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Tr ansi t i ons t o adul t hood: Exam i ni ng t he i nf l uence of
i ni t i at i on ri t es on t he HI V ri sk of adol escent gi rl s i n
Mangochi and Thyol o di st ri ct s of Mal awi
Joanna Ski nner a , Car ol Under wood a , Hi l ar y Schwandt a & Assana Magom bo b
a Depar t m ent of Heal t h, Behavi or & Soci et y , Cent er f or Com m uni cat i on Pr ogr am s, Johns
Hopki ns Uni ver si t y Bl oom ber g School of Publ i c Heal t h, Bal t i m or e, MD, USA
b Depar t m ent of Heal t h, Behavi or & Soci et y , Cent er f or Com m uni cat i on Pr ogr am s, Johns
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To ci t e t hi s art i cl e: Joanna Ski nner , Car ol Under wood, Hi l ar y Schwandt & Assana Magom bo ( 2012) : Tr ansi t i ons t o adul t hood:
Exam i ni ng t he i nf l uence of i ni t i at i on r i t es on t he HI V r i sk of adol escent gi r l s i n Mangochi and Thyol o di st r i ct s of Mal awi , AI DS
Car e: Psychol ogi cal and Soci o- m edi cal Aspect s of AI DS/HI V, DOI : 10. 1080/09540121. 2012. 701721
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Transitions to adulthood: Examining the influence of initiation rites on the HIV risk of adolescent
girls in Mangochi and Thyolo districts of Malawi
Joanna Skinnera*, Carol Underwooda, Hilary Schwandtaand Assana Magombob
aDepartment of Health, Behavior & Society, Center for Communication Programs, Johns Hopkins University Bloomberg
School of Public Health, Baltimore, MD, USA;bDepartment of Health, Behavior & Society, Center for Communication
Programs, Johns Hopkins University Bloomberg School of Public Health, Lilongwe, Malawi
(Received 24 October 2011; final version received 7 June 2012)
Although some cultural practices have been identified as a determinant of HIV transmission, research
investigating how specific practices affect HIV risk is lacking. In Malawi, initiation rites, in which young people
attend ceremonies around the time of puberty, have received little attention. In this qualitative study, we explored
whether communities in southern Malawi perceive initiation rites to be an HIV risk factor for girls. Twelve focus
group discussions were held with adolescents and adults in a rural community of Thyolo district and a peri-urban
community of Mangochi district. Community members observed that certain aspects of traditional initiation rites
propel girls into sexual roles expected of adulthood, without facilitating their adaption to the emerging landscape
of HIV, thereby increasing HIV risk. HIV prevention programming needs to address the role of initiation rites in
adolescent girls’ vulnerability to HIV and help young girls navigate the conflicting messages they receive from a
wide range of channels about expected sexual behavior.
Keywords: girls; adolescents; HIV/AIDS; initiation; Malawi
In sub-Saharan Africa, HIV/AIDS is having a
devastating effect on girls aged 15?24 years, who
are up to eight times more likely than their male peers
to be HIV positive (Joint United Nations Programme
on HIV/AIDS [UNAIDS], 2010). In Malawi, pre-
valence among young women aged 15?24 years (5%)
is more than twice than that among their male
counterparts (2%). Prevalence among young people
is highest in the southern region, where 7.5% of
young women and 2.4% of young men 15?24 years of
age are HIV positive (National Statistical Office
[NSO] and ICF Macro, 2011). Given the impact
that the HIV epidemic is having on girls in this
region, adolescent girl-specific risk factors urgently
require our attention.
