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On the virgin cleansing myth: Gendered bodies, AIDS and ethnomedicine

  • US Agency for International Development


The belief that HIV/AIDS can be cured as a result of having sex with a virgin has been identified as a possible factor in the rape of babies and children in South Africa. While the prevalence of this myth has been a matter of concern in local communities for some time, there have been recent attempts to discern the extent to which this belief is exacerbating perceived increases in child rape and the rate of new HIV infections nationwide. This article attempts to reveal the systematic logic upon which is based the idea of ‘virgin cleansing’ as a therapeutic response to HIV/AIDS amongst the Zulu. Based on ethnographic research in several peri-urban settlements of KwaZulu-Natal province, key aspects of ethnomedical knowledge associated with notions of ‘dirt’ and women's bodies are examined along with the metaphors that inform local interpretations of HIV/AIDS. The author argues that closer attention paid to the shaping influence of cultural schemas are critical to better understanding belief-behaviour linkages in the context of rape and AIDS.
African Journal of AIDS Research 2002, 1: 87-95
On The Virgin Cleansing Myth: Gendered Bodies, AIDS and
Suzanne Leclerc-Madlala
Anthropology Programme, University of Natal, Durban, South Africa
The belief that HIV/AIDS can be cured as a result of sex with a virgin has been identified as a
possible factor in the rape of babies and children in South Africa. While the prevalence of this
myth has been a matter of concern in local communities for some time, there have been recent
attempts to discern the extent to which this belief is exacerbating perceived increases in child
rape and the rate of new HIV infections nationwide. This article attempts to reveal the
systematic logic upon which is based the idea of ‘virgin cleansing’ as a therapeutic response to
HIV/AIDS amongst people who self-identify as Zulu. Based on ethnographic research in several
peri-urban settlements of KwaZulu-Natal province, key aspects of ethnomedical knowledge
associated with notions of ‘dirt’ and women’s bodies are examined along with the metaphors that
inform local interpretations of HIV/AIDS. The author argues that closer attention paid to the
shaping influence of cultural schemas is critical to better understanding belief-behaviour linkages
in the context of rape and AIDS.
The issue of child rape in South Africa has attracted wide public attention in the
past few years. Media reports of the brutal gang rape of a toddler in late 2001
were met with vigorous public demand for an end to the current climate of
relative impunity in which rape is perpetuated in that country. In an effort to
address what was widely perceived to be a growing problem, Parliament held a
three-day hearing on the subject in the run-up to a new sexual offences Bill
expected by July 2002. Whether or not the increase in sexual crimes against
children reflects an increase in reportage or an actual increase in incidence is a
matter of much emotive debate at all levels of society. Government has made a
call to local social scientists, medical researchers and criminologists to embark on
a concerted effort to better understand this problem. Such a call is timely. From
the mid 1990s onwards, the South African public media has reflected a steady
increase in the reporting of all manner of sexual assault and gender-based
violence. According to a nationwide study by the University of South Africa, one
million women and children are raped annually, and this probably reflects a
fraction of the total rape problem, as most rape survivors never report to
authorities (1).
As part of what is perceived to be a national rape crisis, the rape of young
children has elicited the strongest form of public outrage. In late 2001 an article
by two medical doctors appeared in the South African Medical Journal describing
patterns of injury and appropriate treatment management of child victims of rape
(van As et al, 2001). This was followed by commentary on infant rape in South
Africa in the prestigious Lancet, with the authors speculating on the role of the
‘virgin myth’ as a motivating factor for this particular crime (Pitcher and Bowley,
2002). Several South African researchers were quick to respond by drawing
attention to the more pervasive structural violence that exists in contemporary
society as a result of the country’s brutal past (2). The Director of gender and
health research at the Medical Research Council, R. Jewkes, argued that “the
root of the child rape problem substantially lies at more mundane doors. It
should be regarded as part of the spectrum of sexual violence against women
and girls (cited in Michaels, 2002).” According to studies conducted by Jewkes
and others, there was no evidence overall that child rapes were increasing in
South Africa. Such suggestions have left members of the medical profession
and child protection services aghast, many of whom report to never have
imagined dealing with the levels and brutal nature of child rape cases that have
become a routine part of their work (3). In spite of the fact that there is no
available statistical evidence of an increase in this particular crime, there remains
wide public perception of a national child rape crisis. In April 2002 South Africa’s
Minister of Education commented that the country was quickly earning the
reputation of baby rape capital of the world, as it appeared to be tragically
unique in its current baby rape scourge (4).
This paper is neither an attempt to verify perceived increases in the sexual
assault or rape of children, nor is it an attempt to explain these crimes in the
context of present-day South Africa. Rather it focuses on the prevalent myth
that sexual intercourse with a virgin is an effective treatment for AIDS. The
author suggests that the same iteration of psychosocial denial that informs public
discourse on AIDS in South Africa also affect public discourses on the virgin
myth. It has only been with the increasing media attention given to especially
horrific cases of child rape in the past year and the interest shown by overseas
press in the issue of rape in South Africa, that the virgin myth has come under
closer scrutiny. What follows is an analysis of what may be considered as
significant cognitive and metaphoric constructions from which the virgin
cleansing myth is derived. As such, it is an exercise that involves contestations
of world-views and the challenge of interpreting one highly integrated and
systemic medical cosmology (African and Zulu), through the use of symbols and
idioms borrowed from a very different but equally integrated and systemic
western and biomedical cosmology. Shedding light on the nature of some
ethnomedical beliefs that may be informing and underpinning this myth is the
intended purpose of this paper. What follows is an unpacking of some prevalent
notions and shared knowledge of Zulu-speaking people relating to
ethnopathological processes, women’s bodies and notions of illness and illness
management. As the virgin cleansing myth relates to the disease of AIDS, a
brief analysis is provided of some commonly held ways in which people
conceptualise and experience this relatively ‘new’ illness. Studies of HIV
seroprevalence amongst pregnant women attendees of antenatal clinics around
the country, reveal a 22.8% rate of HIV infection (South African Department of
Health, 2001). For the province of KwaZulu-Natal, where research for this paper
was undertaken, HIV seroprevalence is estimated to be between 36 and 38%. It
is hoped that by elucidating a deeper understanding of why a man might seek
sex with a virgin in the current context of a formidable AIDS epidemic, may
contribute towards a more sensitive engagement with the problem of child rape
and our ability to address both rape and AIDS more effectively.
Unravelling the complex web of meanings in which the virgin myth is embedded
was part of a broader research endeavour to understand non-medical
representations and cultural constructions of HIV and AIDS amongst peri-urban
Zulu-speaking people in KwaZulu-Natal province (see Leclerc-Madlala, 1999).
This research was based on ethnographic fieldwork that took place primarily
between 1995 and 1998 in the greater Mariannhill area of Durban. An open-
ended questionnaire schedule was used as a guide for in-depth interviews with
key informants representing a wide cross-section of members from the
Mariannhill community. For the most part interviews were conducted in Zulu.
During that fieldwork period South Africa was experiencing a rapid and steady
rise in HIV infection rates. Towards the close of the 1990s the HIV epidemic
showed signs of maturing into an epidemic of AIDS-related morbidity and death.
