old and has a 4years old child of her own. Just because believe that her parents were promiscuous they think the child deserves what she is going through. There is another case where a widow hated her child so much just because her late husband was so promiscuous, the child turned to the streets, REAP picked him, he is now in school and was reconciled with the mother, Because of stigma, most people fail to take their medication openly in fear that they may be stigmatized Belief in witchcraft (2): Belief in witchcraft. Yes there is witchcraft but when it comes to HIV/AIDS people have to be taught to accept because they end up going to the hospital when it is very late. This hinders treatment, Belief in witchcraft- some people never go to the hospital because they believe that they have been bewitched. Lack of knowledge about your on status (1): There are many children who are taking ARVs and don’t know that they are ARVs. For example there was a case of a 17years old form two student who was taking ARVs but all along he was told that they were asthma drugs. When he realized that they were ARVs he was refusing to take them and REAP had to intervene with some counseling for him to start taking them again. We have a program with youths on ARVs and now we have 126youths so you can imagine how many are out there. These ones now know that they are taking ARVs. When found positive other people spread the virus (1): There are some people who when they are found positive they think of spreading the virus and in so doing affecting themselves as well. Men hide their HIV status (1): When men are the ones who are first found HIV positive and start medication they usually hide it from their wives Traditional practices (1): Chiulira- this is a practice where by when a woman has a child and before she starts having her period again she gets pregnant again. The woman is taken away from the village and they build a temporally shelter for her away from everyone. This hinders the woman to have a well-balanced diet and even to access PMTCT services. People belive in traditional healers (1): Belief in asing’anga- when you first go to traditional healers they cling to you even if they know they cant cure you just because they are interested in money Youths fear to disclose their status (1): Most youngsters are afraid to disclose their status and some end up committing suicide. Traditional hearers cheat patients (1): There are some traditional healers who cheat people that they can cure them of AIDS. Ignorance (1): Ignorance- a lot of people here are ignorant and this is a big problem on its own. Beliefs that combining ARVs with chamba and beerone can get healed (1): Some people believe that if you take ARVs with chamba or kachaso then they work well and the virus dies. Beliefs that creaning genitals with chemicals one can prevent AIDS (1): Some men believe that even if one is on ARV they can have sex with her and then just wash their genitals with coca cola. HIV couple ignore advive (1): In some families where the couples are taking ARV some men say that even if they are advised to be using condoms but only on Sunday, they do not want to use condoms. 11.3.2
Positive Ik for Treatment. 178
Use of local herbs (4): There are herbs which the locals are also using like molinga, ginger, garlic. Neem and mvunguti, They heal so many diseases which come as opportunistic infections but they don’t tell people what kind of medicine it is. Most traditional healers don’t disclose the medicine; here are even some who, when a woman is looking for medicine to help her fall pregnant they take the medication themselves and sleep with the woman and in so doing they spread HIV, What we know is that people use aloevera, People now do have herbal gardens which they use to cure OIs. People use herbs such as bluegum, mvunguti, and other things, Some people use neem, garlic and nkholose (mvunguti) for cure of high blood pressure, diabetes and other diseases. Belief in traditional hearers (4): I just know that there is one traditional healer in Henga valley who gives people immunity booster but he never discloses what type of medicine it is., The only true traditional cure you can find in the village is a cure for STDs excluding AIDS otherwise i do not know any other medication or treatment, I am a traditional healer myself and i heal blood pressure and other sicknesses and have some concoction which helps in boosting immunity. I just us the local leaves here and I know there are also some people who know other types of medications, I believe that traditional healers can also help because we had AIDS from long ago but before it was known that it is AIDS people called it, kaliwondewonde or kanyera wankulu and then people could go to a traditional healer and get well. AIDS has no cure (2): There is nothing traditional or local that can treat HIV/AIDS. We know that other people plant some trees but nothing that is indigenous can help in HIV/AIDS treatment, There is no specific Ik that treats HIV/AIDS but some traditional healers do cure STIs. Some people use herbs to cure some opportunistic infections like shingles, Asthma and sugar, and these people are not “asing’anga” Vimbuza (2): At this place, that building you are seeing there is a place where the zimbuza doctor operates from, we work hand in hand and some people get healed by the zimbuza women, Vimbuza dance is believed to have spiritual powers that heal any form of sickness. Spirit of sharing (2): In our culture we believe in sharing, so we even share food to those who are ill so that they can be taking their medication without any problem, People here live like a community. If a person lives alone and is bed ridden a guardian is identified and the person is always helped The is no treatment for AIDS (1): There is no treatment of AIDS apart from ARVs but some people use aloevera, neem and pear leaves just to increase immunity. Good diet (1): Even diet helps to cure some of the OIs like taking the local vegetables like potato leaves, chamwamba and others also help boost immunity, I heard that when honey is mixed with some herbs it also is a cure of several conditions 11.3.3
Challenges to Treatment.
