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 Samantha Page

Development,
Sexual Cultural
Practices and
HIV/AIDS
in Africa
Development, Sexual Cultural Practices
and HIV/AIDS in Africa
 Samantha Page

Development, Sexual
Cultural Practices
and HIV/AIDS
in Africa
Samantha Page
Department of Global Development
and Planning
University of Adger
Kristiansand, Norway

ISBN 978-3-030-04118-2 ISBN 978-3-030-04119-9 (eBook)

https://doi.org/10.1007/978-3-030-04119-9

Library of Congress Control Number: 2018962020

© The Editor(s) (if applicable) and The Author(s) 2019. This book is an open access publication.
Open Access This book is licensed under the terms of the Creative Commons Attribution
4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits
use, sharing, adaptation, distribution and reproduction in any medium or format, as long as
you give appropriate credit to the original author(s) and the source, provide a link to the
Creative Commons license and indicate if changes were made.
The images or other third party material in this book are included in the book’s Creative
Commons license, unless indicated otherwise in a credit line to the material. If material
is not included in the book’s Creative Commons license and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and
information in this book are believed to be true and accurate at the date of publication.
Neither the publisher nor the authors or the editors give a warranty, express or implied,
with respect to the material contained herein or for any errors or omissions that may have
been made. The publisher remains neutral with regard to jurisdictional claims in published
maps and institutional affiliations.

Cover design by Tom Howey

This Palgrave Macmillan imprint is published by the registered company Springer Nature
Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
 Foreword

Samantha contacted me back in 2008 when she was thinking of doing a

Ph.D. about traditional cultural practices and HIV in Malawi. She’d read
my research about traditional cultural practices and AIDS.
Initially, Samantha wanted to interview women and girls who had par-
ticipated in sexual cultural practices. But I said to her perhaps it would
be better to interview people who were worked on HIV prevention
programmes in Malawi. As an outsider, trying to interview women about
a sexual practice shrouded in secrecy is problematic.
Samantha went to Malawi to do her doctoral research in 2008. I met
her for the first time there. I employed her to be my research assistant
and collect data whilst she was conducting her interviews.
Since then we have been in regular contact and I have provided advice
to her on her Ph.D. and her post-doctoral career.
This book is a welcome addition to the dearth of literature on sexual
practices and AIDS in Malawi. It is an under researched topic but nev-
ertheless an important one. Many assumptions are made about the link
between AIDS and sexual practices so this book is an important contri-
bution to knowledge as it highlights the reality in Malawi, based on 60
interviews with policymakers, programme managers, lawyers and MPs,
Malawian and foreign, who work on HIV prevention issues.
What is interesting about her findings is how Malawians volunteer
information about sexual cultural practices and AIDS as if they are mak-
ing themselves appear modern and distancing themselves from the rural
villager. Samantha uses the term ‘narratives of blame’—I think this is

v
vi    Foreword

very fitting—in other words how the stories told by Malawians blame the
backward villager. In other words, the urban, educated Malawian elite is
not responsible for the high HIV prevalence rates in Malawi, rather it is
the uneducated, rural person.
Why is this book important? The significant amount of money inter-
national donors spend on trying to eradicate or modify sexual cultural
practices is unjustified and wrong. So Samantha unravels the story using
evidence from her interviews to highlight a flaw in donor thinking. That
far too often donors don’t use evidence to support their work. They
latch on to an idea thinking it is important, when really it isn’t.

Los Angeles/Philadelphia, USA Susan Watkins

Visiting Scholar,
California Center for Population Research,
University of California-Los Angeles,
Professor Emerita of Sociology,
University of Pennsylvania
 Acknowledgements

I would like to thank all those I interviewed in Malawi. I would particu-

larly like to thank the family I stayed with in Malawi who were so kind
to provide me with accommodation and food and welcomed me to their
home. I can’t thank you enough.
Thanks to all who supported me at Palgrave Macmillan: Karthika
Purushothaman, Alina Yurova and Mary Fata in particular.
Thank you to Tony Chafer. If it wasn’t for you I would have dumped
the idea of completing a Ph.D. many years ago but you encouraged me
to persevere.
I have many mentors. Thank you to Susan Watkins who has provided
me with endless support ever since I first became interested in the topic.
A huge thanks also to Louise Ackers. I really appreciate your advice
and support.
Thanks to my colleagues in the Faculty of Social Sciences and the
library at the University of Agder for providing financial support so that
this book can be accessible online.
Also thanks to my colleagues in the Department of Global
Development and Planning, especially Hanne Haaland, who gave me
the time to write the book, Alf Gunvald Nilsen for pushing me to think
about this book, write a proposal and for helping me with the process
and reviewing chapters and Gibran Cruz Martinez for reviewing chapters.

vii
viii    Acknowledgements

Thank you to my wonderful friends Bella and Sandra. Thanks also to

Mitty.
Lastly, I owe the deepest of thanks to my Mum and Dad, Martin and
Jodie.
 Contents

1 Introduction 1

2 Theoretical Perspectives 25

3 The Development Aid Situation in Malawi 43

4 ‘Harmful Cultural Practices’ and AIDS 61

5 How the Church Frames AIDS 107

6 The Construction of Policy: Donors, AIDS

and Cultural Practices 141

7 Conclusion and Recommendations 187

Glossary 199

Index 203

ix
 Abbreviations

AIDS Acquired Immune Deficiency Syndrome

ATR African Traditional Religion
CABS Common Approach to Budgetary Support
CBO Community Based Organisation
CEDAW Convention on the Elimination of all forms of Discrimination
Against Women
CHAT Country Harmonisation and Alignment Tool
DFID Department of International Development
EU European Union
FBO Faith-Based Organisation
GBV Gender Based Violence
GFTAM Global Fund to fight AIDS, Tuberculosis and Malaria
GTZ German Technical Development Agency
HADG HIV/AIDS Development Group
HCP Harmful Cultural Practice
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
IAWP Integrated Annual Work Plan
INGO International Non-Governmental Organisation
M&E Monitoring and Evaluation
MANASO Malawi Network of AIDS Service Organisations
MANET+ Malawi Network for People Living with HIV/AIDS
MBCA Malawi Business Coalition on AIDS
MDHS Malawi Demographic and Health Survey
MDICP Malawi Diffusion and Ideational Change Project
MGDS Malawi Growth and Development Strategy

xi
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