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Study unpicks cultural factors behind HIV pandemic

More than six million South Africans are known to be HIV positive but in spite of effective anti-retroviral therapies there is widespread resistance to being tested or even to accept it is sexually transmitted.

Research by Brunel anthropologist Dr Isak Niehaus is helping to unpick the cultural and social factors which shaped the pandemic and so help health practitioners and policy-makers shape their responses.

Spending a month each year over a decade of fieldwork in the low veldt, Dr Niehaus has built an unrivalled understanding of the complex social interactions, beliefs and attitudes which prevent many seeking early diagnosis and early, life-extending treatment.

He found there are a number of contradictory attitudes being held all of which stigmatise those with HIV or AIDS and that some of the most widespread contradict the previous orthodoxy that it was because of an association with sexual promiscuity.

Dr Niehaus suggests among the rural populations it is a combination of perceiving that those living with AIDS are “dead before dying” with the view held by fundamentalist churches that AIDS is a new, deadlier form of leprosy sent as a divine punishment.

Societal changes have also had an impact, consequences of de-industrialisation include a subsequent increase in male sexual violence against women sometimes coupled with an increased openness to accepting conspiracy theories.

This widespread culture of blame is also at play even after diagnosis. Accepting one is HIV positive forces an acknowledgement that sexual partners may have been exposed. So response can be silence or claiming that witchcraft is involved.

Against such a background Dr Niehaus argues that maintaining confidentiality of diagnosis and treatment might be a better route to increasing the numbers coming for testing before symptoms appear and therapies are less effective.