By the mid 1990’s the virgin myth had established wide currency in several
communities in the area. In interviews and discussions with a range of
informants, ‘virgin cleansing’ was identified as a possible ‘cure’ for this new
disease that people dared not to mention by name. While some informants
professed a belief in the myth, more often they claimed that it was ‘other people’
who believed in virgin cleansing as an HIV/AIDS treatment. Certain traditional
healers were blamed for perpetuating the myth, as it was said that healers
advised their HIV infected clients to seek a virgin for ‘cleansing’. It was a
widely-held view amongst informants that this belief was helping to drive the
spread of HIV and contributing to increased incidences in the rape of children
(Leclerc-Madlala, 1996). In one township a group of women held a public rally
to simultaneously raise awareness about this growing problem and strongly
condemn its practice. They intended to send a memorandum to then-president
Nelson Mandela, imploring him to speak out against this heinous response to
AIDS. Despite communities expressing deep concern over men sexually
assaulting children in the hope of obtaining an AIDS ‘cure’, there were no
attempts made to publicly address this issue through AIDS education campaigns
in KwaZulu-Natal or elsewhere throughout the whole of the 1990s.
Bodily dirt
Sontag’s foundational work Illness as Metaphor (1978) points out the historical
specificity of the ways in which illness and those affected by illness have been
socially conceived. How this social conception accrues meanings has been
explored by Fernandez (1986) as a process of ‘metaphorizing’. He writes:
Because of their embodied nature, metaphors create meaning not only
through representation but through enactment or presentation. The
presentation of metaphor takes two forms: metaphors as cognitive tools
that work on our concepts to fashion new meaning: and metaphors as
communicative acts or gestures, constrained by social structure yet giving
rise to new patterns of social interaction and modes of discourse (cited in
Kirmayer, 1992, p.337).
Central to the process of understanding medical-related knowledge and practice
amongst the Zulu is an analysis of metaphors used to signify ill health. This
encompasses more than an examination of a ‘system of belief’, an analytical
approach that is limited in its ability to explain embodied experience and illness
management. For one thing, Zulu cosmology is not ‘standardized’ in theory or
practice and therefore varies, not only by researcher interpretation but also by
regions of KwaZulu-Natal from which members of individual Zulu clans
originated. Thus what might typify medical epistemology and lived experience in
Mariannhill may be considerably different in more northern parts of the province
for example, where people are said to have secret medical knowledge and
‘stronger’ medicines.
Yet, some aspects of medical knowledge seem to have fairly wide currency
amongst people who identify themselves as Zulu, as well as amongst other
ethnic groups in South Africa. The metaphor of ‘dirt’ and the meaning it holds in
relation to illness and illness management is significant in this regard. An
analysis of previous South African ethnographies that have attempted to describe
indigenous medical-related knowledge and practice (i.e. Krige, 1944, 1974;
Bryant, 1949; Ngubane, 1977; Hammond-Tooke, 1970, 1981) reveal that the
notions of pollution and ‘dirt’ in relation to illness have not been sufficiently
problematized. Jewkes and Wood (1999) have argued that these previous
authors have largely relied upon discreet analyses and interpretations of the
‘system of belief’ and have consigned the notions of pollution and ‘dirt’ to the
causal category of ‘ritual pollution’. Categorized as such, these notions have
been explored almost entirely in relation to the spiritual realm only. An analysis
of women’s reproductive health discourse in the Eastern Cape province have led
Jewkes and Wood to suggest that notions of ‘dirty wombs’, for example, which
appeared to be widespread among their informants, may represent a category of
disease used as an idiom to express physical illness amongst the Xhosa.
Amongst the Zulu, a group closely related to the Xhosa and belonging to the
same family of Nguni languages, metaphors of pollution and ‘dirt’ play a
significant role in the popular representation of illness. Ideas of bodily ‘dirt’ and
the state of being ‘dirty’ are used as broad ethnopathological explanatory models
for disease
that are embodied and encoded in common processes of illness
management among the Zulu. While some South African ethnographers such as
Hammond-Tooke (1981) have explicitly striven to keep various etiological
categories of disease ‘analytically separate’, as Jewkes and Wood have argued,
such a biomedically-inspired exercise serves to limit our understanding of local
disease etiology. Although these works may provide valuable cultural
information they tend to objectify a lived worldview by stressing disease
classification over illness experience and management. Human action in relation
to illness, in other words, is assumed in such works to derive solely from abstract
‘rational’ knowledge or beliefs. This assumption provides a narrow
understanding and limited insight into the experience of illness in the
communities studied.
Cleansing cures
As a form of non-ritual pollution the state of being ‘dirty’ is a central concept of
disease among the Zulu, and it would seem the neighbouring Xhosa as well,
through which other causal factors (be they witchcraft/sorcery, the ancestors,
nature etc.) work. Rather than being an alternative causal typology, the state of
being ‘dirty’ can be understood as an explanatory model for illness. To say that
one has ‘dirty’ kidneys or a ‘dirty’ womb, is to say that one has an illness in
relation to these organs. As part of a therapeutic process to ‘cure’ the specific
illness, one would necessarily take steps to ‘cleanse’ that organ of the ‘dirt’.
Various preparations, some obtainable through modern pharmacies and others
obtainable through traditional medical practitioners, are used for therapeutic
cleansing that involves purging the body of harmful ‘dirt’. Commercial laxatives
and enema preparations are used primarily for the cleansing of ‘dirt’ believed to
be affecting organs in the abdominal region. Diuretics are used primarily for
urinary complaints. Emetics are believed effective for cleansing ‘dirt’ associated
with ailments in the chest or throat. Traditional preparations made from
combinations of herbs to effect the same purging response are also popular.
Managing illness by taking steps to eliminate the ‘dirt’ associated with the ‘dirty’
organ, can be viewed as a first-line defence against illness and a routine part of
most all traditional approaches to therapy (Leclerc-Madlala, 1994). The Zulu
term ‘ukwelapha’ is a term that refers broadly to treatment of disease. It may be
used to describe a range of therapeutic procedures that could encompass any
and all efforts to prevent, treat or cure an illness. Claims by traditional medical
practitioners that they can ‘cure’ an illness, whether AIDS, brain tumours, or
chronic fatigue, are ethnomedical interpretations that can be understood as
claims of their abilities to treat disease. The meaning of ‘treatment’ refers to a
comprehensive approach to illness that may include prevention, cure and/or
simple palliative care and treatment of symptoms.
An understanding of the concepts of bodily ‘dirt’ and its significance as an
ethnopathological explanatory model for disease and the wide meaning of the
term ‘ukwelapha’ as treatment, are central components in both the metaphoric
construction of and therapeutic response to illness, including illnesses related to
AIDS. According to local folk models of the human body, any ‘dirt’ responsible
for causing illness symptoms in a particular body part, whether ‘dirt’ associated
with ‘dirty stomach’ (experienced symptomatically as any abdominal complaint
whether stomach-ache, diarrhoea, constipation, etc.) or ‘dirt’ associated with a
‘dirty chest’, (experienced as persistent cough or any other bronchial pain or
discomfort), or ‘dirt’ causing ‘dirty kidneys’ (experienced as painful urination,
lower backache, etc.), has the ability to ‘mix with the blood’ if not cleansed early-
on when the symptoms first appear. When this bodily ‘dirt’ mixes with blood the
result is said to be more generalized illness symptoms than those associated with
specific organs or regions of the body. Related to this idea is the notion that all
organs in the body are inter-connected. Thus ‘dirt’ producing illness symptoms
in one part of the body may be conveyed to other parts of the body, via the
blood, to cause illness symptoms elsewhere. By purging through the use of
enemas and emetics, traditional therapeutics aim to cleanse the entire system
rather than a singular affected organ.