Adolescent girls’ sexual behavior takes place with-
in a complex web of social and cultural influences
(Harrison, 2008) ? as is recognized by the social?
ecological perspective. This perspective views indivi-
duals as nested within a system of sociocultural
relationships ? families, social networks, commu-
nities, nations ? that are influenced by and influence
their physical environments (Bronfenbrenner, 1979;
Kincaid, Figueroa, Storey, & Underwood, 2007;
McLeroy, Bibeau, Steckler, & Glanz, 1988; Stokols,
1996). This approach draws attention to the role of
extra-individual factors in health outcomes (Rose,
1985), and yet does not ignore the individual. Rather,
individuals’ decisions and behaviors are theorized to
depend on their own characteristics as well as the
social and environmental contexts within which they
In this framework, sexual behavior is shaped
through personal experiences and influenced by
cultural assumptions, expectations, roles, and prac-
tices (Boyce et al., 2007; Parker, 2009). The impact
of community-level influences may differ based on
the expected behaviors of young men and women
(Stephenson, 2009). To understand the sexual beha-
vior of adolescent girls and subsequent HIV risk, it is,
therefore, essential to understand local norms and
practices that shape sexuality (Boyce et al., 2007;
Parker, 2009). The research conducted to date to
understand the sociocultural influences on adolescent
sexual behavior has been rather limited, particularly
in Africa (MacPhail & Campbell, 2001).
Initiation ceremonies are a sociocultural forum
during which adults convey to young people commu-
nity-held attitudes and beliefs about sexuality to-
gether with a code of behaviors deemed appropriate
for the transition to adulthood. For the most part,
these sociocultural ceremonies coincide with the
physiological stage of puberty, demarcated for girls
by the onset of menarche. Van Gennep (1908), in the
‘‘Rites of Passage,’’ identified a pattern of initiation
that includes ‘‘rites of separation from the asexual
*Corresponding author. Email: firstname.lastname@example.org
2012, 1?6, iFirst
ISSN 0954-0121 print/ISSN 1360-0451 online
# 2012 Taylor & Francis
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world, and they are followed by rites of incorporation
into the world of sexuality’’ (p. 67) and ‘‘mark the
transition from childhood to adolescence’’ (p. 68).
In Malawi, participation in initiation ceremonies
varies by region and ethnicity. In the southern region
57% of girls aged 12?19 years have undergone
initiation ? higher than in other regions of the
country. The majority of Yao girls (75%) and Lomwe
girls (60%), the dominant ethnicities in the southern
region, have participated in initiation ceremonies
(Munthali & Zulu, 2007).
During initiation, girls are taught about personal
hygiene, how to show respect for elders, how to take
care of the family, and how to please their future
husbands, including sexually (Malawi Human Rights
Commission [MHRC], 2005; Malisha, Maharaj, &
Rogan, 2008; McCreary et al., 2008). Attending
initiation is considered an important symbol of
becoming an adult and an opportunity to teach
young girls about expected roles and behaviors in
the next phase of their life. Youth who do not attend
risk being socially isolated in their communities
(Malisha et al., 2008).
In settings where HIV prevalence is high and
transmission is primarily sexual, the extent to which,
and how, initiation influences adolescent sexual
behavior is important to understand; yet, research
on this topic is thin. This study uses qualitative data
to examine the link between initiation practices and
implications for adolescent girls’ vulnerability to HIV
from the perspective of community members in
The findings were drawn from a qualitative research
study conducted in November and December 2008
in purposively selected communities in Botswana,
Malawi, and Mozambique. A comparative analysis
of the findings has been published elsewhere (Under-
wood, Skinner, Osman, & Schwandt, 2011). This
article focuses exclusively on the findings from
Malawi due to the unique nature of initiation rites
in that country.
Focus-group discussions (FGDs) were used to
promote interactive dialog and encourage partici-
pants to examine and reflect on their own priorities.
Six FGDs were held in a peri-urban area of Mangochi
District and six in a rural community in Thyolo
District. In each site, one FGD was held with each of
the following groups: adolescent girls (two cohorts ?
ages 10?14 years and 15?19 years), adolescent boys
(ages 15?19 years), adult women (ages 20?49 years),
adult men (ages 20?49 years), and community
opinion leaders, including local officials, headmen,
religious leaders, teachers, and so on. Eight to twelve
people participated in each focus group for a total of
Participants were purposively recruited through
traditional leaders and local community organiza-
tions using age and sex as the main recruitment
criteria. No names or personal identifiers beyond age,
sex, and occupation of participants were recorded.
