“Balinsalamu embawo?” AIDS and the context of sexual behaviour adjustment in Rakai, Uganda, c. 1975–90

Abstract

This paper approaches HIV and AIDS in Rakai district, Uganda, from a historical point of view, offering a representation that takes into account the broader socioeconomic context of the epidemic. It deals with the local behavioural responses to HIV and AIDS, and the effect and aftermath of the first AIDS education campaign in the district in the late 1980s. At that time, a popular catchphrase – “Balinsalamu embawo?” (lit. “Do they want to cut me up for timber?”) – emerged among the youth and young adults, expressing criticism of the political and medical establishments and their attempts to govern the lives and intimate behaviour of individuals in the name of disease control. It is argued that the first AIDS education campaign undertaken by the Ugandan government was not entirely successful in Rakai, leading only to slight behavioural adjustments.

Keywords:

• Uganda
• AIDS prevention
• sexual culture
• magendo
• poverty

Acknowledgements

The author wishes to thank Patrick Mulindwa, Jonathan Ngobi, Annet Babirye and Thomas Kanooti for their cooperation and assistance. This study has been funded by the Academy of Finland.

Notes

1. UNAIDS, A Measure of Success in Uganda.

2. Hogle, What Happened in Uganda?; Green, Rethinking AIDS Prevention,139–226; Slutkin et al., “How Uganda Reversed its HIV Epidemic,” 351–61; Green et al. , “Uganda's HIV Prevention Success,” 335–46; Kirby, “Changes in Sexual Behaviour,” 35–41.

3. Delius and Walker, “AIDS in Context,” 5–12; Rosenberg, Explaining Epidemics, 279.

4. Gray et al., “Uganda's HIV Prevention Success,” 349.

5. HI-virus was known as HTLV-III in the early 1980s.

6. Denis, “Towards a Social History of HIV/AIDS.”

7. Kuhanen, “Historiography of HIV and AIDS in Uganda,” 301–25.

8. See Kuhanen, “Historiography of HIV and AIDS in Uganda,” 301–25.

9. Iliffe, The African AIDS Epidemic, passim.; Iliffe, East African Doctors, 220–46.

10. Thornton, Unimagined Community.

11. Parkhurst, “HIV Prevention Policy”; Putzel, Institutionalizing an Emergency Response; Kirby, Success in Uganda.

12. O'Manique, Neoliberalism and AIDS Crisis.

13. Lyons, “Point of View,” 131–46; Bond and Vincent, “Living on the Edge,” 113–29; Bond and Vincent, “AIDS in Uganda,” 85–97;

14. Obbo, “HIV Transmission,” 211–43; Barnett and Blaikie, AIDS in Africa.

15. Hooper, Slim; Hooper, The River, 31–51.

16. Abstain, Be faithful, use Condom.

17. Rakai is a predominantly rural district in south-west Uganda, bordering Tanzania, and the home of the first longitudinal community-based research project on HIV and AIDS in Uganda. Another such project was established in the neighbouring Masaka District and, though similar research took place at both sites, the results have been remarkably different, with lower incidence and prevalence levels and a greater degree of reported behaviour change documented in Masaka than in Rakai. The differences in results are partly due to the composition of the populations, as the initial population cohort in Rakai consisted of 12 rural villages and nine peri-urban trading centres with 40 households in each, while the Masaka cohort consisted of a cluster of 15 villages in one rural sub-county located 35 km away from the town of Masaka and 16 km from the main highway. Masaka had a larger population in absolute terms (about 10,000 people), but did not include urban or peri-urban communities. Given the greater proportion of townspeople in the Rakai cohort, the occupational and income differences and the types of social activity, it is clear that the levels of mobility, sexual networking and HIV incidence and prevalence tend to be more variable there than in the purely rural Masaka cohort. The Rakai cohort is therefore more representative of the whole area, whereas the Masaka cohort may only be representative of the rural population of the Masaka district. Indeed, the levels of HIV prevalence in rural villages belonging to the Rakai cohort, where people generally reported lower levels of risk behaviour, substantial behavioural change and almost no increase in condom use, were not significantly different from those reported in Masaka. When research results from the Rakai Project are made public, however, they are often reported as representing a “rural” Ugandan community. For this reason, the results regarding behavioural change, condom use and HIV incidence and prevalence levels tend to be less impressive in Rakai. Comparison of HIV incidence and prevalence levels between the two studies is therefore difficult. See Ssengonzi et al., “Socio-economic Status”; Nunn et al., “Risk Factors,” 82; Musagara et al., “Recent Changes in Behaviour.”