‘Dirty’ women
Conceptions of women’s bodies as highly suitable places for hiding and
harbouring ‘dirt’, echo through informants’ descriptions of female reproductive
anatomy. Research conducted in Botswana (Ingstadt, 1990), Kenya (Udvardy,
1995) and Tanzania (Haram, 1997), reveal similarities in the depiction of adult
women’s bodies. Ingstadt (1990) records how women’s bodies were often
compared to suitcases that conceal and transport disease to others. Such
imagery resonates in the descriptions of female anatomy in Mariannhill. One
young man described how ‘dirt’ especially ‘likes all those folds and curves inside
a woman because it can ‘hide and grow’. Both men and women hold similar
views that reflect a symbiotic relationship between women and bodily ‘dirt’. As a
place where ‘dirt’ is especially likely to be ‘hiding’, the vagina is described as an
open-ended passage that leads up into the womb. This belief may help to
explain the widespread fear that a condom might ‘go up’ and ‘get lost’. Women
express an anxiety that should a condom break or slip off the penis, it may ‘float
around inside’ and eventually find its way up into the body cavity and cause
grave illness. One informant asked: “What if it (the condom) goes up to the
heart or even the throat? It can choke you and then you can die.” Another
suggested that a lost condom could become ‘twisted’ and thus obstructs the
blood flow and cause high blood pressure. Studies by Abdool-Karim et al (1995)
revealed similar beliefs among commercial sex-workers who plied their trade
between Durban and Johannesburg.
Along with the notion that the vagina opens into the rest of the body, and that it
provides a suitable hiding place for disease-causing ‘dirt’, there are ideas about
vaginal ‘wetness’ that are significant to the conceptualisation of women as ‘dirty’.
The vagina and womb were the two places most often identified as places where
‘dirt’ can ‘hide’, ‘stick’ and ‘grow’. The HI virus was discursively represented as
an especially strong ‘dirt’ that ‘easily enters the blood’ via the vagina and womb.
The theme of a ‘wet’ vagina associated with an ability to cause ‘dirt’ to ‘stick’ to
its walls featured prominently in informants’ discourses on sexually transmitted
diseases including HIV. One young nursing student described HIV infection in
this way: “Women are wet down there. When they have an infection the germs
just stick inside and smell. This is how they know they have infections like STDs,
HIV or whatever. With men you can’t smell it because there’s nothing inside.”
One young man expressed sexual anxieties with reference to similar notions
about vaginas. “Inside there it is dark, wet, not nice. AIDS can live there,
waiting, and you wouldn’t know. Maybe the woman herself doesn’t know
because it just sticks. She really needs a blood test to know for sure”. Another
young man offered the view that nowadays men are more afraid to touch a
woman “down there”, because HIV or AIDS can “stick to your fingers and then
pass into your blood if you have a scratch or open sore.”
The menstrual paradox
Previous writers on the Zulu such as Krige (1974), Bryant (1970) and Berglund
(1976) have noted that disease is usually defined by its somatic symptoms. This
is still largely the case. With no symptoms, there is often believed to be no
disease. With the recent disease of AIDS, popular media and professional
medical discourse on the subject emphasize the long a-symptomatic period of
HIV infection. While such a relatively new and different way of knowing illness
may contribute to uncertainty over approaches to treatment, there are
physiological processes associated with women, namely menstruation, that is
viewed as a means through which ‘unseen’ or a-symptomatic ‘dirt’ may be
flushed out of the body.
Menstruation is conceived as a kind of built-in cleansing system. Menstrual
blood is considered ‘dirty’ because it is believed to be blood that consists of
many different kinds of ‘dirt’ that may have accumulated in any region or organ
in the body. This ‘dirt’ then ‘mixes with the blood’ before ‘pooling’ in the womb
and then exiting through the vagina during menstruation. From an ethnomedical
perspective, menstruation is representative of a process by which the female
body automatically and regularly cleanses itself. Here we see the metaphor of
‘dirt’ accruing meaning as both a cognitive tool and a communicative
presentation, a process that resonates with Fernandez’s (1986) description of
metaphor’s production as a dual meaning-making process. Menstrual blood and
women’s menstruation are ‘polluting’ not only in a ritual and symbolic sense, but
as they are associated with the coagulation and conveyance of ‘dirt’ from other
parts of the body, menstruation in a real ‘lived’ sense is inherently unclean. As
menstrual blood passes through the vagina, it is believed that some of the
infused bodily ‘dirt’ will ‘stick’ to the walls of the vagina, and form part of the
‘wetness’ conceived as ‘dirty’ and associated with adult vaginas and disease. As
with any ‘dirt’ that can be expelled or ‘cleansed’ from the body during
menstruation, local discourse on the HI virus indicates that it too is believed
capable of expulsion during menstruation. However menstruation is not believed
to be capable of cleansing all the ‘dirt’ associated with AIDS that may be hiding
in the woman. One young woman put it this way: “When a woman bleeds, the
dirt all comes out down there. But with AIDS, most of it stays in your blood
because it is very strong. But of course the rest that comes out, well I think
most of that just sticks inside. You really only know with a blood test”.
As previously noted, many informants think that ‘dirt’ in the blood can be
expelled through menstruation, but menstruation alone is not believed to be
completely effective as a way to rid the body of ‘dirt’-inducing illness. This
especially holds true for the ‘dirt’ associated with HIV infection, a type of ‘dirt’
construed as exceptionally potent and stubborn.
While most all popular and academic writing on menstruation tends to highlight
the negative sociocultural meanings attached to the process, there are
nonetheless positive associations, not the least of which is with fertility. In the
case of the Zulu, the Xhosa (see Jewkes and Wood 1999), and probably amongst
other ethnic groups in Southern Africa, menstruation has a positive dimension as
a kind of innate health-promoting process or, ethnomedically speaking, a natural
mechanism to regularly ‘cleanse’ the body of ‘dirt’ associated with illness. A
popular way to describe a woman who is menstruating is to say that ‘she is
cleansing this week’. The cultural prescription that a man should avoid
intercourse during menstruation because it will ‘weaken’ him, has meaning well
beyond the realm of spiritual misfortune associated with ritual pollution. In a
very real ‘lived’ sense, it makes good ethnomedical sense for a man to avoid
intercourse with a woman who is ‘cleansing’ in order to avoid being ‘infected’ by
any manner of bodily ‘dirt’ that may have mixed with her blood and is being
expelled through menstruation. The cyclical nature and regularity of
menstruation also has meaning as physical proof that the accumulation of bodily
‘dirt’ is a natural property and process of women. With the continual functioning
of what might be described as an automatic cleansing system, the physical
manifestation is there of a woman’s propensity for accumulating and harbouring
‘dirt’. Accordingly, one would have to assume that nature has provided women
with the natural ability to expel ‘dirt’ through menstruation because they need
such an ability. Thus an adult menstruating woman is conceptualised as ‘dirty’,
not only in a ritual or metaphorical sense, but her ‘dirtiness’ has meaning in a
very real physical sense. As Kirmayer (1992) argued, it is because of their
embodied nature that metaphors create meaning, not only through
representation but through actual enactment and presentation. Menstruation
provides the presentation of the ‘dirt’ metaphor associated with women. It also
creates a set of meanings attached to the notion of womanhood and I would
suggest it provides a very basic justification for gender inequality. Yet it is this
same processual ‘dirtiness’ that is simultaneously proof of her very real power;
her fertility, the ability to reproduce new members of society. This would
support Douglas’ (1966) theory that both positive and negative valences are
reflected in the particular substances that a culture selects and codifies as ‘dirt’.
