Annalisa Boslough

Abstract

Research investigated the social stigmatization of HIV/AIDs in remote tribal villages in the East Sepik Province of Papua New Guinea in the summer of 2012. Pre-field preparation included human subjects testing training and IRB certification, as well as a $1500 UAR small grant to fund project. Research methods were qualitative and focused on interviews with community health workers, village health volunteers, stationed missionaries, and village people. Three primary facets of village life were investigated; village social structure, the current state of health education in villages, and ancient tribal beliefs in witchcraft and its associations with traditional medicinal practices. Many factors across these categories were determined to be critical influences in the stigmatization of HIV/AIDs in isolated tribal communities. Prominent contributors include but are not limited to polygamist relationships, communal living among multiple families, exchange of children for goods or other services, non-scientific missionary health education, inadequate resource to prevention and treatment resources for HIV/AIDs as well as testing methods, and finally the underlying belief that chronic disease is a ramification of sorcery or black magic. All of these factors create an intense stigma against people suspected of being HIV-positive, causing them to be ostracized by their village and exiled to the jungle to survive on their own. Although such practices may seem shocking, this study also critically evaluates the place of western aid in such unique indigenous cultures through the lens of doing no harm. This study was primarily an assessment of the causes of stigmatization, however, I also include some speculation on how to best address the issues of HIV/AIDs stigmatization in the context of an incredibly unique indigenous society.

Introduction

“When a person has HIV, we cannot interact with them. They are a danger to the community and their family. It is hard but they must leave,” said Nathan, an educated and respected Village Health Volunteer in Papau New Guinea. This statement was my first realization of the great cultural rift between my background and that of the people I was trying to help. During my internship in the East Sepik Province of Papua New Guinea, I planned to determine the rate of HIV/AIDs infections in five remote villages along the river.

There is an immense stigma surrounding the disease that shames and exiles anyone suspected of being HIV-positive. Opinion’s like Nathan’s would make physical testing for HIV far too dangerous to the village communities. I conducted interviews with people to gain a better understanding of the many societal facets that create such an intense stigma.

The problem of HIV/AIDS in Papua New Guinea extends far beyond simple statistics of infection rates. Beneath the medical issues of access to basic testing and treatment in rural areas is a conflicted cultural structure that ostracizes anyone suspected of being HIV-positive. The clash of ancient tribal beliefs and social structures with introduction of Westernized health practices creates a gross misunderstanding of HIV/AIDs in rural village communities. This problem is compounded by the current state of health education in rural villages, which is based on Christian ideals rather than the science of HIV/AIDs. Understanding village social structure, Christian influences, and ancient Papuan beliefs is integral to restructuring current health education programs to teaching more accurate and acceptable methods of HIV/AIDs prevention and treatment.

 

Village Social Structure and Contrasts to Christian Ideals

Currently, HIV/AIDs education is a confusing clash of new religious preachings and traditional cultural values. As described by researcher Angela Kelly, “the way the [HIV/AIDS] epidemic is brought to people’s attention will be a critical determinant of how they will respond to it.”[i] I found this contrast in interviews of two village members. Said one of the elders, “HIV/AIDS is bad disease. It is black magic, sorcery, we cannot understand. It is a danger to the village.” Said a young man, “I have found the way to Jesus, I do not worry about HIV/AIDs because he will protect me.”

Traditional tribal beliefs that HIV/AIDS is caused by witchcraft stem from a lack of knowledge about the biological basis of the disease. In addition, the Christian mindset that sex is sinful further shames infected individuals who are already accused of practicing sorcery. Both of these factors lead to extreme discrimination against infected people. One major solution to this discrimination is to change current health education programs to accept traditional social structures of rural villages. To do so, the many complex aspects of village social structure must first be understood.

Author Nancy Lutekas observed that “social structure is simple and highly flexible. The family comprises a man, his wife or wives, his and their children, occasionally an older widow, and those teenage boys living nearby who are fed by the women of his household.”[ii] In Papuan tribal cultures, living situations are much more communal than Western ideals of households. Furthermore, “the largest and most important political unit is the village”.² The safety of the village is tantamount to individuals’ health, and any incurable infection is seen as an irredeemable threat to everyone in the village. This mindset contributes to the act of ostracizing individuals suspected of being HIV-positive.