18. Konde-Lule, “The Declining HIV Seroprevalence,” 27–33; Mulder et al., “Decreasing HIV-1 Seroprevalence,” 833–6; Stoneburner et al., “Human Immunodeficiency Virus,” 682–95; Wawer et al., “Trends in HIV-prevalence,” 1023–30; Pool et al., “Understanding Sexual Behaviour Change,” 479–88; Parkhurst, “What Worked?,” 275–83.

19. Nabaitu et al., “Community Perceptions.”

20. The Resistance Councils formed a structure for local administration from the village (RC-1) to the district level (RC-5) in Museveni's Uganda since 1986.

21. Rakai District was officially established in 1976.

22. Karlström, “Modernity and its Aspirants,” 595–619.

23. Mutabwe, Uganda since Independence, 115–24; Kasozi, The Social Origins of Violence, 104–27; Kiwanuka, Amin and the Tragedy of Uganda.

24. See Dodge and Wiebe, Crisis in Uganda.

25. Interview with preacher, November 6, 2007, Mutukula; Interview with businessman, November 14, 2007, Kyotera.

26. Interview with farmer/fisherman, November 2, 2007, Kasensero; Interview with farmer/midwife, November 3, 2007, Lukunyu; Interview with businessman, November 14, 2007, Kyotera.

27. Interview with LC-1 chairperson, November 2, 2007, Kasensero.

28. Interview with LC-1 chairperson, November 2, 2007, Kasensero; Interview with LC-1 chairperson, November 3, 2007, Lukunyu-Mizinda; Interview with LC-1 chairperson, November 4, 2007, Kinyiga; Southall, “Social Disorganisation in Uganda,” 647–8.

29. Green, Magendo in the Political Economy of Uganda, 26–7.

30. Many informants viewed the 1970s as a time when people experienced profound changes in terms of everyday life and social behaviour. Kuhanen, “Emergence of Sexualised Spaces,” 8–10.

31. Interview with RC priest, May 15, 2008, Ssanje; Focus group discussion with men, May 13, 2008, Kateera.

32. On sexual networks, see Thornton, Unimagined Community; Morris and Kretzschmar, “Concurrent Partnerships,” 641–8; Dyson, Sexual Behaviour and Networking.

33. “RC Takes Root in Fishing Village,” The New Vision, January 2, 1987.

34. Focus group discussion with men, May 13, 2008, Kateera.

35. Focus group discussion with men, May 13, 2008, Kateera.

36. Interview with LC-1 chairperson, November 2, 2007, Kasensero.

37. Focus group discussion with women, May 16, 2008, Ssanje.

38. Interview with health educator, November 8, 2007, Kalisizo; Focus group discussion with women, May 16, 2008, Ssanje.

39. Focus group discussion with women, May 16, 2008, Ssanje.

40. Interview with LC-1 chairperson, November 4, 2007, Kinyiga.

41. Lwegaba, “A Preliminary Report.”

42. Interview with fisherman, November 2, 2007, Kagera-Kibuuko.

43. Interview with LC-1 chairperson, November14, 2007, Kyotera-Lubira; Interview with LC-1 chairperson, November 13, 2007, Ssanje.

44. Interview with LC-1 chairperson, November 3, 2007, Lukunyu-Mizinda: Interview with LC-1 chairperson, November 2, 2007, Kasensero; “RC Takes Root in Fishing Village,” The New Vision, January 2, 1987.

45. Interview with butcher/LC-1 member, November 6, 2007, Mutukula; Interview with LC-1 chairperson, November 7, 2007, Rakai town.

46. Interview with businessman, November 4, 2007, Lukindo.

47. Interview with health educator, November 8, 2007, Kalisizo.

48. Interview with LC-1 chairperson, November 3, 2007, Lukunyu-Mizinda

49. Interview with LC-1 chairperson, November 4, 2007, Kinyiga.

50. Interview with LC-1 chairperson, November 2, 2007, Kasensero.

51. Interview with LC-1 chairperson, November 7, 2007, Rakai town.

52. Interview with LC-1 chairperson, November 3, 2007, Lukunyu-Mizinda.

53. About 33% of the people in Rakai in 1989 were aware of the sexual transmission of HIV. See Serwadda et al., “An Assessment of AIDS-related Knowledge.”

54. Konde-Lule et al., “Knowledge, Attitudes and Practices Concerning AIDS,” 513–18; Konde-Lule and Sebina, “The Impact of AIDS,” 725–29.