Vaginal Anomalies
Beyond associations with menstruation, ‘dirty woman’ imagery is echoed in
descriptions of physiological differences between male and female sexual organs.
A woman’s vagina is ‘inside’ and ‘open at top’ while a man’s penis is ‘outside’
with only a smallish opening often described as a ‘tube’ leading into the body.
While men are said to be capable of expelling bodily ‘dirt’ through their semen,
their particular reproductive anatomy is generally not associated with ‘dirt’ that
‘hides away’, ‘sticking’, ‘waiting’ or ‘sitting quietly like a baby inside’ as one male
informant described ‘dirt’ in the womb that causes STD symptoms. Descriptions
of female reproductive anatomy are descriptions of a wet disease-lined vagina
that opens into a dark nest-like womb, a womb discursively represented as
attached to or part of the stomach and interconnected in a complex way with
other internal organs that convey blood and ‘dirt’ between them. A man who
has sexual intercourse with a woman who is ‘cleansing’ (the same term used to
describe menstruation) is said to run the risk of having his own blood
contaminated with his partner’s ‘dirt’. As discussed, while some of a woman’s
bodily ‘dirt’ will be expelled along with the menstrual flow, some of it can be
expected to ‘stick’ to the walls of the vagina. If one of the impurities or kinds of
‘dirt’ found in a woman’s blood or sticking to vaginal walls happens to be the
kind responsible for the ‘new’ disease of AIDS, then that is what informants say
will be conveyed to her sexual partner. Some young women believe that
toothpaste used to clean the vagina internally after menstruation can help to ‘kill’
some of the lingering ‘dirt’. But as HIV infection is believed to be especially
strong, it is said to be resistant to home remedies such as toothpaste,
antibiotics used to treat STDs. One 16-year-old girl said that most infections
‘down there’ could be cured by douching with salt water, bleach or Dettol (a
topical antiseptic) or by applying toothpaste regularly on the sores (if nothing
else is available) for two to three days. Like many young women, this girl
believed that HIV was ‘too strong’ to respond to the use of toothpaste or ‘any
white creams’ alone. Most informants concurred that HIV required additional
treatment with traditional medicines that were black in colour, ‘stings’ when
applied to sores, or bitter to the taste. Ngubane (1977) provides a detailed
analysis of the significance of colour and indigenous medicinal preparations.
Medicines of a blackish colour are believed to be especially potent for ‘taking out
evil’ and counteracting illness associated with witchcraft activity.
It is a commonly held view that HIV along with a host of other diseases can be
transmitted through sex with a menstruating woman. As discussed ‘dirt’ from
any disease with which a woman may be infected, is likely to be lingering in the
vagina when not menstruating. One woman said that if a man really wanted to
avoid HIV or any other infection, one of the surest ways to do this was to wear a
condom at all times when sexually involved with a woman. “Germs are always
there. It’s where they come out. A woman knows she must clean down there
often.” Green (1994) found similar ethnomedical beliefs regarding the sexual
transmittability of a wide variety of illness conditions in other Southern Africa
ethnic groups in both Swaziland and Mozambique. Some of those same diseases
identified by informants in KwaZulu-Natal included tuberculosis, conjunctivitis,
urinary complaints, biliousness, and skin rashes. “If she is sick with these
diseases then a man can get them if he sleeps with her.” Such was the claim of
one young man who pointed out that because ‘dirt’ can ‘stick’ to wet vaginal
walls, a man may get an infection even when a woman is not menstruating. Like
many others, this young man referred to HIV as an example of a particularly
‘stubborn’ infection and for this reason it was believed to ‘hide away’, ‘waiting
quietly’ inside the vagina between menstrual periods. He stated: “The HIV is
always there. It doesn’t leave the body easily.”
Dry and tight, wet and loose
The presence of vaginal moisture or fluids, along with the width and muscle tone
of the vaginal canal, is used as indices of moral character and sexual experience.
Associations of ‘wet’ and ‘loose’ vaginas are mirrored in local discourses on
morally ‘loose’ women. It is women’s promiscuity that is widely held to be at the
root of the current AIDS epidemic (Leclerc-Madlala, 1999). The ‘loose’ woman,
metaphorically represented in the image of the ‘loose’ vagina, is the one held
responsible for the scourge of AIDS. The growing popularity of virginity testing
in KwaZulu-Natal can be understood as an attempt to reassert control over
women’s sexuality at a time when it is perceived to be ‘out of control’ and
wreaking havoc in the form of increasing disease and death (Leclerc-Madlala,
2001). Based on a set of physical attributes including vaginal characteristics,
virginity testers make judgements sexual experience. Virginity is believed to be
attested to by having a ‘tight’ and ‘dry’ vagina. A non-virgin is said to be
recognisable on the basis of having a ‘wide’ and ‘wet’ vagina.
Young women acknowledge the importance of being ‘dry and tight’ in order to
pass virginity tests and be declared virgins. Being ‘dry and tight’ is also
important when sleeping with a man, especially when doing so for the first time.
This was considered necessary in order for a man to believe that a woman was
‘like a girl’ not ‘someone with many boyfriends’, and therefor ‘clean’. The ability
to give the illusion of virginity by having a ‘tight and dry’ vagina was considered
part of a woman’s secret knowledge and sexual repertoire. Women are familiar
with a variety of methods and substances that are said to ‘dry’ and ‘clean’ the
vagina and hence make sex more attractive and acceptable to men. In a study
of commercial sex-workers, Abdool-Karim et al (1995) noted the use of a douche
made with Jik (bleach), Dettol or Savlon (topical antiseptics) as forms of
contraceptives. Women in Mariannhill say that these substances not only ‘kill
sperm’ and ‘germs’ but are useful for causing the vagina to ‘tighten up’. Women
say they ‘feel fresh’, clean and sexually attractive after such a douche. Other
substances identified as useful for drying and tightening the vagina include snuff,
bicarbonate of soda, talcum powder, ice-cubes, or plain salt. A most popular
substance seems to be coarse salt (the brand name ‘LION’ is often referred to)
which is put into the vagina up to two hours before intercourse.
Women claimed that a dry vagina was more pleasurable for men, causing them
to ejaculate more quickly, and assisting those with a small penis or one which
was ‘too soft to do the work’. Beyond the meanings associated with pleasure
there are meanings that accrue psychological value to dry and ‘clean’ vaginas.
