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| From the November 2003
Anthropology News, p 4 and 8
Cultural Integration for Elizabeth A Onjoro The central argument of Green’s commentary is that HIV/AIDS prevention and treatment strategies in Africa should pay close attention to African values, philosophy and beliefs. HIV/AIDS prevention programs that do not adequately address the cultural milieu in which they operate are bound to achieve only minimal success. Prevention strategies centered on providing large amounts of condoms have demonstrated very limited effectiveness in many African nations precisely because they do not take into account cultural factors. Initiatives in Botswana and Kenya provide vivid examples of the failure of a mainly condom strategy, while Uganda (reduced prevalence from 25% to 6%) and Senegal (which has kept its HIV prevalence rate at 1%) illustrate the success of a more culturally sensitive approach. Health and Culture It is no surprise that ABC has been at the center of effective HIV/AIDS prevention in Senegal and Uganda. The ABC strategy in each country is tailored to fit that country’s cultural reality. Among the driving forces behind the strategy’s successes are strong political leadership, sound public health practice, integration of cultural knowledge and environmental reality. This points to what many Western researchers and policymakers do not like to hear: effective HIV programs must integrate a cultural framework of health and healing, treatment and prevention messages. Prevention messages that are perceived as best and effective in the West may not necessarily be equally effective in the African context. Given the myriad driving forces that can have a profound effect on HIV infection rates, more funding needs to focus on strengthening these elements and our understanding of them; even if it means reducing funds available exclusively for condoms. As in all cultures, local health beliefs influence the perception of causes of illness, and thereby prevention and treatment choices. The particular causes and effects however are broadly defined. The indigenous medical knowledge found on the African continent derives from cosmological beliefs that, among other things, contend that many illnesses and imbalances occurring in the body can be caused by sorcery, ghosts/spirits, breach of taboos or loss of ancestral protection. Entities such as witchcraft, magic, or supernatural powers are considered invisible and beyond human fact-finding rationality. Recognizing the validity of these local beliefs, however, opens room for the existence of diverse systems. This also demands greater flexibility in prevention and treatment planning and action. This allows for acknowledging other models of folk knowledge as expert systems authoritative within their own cultural contexts. Such recognition, on the one hand, challenges the longstanding bias toward science as the knowledge that should direct health development endeavors worldwide. For instance, biomedical knowledge, a product of Western technology and driven by a scientific ideology that is disease focused, can be critiqued. In this worldview, condoms are often seen as the sole solution for avoiding HIV infection. On the other hand, such recognition opens the door for testing the validity of other epistemic models of health and healing, and applying those models that are found effective. Equitable Integration Studies in the past two decades show that development, including health prevention, projects continue to fail for the same reasons they did in the past: the neglect of integrating indigenous perspectives as part of development discourse. The problem, however, as I see it, goes deeper than the mere recognition of indigenous knowledge. Western and indigenous knowledge should be equitably integrated in development efforts. Furthermore, what is important is not just integrating knowledge as a technical requirement and process; knowledge should be considered in its broader cosmological senses. Health and healing within the African context demonstrates the central role that the understanding of culture as a holistic entity contributes toward unveiling the fundamental reality under which a group thrives. Considering health as a part of a holistic whole is essential in understanding the dynamics of a group’s behavior toward the parameters set by any technical change initiative. Therefore, it is also important to consider people's views about such things as their relationship to their environment, their values on the use of resources, and in general, how they see themselves in relation to the rest of nature and other humans. In this respect, the idea of what health and healthcare means should not be imposed from the outside. When it is imposed it may conflict with local values and customs and end in failure. Equitable integration places indigenous and biomedical health knowledge in a comparative analytical plane, locating the historical struggle between the cultural rights of indigenous peoples and the dictates of positivist-inclined science within the Western world as a political and ethical issue. There is no question that poor health outcomes are a financial burden to agencies funding healthcare development initiatives, and the repeated lack of sustainability of many of these projects has brought false hope to many rural communities. This is an ethical issue social scientists can no longer ignore. Integrating Western and African systems would mean building effective health and healthcare knowledge for prevention and treatment in Africa, not only because they both have successful methods, but also to better integrate the two belief systems in an environment in which they can thrive. Equitable integration challenges Western program planners and professionals to pay attention to indigenous knowledge and seek direct local participation. That would be a step toward initiating a true beginning in building a bridge in development enhancing initiatives. Insanity is doing the exact same thing over and over again and expecting to get a different result. Elizabeth A Onjoro works for the Department of Health and Human Services’ Office of HIV/AIDS Policy. In her previous position, she was Coordinator and Trainer for the Florida AIDS Education and Training Center (FAETC) at the U of South Florida Center for HIV Education and Research. She also served as adjunct faculty at the USF Department of African Studies and at Hillsborough Community C. She received her PhD in medical anthropology with a minor in public health from the U of South Florida in 2001. |
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