In this article of a series by Dr. John David Dupree, he continues the discussion by describing his role in helping create the HIV/AIDS education curriculum for Malaŵi. Dr. Dupree discloses his experiences as a public health practitioner in Africa, illustrating the connection between intolerance of homosexuality, lack of age-appropriate sex education, and the HIV/AIDS epidemic.
Can you describe how myths and stereotypes about sexuality and HIV/AIDS have affected your work in Africa?
In Malaŵi, I encountered many and varied myths. For instance, when I first arrived in the country, there was a widespread rumor that mango trees were the source of “Edzi” or the “AIDS germ”. So literally thousands of mango trees were murdered, girdled by machetes in an attempt to ward off the epidemic, even though mangoes are a major source of nutrition for people there, particularly in the rural areas.
At a societal level, we were tasked with trying to ward off the epidemic via development of an age-appropriate AIDS education curriculum from primary, through secondary, to tertiary. The curriculum was eventually adopted and Malaŵi became one of the few non-Scandinavian countries in the world that required all private and public schools to use this curriculum from age 5 to about age 25 (and beyond for some slow learners).
It was important to me when we were developing the curriculum materials to tailor it for the different age groups. You’ve got to start with how families interact, what moms do and what dads do, etc. So I felt like we needed to include everybody in development of this potentially controversial curriculum. If representatives from the various religious communities took part in the material development process from the outset, then, after the materials were going out to consultative meetings around the country, people would have much less grounds to object to its content, since the churches and mosques were part of the process from the get-go.
Reverend Moto, a Methodist pastor trained and ordained in England, had been assigned to a church in Lilongwe, Malaŵi’s capital city. He was among the clergy invited to be part of the initial week-long materials development process. There was a Seventh-Day Adventist missionary there, since ADRA (Adventist Development and Relief Agency) is big all over Africa. There was also a Catholic priest, as well as a Southern Baptist missionary. Reverend Moto is the only clerical type whose name I can recall, largely because he was quite verbal and opinionated throughout the workshop.
When it came time to talk about sexual transmission, we conducted 15 to 20 focus groups with parents of primary, secondary, and tertiary students. I attended three of them. One of them was actually done in English and, during the others, I had to sit next to an interpreter. In this focus group process, after introductions were made, and participants were made to feel comfortable, and the subject of AIDS had been brought up, the moderator would ask, “What would you do if you found you or your sexual partner, husband, wife, boyfriend, or girlfriend was HIV positive?” And in all three of the groups I went to, everybody agreed that the thing to do was to abstain from sex. During report-back sessions, it was clear that this response was true for virtually all of the focus groups.
Above: Often patents – like this young boy – are brought from as far away as Mozambique to Nsanje district hospital in Malaŵi, bringing with them concerned family members, who wait in a small smoke-filled cooking shack.
In one of the groups, a 60-something mother of a college student raised her hand. She said she would “lay without sex” and everybody laughed – many said they couldn’t imagine her having sex in the first place. So then the next probing question was, “Then if not abstinence, then what would you do?” And in all three of three groups I went to and in most of the other groups, as well, the participants concluded that, “Then anal sex would be the next best thing.”
“Why would that be the next best thing?” the moderator would ask. The parents generally responded saying things like, “It’s not risky like vaginal sex is.” The reasoning behind that, they said, was they never heard that anal sex was risky and they knew that some young people use it as a birth control measure. So it was “obviously” safer.
Nobody – not a single person in my three groups – ever brought up condoms until the moderator brought them up.
If nobody brought it up, the moderator would ask, “What about condoms?”
The participants would look at each other and say, “Well, I don’t know, what about condoms?” or “And what is a condom?”
So there was a lot of ignorance.