The metaphor of dry-clean-virgin has significance as both a cognitive
construction and an enacted experience. A dry vagina negates the fears
conjured up by associations of female wetness with ‘dirt’ related to illnesses of all
kinds that may have descended from other parts of the body. One woman who
defended the use of LION salt and talcum powder as drying agents stated simply
that the vagina contains dirt that has to be removed from the body. She added
that men prefer a woman who is ‘tight’, and ‘dry’ because they (the men) ‘think
she is clean’. The use of similar substances to dry and tighten the vagina have
been widely reported from other African countries (see Arnfred, 1989;
Runganga et al, 1992; Brown et al, 1993; and Green, 1994), but remain
inadequately studied in terms of their contribution to the epidemiology of HIV
and other sexually transmitted diseases.
The therapeutic power of virgins
In her ethnographic study of medical notions among the Zulu, Ngubane (1977)
made the point that compared to other bodily emissions, female sexual fluids
were a class apart. That author attributed the unique status of these fluids to
the fact that they represented a woman’s power in the form of reproduction. It
is within this context of patriarchally structured and dominated Zulu society that
the dank-and-disease model of female sexual anatomy must be considered.
Douglas (1966) argued that polluting substances (read vaginal fluids) symbolise
threatening forces that pose a danger to the very symbolic order that produce
them. The vagina is the primary site of male pleasure as well as being the site
or passage of birth. It is a potent symbol of a woman’s sexual and reproductive
power, both acknowledged as necessary ingredients for life. Patriarchal fears of
female power all coalesce in the symbolism of the vagina; the dark, wet,
mysterious passage fraught with hazards in the form of ‘dirt’ and filled with
delights in the form of sexual pleasures and the issuing forth of new members of
society. I would suggest that strong negative associations of the vagina and its
fluids can be understood as essentially an expression of culturally-defined fears
and insecurities vis-à-vis a woman’s inherent power, a power at variance with
her social inequality and general lack of power in society.
The process of managing an illness that is etiologically related to sex with a
‘dirty’ woman could be expected to follow the logic of ethnopathological
processes for cleansing bodily ‘dirt’. In addition it could be expected to draw
upon the symbolic meanings attached to adult women and their disease-related
vaginal ‘wetness’. The belief that sexual intercourse with a virgin can ‘cure’ a
man of HIV/AIDS is embedded in metaphoric associations of sexually active
women with ‘wet/dirty’ vaginas. According to the virgin cleansing myth, a man
can ‘cleanse’ his blood of HIV/AIDS through intercourse with a virgin, but the girl
herself would not be infected in the process. The broad category of prevention-
treatment-cure is encompassed in virgin cleansing therapy, whereby sexual
intercourse with a virgin is also thought to provide a type of vaccination against
the threat of future HIV infection. Thus virgin cleansing is believed to have both
a therapeutic and a prophylactic effect. In interviews with several traditional
healers, virgin cleansing or sexual intercourse with a virgin, was said to be a way
in which a man thought he could obtain a measure of ‘strength’ against HIV
infection. It was unclear whether this meant that additional ‘cleansing’ was
needed periodically in order to maintain the strength of the inoculation.
Although these particular healers said they were opposed to this practice and
rejected claims of its efficacy, they all professed to have first-hand knowledge of
other healers who did actually recommend virgin cleansing as a way of treating
Amongst this group of healers there was no consensus as to what qualities
associated with virginity were believed to give the girl a special ‘immunity’
against acquiring HIV infection from the infected male sexual partner.
Basically there were two competing arguments used to explain this process.
Some informants said a virgin avoided infection by nature of being ‘closed up
there’. The vaginal passage into the body is seen as being ‘sealed off’ by the
intact hymen. The intact hymen was viewed as a barrier that prevented the HIV
from getting into and settling in the girls’ womb and thus into her ‘blood’. This
belief is somewhat akin to beliefs found in West Africa whereby certain sexually
transmitted diseases are thought to be transmitted in the form of a worm
entering through a man’s urethra after sex with an infected woman (Green 1994,
p.88). The worm is said to be killed when it comes up forcibly against an intact
hymen. An alternative view offered by informants to explain why a virgin girl is
believed to have a special immunity against HIV infection (and other afflictions
believed to be sexually transmitted), had to do with her ‘dry’ vaginal tract. The
vagina of a pre-pubescent girl is not associated with the vaginal lubrications of
the adult woman. Her vaginal tract, yet undeveloped, is conceptualised as
‘clean’, ‘dry’, ‘uncontaminated’. Being a dry surface, it is believed that ‘dirt’
cannot easily attach itself. One informant used the analogy of taste: “You can
only taste something on your tongue because it’s wet, the taste can stick there.
You can’t taste things on your hand. It’s dry”. Another referred to the case of
nurses in a rural Zululand hospital who were reported several years ago to have
shown their displeasure over working conditions by throwing vials of HIV-
infected blood around hospital wards. “You see, patients there could get that
infection if it touched their eyes or lips or bleeding wounds. Not if it fell on dry
skin. It can only stick on those wet places”. Moist anatomical surfaces in
general seem to be associated with disease as places where ‘germs’ or ‘dirt’ can
stick. I would suggest that the qualities of ‘dryness’ and the linked metaphor of
being ‘clean’ are the essential characteristics associated with the efficacy of
treating AIDS through sexual intercourse with a virgin.
Sympathetic magic
The frame for the underlying logic that links ethnomedical beliefs to the idea of
virgin cleansing as a therapeutic approach to AIDS may be found in the
homeopathic principle which previous writers on Zulu ethnomedicine such as
Callaway (1884), Schimlek (1950), Bryant (1970) and Berglund (1976) have all
described as a fundamental central tenet; namely sympathetic magic.
Sympathetic magic draws upon ethnopathological notions of homeopathy
whereby ‘like produces like’. Medical conditions are believed treatable by
substances that are symbolically associated with the conditions. For example, a
bald man will be treated with herbs from gardens with a profuse growth;
cowardice is treatable by consuming pieces of a lion’s heart; talkative aggressive
women may be treated for this ‘illness’ with parts from a timid sheep, etc. These
are just a few examples of some ethno-therapeutic processes that involve the
manipulation of symbols as well as material substances, and that may be
relevant to an understanding of virgin cleansing as a response to HIV/AIDS.
Like things and similar actions, as well as similar sounds and colors are thought
to produce similar effect. Berglund (1976, p.354) referred to these notions as
‘sympathetic associations’. Along with sympathetic associations used in medical
treatments are related ‘antagonistic’ properties. Here things associated with
each other are thought to act against each other, being antagonistic
they are similar. Conceptually, a virgin may be sufficiently similar to a non-
virgin. The key difference is that her sexuality is perceived to be free of the
dirty-wet-disease qualities associated with the sexuality of a non-virgin.
Therefore sex with a ‘clean’ virgin may be thought to have an ‘antagonistic’
effect on a disease believed to have been caused by having sex with a ‘dirty’
non-virgin. Beliefs about the efficacy of virgin cleansing are doubtless closely
linked to ideas that the potential ‘sticking place’ of the AIDS-related ‘dirt’, the
vagina, is clean and dry, thus void of the disease-associated ‘wetness’ of the
sexually active woman. The metaphor is embodied in (and potentially enacted
through) the idea that if a dirty-wet adult woman can give a man AIDS, then a
clean-dry girl can take it away (5).
