Cultural practices inadvertently promote the spread of HIV

KAMPALA, UGANDA — Uganda is a land of many cultures and sometimes the spoken and unspoken cultural dynamics lead to conflict, according to Gabriel Amori of Uganda Network of Religious Leaders living with or personally affected by AIDS (UNERELA+).

Some persistent cultural practices actually promote the spread of HIV/AIDS, he said.

“For example, it is common for grandmothers to care for their orphaned grandchildren. In this situation, many relatives stop by her home to check on the children,” Amori said. “In the case of male visitors, such as a brother in law, it is custom for the woman to lay his bed. Part of this is providing sex to him.”

Gabriel Amori, national coordinator of the Uganda Network of Religious Leaders Living with or Personally Affected by AIDS (UNERELA+), said that he experienced stigma related to HIV when his first wife died of the disease. (Bente Bouthier | The Media School)

When an elderly woman starts to exhibit symptoms or get sick, she and society are confused, according to Amori.

“People do not think of HIV as a disease for elderly because they do not think elders have business in sex,” said Atim Salome from Reach Out, an NGO focused on care and counseling of people living with HIV. “When they find out, they think, ‘you also?’”

Mary Kiconco, a nurse at Reach Out, says she sees elders come in from treatment who are secretive or fear judgment.

“Some elders, especially men, try to send their wives or children to collect their ARVs,” Kiconco said.

ARVS (antiretroviral medication) is taken to balance out the HIV virus in the body and prevent it from worsening.

These behaviors persist because people forget the cultural practices that come into play, even for elders, according to Amori.

Elders face pressure of being denied ART (antiretroviral therapy) service because of their age, he said.

There is little counseling available or provided specifically for elders. Some elders are not receptive to advice from younger counselors.

“Often the counselors available are HIV-negative, making positive elders feel especially alienated,” Amori said.

Elders often feel out of place when they visit clinics.

“There is a lot of stigma for single elders who contract HIV. The question everyone asks is, ‘how?’”

“In the example of an elderly who contracted from a visiting guest, practicing a cultural norm, she is not expecting (HIV),” Amori said. “Culturally, she believes what she is doing is right. This brings conflict between what is a lawful and what is safe.”

The stigma exists once they contract HIV from these unspoken cultural practices, according to Amori.

Then when elders go into clinics, it is easy for them to be discouraged. They see in the centers that most people accessing services are younger, according the Amori.

Futuma Nabalence, age 62, smiles at Reach Out where two of her grandchildren attend secondary school. (Amelia Herrick | The Media School)

This discouragement brings dangers of isolation for elders, according to Prosper Byonanebye of the Uganda Network on Law Ethics and HIV/AIDS.

“With fear of discrimination, they will hide their condition and waste in bed,” said Byonanebye.

The focus now is on improving cultural practices.

Amori and Byonanebye agree that the best way to remedy unhealthy cultural practices is through spiritual and cultural leaders.

With children away for employment, elderly expect local spiritual leaders to have their interests at heart.

“We need sensitized spiritual and cultural leaders, because they are often how elders discover resources,” said Byonanebye.

These leaders alleviate stigma when they are informed, according to Amori.

This breaks down the fear for elders to seek medical aid independently.

Mbowa Musa, 42, receives treatment for HIV at Reach Out.

“When I am serviced by a much younger person, it gives me hope,” said Musa. “I hope that this younger generation will not infect themselves the same way we did.”

Mbowa Musa, 42, takes a call from a friend. He works construction when he can, but struggles to find employment because he doesn’t have the right connections. “It is all about who you know,” he said.