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ZAMBIA: Study shows urgent need for information campaigns

[This report does not necessarily reflect the views of the United Nations]

JOHANNESBURG, 15 March (PLUSNEWS) - A study of young Zambian males indicates that misconceptions, folk beliefs and denial are affecting their personal risk assessment of HIV infection.

Thirty interviews, conducted in May and June 2001 with out-of-school males in Lusaka, the capital of Zambia, revealed that accurate information was mixed with these perceptions.

Folk beliefs linking HIV infection to the "strength" of the individual's blood, menstruation or sorcery were common, as were misconceptions about HIV being transmitted through kissing and mosquito bites, said the report by Population Services International (PSI).

"Some participants believed that people with 'weak blood' were more likely to become infected and exhibit symptoms earlier than those with 'strong blood'," Rebecca Cramer, senior research assistant at PSI, told PlusNews.

Other participants believed that women could shed the virus during menstruation and therefore took longer to exhibit symptoms. Participants who attributed infection to sorcery said people infected with HIV acted as if they had been bewitched, displaying "bizarre behaviour".

Despite acknowledging that a healthy looking person could be infected with STIs or HIV, respondents continued to rely on outward appearance as a means of identifying infected individuals.

"The beginning stages of HIV are asymptomatic - people do not display outward signs of being sick. Not until their T4 cell counts are very low do people show symptoms like wasting and hair loss," Cramer told PlusNews. "So it is particularly difficult for people to understand that people are sick when they don't show any symptoms."

Information pertaining to sexual matters was impeded by embarrassment or fear, said the report.

"From our research it seems that young Zambian males predominantly receive information through overheard conversations between parents or elders talking, and not through direct questioning," said Cramer.

Participants agreed that although abstinence was one of the most effective methods of STI/HIV prevention, it was not reasonable to expect young people to abstain. According to PSI, participants in the study said sex was a fundamental human need, pleasurable and essential for emotional and physical development.

The research showed that risky sexual behaviour was rationalised and, in some cases, infection was viewed as punishment for moral shortcomings or a lack of self-control, since transmission was associated with deviant behaviour.

Participants considered monogamous relationships to be risk-free, despite the fact that the majority of their relationships lasted less than six months. None of the participants linked past sexual encounters with potential risk in current relationships.

"By associating the threat of infection with promiscuous, careless or unhygienic individuals, participants placed the responsibility for behaviour change on others," noted the report.

Respondents did not always recognise the importance of consistent condom use with all sexual partners. Some rationalised non-use of condoms because they considered them ineffective in preventing STIs and HIV, while others thought condoms could prevent STIs but not HIV.

Trust in one's sexual partner was the most common rationalisation for not using a condom. Participants' experience illustrated that "trust" was used as a bargaining tool to convince partners that condom use signified mistrust, and also said that once sexual fidelity had been established, condom use was no longer necessary.

Many participants harboured misconceptions about testing services. They had inaccurate information about the testing process, had not heard about testing, or were simply poorly informed about the availability and cost. Some spoke candidly about their fear of being tested and how a positive HIV diagnosis would be a "death sentence".

PSI concluded from the research that peer-based interventions needed to be stepped up to ensure that the youth had access to accurate information, while communication campaigns should target adults, encouraging them to talk openly to their children about sex.

Information should be made available to correct incomplete knowledge, challenge misconceptions, make known the availability of HIV and STI testing, and stress the importance of knowing one's HIV status. To decrease the likelihood of denial, programmes should work with communities to decrease the stigma associated with STI/HIV infection, the report concluded.

In Zambia, one of nine countries in southern Africa hard hit by the AIDS pandemic, approximately 21 percent of 15 to 49 year olds are HIV positive. Condom use has reportedly increased, but is inconsistent. According to the United States Agency for International Development, 84 percent of Zambian youth have had sex by the age of 19, and approximately one in six urban youth are HIV-positive.

[ENDS]