Further research is needed to discern the historical specificities that have
conspired to bring the ideology of sex-with-a-virgin-as-cure-for-AIDS to the fore
in contemporary South Africa. While the virgin cleansing myth may have gained
popularity in the local context of the AIDS epidemic, there are some interesting
parallels with techniques formerly used in other places for similar reasons. For
example virgin cleansing was once believed to be a way to cure venereal
diseases in Europe. Smith (1979) tells us that English men of the last century
believed that intercourse with a child virgin would cure VD. Quack doctors
apparently kept special brothels in Liverpool, since 1827 at least, to provide this
cure. The girls used were often imbeciles. Smith describes a court case in 1884
whereby a man with ‘bad syphilis ulcers’ raped a girl of fourteen years. His
defence was that he had not intended to harm her, but only to cure himself
(Smith, 1979 p.303). Such ways of dealing with sexually transmitted diseases in
Europe during the last century have intriguing and very disturbing similarities
with ways of dealing with AIDS in parts of Africa today.
In a study of tuberculosis in Ethiopia, Vecchiato (1997) makes the point that
health beliefs are embedded in systems of ethnomedical knowledge that have
their own internal logic. They are part of a cultural model invoked to make
meaningful the experience of illness. Understanding this, we have yet to fully
appreciate the importance of cultural schemas in relation to health seeking
behaviours, particularly as they relate to our efforts to understand responses to
HIV and AIDS in Africa. In this paper I have attempted to bring into relief some
ethnomedical beliefs of Zulu-speaking people relating to bodily dirt, women and
HIV/AIDS that may be relevant to an understanding of the virgin cleansing myth.
Focussing on this body of indigenous medical-related knowledge, does not in any
way deny the complex systematic nature of peoples’ health-illness belief systems
and the relationship of these to illness management or other forms of behaviour.
In a rapidly modernising and multicultural society such as South Africa, medical
pluralism has long characterised the context of decision making around health
and therapeutic choice. A range of complex and often internally contradictory
views related to health and illness are held and reflected in peoples’ daily
responses to illness. People pick and choose among alternative actions through
a process based on the use of all available knowledge. Some actions may have
more of a basis in ethnomedical belief systems, while others may have more of a
basis in western biomedicine or some other system. In addition to
acknowledging the existence of competing belief systems, it is vital that we
locate our understanding within the framework of culture and the contemporary
social context. A cognitive explanation of illness behaviour is simply not enough.
The cognitive components, what we label as beliefs and knowledge, are
elements to which economic, material, social, and political factors must be joined
for a full-scale understanding of behavioural patterns. As Pelto and Pelto (1997)
point out, weighting and negotiating these factors is a big part of the culturally
shaped decision making process of illness management.
Theories and models used to develop HIV and AIDS communication in South
Africa as elsewhere in the world have been largely based upon social
psychological models that emphasise individual choice. As Triandis (1994)
argued the corpus of social psychology is based on the behaviours of people in
Western cultures, and may have severe limitations when applied in contexts for
which they were not designed (Yoder, 1997). After two decades of battle with
the AIDS pandemic, there is now serious questions raised regarding the
relevance of some of the most commonly used theories/models that guide
communication strategies and policies to prevent HIV/AIDS particularly in Africa,
Asia and Latin America (see for example Airhihenbuwa, 1995). The ‘flaw’ in
these strategies has been largely attributed to their failure to understand
differences in health behaviours as primarily a function of culture and social
context. At best, ‘belief’ has come to be used as a proxy for culture, such that
beliefs and knowledge of illness becomes the focus of ‘culturally appropriate’
messages and interventions. More commonly ‘belief’ is contrasted with
‘knowledge’ such that ‘belief’ is used to connote ideas that are erroneous from
the perspective of biomedicine and that constitute obstacles to appropriate
behaviour (Pelto and Pelto 1997, p.148). The coupling of ‘culture, and ‘belief’;
then acquires a negative biomedical appropriation and becomes a metaphor for
‘barrier’. Thus, the task in AIDS prevention in many non-western contexts, is
conceptualised as a task in removing ‘cultural barriers’ and essentially exercises
in behavioural modification, an enterprise that as Clatts (1994) contends, has
more to do with social control than the prevention of disease.
Recent interest in the virgin cleansing myth in South Africa has resulted in
several attempts to quantify the existence of this ‘belief’, a belief understood as a
cultural barrier, and most often described as a mistaken belief resulting from
ignorance or lack of education. A recent study of attitudes among workers at a
Daimler Chrysler factory revealed that 18% of the workforce believed in the
virgin cleansing myth. In another study by health educators in Gauteng
province, 32% of interviewees indicated a belief in this myth (Plusnews, 2002).
A nationwide survey involving over 9000 young people found that an estimated
13% of participants believed that virgin cleansing could prevent AIDS (Anderson,
While such findings are of interest as ‘proof’ of the existence of this myth, and
may be useful in discussions about specific views of the world, they reveal little.
Research that attempts to expose and attach a percentage to a singular AIDS
related ‘belief’ is of relatively little value when trying to develop interventions that
factor in culture as a pivotal organizing theme. At issue is the relationship
between verbal statements about the world and daily practice. What is needed
is a model that links belief and knowledge to behaviour that is sensitive to
cultural schemas and the world of daily social interactions driven by material,
economic, political, or other concerns. Assessing behavioural change models
used in AIDS prevention in Africa, Airhihenbuwa and Obregon (2000) strongly
argue in favour of a much deeper appreciation and understanding of the
centrality of cultural contexts, rather than simply an identification of individual
With new challenges such as a false security currently being generated by the
media-hyped prospect of mass-scale, anti-AIDS treatments and hope for a
vaccine in the local effort to control HIV/AIDS, it becomes even more critical that
we pay attention to contextual factors that may or may not inform peoples’
responses to the epidemic. Virgin cleansing as a therapeutic option against AIDS
to some extent, may have acquired popular currency due to the fact that modern
biomedical treatments have not been readily available to the mass of people
infected and affected by HIV/AIDS. It remains to be seen whether the perceived
scourge of baby-rape and rape more generally, along with the belief in virgin
cleansing, recedes with the introduction of affordable and accessible anti-
retroviral treatment. Given the current lack of alternative treatments, coupled
with the fact that an extremely small proportion of rape cases ever get to court
and most are those convicted are given suspended sentences (see Jewkes and
Abrahams, 2000), it is probably the case that some men feel they have very little
to lose by attempting to cleanse themselves of AIDS through sex with a virgin,
irregardless of whether or not they believe in the myth.
1. Statistics from this study were reported in the UNAIDS collaborative on
line news service PLUSNEWS (April 24, 2002) in an article entitled “South
Africa: Focus on the virgin myth and HIV/AIDS”. While the South African
Police provides regular up-dates on rape statistics, there is much debate
about the accuracies of these statistics, as it is widely assumed that this
crime is much under-reported. While some researchers claim that one
rape is committed every 24 seconds in South Africa, others suggests that
it is closer to one every 5 minutes at least in the prime 17-48 year age
group (see Jewkes and Abrahams, 2000).
2. Opposing views on the incidence of and causal factors in child rape in
South Africa featured in several on-line health news forums in early 2002.
AF-AIDS (May 9 2002) carried an article entitled “The virgin myth and
child rape in South Africa” analysing the response by R. Jewkes to
Commentary in the Lancet by G. Pitcher and D. Bowley (vol. 359, p.9303,
Jan. 26 2002).