Discussion guides for youth and adults were
created to provide structure to the FGDs based on
the social?ecological perspective and findings of a
literature review on girls’ vulnerability to HIV in
southern Africa. The guides included questions to
explore participants’ perceptions of the most vulner-
able groups in their community and then delved into
the issue of girls’ vulnerability in more depth by
asking which adolescent girls are most vulnerable to
HIV and why. The guides used prompts to explore
knowledge of and attitudes toward initiation rites and
their relationship with HIV risk. Each FGD lasted
approximately two hours and was facilitated by same-
age, same-sex peers, except for the youngest group
who had same-sex, older teen facilitators.
Ethical approval to conduct the study was ob-
tained from the Institutional Review Board at the
Johns Hopkins Bloomberg School of Public Health
and the National Health Science Research Committee
in Malawi. The support of community leaders was
also obtained at the local level. Oral informed consent
was obtained from adults before they took part in the
FGDs. Minors were invited to take part in an FGD
only after obtaining the oral consent of a parent or
guardian as well as their own oral assent.
All FGDs, with the consent of the participants,
were audio taped, the recordings were transcribed
verbatim in Chichewa, and translated into English.
Data sorting and analysis were carried out using
ATLAS.ti software, guided by the thematic content
analysis approach (Green & Thorogood, 2004). The
codes used in the analysis were both pre-determined,
from the conceptual framework, and based upon the
participants’ own words, through careful reading of
all the transcripts and field notes. A structured coding
scheme was discussed and developed by the research
team, which included Malawians and Americans. All
transcripts were then re-read by two researchers and
final codes were agreed upon, addressing any dis-
crepancies through discussion. On the basis of these
final codes, one researcher coded the content. The
coded data were first analyzed to examine group-
specific experiences and perspectives. Matrices were
then created in each thematic area to allow for
comparisons between communities and between
groups. The four authors of this article conducted
2 J. Skinner et al.
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the data analysis; team members in Malawi reviewed
the manuscript. Disagreements about interpretations
were resolved through discussions; only conclusions
that garnered consensus are included herein.
Major analytical themes
The key question explored in the research was the
relationship between initiation rites and HIV risk, for
which five main themes were identified: (1) Sexual
risk behaviors in initiation rites; (2) Transition to
adulthood; (3) Consequences of non-participation;
(4) Changes in initiation rites; and (5) Recommended
changes to initiation rites.
Sexual risk behaviors in initiation rites
Practices carried out during the initiations, particu-
larly those related to sex, are rarely openly discussed
outside of the ceremonies. During the ceremonies
girls are taught how men and women have sex, either
through drawings or by acting out sexual intercourse,
‘‘the girl lay down on the ground and an older woman
on top and they instruct the girl what to do’’ (Peri-
urban, adult woman).
The most common aspect of initiation rites that
respondents linked to HIV risk was the tradition of
kusasa fumbi (‘‘cleansing the dust’’), kuchotsa fumbi
(‘‘removing the dust’’), or kutaya mafuta (‘‘spilling the
oil’’). In order to ‘‘cleanse the dust,’’ initiates are
encouraged to have sex soon after the ceremony. This
practice was noted by all but one of the groups:
Girls who have gone through the ceremony organized
by elders are told to sleep with boys soon after they
have graduated from the initiation ceremony and
they call it ‘kuchotsa fumbi’ (removing dust). (Rural,
adolescent boy 15?19 years)
Some respondents noted that the girls are encouraged
to have sex with new initiates of the opposite sex,
whereas others referred to having sex with anyone,
‘‘girls are even instructed not to refuse sex with
anyone who comes their way first’’ (Rural, adult
The adolescent groups, particularly in the peri-
urban area, demonstrated awareness about the HIV
risk associated with cleansing the dust. Although the
adult groups were aware of HIV, none of them
explicitly linked HIV risk to this practice:
...when they come out of their initiation ceremonies,
they are told to have sex with the opposite sex in
order to shake off dust but while doing that a person
can contract HIV. (Peri-urban, adolescent girl 15?19)
Transition to adulthood
In the participants’ narratives, the initiation cere-
mony clearly demarcated childhood from adulthood.
