Most Africans know what to say when asked about AIDS. HIV causes AIDS. Abstinence, fidelity and condoms prevent it. Western-style advertising campaigns have accomplished that much. So why aren't the prevalence rates plummeting? Because deep down, people don't fully believe it's that simple. They may hold to one belief system by day and another at night. "Someone did witchcraft on me and my eldest son got polio," says Salim Mohamed Said, a dhow captain on the Kenyan island of Lamu. He knows polio is a disease, and he also believes in witchcraft.
Traditional medicine in Africa attributes illness to contamination, witchcraft, natural causes or vengeful spirits. Blood, especially menstrual blood, is a contaminant. In this view, sex with a menstruating woman brings disease--including AIDS. It follows that postmenopausal and very young women are safe--a factor in the alarming incidence of child and "granny" rape. Many men also believe that during sex children can transfer an unused lifetime quota of good luck, staving off contamination. Death is also a contaminant. Widows must be cleansed by having sex with a brother-in-law or healer. In the capital of Botswana, I've met teenagers in Nikes who call AIDS bosgawadi, a disease brought on by having sex with a widow or widower in mourning.
The "ABC" injunction--"abstain, be faithful and condomize"--quickly runs afoul of tradition. In rural Malawi, a Red Cross study found most women believe sexual pleasure depends on direct contact with semen. Throughout the continent, children link the living to their ancestors. African men and women have unprotected sex until they have children. The language of AIDS prevention often doesn't connect. In one survey in Namibia, three quarters of the young adults polled had never heard the word "monogamy." Most believed that abstinence means to be absent, and that faithfulness refers to religious faith. Even basic ideas about the body are often different. In northern Mozambique, teenage girls think they can't get pregnant by having sex only once with a partner. "Every Western kid knows about the liver," says Dr. Kwame Ampomah, a Ghanaian with UNAIDS in Botswana. "In Africa, the body is like a closed box, its interior shrouded in mystery."
What's needed is a change in approach to AIDS prevention. To begin with, Africans should hear about AIDS in their own idioms, and the message must address traditional beliefs. Many AIDS campaigns already have enlisted traditional healers. The problem is that the healers can't be expected to convert to the mechanistic perspective of Western science. "Interpretations of reality are multiple," says Dr. Leslie Nthoi, of the University of Botswana. "AIDS campaigns are based on one." Some rural health workers in cattle-raising Botswana now liken HIV to ticks, and condoms to a protective cattle stockade. In Mozambique, a new ad compares wearing a condom to the way villagers protect a mud-and-pole hut from termites by building it within a circle of fire. Fighting the plague at its epicenter requires unconventional initiatives that value myth and ancient practices. AIDS prevention in Africa is not as simple as ABC.