3. Personal communication with paediatricians at 3 provincial hospitals in
Kwa-Zulu Natal and social workers at Childline, an organisation dedicated
to the fight against child abuse more generally, reveals a high level of
disbelief that a recent sharp rise in child rape in not reflected in
government-sponsored studies. From their experiences, they believe
there has been marked increases over the past 2 to 3 years, or from 1999
onwards. It is may be significant that this time period coincides with the
maturation of the latent HIV epidemic into an visible epidemic of AIDS-
related illness and a marked rise in death.
4. These comments were made by Minister of Education Kader Asmal at the
close of Parliament’s public hearing on child abuse and baby rape held in
the week of 17 March 2002.
5. It is significant that the virgin cleansing myth is also believed to be a
motivating factor in the rape of elderly women. Like the virgin girl, the post-
menopausal woman is one whose sexuality is no longer associated with
the ‘contaminating’ sexual fluids of menstruation and vaginal ‘wetness’.
Perhaps an elderly woman shares a conceptual virgin status with the non-
sexually active girls, and therefor intercourse with her could be expected
to have the same ‘antagonistic’ effect on HIV infection.
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... These conceptions are evident in the language used to communicate about the vagina and its secretions. Other research from South Africa supports the notion that menstrual blood is regarded as unlike blood from other parts of body, its disgusting nature comes from the fact that it comes out of the vagina (Masuku 2015),and also because it is believed to consist of many different kinds of 'dirt' accumulated throughout the body, which collects in the womb and exits the body via menstruation (Leclerc Madlala 2002). Similar notions of the vagina being a dirty, shameful area of the body are apparent in many socio-cultural settings (Braun and Wilkinson 2001;Gafos et al. 2013;Hawkey et al. 2017;Leclerc Madlala 2002;Schooler et al. 2005;Zielinski 2009). ...
... Other research from South Africa supports the notion that menstrual blood is regarded as unlike blood from other parts of body, its disgusting nature comes from the fact that it comes out of the vagina (Masuku 2015),and also because it is believed to consist of many different kinds of 'dirt' accumulated throughout the body, which collects in the womb and exits the body via menstruation (Leclerc Madlala 2002). Similar notions of the vagina being a dirty, shameful area of the body are apparent in many socio-cultural settings (Braun and Wilkinson 2001;Gafos et al. 2013;Hawkey et al. 2017;Leclerc Madlala 2002;Schooler et al. 2005;Zielinski 2009). Evidence from South Africa and further afield supports the notion that many women react with discomfort, reluctance and disgust at the idea of having to touch their own vaginas, let alone their own menstrual blood (Braun and Wilkinson 2001;Epstein et al. 2008;Masuku 2015;Scorgie et al. 2015). ...
Socio-cultural beliefs and practices surrounding menses influence women’s sexual and reproductive health behaviors and decision-making. We analyzed menstrual experiences within the context of the MTN-020/ASPIRE clinical trial during which women were asked to use a monthly vaginal ring for HIV prevention. The qualitative component of the trial was conducted during February 2013-June 2015, included interviews and focus group discussions with 214 women aged 18–42, in Malawi, Zimbabwe, Uganda, and South Africa. Emotions of shame, embarrassment and disgust relating to menses emerged. Menstruation was referred to using euphemistic terms or language about dirtiness. Women were uncomfortable touching their own menstrual blood when removing vaginal rings and felt embarrassed about study staff seeing blood on returned rings. Despite reassurances, women felt ashamed performing study procedures while menstruating, leading to missed study visits. Women’s aversion to menstrual blood was linked to narratives about avoiding sex during menses and beliefs about its potential harms. Women associated men’s disgust pertaining to menstrual blood with men’s willingness to use condoms for sex only during menses, highlighting another way through which socio-cultural beliefs and practices around menstruation affect HIV protective behaviours. These findings provide novel insight into menstrual shame among women in these four countries.
... There are many causes of the issues revealed through this study, particularly when in the national context pregnancies inadvertently offer a source of income through government-sponsored child grants for unemployed mothers. More specifically, in terms of this research study, what can Science Education in association with IK offer to prepare learners for the world in which they find themselves and in a society in which belief in 'virgin cleansing' 60 could be a contributing factor to the rape of young girls (Leclerc-Madlala, 2002). The belief and practice of virgin cleansing could be contributing to high HIV infection rates and to 60 There is widespread belief that having sex with a virgin girl is a cure for AIDS. ...
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Prior to democracy in South Africa, education was used as a means to achieve segregation, privileging a minority of the population in both economic and worldview domination. With the attainment of democracy in 1994, educational reform was aimed at getting rid of both apartheid content and method. The aims and principles of the new curricula (the Revised National Curriculum Statement Grades R-9, the National Curriculum Statement Grades 10-12, and later on, the Curriculum and Assessment Policy Statements) were aligned to those of the national constitution, which include the establishment of human rights, inclusivity, environmental and social justice, and valuing of Indigenous knowledge systems. In the science subjects, teaching and learning are expected to acknowledge the existence of different knowledge systems. In the absence of clear guidelines as to which Indigenous knowledge to include and how, the recognition of IKS in science classroom has largely been left to the teachers' discretion. The purpose of this interpretive research study, carried out in collaboration with a rural community in KwaZulu-Natal Province, was threefold. The first was to identify the Indigenous knowledge held by the community and the worldview underpinning that knowledge. The second was to find out what knowledge could be integrated with classroom science, and explore ways in which such integration could be done, considering students' and community worldviews. The third was for the research to contribute to transformation in Indigenous knowledge research by following methods that recognised Indigenous knowledges, practices and languages as valuable. The findings from this study underscore the importance of extending the thinking about IKS-science integration beyond aspects that suit science content, to considering methods of teaching and learning science, as well as considering relevance to community needs. iv DEDICATION In memory of my mother, Varaidzo Priscilla Chikuni (1946-2005), and her mother Rachel Chikuni (1904-2011) both of whom taught me ubuntu and the love for school. v ACKNOWLEDGEMENTS
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This material is copyright and may not be reproduced for any purpose without permission. Formal permission is required for all uses but normally will be granted immediately; material shall not be used for resale. For copying in other circumstances or for reuse in other publications, or for translation or adaptation, prior written permission must be obtained from the copyright owner, and a fee may be payable. MonWHO 2015 conference will revolve around the theme of mental health. Mental health is a public health issue that affects all regions of the world. Whether perceived as stemming from the wrath of God or ensuing from tangible factors such as genetics, trauma or aging; the disparate perceptions of mental health often dictates the manner in which its treated and approached. As delegates, you will address this issue through the lenses of the specific country or role you are representing. This theme guide merely serves as an overview of important topics. Delegates are encouraged to become familiar with chapters of the guide applicable to their countries and conduct additional research to complement their preparation. However, it would also be beneficial for delegates to accustom themselves with all main points addressed in the guide and follow recent global mental health news. We look forward to meeting you all! Sincerely, Marieme Dembele,
The interconnection between men’s sexual behaviour as a contributor to burden of reproductive and sexual health diseases in sub-Saharan Africa are often presented with complex and sophisticated statistical analyses with little or no comprehension among the affected population that are mostly with little or no statistical literacy and education. The study adopted simplicity-parsimony idea as amalgam of simplicity and parsimony theories in analysing the trends and patterns of men’s sexual behaviour in Ethiopia, Nigeria and Zambia, the three countries selected from Eastern, Western and Southern parts of sub-Saharan Africa. Demographic Health Survey male-recode datasets (2000–2014) were used. Simple descriptive statistical techniques at univariate and bivariate levels were conducted. The results highlighted that men’s sexual behaviour are not the same in these regions. The men median sexual debut is 18 (Nigeria and Ethiopia) but 16 in Zambia. The median age at first cohabitation differs: 22 in Zambia and Ethiopia but higher in Nigeria. From 2000/2004 to 2010/2014, cohabitation practice reduced in Ethiopia across all ages but increased among men aged 25–29 (Zambia: 14.7–15.0%, Nigeria: 13.3–13.9%). There were declined in union-turnover in Ethiopia (−8.8%), Nigeria (−11.4%) and Zambia (−9.3%) including condom use; but non-spousal sex increased. The study concludes that the increase in non-spousal sex, non-condom use could have implications for STIs/HIV spread and zero-AIDS deaths agenda in the region. The authors suggest that policy decision-takers focus on non-spousal sex, non-use of condom, and union-turnover as crucial factors in the fight against STIs/HIV in sub-Saharan Africa.
