Culture defines place of HIV in Africa

Altogether, a careful consideration of the available evidence undermines attempts to blame an exotic cultural milieu for the high prevalence of HIV/Aids. COURTESY PHOTO

Culture and HIV/Aids have been assumed to be inextricably linked since the disease was first described. Cultural assumptions about Africans in particular were taken for granted early in the pandemic and shaped the search for socio-cultural cofactors. Many of the proposed cultural risk factors were isolated from the ethnographic record and stripped of their cultural meanings, societal context and historical positioning thereby de-contextualising them.

The fixation on cultural causation has many negative consequences. An overemphasis on the role of cultural elements can easily be misdirected to blame afflicted societies for their own high rates of infection. Particular cultural groups can also become stigmatised and ostracised by a fearful wider society on account of inappropriate claims of cultural causation.

The belief in cultural determinism conveniently releases the West of any responsibility for the plight of sub-Saharan Africa. Moreover, it distracts stakeholders from developing interventions based on knowledge of true causative factors rather than assumptions that have in the end proved incorrect.

In recent years, as many of the proposed relationships between HIV/Aids and culture have become controversial, the trend in the literature has appropriately shifted towards a consideration of social structural factors as more important determinants of the disease.

The shift in focus conforms to calls by Packard and Epstein for illumination ‘by a more fundamental knowledge and understanding of the contours of African social and economic life, which involves more than a cataloging of risk behaviours’.

These structural considerations include, amongst others, poverty, social inequality, migratory labour practices, food insecurity, inaccessibility to healthcare, unavailability of antiretroviral medications and political disempowerment.
The role of structural factors is multifaceted and defies simplistic explanation, but generally fits the pattern that poorer, more marginalised groups are more likely to be affected by HIV/Aids. The emphasis on social structure and power imbalances has the added benefit of recasting HIV prevention as an attempt not only to modify disease patterns, but also to mitigate social injustice and inequality.

The trend towards de-emphasising culture as the driving force behind the prevalence of HIV/Aids in sub-Saharan Africa is being supported by new ethnographic and epidemiological evidence. The proposed cultural risk factors in sub-Saharan Africa fail on inspection to explain global disparities in HIV prevalence because they are insufficiently dangerous, insufficiently widespread or insufficiently different from other parts of the world, where HIV/Aids rates are far lower. Altogether, a careful consideration of the available evidence undermines attempts to blame an exotic cultural milieu for the high prevalence of HIV/Aids.

In short, support for culture as a singular determinant in the African epidemic of HIV/Aids falls flat when disabused of its culturally biased and ethnocentric assumptions.
Nicholus Sserunjogi,
Makerere University