The traditional rite of passage is intended to trans-
form the obedient, subservient and virginal child into
an assertive adult. A key component of adulthood, in
this narrative, is sexual experience, which is thought to
‘‘remove the dust’’ of childhood to reveal an adult.
The girl is expected to acquiesce to sex to demonstrate
that she has truly come of age:
When they have gone through this rite of passage
some girls when it is evening time are sent some boys
or even men who enter the girls’ room as a
‘‘hyena’’...They say they want to see whether the
girls have really grown up by having sex with them.
(Peri-urban, adult woman)
This practice forms part of their transition to adult-
hood and entry into the sexual world, a chance to
demonstrate that they are now part of adult society:
I want to talk on the cleansing (kusasa fumbi). When
a girl has reached puberty stage she is told that she is
now a grown up person and she can have sexual
relationships with anybody. (Rural, opinion leader)
The adolescent groups pointed to the detrimental
effects of initiation rites on the dynamics of parent?
child relationships. Several rural male adolescents
pointed out that parents no longer think of their
daughters who have been initiated as young girls and,
as a result, essentially leave them to make decisions
without parental guidance.
The peri-urban adult groups all discussed the
impact that initiation had on adolescents’ self-
concept. In particular, they recognized their own
culpability in turning children into defiant ‘‘adults’’
since it is the rites, and adult support for their
continuation, that lead young people to think of
themselves as adults:
Let us be honest, these rites are to blame because we
most of the times tell our children there that they are
now grown up persons. (Peri-urban, adult man)
Consequences of non-participation
Respondents expressed the important cultural signif-
icance of initiation rites as venues to pass on
community values to youth. The consequences of
not being initiated are considered serious and far-
reaching. Those young people who do not cleanse the
dust are regarded as ‘‘stubborn’’ and, ‘‘if there is
another initiation rite of the same type she is called so
that she can be advised again’’ (Peri-urban, adoles-
cent girl 15?19).
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In Thyolo, those who do not go for initiation are
called alukhu (‘‘people who eat using the back of the
hand’’). Boys and girls who have not gone through
the ceremony are looked upon as outcasts and
erstwhile friends refuse to associate with the unin-
itiated as they are still considered children:
Whenever a person, be it a girl or a boy, has not gone
through initiation he or she is not regarded as a
member in society. (Rural, opinion leader)
Changes in initiation rites
Findings from the peri-urban site suggest that initia-
tion rites may be changing in part because of the
emergence of HIV. Although many respondents
asserted that cleansing the dust is still practiced,
others believed that initiation ceremonies do not
promote this custom.
Several of the adults and opinion leaders in this
site indicated that initiation ceremonies advise young
people to avoid premarital sex and to not ‘‘sleep with
men carelessly,’’ although some maintained that this
advice went unheeded:
The youth are advised on how to take care of
themselves and not to indulge in premarital sexual
activities after their initiation ceremonies...But after
they come out of those ceremonies they go wild as if
they have been told to do so. (Peri-urban, adult male)
A few peri-urban respondents noted that some
community members have taken action to change
initiation rites, particularly the practice of cleansing
the dust. No such changes were noted in the rural site:
There is another group called ‘‘Nchanda ni Nchanda’’.
The group had put up a rule that anyone forcing girls
to spill oil should be reported to this group. (Peri-
urban, adult woman)
Recommended changes to initiation rites
Among the respondents who expressed concern over
the link between initiation rites and increased vulner-
ability to HIV, some peri-urban participants pro-
posed taking action to modify or stop those practices
that are putting youth at risk, such as by teaching
‘‘the initiation counselors...about HIV in order to
protect the youth’’ (Peri-urban, opinion leaders) or by
educating young girls about puberty and sex in a new
I wish women here could summon all the girls and
advise us. These women should be well cultured and
brilliant not those who teach sarcastic words at
initiation ceremonies. They should advise us on
pregnancy and about HIV. (Peri-urban, adolescent
Parents in particular were perceived to be responsible
for making necessary changes. The potential for
initiation ceremonies to become places of education
about HIV was also highlighted.
It is important to understand how initiation rites as a
cultural practice in southern Malawi influence ado-
lescent sexual behavior and HIV vulnerability.