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Times of economic uncertainty, civil unrest, and disaster are linked to a myriad of risk factors for increased violence against women and children (VAW/C). Pandemics are no exception. In fact, the regional or global nature and associated fear and uncertainty associated with pandemics provide an enabling environment that may exacerbate or spark diverse forms of violence. Understanding mechanisms underlying these dynamics are important for crafting policy and program responses to mitigate adverse effects. Based on existing published and grey literature, we document nine main (direct and indirect) pathways linking pandemics and VAW/C, through effects of (on): (1) economic insecurity and poverty-related stress, (2) quarantines and social isolation, (3) disaster and conflict-related unrest and instability, (4) exposure to exploitative relationships due to changing demographics, (5) reduced health service availability and access to first responders, (6) inability of women to temporarily escape abusive partners, (7) virus-specific sources of violence, (8) exposure to violence and coercion in response efforts, and (9) violence perpetrated against health care workers. We also suggest additional pathways with limited or anecdotal evidence likely to effect smaller subgroups. Based on these mechanisms, we suggest eight policy and program responses for action by governments, civil society, international and community-based organizations. Finally, as research linking pandemics directly to diverse forms of VAW/C is scarce, we lay out a research agenda comprising three main streams, to better (1) understand the magnitude of the problem, (2) elucidate mechanisms and linkages with other social and economic factors and (3) inform intervention and response options. We hope this paper can be used by researchers, practitioners, and policymakers to help inform further evidence generation and policy action while situating VAW/C within the broader need for intersectional gender-and feminist-informed pandemic response.
Ukuhanjwa illness was used as an example to understanding abantu illnesses. With attributional theory ukuhanjwa illness is attributed to spiritual and social causes rather than biomedical causes, whereby causal link is socially constructed between ukuhanjwa illness and entry into the body by familiars. Issues explored included conceptualisation of ukuhanjwa illness. The focus of the chapter is on the reasons for continued pluralistic tendencies in healing regardless of the expectation by the West that people should be focusing on the use of the fast evolving biomedical healing methods. The ethnographic study took place among the Southern Nguni people of OR Tambo District Municipality (ORTDM) in the Eastern Cape, South Africa. Data was collected using qualitative and ethnographic research methods amongst a sample group of 50 participants. The sample was composed of traditional healers, mothers of children who have experienced ukuhanjwa illness, elderly people (male and female), biomedical practitioners and nurses.
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Virginity is part of our existence in the world as embodied sexual subjects. What is the value of virginity? What are the characteristics of virginity pledgers? How is virginity testing carried out? Can a hymen be restored? What are the characteristics of adolescent sexuality? What are the features of early sexual experience? What are the adverse health outcomes? What are the characteristics of sexual assault in childhood and adolescents? How does the cleaning process occur? What is the virgin cleaning myth? Biblical verses dealing with these verses are studied from a contemporary viewpoint.
Adolescents in sub-Saharan Africa hold particular social and economic development potential. This sub-group will grow into future parents, leaders and employers driving the sub-continent forward. However, they face a myriad of challenges not limited to healthcare, education and future employment opportunities. In order to better prepare sub-Saharan Africa for the future needs of these maturing individuals, there is a need to know more about who adolescents are. The purpose of this study is to examine the changing composition, fertility and mortality patterns of adolescents in sub-Saharan Africa. Guided by the social determinants of health framework, the study uses demographic and health surveys and census data from six sub-Saharan African countries. Frequency distributions, rates, population pyramids, age-specific fertility and mortality rates and regression models are used to profile adolescents in the region. In all countries, adolescents are highly concentrated in rural areas. Furthermore, the probability of adolescent fertility is higher in rural than urban areas. However, adolescent mortality is higher in urban compared to rural areas. In conclusion, concentrated efforts should be made on addressing the needs of adolescents in rural areas to achieve a healthy and successful transition to adulthood.
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The manner in which sexual behaviour terms are defined, operationalised and interpreted has implications for research, policy, and clinical practice, and is central to ensuring the accuracy of reporting and the efficacy of interventions. Understanding how people conceptualise and define sex-related terms is vital for meaningful research and health interventions, especially for epidemics that are predominantly transmitted through sex, such as HIV in Africa. Nonetheless, much of the terminology relating to sex acts remains inconsistent and imprecise. A deeper exploration of these ambiguous terms – regularly used in research and clinical practice – and how they are understood sheds light on how phallovaginocentric heteronormative assumptions have shaped the study of sexual behaviour and the provision of sexual health interventions in the sub-Saharan African region.
Opening Paragraph The general aim of this paper is to test by quantitative methods Mitchell's statement (Mitchell, 1965, p. 193) that ‘we expect the meaning which people read into misfortunes to change when they become part of an industrial urban community’. Mitchell was commenting (and elaborating) on the demonstration by Marwick (1952) that witchcraft accusations are particularly likely to occur between people who are in competition with one another, but who are prevented by the norms of the society from expressing their hostility openly. He suggests that Africans in town continue to interpret their misfortunes in ‘personal’ terms but that ‘the meaning that they attach to the misfortune must be of a type which will allow them to take effective action’. In the towns of the Copperbelt hostility and opposition may be openly expressed toward strangers, so there is no need for accusations of witchcraft (signalling interpersonal tensions), except where townsfolk are linked in co-operative enterprises in which, nevertheless, there is an element of competition, e.g. as between rival beerbrewers or fellow workers. In such cases open accusation tends to be inhibited and the interpretation recouched in terms of ancestral wrath. Mitchell sees, therefore, an increase in ancestor-centred explanation of misfortune in urban areas and implies a decrease in witch accusations. Marwick has suggested, on the other hand, that ‘the immediate effect of contact with Western influence is not a decrease but an increase in the African's preoccupation with magic, witchcraft and sorcery’, due to new social alignments and social, economic and political changes, which create insecurity, anxiety, and impart a ‘dangerous flexibility’ to human relationships (Marwick, 1958, p. 106).