Spatial and Cultural Ramifications of HIV and AIDS

Abstract title:  
Spatial and Cultural Ramifications of HIV/AIDS in Manya Krobo District of Ghana  
Author:  
K.O.Y. Gyabaah  
Institute:  
Department of Geography and Resource Development, University of Ghana, Legon (Accra). This thesis is submitted in partial fulfilment of the requirements for the award of M.Phil degree (June 2005).  
Background:
The focus of the study is an examination of the magnitude of the HIV/AIDS problem in Manya Krobo with reference to the extent of spatial, cultural and socio-economic factors affecting the spread. The chosen area, the Manya Krobo District of Ghana, is one with very high prevalence of HIV/AIDS. Since the identification of the problem of HIV/AIDS in the district, most studies have linked the disease to poverty and mobility patterns of the people. None of these studies have examined the direct link between HIV/AIDS and culture in the district. Thus the studies that contribute to the cultural dimensions of the disease should be encouraged. Methods:
This study used a combination of qualitative and quantitative methods at individual, household, community and clinical levels. It addressed a number of questions like spatial and cultural milieu in which AIDS prevail, the relationship between premarital sex after puberty initiation rite and risk of HIV infection, relationship between migration and HIV vulnerability, and other factors affecting HIV/AIDS infection. Objective was to determine the cultural ramifications of HIV/AIDS specifically to determine patterns and trends by age, sex and geographical variations, examine the socio-economic, historical and cultural factors, and assess the levels of interventions and constraints at place. The propositions used were that there is a positive relationship between premarital sex and HIV/AIDS transmission, and tender age at which puberty rite was performed (Huber, 1993; Teyegaga, 1985) encourages premarital sex hence exposure to risk of HIV.  
Results:
The thesis has increased knowledge tremendously on spatial dimensions of the disease and is a great contribution to scholarship on Geography of Health in general and prevalence/incidence of diseases in particular. Spatially, there are significant differences in patterns of HIV/AIDS infection by current place of residence i.e. urban/rural, ethnic group, age, education and occupation. The study found that aspects of some centuries-old traditional practices could produce vulnerability situations for HIV infection through early and premarital sex as well as cohabitation and multiple sexual activities. Such practices included "yesodofiermi", “dipo” (puberty rite), “fiaa” (dowry), “la pomi” (cohabitation), “yalɔ–gba” (levirate), “kaduba fiame” (corpse treatment), and “wamzam” (circumcision). "Yesodofiermi" produces social inferiority relationship for women, which leaves them economically weak and vulnerable to HIV. Another worrying aspect of the findings was that many respondents were not in recognized marriage but co-habiting (lapomi), divorced or widowed. “La pomi” often results from exorbitant dowry (‘fiaa’) demanded by parents of the bride. With current economic difficulties such ‘la pomi’ mothers, mostly single parents, are driven to engage in social vices like multiple sexual relations which expose them to acquiring HIV.  
Conclusions:
The major conclusion is that though socio-economic factors are important in the spread of the disease in the area, they are to some extent shaped by certain deep-rooted cultural practices. Also, the ostensible socio-economic factors including poverty-prompted migration often blamed for the high HIV prevalence documented in Manya Krobo district seem to be, to some extent, consequences of certain deep-rooted cultural practices. Significantly, HIV/AIDS stigma appeared to be a perception than reality with orphans supported through Family Net System (FNS). Thus strategies to expand HIV/AIDS control programmes in the District must incorporate the cultural dimension.