Christianity (3): Most of churches do not like traditional healers. We see it even here they do not not come to our hospital just because we also use that zimbuza doctor, Mostly the problem which is there is that there are a lot of people who pray for others and cheat them that they are healed and should stop taking medication. Some traditiona doctors are liers (3): There are some traditional healers who cheat people that they cure AIDS and this has made people not to trust them, The other problem is that when these people know one type of medication and it really works they start cheating people that they know a lot of medication. Modernization (2): People are modernized and many just rush to the hospital and never believe in herbal medicine. The problem is that most of these are not documented, Modernization. People are getting 179
modernized and changing their ways of living. Sometimes it depends on your location. When you live next to town you usually have mixed cultures. Government does not involve traditional doctors (2): The government does not involve asing’anga in HIV/AIDS programs. Some time back donors for HIV/AIDS programs involved them but were later left out. Now the traditional healers lack the right information because they are not involved. Then the traditional healers were getting expelled if a patient would die in their hands, Government does not want to work hand in hand with herbalists People stoped believing heberlists (2): People these days go to the hospitals because they feel that these traditions are old fashioned, Many people stopped believing in herbalist and go to the hospital whenever they have a medical problem. This is because there are some herbalists who are crooks and cheat people a lot Lack of scientific research (1): most of these medications are never researched by scientists so it does not give people a lot of confidence. Traditional hearers are vulnerable to AIDS (1): The traditional healers themselves are vulnerable to HIV People do not trusting tradition healers (1): People are not trusting tradition healers because of the circular humanism campaign going on in Rumphi, Traditional healers mostly don’t accept that they have failed to heal a person and people die because of seeking medical attention very late. ARV are used to brew beer (1): People use ARV’s for brewing local beer 11.4
IK FOR CARE AND SUPPORT
11.4.1
Negative IK for Care and Support
Stigma and discrimination (4): Stigma and discrimination comes here again. A lot of people believe that HIV is only spread through unprotected sex. We have a big problem among the youth because there are some youths who are in teens and got infected by their mothers; Modernization and individualism (3): Some people feel that they are rich now and don’t want to share with others, The problem is that some people now have money and it is difficult to share, that is the main problem, When people go to stay in town they bring new things to the village and people stop helping each other. Business and work (2): Many people are busy looking for money now and don’t have time to look after others, People here like money so much that if a girl is in a relationship which is bringing in some money they never stop the girl from that relationship and when a girl like this one falls sick no one wants to help. Traditional practices (2): Chiulira also fits here, Chiulira- when a family has given birth to twins or the woman is expectant for another child before having her period after the previous birth they are not supposed to come in contact with anyone. Previously they were taken away from the village but this time around they leave them in the village but they are not supposed to be in contact with anyone until the time when they are cleansed. The cleansing involves burning the thatch of their house, their clothes and then they take a herbal bath. If these people are poor and may be positive it means that they won't get any support from anyone Support groups (2): Most of the support groups have limited knowledge about care and support, they need to be trained, Most of the support groups rely on individuals and if those individuals die or choose to leave the village the support groups die.