Although the link between initiation practices and
exposure to higher risks of sexually transmitted
infections, including HIV, has been documented
(MHRC, 2005), research on this topic from the
perspective of community members is sparse. In this
qualitative study, participants expressed disagreement
as to whether initiation rites per se are protective or
problematic for young girls; however, there was wide
agreement that the specific practice of ‘‘cleansing the
dust’’ increases HIV risk for adolescent girls by
encouraging sex among initiates.
This study found that many community members
in southern Malawi continue to perceive initiation
rites as critical to young people’s transition to
adulthood; however, community members observed
that certain aspects of initiation rites propel girls into
sexual roles without facilitating their adaption to the
emerging landscape of HIV, thereby increasing HIV
Since the emergence of the epidemic, messages
about sexual behavior that young people in Malawi
are exposed to have multiplied, and are often contra-
dictory. Religious institutions were a primary venue
noted for discouraging sex, as were school and
community AIDS clubs, parental counseling and
HIV prevention programs. However, perceived social
norms, peer pressure, and exposure to radio were seen
to encourage youth to engage in sex. Young people
are not passive recipients of this information, but
rather critically reflect on these contradictions, ac-
tively interpreting them as they construct their
sexuality (Dilger, 2003). Initiation ceremonies there-
fore form just one part of the often-conflicting
messages on sexuality that adolescents receive and
HIV prevention programs have not provided
adequate guidance to youth on how to interpret the
different viewpoints, expectations, and traditions
about sexuality in a way that is responsive to their
needs (Harrison, 2008). Moreover, HIV prevention
messages designed for adolescents are often simplistic
4 J. Skinner et al.
Downloaded by [Joanna Skinner] at 10:39 09 July 2012
and fail to engage adolescents in critical reflections
about the consequences of their decisions.
The relationship between initiation rites and HIV risk
signals an urgent need to address these practices in
HIV prevention efforts. There is a need to stimulate
community dialog about the HIV risk posed by post-
initiation sexual behavior. Such action is most
effective when it is embedded within the local cultural
context and initiated by community members them-
selves. The practice of cleansing the dust is perceived
by community members not just as ‘‘sex’’ but as a
symbol of a young person’s entry into adulthood.
Any change in initiation ceremonies is likely to fail if
it does not incorporate this cultural meaning.
Initiation ceremonies have the potential to serve
as a platform to reach adolescents with HIV preven-
tion messages (Groce, Mawar, & MacNamara, 2006;
Munthali & Zulu, 2007) but remain an untapped
avenue. Only a few programs have utilized this
approach, but findings have not been published
(Groce et al., 2006). HIV prevention messages should
be tailored to the different needs of adults and young
people. For example, messages could encourage
adults to maintain protective parental guidance dur-
ing and after initiation and increase risk perception of
cleansing the dust. For young people, messages could
be built around shifting self-identities and the transi-
tion to adulthood. Any messages shared through
initiation ceremonies or other avenues must consider
the alternative messages that adolescents receive
about sexuality and assist them in actively processing
and interpreting contradictions.
Due to the qualitative nature of this study the results
are not generalizable. In particular, the practice of
initiation rites in Malawi is regionally specific and the
findings herein are based on research carried out in
the southern region. Extensive discussion took place
among the study authors to establish a detailed
coding scheme; one author coded the data. Given
that the discussions on initiation practices were part
of a broader focus group on girls’ vulnerability,
further dedicated research on initiation would be
useful to assist communities reconstruct initiation
rites to provide girls with a safe passage to adulthood.
This research was funded by the President’s Emergency
Plan for AIDS Relief (PEPFAR) and the US Agency for
International Development (USAID) under the terms of
Contract No. GHH-I-00-07-00032-00, USAID j Project
SEARCH, Task Order 01. The contents are the responsi-
bility of the authors and do not necessarily reflect the views
of PEPFAR, the US Government or Johns Hopkins
University. The authors would like to thank Glory
Mkandawire and Jane Brown for their contributions to
this study. Finally, our thanks go out to the men, women
and youth in Thyolo and Mangochi, who participated
in the focus group discussions.
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