Another practice that stems from the communal living style and contributes to the spread of sexually transmitted infections is polygamy. In Papua New Guinea, polygamy is legal and common, practiced in “seven in ten village households.”[iii] Polygamist relationships are always between one man and many women. Existing HIV/AIDS education programs focus on changing such social structures to match Western ideas of morally correct living situations. This makes sexual health education ineffective, as villagers do not want to change the way village life is structured.

Writer Leslie Butt writes, “The problem is that although having unprotected penile-vaginal intercourse acquiesces in male sexual prerogative and upholds Christian doctrine about two bodies becoming one, [not using protection] increases people’s risks.”[iv] In light of this observation, an effective way to reduce HIV/AIDS rate would be to accept polygamist practices and teach preventive measures in a way that does not attempt to change ancient social structures, regardless of Western ideals about the morality of those traditions. Polygamist practices are so engrained in society that any attempts to change them should be separate from treating serious health issues, like HIV/AIDS.

Current Health Education in Rural Village Communities

Health education in rural Papua New Guinea can only be effective if it is implemented in a way that does not attempt to change the current social structures and values present in village communities. Despite the recent growth of government funded health education programs in larger cities, the only health education programs present in the East Sepik Province are run by Christian missionary aide organizations. Although these programs benefit the villages through providing water tanks and medical supplies, their missionary health education aims to eradicate sexually transmitted diseases by changing existing social values and practices, primarily polygamy.

The missionary Village Health Volunteer education program is run by Protestant and Catholic missionary organizations and is centered on educational classes held at large villages to train village health volunteers. The volunteers learn everything from village health volunteer manuals that are written, printed, and published by the missions. The manuals rarely explain the scientific processes behind serious diseases like HIV/AIDS. Furthermore, as the manuals were written by a combination of Protestant and Catholic missionaries, they present conflicting viewpoints. Consider this excerpt from a village health volunteer training manual on Sexual Health outlining the ABCD’s of HIV prevention:

Protect yourself from sexually transmitted infection by:

–       Abstain – Do not have sex before marriage.

–       Be faithful to one partner, who is also faithful to you.

–       Condoms should be used if you have sex with someone who is not your partner.

–       Do not have sex before marriage

Both Catholic and Christian mission influences are present here. The Catholic mission’s influence is so strong that both letters A and D mean the same thing. C for condoms results from the Protestant mission’s teachings, which allows sex before marriage, and attempts to address the common village practice of polygamy. In sum, these dual influences present contradictory information, preventing the teaching of any lasting preventive measures.

These contradictions are also present in other programs across the East Sepik Province. In 2007, researcher Sarah Hewett concluded that “there are so many mixed messages: there’s no medicine, there’s a new medicine, don’t have sex, do have it but with the right person; use a condom, but they’re not really safe, so go ahead and use a couple at a time.”[v] Hewett called this strand of contradictions “cognitive mayhem,” which is an apt term to describe the state of not only HIV/AIDs education, but also the social response in village communities.

Missionary education not only disagrees on preventive measures, but also with the entire social structure of Papuan villages. Leslie Butt argues that “increasing stress upon premarital abstinence and conjugal chastity still collide against the legal status of polygamy and normative nature of concurrent, multi-partner sexual networking.⁴ Currently, “Many health workers, specifically Christian…refuse to distribute condoms, which they claim increase promiscuity and facilitate, rather than prevent, HIV transmission”⁴ The Christian missionary organisations view polygamist relationships as promiscuous, when in fact they are an accepted and traditional part of Papuan culture.

Ultimately, the Christian mindset regarding sex differs completely from that of traditional Papuan culture. Butt notes that “Christian rhetoric about sex is more about sin and duty than pleasure and necessity.”⁴ Sex in Papuan villages is not about mutuality but about pleasure between a man and his wives. It is also about necessity, as traditionally wives are expected to bear many children to care for aging parents. The Missionaries’ blatant ignorance of Papuan tradition and culture to further the word of God results in confusing health standards and education that is not just ineffective, but culturally detrimental. Distributing condoms and restructuring health education to accept Papuan cultural values would not increase HIV/AIDS rates by increasing sex, but rather would ensure that existing unprotected sex practices are safer.