55. “RC Takes Root in Fishing Village,” The New Vision, January 2, 1987; Obbo, “HIV Transmission,” 218.

56. Uganda Ministry of Health/AIDS Control Programme (MOH/ACP), Progress on the AIDS Epidemic, 1; Interview with health educator, November 8, 2007, Kalisizo; Barnett and Blaikie, AIDS in Africa, 29; “Mysterious Disease Kills 100 People in Rakai,” The Star, December 29, 1984; “Endwadde empya ‘Siriimu’ egobye mu Uganda,” Munno, April 13, 1985.

57. “Press Overplaying AIDS Scare,” The New Vision, June 24, 1986; Nalugoda et al., “HIV Infection in Rural Households,” 138.

58. Ntozi and Kirunga, “HIV/AIDS, Change in Sexual Behaviour and Community Attitudes,” 169.

59. Interview with medical doctor, December 3, 2007, Kampala.

60. This catchphrase was mentioned by several informants as an expression of a careless and disobedient attitude among the youth. Other versions of it, such as balimbajjamu embawo (Do they want to carve timber out of me?) also exist, but they all express the same attitude.

61. Interview with epidemiologist, October 16, 2007, Kampala.

62. Kisekka, “The Baganda of Central Uganda,” 148–63; Olowo-Freers, Sociocultural Aspects, 24.

63. Focus group discussion with women, May 16, 2008, Ssanje.

64. Interview with farmer/former LC-1 chairperson, 19, November 13, 2007, Ssanje.

65. Interview with businessman, November 4, 2007, Lukindo.

66. Interview with health educator, November 8, 2007, Kalisizo.

67. Konde-Lule, Musagara, and Musgrave, “Focus Group Interviews,” 680.

68. Interview with medical doctor, December 3, 2007, Kampala.

69. Interview with fisherman, November 2, 2007, Kagera-Kibuuko. Also Kisekka, “AIDS in Uganda,” 41–2.

70. Interview with LC-1 chairperson, November 2, 2007, Kasensero.

71. Interview with LC-1 chairperson, November 4, 2007, Kinyiga.

72. Interview with health educator, November 8, 2007, Kalisizo.

73. Interview with fisherman, November 2, 2007, Kagera-Kibuuko.

74. Forster and Furley, “1988 Public Awareness Survey,” 150.

75. Konde-Lule, Wawer, and Lainjo, “Condom Use in Young Adults”; Kamali et al., “Seven-year Trends in HIV-1 Infection Rates,” 427–34; Ministry of Health and ORC Macro, Uganda HIV/AIDS Sero-Behavioural Survey, 66.

76. For example, Hogle, What Happened in Uganda?; Green et al., “Uganda's HIV Prevention Success.”

77. Focus group discussion with men, May 15, 2008, Kangabwe.

78. Focus group discussion with women, May 13, 2008, Kateera.

79. FoG 11, May 16, 2008, Ssanje.

80. Interview with health educator, November 8, 2007, Kalisizo; Interview with RC priest, May 15, 2008, Ssanje; Lugalla et al., “Social, Cultural and Sexual Behavioral Determinants,” 191.

81. Interview with epidemiologist, October 16, 2007, Kampala; Konde-Lule, Musagara, and Musgrave, “Focus Group Interviews,” 680–1.

82. Konde-Lule et al., “Condom Use Trends.”

83. Konde-Lule et al., “Condom Use in Young Adults.”

84. Konde-Lule et al., “Adolescents, Sexual Behaviour and HIV-1,” 791–9.

85. Wawer et al., “Incidence of HIV-1 Infection,” 171–3.

86. Interview with LC-1 chairperson, November 4, 2007, Kinyiga.

87. Focus group discussion with women, May 6, 2008, Kampala.

88. Interview with LC-3 chairperson, November 15, 2007, Kalisizo.

89. J.B.K. Ssemogerere (opinions), The Star, January 6, 1986; The New Vision, December 19, 1986; The New Vision, March 31, 1988; The New Vision, November 29, 1991; Bukenya, Pastoral Care, 26–55; Lyons, Women and AIDS in Uganda, 18.

90. The New Vision, June 21, 1990; The New Vision, June 22, 1990.

91. Wawer et al., “Dynamics of Spread of HIV-1 Infection,” 1305; Wawer et al., “Incidence of HIV-1 Infection,” 172.

92. Wawer et al., “Dynamics of Spread of HIV-1 Infection,” 1305.