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Promiscuous (1): People just believe that everyone who has HIV/AIDS got it because s/he was promiscuous. 11.4.2
Positive IK for Care and Support
Sense of togetherness (12): We help each other as a community, when one is sick; s/he is visited by everyone and with food or money.(6), Traditionally as tumbukas we believe in sharing the little we have with others and it is very helpful when one is ill, As a culture, the people here grow up trusting that relatives have to care for each other and there is always support for each other when one is ill. We usually go to see that person with gifts, In the tumbuka culture they say a sick person is never a responsibility for one person, but of everyone around so the whole community helps when one is ill, Isangweni- isngweni is the practice where people were having their meals together, and for children, it was called ntcheni, People were eating in one place which ensured that everyone had food to eat. They called it “kulya pa mphara”, Those who are sick are always helped with their household chores Extended families (6): Having extended families is a norm here in the tumbuka culture. (5), Orphans are always taken over by relatives and even when a person is bed ridden s/he and her/his children are cared for by relatives Visiting the sick (2): When a person is sick in hospital or at home it is tradition that we visit them with gifts (mituka) and this helps the sick person a lot, People here always visit those who are sick and always bring some gifts. Support groups (1): There are support groups in the villages especially around Bolero ad they are better than the home based care. Traditional hearers (1): having asing’anga in the villages also helps to get some help right in the village. Chokolo (1): Chokolo- chokolo is good because there is assurance that the deceased’s wife and children will be taken care of, what is need is to sensitize people that it should be minus sex. HBCs program (1): We still have home based care programs and they are working well 11.4. 3 Challenges to IK for Care and support. Civilization and individualism (7): Civilized families don’t like extended families, people are getting westernized, People are adopting modern ways of life and it is changing everything. The problem is the same modernization. When we have children and they go to leave in town they bring some good things here and discourage sharing, Belief that the things from the western countries are superior to our traditional ones. Some people even de campaign traditional healers, People are now moving into nuclear families and it is difficult to share. Urbanization. Though we are in the village here people want to live as if they are in town and they no longer want to share what they have, Things are changing in the community, the sharing spirit is dying. Business and work (3): We have a lot of tenants here working in tobacco farms and they are bringing strange culture and mixing it with ours, A lot of people now are busy with their own businesses, Aunties and uncles were the ones looking after the children but now they are busy making money for their own families Discrimination and stigma (2): Discrimination plays part. People don’t like to help the people they believe that got infected because they were promiscuous, Stigma and discrimination- there are a lot of people who want to distance themselves from AIDS patients Support groups (2): Most of the support groups have limited knowledge about care and support, they need to be trained, Most of the support groups rely on individuals and if those individuals die or choose to leave the village the support groups die. 181
Poverty (1): Umphawi is a challenge- some fail to take care of their relatives because they can just not afford to. Prolonged illness (1): Prolonged illness always wears away economic muscle of the helpers and it becomes difficult to take care of a person. Culture dilution (1): I really don’t know what the problem is, maybe because there is no one to teach the young generation abot our way of life an now our culture is being diluted by new things. Technology (1): Techology-videos, internet and phones are teaching people things which are contrary to our culture and some people are adopting that. Tradition medication is viewed as inferior (1): People feel that traditional medicine is old school and primitive. Gender equality (1): Gender equality- so many things are going wrong these days just because women are becoming big headed. They don’t want to listen to men Women are stakeholders of the community (1): We the women are the ones who take care of the community and when our marriages are not working it means that things will not work in the community and the problem is that marriages only work during this farming season but when we sell our crops and the men get the money everything stops working and how can you take care of someone when you also need to be taken care of. 11.5
COMMUNICATING IK IN THE TUMBUKA CULTURE
11.5.1
COMMUNICATING IK FOR HIV PREVENTION
