Gender, sexuality and vulnerability to HIV infection among the Borana pastoral community of southern Ethiopia

HIV prevention interventions were mainly guided by behavioural models that focused on awareness creation through information provision. Similarly, studies on factors for HIV infections were associated with sexual behaviour and lack of information. As such conclusions were made that women were more at risk due to their social positions that denies them access to information and services. As a result prevention interventions failed to pay attention to the underlying factors that anchored risk behaviours on the one hand and undermined the fact that men are also at risk. Consequently, after thirty years of interventions, HIV remains to be a concern in Ethiopia and its spread to pastoral communities remains unchecked.
Objectives
The objective of this study is to explore factors of vulnerability to HIV and potential resources for prevention among Borana pastoral community in Ethiopia.
Methods
Cross-sectional exploratory design was applied with quantitative and qualitative methods applied to collect data. Survey of 502 sample HHs was completed in three districts to generate data on HIV awareness and misconceptions. Nine sessions of separate FGDs and sixty nine in-depth interviews with men and women were completed to generate data on gender attributes, extramarital concurrent sexual practices and reasons for such practices, perceived association to HIV infection and potential local resources to improve HIV prevention interventions. The researcher has lived in the community during close to a year in the community that offered opportunities to informally interact with community leaders, which helped to consolidate the data. Survey data was analysed using STATA version 10, while data from in-depth interviews and FGDs was summarized and coded using the MAXQDA qualitative data analysis tool.
Key Findings
Survey findings showed that only 18% of the respondents could mention abstinence, faithfulness, condom use and avoidance of contact with blood as prevention methods, while the greater majority of respondents sustained incomplete information on prevention methods. Only 9% of survey respondents cited the three modes of HIV transmission (unsafe sexual practices, sharing contact with blood, and from pregnant mother to the foetus) while the majority could identify ‘sex’ and sharing skin piercing materials. In addition, 85% of the respondents were found to hold three or more misconceptions about HIV transmission. Source of information was found to be Health Extension Workers (HEWs), school teachers, youth AIDS clubs and to a lesser extent, radio were found to be major sources of information on HIV and AIDS in the community. The information remained to focus on abstinence; faithfulness and condom use some which does not give sense in the Borana context.
Qualitative finding shows that gender-specific attributes such as differential participation in public forums and decision-making power over resources were not factors of vulnerability to HIV infection. Nonetheless, it was gathered that of gender roles, men are more exposed to HIV due to their mobility in search of pasture, water and markets for livestock which brings men into contact with women other than their regular sexual partners. Although it was commonly argued that extramarital concurrent sexual practice is not culturally approved, the practice is widespread and tolerable among the Borana. Such practice is considered as a mark of desirability and proof of fulfilled gender roles. Although the practice is known to be associated with HIV infection, there remained dilemma on what to do in view of the fact that awareness is poor, misconception is widespread, source of information is not trusted and desire for concurrent extramarital sexual practice is the case than exception.
Conclusions and recommendations
In Borana, vulnerability to HIV infection is not limited to women or the youth as broadly documented elsewhere. The entire Borana is found to be vulnerable due to among others lack of information and widespread concurrent extramarital sexual practice among others. Prevention intervention by health extension workers, school teachers and youth club members with the use of generic information in Borana is found to be out of context. Although the concern is mounting, there are opportunities within the community that includes: capitalization on the influence of local influential (Gada) leaders and expressed interest to consider condom use. In the long run however, it would be important to study gender stereotypes and sexual values among the Borana in connection to sexual health problems including HIV infection.