While we were at that first workshop, we discussed that two “third-world” leaders (Mobutu in what was then Zaire – now the Democratic Republic of Congo – and Egypt’s Mubarak) had made an earth-shaking announcement. They said that collaboration between scientists from their two countries had discovered the cure for AIDS and they had somewhat immodestly named it after themselves, so it was called “MM1,” after Mubarak-Mobutu. You could always come to Kinshasa or Cairo if you got infected with “the AIDS germ” and be cured, focus group participants informed us. Well, of course, that was bunk, but these two African Presidents still said it; therefore, it must be true. And there we were in this very rural area in Malaŵi where nobody had heard of condoms but most of them had heard that “you could always just book a flight to Kinshasa and go to the Mama Yemo Clinic and you’ll be fine.”
It’s one of those bells that you simply can’t “un-ring” – at least not overnight – or, more likely, not in one generation. Once the information is out there, inaccurate information, it seems that it travels light-years faster than accurate information. It became clear to everybody during the report back, that you needed to correct the assumption that, since we haven’t heard anything about anal sex, then it was obviously not risky. Nobody in those groups said it was risky. So in the course of developing the materials, it was decided by the group that by the time a student turned 13, it was recommended to begin mentioning all of the routes of transmission.
This included teaching students HIV can be transmitted through vaginal sex, anal sex, through sharing needles/piercing instruments of some kind, through blood transfusions, in childbirth and, possibly, through breastfeeding (this last route hadn’t yet been formally documented at the time).
In these discussions, Reverend Moto became – what would you call it? – apoplectic. He nearly had a calf, right there in the middle of the room. He said, “How could you tell a 13-year-old about such things. I mean it’s so disgusting.” He went on, “And besides, there is no such thing in Malaŵi. We do not have anybody doing those nasty things here in Malaŵi.”
And bless his heart, our anthropologist friend, Samu Samu, who taught at nearby Bunda College, had been asked to participate in these meetings, as well. He had just come for that one day because he was a full-time university professor..
It was Samu Samu who led the counter-attack from Reverend Moto’s attack. I appreciated that very much, so I didn’t have to feel like the white boy from the U.S., you know, trying to inflict “western ways” on them.
Samu said very calmly, “Reverend Moto, if this doesn’t happen in Malaŵi, why do we have two words for anal sex in ChiChewa” (the local language). “We have ‘matanyula’ which means male to female anal sex and we have ‘chiswahili’ which is male-to-male anal sex. Why do we have two words in our language if there’s no such thing going on?”
And there was a delightful woman among the participants, who just shouted out, “I’m a good catholic, and I don’t go to your church, but I’m telling you that I’ve known since I was a child that anal sex is going on not only between men and men, but it goes on between men and women.”
So we were eventually able to generate curriculum policy recommendations calling for 13-year-olds, by the end of the equivalent of their 8th grade – at a point when many are becoming sexually active – to start talking about these things. By that age, it was time to start using realistic dildos, rather than fingers and broomsticks, which can be misconstrued, for condom demonstrations and so on. Those recommendations made their way through the Ministry of Health and, most of them, after several years and much testing in the field, have been implemented into the currently functioning curriculum.
You must remember that the second time I was ever in Malaŵi, I encountered a nine-year-old girl in hospital, who had just given birth to a child – babies literally having babies! It’s never too early to start educating people about healthy family lives, relationships and responsibility, no matter what God you pray to or which language you speak! “Protecting” our children from the truth in the name of religion, politics or culture does a disservice to the nation and its future leaders, its children.
In the next segment, Dr. Dupree discusses Christianity, Islam, and politics as being among the worst enemies for not only HIV and AIDS prevention, but more specifically for the LGBT community worldwide, [and] certainly in Africa. Coming on 5/15/2013.
The content of this article is sourced from an interview with Dr. John David Dupree conducted by Benjamin Eveslage on September 18, 2012.
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- Ghana’s modern gay issues. 4.17.2013
- Stigmata from the U.S. to Africa. 4.24.2013
- “They robbed us of our sexuality!” 5.1.2013
- The bell you cannot “un-ring”: Confronting HIV/AIDS myths in Malawi. 5.11.2013
- Religion and politics join forces to target LGBT in Africa. 5.15.2013
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