Ancient Traditions: HIV/AIDS as Evidence of Sorcery

Amongst the clash of traditional social structure and religious teachings are ancient tribal rituals and beliefs about sorcery. Any serious illness is traditionally believed to be evidence of black magic through angry ancestor spirits. Leslie Butt observes that “there is a great deal of fluidity between the biomedical and the magical, since intractable illnesses are subject to debate and negotiation between the rationales of biomedicine and the magical world of sorcery and spirits.”⁴

Many people I interviewed, even trained Village Health Volunteers, believed HIV infection to be the result of sorcery. An elder in the village of Oum told me, “Black magic is a danger to every person in the village. If someone is very sick, with HIV, it is a bad sign of bad sorcery. They must leave to protect the village.” Community elders have the largest say over the fate of a village and generally have the staunchest belief in sorcery and ancient magic rituals. However, even among the younger more educated population of the village, belief in sorcery was common. Paul, the lead Village Health Aide in Oum, said, “It is traditional belief that angry spirits bring bad luck to the village. I know HIV is caused by virus. But angry spirits bring that virus to Oum.” In general, educated younger villagers share the opinion that HIV itself is not caused by magic, but the reason for its presence in a village is angry ancestral spirits. Although beliefs in sorcery are a fascinating element of Papuan culture, they dramatically increase the stigma surrounding HIV-positive individuals and encourage ostracizing behavior.

While Westerners may view this practice as cruel, such traditional beliefs run very deep and are deeply engrained in tribal cultures. The expulsion of HIV-positive individuals has existed since Papua New Guinea was under German and British control in the early 1900’s. Although the colonisation of Papua New Guinea is thought to be responsible for the introduction of HIV/AIDs to the country, indigenous people with STD’s were locked up by national mandate.[vi] Concurrent tribal explanations connecting HIV with sorcery created a deep stigmatisation of anyone and anything connected to the disease. Although the mandate was revoked in the late 1980s, the stigma remains, particularly in rural communities.

The tribal response to HIV/AIDs in Papua New Guinea makes it nearly impossible to teach HIV awareness in the style of the Western world, in which programs focus on openness and willingness to be tested and societal acceptance of those who are HIV-positive. Getting tested for HIV in Papua New Guinea is extremely unpopular due to the repercussions of being HIV-positive. Furthermore, keeping such knowledge private in rural village settings is unrealistic. These concerns make implementing widespread HIV-testing as a preventive measure very difficult. Nancy Butt anticipates that attempting to force villages to accept HIV-positive individuals would result in “moral panic” due to the risk of village health and the backlash from angry ancestral spirits.⁴

Conclusion: How Much Intervention is Really Helpful?

In light of such an engrained stigma, is there a way to teach HIV prevention and treatment that would allow HIV-positive individuals to be accepted in society? Realistically, the rural villages have little access to basic healthcare, let alone the expensive medications and counselling required to treat people who are HIV-positive. Even if villages were to accept HIV-positive individuals, they would have no means of caring for them.

In the context of available healthcare resources, a better plan may be to treat HIV-positive individuals in large cities where medication and more reliable long-term treatment are available. Thus, HIV education could become a primary preventive measure in rural villages without becoming confused by the medical and counselling resources required to deal with infected people. Furthermore, if preventing the spread of HIV/AIDs becomes the goal of education programs, lessons in villages can focus on the scientific causes of the disease rather than attempting to tackle the difficult psychological issues of treating those already infected. Such a plan may be better received by remote villages.

Although focusing sexual health education on prevention does not directly address the moral issue of ostracising HIV-positive individuals, this may exceed scope of Western aid. Through my research, I found that any study of HIV/AIDS requires a thorough understanding and acceptance of cultural differences. To best help people in rural Papua New Guinea, we can only provide health resources and unbiased education. Attempting to solve deeper sociological problems contributing to the stigmatisation of HIV/AIDs from an outsiders’ perspective creates more problems than it sets out to solve.