(a) Keyholders For all: Chiefs and community leaders (9), Development committee members (6), grandparents(5) aunties and uncles(4); parents; religious leaders (9), local NGOs; health workers; , elderly and cultural custodians, parents, teachers; For Men: The elderly and cultural custodians, parents, teachers; For Women: Chiefs and community leaders, women’s groups, Support groups, development committee members, PLWHA, For Youth: NGOs, traditional and community leaders, elderly and cultural custodians, parents, teachers (b) Key Players For all: Chiefs and influential community leaders (10), development committee members (6), local NGOs and CBOs (5), Church leaders (6), community health workers and volunteer (5); youth groups; For Men: traditional leaders, mens groups, VDCs local people themselves; For Women: Chiefs, women groups; NGOs, health workers, CBO; For Youth: NGOs, parents, the youth themselves. (c) Approaches, Media and Channels For All: Face to face -FGDs and meetings(8), tallsat community gathering like funerals, fertilizer distribution because that is where you can have a lot of people listening, class and assembly, churches or religious preaching, drama, videos and traditional songs, talks and counselling by parents and guardians, role models, elderly and cultural custodians who bring testimonies about how they have lived longer: For Men: FGDs, Door to door, FGDs, one to one, traditional dances; For women: Community radio, One to one, door to door, peer counselling; FGDs, radio programs, community development meetings, women group meetings; For Youth: IEC materials but should be specifically for a particular culture, games that involve HIV issues discussions, Meetings so that they can target even those who are illiterate, video, drama, talks in schools, arts, peer education 182
(d) Time and Place For all: In community or chiefs court meetings, public meetings when people are dome working in their fields so that everyone is targeted, meetings in the villages at any time when people are not in their gardens and during funerals, at churches, village meetings, funerals and fertilizer distribution; at video shows and drama places in the afternoon, home whenever parents talk to their children, youth forums any time; For men: Any time, mostly when people are not busy in the fields, home or secluded places, chiefs places; For women: Any time, at community meetings, homes, initiation rite places, For youth: games, after school; during school holidays; at youth clubs, fin schools; village, homes and peer groups including community grounds. 11.5.2
COMMUNICATING IK FOR HIV TREATMENT IN TUMBUKA
(a) Keyholders For ll: traditional healers(7) like Rumphi traditional Healers Union (RUTHU), TH(s), health staff and their institutions; local NGOs and CBOs, they already have some remedies like neem, molinga, ginger, garlic, mvunguti and others which help some opportunistic infections; Support groups and PLWHA(5; TBAs, For Men, TH, health workers, and cultural custodians; For Women: Community health workers and herbalists, PLWHA; For Youth: NGOs, health staff and workers, teachers, parents, (b) Key Players For ll: Traditional healers (3), health staff in collaboration with herbalists (5), local NGOs and CBOs, religious leaders and groups, support groups and PLWHA; For Men: traditional leaders, health workers, men groups, THs, FBO, CBOs; For Women: Community health workers, herbalists, CBVs, PLWHAs, women’s group; For Youth: NGOs, health workers, teachers, CBOs, youth groups, religious groups (b) Approaches, Media and Channels For ll: FGDs and meetings (5) drama, viallge to village, home to home, one to one counselling, talks in schools, drama, quiz, Men: FGDs, door to door, one to one, For Women: Dances, songs and FGDs, door to door, testimonies, visits, discussions; For Youth: FGDs, meeetings, class talks, parents talks, (c) Time and Place For all: at community or village meetings, churches, hospitals, funerals, at traditional healer; in schools, homes and work places. For Men; homes, hidden places; hospitals, chiefs place, church: For Women: It should be during the day, homes. Church; For Youth: Any time at community grounds, schools, homes, in their peer groups. 11.5.3
COMMUNICATING CARE AND SUPPORT
(a) Keyholders For All: Chiefs, community leaders (8), village elderly and cultural custodian; support groups and PLWHA these people are slowly by CBO which are funded by organisations, Parents (4); For Men: Community leaders and elders; THs and herbalists; For Women: Elderly and village counsellors, chiefs and community leaders(5), support groups and PLWHA, women groups; For Youth: chiefs and community leaders; health workers, parents(3), teachers (b) Key players For All: Chiefs and influential leaders (8), the elderly, development committee members, parents(6) and, HBC volunteers, health workers, NAC and MoH should provide the information about care and support, herlalists(4); palliative care which used to be available some time back; For Men: Local people and AIDS support groups; chiefs; health workers; For Women: The elderly, support groups and PLWHA, chiefs and community leaders, women groups; For Youth:Community based volunteers, youth groups, health workers 183
(c) Approaches, Media and Channels For All: Meetings and discussions, meetings, social gatherings like funerals and churches, chiefs at community meetings; parents in their homes; traditional songs and dances; counselling to young generation, drama and even in churches and funerals, talks in schools; village to village, door to door by community nurses and HBC volunteers; For Men: Discussions; For Women: Discussing in community meetings whenever a chance arises; For Youth: Public meetings, drama and songs (d) TIME AND PLACE For All: In village meetings; social gatherings at any time a chance may rise, in homes, at churches, funerals, Any time the parents can talk to their children; when there are community meetings, In schools at any time, In homes and village meetings at any time; For Men: Chiefs place; homes; community meetings; church. For Women:; At community meetings, homes, groups meetings, chiefs place, any time convenient; For Youth: Community grounds, homes, one to one, schools, peer groups
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