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Haitian Women's Role in Sexual Decision-Making: The Gap Between AIDS Knowledge and Behavior ChangeII. Presentation of Findings |
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2. Causes of AIDS: Men's and Women's Knowledge of Transmission If she has AIDS, the germ has to spread It is now common knowledge in Delmas and Savanne that AIDS is a sexually transmissible disease. In all the focus groups of this study, women and men were acutely aware of the risk posed by sexual contact with an infected person and offered strikingly consistent explanations of how unwary partners may become infected. The more partners one has, they explained, the greater is the risk of acquiring the disease and transmitting it to others. In a typical exchange of views on transmission, men in Delmas demonstrated their understanding of this process:
Women's views on transmission were similar; both men and women constructed an explanation for the transmission of AIDS in a network of relationships. Men were usually described as the link between women on the outside infected with AIDS and women at home, either wives or relatively steady partners who were not expected to be involved in other sexual relationships. The implication was that it is the "other women", not the "wife" at home, who are most responsible for the spread of AIDS. In effect, men were most often portrayed as vectors of disease, oblivious to the consequences of their sexual adventures. A 40-year-old married father of three in Delmas compared it to bringing home a tick:
From time to time participants acknowledged that the extramarital affairs of women in stable relationships may also lead to HIV infection, but most of the discussions supported the notion that "wives", or women with domestic as well as sexual responsibilities, were less likely than their men to have liaisons outside the home. Multiple partnerships are treated in more detail in Sections 2.3 to 2.5. It's from blood that you can catch it Participants were aware of the role that infected blood plays in the transmission of AIDS, although their concerns were sometimes exaggerated. They worried most about injections that people receive in clinics and were concerned that nurses or doctors might use the same needle or syringe for infected and non-infected patients. A Delmas man told his group that when he visits a doctor, he feels he must look in the doctor's drawer to "find out if he is giving me an injection and if he is using the same syringe. I would rather go out and buy a syringe," this man said. Concern about exchange of blood also surfaced in other ways, varying from the plausible to the impossible. Participants seemed to have given considerable thought to the risk of transmission through casual relations which might involve contact with infected blood or other body fluids. For example, in all groups except the women factory workers in Delmas, there were references to transmission by kissing and the transfer of saliva. The risk associated with kissing was almost always linked to the presence of sores, cuts or dental cavities which they believed would allow passage of blood from the infected to the uninfected person. The same reasoning applied to the risk of touching an open lesion or washing an open wound in water used by an HIV-contaminated person. There were no dissenting voices to the assertion that blood is a channel of transmission, but on the issues of saliva and of casual contact that does not expose a person to blood, participants were not in agreement. Women in Delmas contributed various opinions on the issue:
I think there are two types of AIDS Focus group moderators did not present the question of supernatural causation explicitly, but spontaneous discussion in three of the groups raised the possibility that AIDS transmission might result from malevolent forces. A never-employed non-literate woman in Delmas said she had heard that "a person with AIDS may curse someone else with it ("voyé li sou moun nan") after his or her death. The doctor may think she has AIDS, but that is not the case. Then she can not transmit it to someone else." Comments from other members of her group neither supported nor denied the assertion. On the other hand, when the question of supernatural transmission arose in a group of female Delmas factory workers, there was both agreement and disagreement.
Men also spoke of "the AIDS powder," a reference to supernatural alchemy, and discussed the possible role of voodoo on AIDS transmission and diagnosis. A man in Savanne explained how a case of AIDS caused by a powder can be misdiagnosed in a laboratory with the result that the victim may neglect to seek appropriate treatment from a "houngan" (voodoo priest) and may subsequently die. His explanation and reasoning seemed to be accepted without further discussion by others in the group. However, when a man in another Savanne group implicated supernatural practices in the transmission of AIDS, other participants disputed his allegation. The issue, however, was not one of religious belief but rather of scientific logic pivoting on the question of whether HIV-infected blood can affect a person in a poisoned drink.
You can get AIDS in water, in food, in humidity Transmission through casual contact was cited more often by men and women in Savanne and less often by the factory workers in Delmas. In all categories, however, there were people who believed that an AIDS-infected person would endanger other household members. They mentioned several modes of transmission, including drinking or washing in water contaminated by a person with AIDS, sharing food and eating utensils, sitting on a common chair, and using the same toilet. Sometimes they supplied detailed explanations of how the blood or body fluids of the infected person might come to be on the contaminated article. Participants in Savanne were most likely to mention mosquitoes and flies as vectors and to express concern about infected meat. One man in Savanne explained that AIDS, like anthrax, passes to consumers who unknowingly purchase meat from sick animals in the market.
Another man in the same group blamed outdated milk, but others disagreed:
These segments illustrate a common source of confusion in the minds of people for whom water- and food-borne disease is a fact of daily life. Nevertheless, although many suspected food and water of carrying HIV disease, there were always others ready to provide more accurate information and debate the issue. The baby could get the germ Vertical transmission from an HIV-infected mother to the unborn infant was rarely mentioned spontaneously. Even when moderators asked probing questions concerning means of transmission, the danger of perinatal infection seldom came to participants' minds. When discussion turned to issues of vulnerability and the consequences of AIDS for the family, only then did a few people volunteer the information that unborn babies may be at risk. In response to a moderator's question, "What kind of person can get AIDS," a man in Savanne explained that "if the father has the virus and has sex with the mother, and if the mother gets pregnant, the virus gets inside with the germ (sperm). Women in Savanne reacted similarly to a question concerning their responsibility to protect an unborn child:
It was not clear from the above dialogue whether the participants were attributing AIDS in the newborn to the behavior of the mother or the father - or both. However, a comment from a 22-year-old Savanne mother in a "vivavek" relationship may provide a clue to their reasoning:
These comments reflect some confusion about the relationships between the sex cell, the AIDS virus, and other microorganisms. All of these were referred to throughout the discussions as "germs" ("jem"). The woman (P11) above who alluded to vaccination was the only participant in this study to associate immunization with AIDS prevention, but her comment stands as a warning that others may also gain a false sense of security from preventive health measures that have no bearing on HIV transmission. Thus, people in all the study groups wrestled with the logic of many fragments of information, some scientifically valid, others partly true or distortions of actual fact, others with no scientific basis. Some participants expressed confusion or uncertainty in the face of so many conflicting notions. "The problem of AIDS is very hard to understand," said this woman factory worker in Delmas:
Women who worked, or had worked, in Port-au-Prince factories were least likely to suggest inaccurate modes of transmission. Differences were negligible among the other five categories, in all of which there were people who expressed exaggerated or inaccurate ideas about how AIDS can be transmitted. Nor were there discernible intra-group differences on the basis of schooling and literacy. One consistent theme left no doubt as to the dominant belief about the most important cause of AIDS: sexual contact between men and women, either of whom has had sex with more than one partner. |
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