Indigenous health beliefs , attitudes and practices among VhaVenda : A challenge to the promotion of HIV / AIDS prevention strategies

Curationis 30(3): x-y Currently, the syndromic management of HIV/AIDS is based on a biomedical model that focuses on the ABC (Abstain, Be faithful, Condomise) model. The ABC model overlooks the issue of indigenous cultural practices, sexual behaviours, knowledge and attitudes o f the society. A grounded theory study was used for the research. The population for the research on which this article is reporting, was selected from the Vhavenda ethnic group using purposive sampling. In-depth interviews were held at the participants’ own homes. The outcome of the study on which this article is reporting, may assist in identifying indigenous health beliefs, attitudes and practices that will assist in curbing the spread of HIV/AIDS. The findings revealed that cultural practices, such as premarital counselling, polygamy and widow inheritance, are believed to be influential in making women more susceptible to sexually transmitted diseases, including HIV/AIDS. The practice of abstinence, as emphasised at initiation schools, should be incorporated into current policies and preventative practices. The findings further demonstrate that policy-makers who formulated the HIV/AIDS strategy have limited knowledge of the health beliefs, attitudes and practices of the people they serve. They thus find it difficult to draw up promotion and prevention strategies that meet the needs of the community. It is therefore imperative that our health-care training curriculum be reviewed to make provision for the incorporation of sound and effective indigenous practices to reduce the spread of HIV/AIDS and to eliminate or refine practices that are harmful and detrimental to people’s health. The cultural practices that were proved reliable and effective will be recommended for integration into health education.


Introduction
Sub-Saharan Africa has 25,8 million people living with HIV/AIDS; 5.6 million of these are in South Africa.More than 3 m illion people died o f A ID S-related illnesses in 2005 (UNAIDS 2005:3).A cco rd in g to the re p o rt by the Department o f Health (2004) regarding HIV/AIDS and syphilis sero prevalence in South Africa, infection levels among pregnant women are 20% and higher.Deaths among South Africans aged 15 years and older have increased by 62% and more than doubled in the 25-44 age group from 1997-2002.The prevalence o f HIV infection am ong w om en o f reproductive age is increasing worldwide.The literature indicates indirect evidence that the HIV epidemic in South Africa is raising the mortality levels o f prime-aged adults.
Currently, the syndromic management of HIV/AIDS is based on a biom edical approach th at focuses on the ABC (Abstain, Be faithful, Condomise) model.Primary prevention therefore emphasises the use o f condoms and restricting the number o f sexual partners one should have.The use o f a n ti-re tro v ira l medication (ARV) as a form o f secondary prevention is, however, also emphasised (Smith 1999:79).Despite the promotion of ABC strategies, mass health education and the roll-out o f ARV treatment, the mortality and prevalence rates o f HIV/ AIDS continue to increase (UNAIDS 2005:3).Gausset (2001:152) argues that the ABC model overlooked the issue of indigenous cultural practices, sexual behaviours, knowledge and attitudes of the society.The prevalence o f the epidemic despite current management strategies intensifies the need for health care professionals to make a conscious effort to increase their knowledge o f the varied cultures within the communities that they serve.Giger and Davidhizar (1998:4) indicate that nurses need to devise some means o f learning people's cultures in order to provide culturesp ec ific or u n iv ersa l h ea lth -care practices.H elm an (1996:152) and Lowdermilk, Perry and Bobak (1999:225) support the above views w hen they maintain that the norms and customs that are inherent in these indigenous cultures are fu n d am en tal in the d ay -to -d ay existence o f the people concerned and may hold a key to the understanding of many aspects o f people's lives, including the understanding o f HIV/AIDS.Also inherent in culture is socially generated sexual behaviour that may be different for wom en and men.Some o f these gender-based behavioural patterns and practices will be described in this article and may arguably be linked to the spread ofHIV/AIDS.Cultural and ethnic identity and folk beliefs play a decisive role in shaping p e o p le 's percep tio ns, attitu d es and practices regarding health care and illn ess.The u n d e rsta n d in g and incorporation o f these concepts into conventional ways of health care could facilitate solving some o f the problems facing professional health-care providers in South Africa.The outcome o f the study on which this article is based, will assist in identifying cultural practices and beliefs that may assist in curbing the spread o f HIV/AIDS.The practices that have proved to be reliable and effective will be recommended for integration into h ealth ed u c atio n program m es.Awareness will be created around the dangers o f cultural practices that are detrimental to women's health, especially those that put women at risk o f HIV/ AIDS.Mechanisms to address cultural and indigenous practices that perpetuate women's vulnerability to HIV/AIDS will be recommended.This article aims to explore and describe indigenous beliefs, attitudes and sexual practices, which pose ch a lle n g es to the p re v e n tio n strategies of HIV/AIDS.These beliefs and practises can serve as points o f departure in teaching clients about HIV/ AIDS.

Literature review
Indigenous health systems have provided care to people for many years, even before w estern health system s were integrated into trad itio n al cultures.A b d o o l-K arim , Z iq u b u -P ag e and Arendse (1994:1) state, "when an African patient consults a biomedical doctor, a third figure (this "third figure" being a traditional healer) is often present, albeit unseen" .Furthermore, these authors assert that 80% of black patients visit traditional healers before or after they c o n su lt w ith a b io m ed ical doctor.Although a variety of modem health-care options, like local government clinics, health centres and hospitals are available in Venda, patients continue to visit traditional healers.The incidence of visits to traditional healers is aggravated by the Vhavenda people's own beliefs and classification o f diseases.The Vhavenda classify diseases according to causes.There are those diseases that are believed to be caused by supernatural powers or the gods (vhadzim u), and those that are caused through witchcraft and sorcery (Mabogo 1990:94;Mafalo 1997:63).The fin d in g s by G reen (1994:122) on Swazi culture are relevant in this regard: the Swazi believe that there are diseases or conditions regarded as African (indigenous) and those that are foreign (western).In addition, they believe that indigenous diseases can be treated better by traditional healers whereas western diseases are treated more successfully by biomedical doctors.

Sexuality education
The health-care system o f a society cannot be studied in isolation from other cultural aspects o f that society.It is known that black people have their own beliefs and practices on how to prevent, diagnose and treat diseases, including sexually transmitted diseases.They have their own methods o f sex education, in clu d in g how to p re v e n t teen ag e pregnancies (Madima 1996:25) A lth o u g h th is is a psychological perspective, it becomes evident that a similar trend can be noted in medicine and nursing.It has been noted that health professionals often p erceiv e in d ig en o u s p ra c tic e s as inadequate, prim itive, superstitious, magical and quackery.As a result, the opportunities for understanding the v alu es, norm s, b e lie fs, needs and practices o f women and men continue to be remote (Leininger 1999:64,65).Ethnic identity and cultural background o f individuals influence their health-care attitudes, values and practices and could influence the policies and treatm ent strategies o f diseases such as HIV/AIDS, thus enabling the national health-care system to achieve its g o als and objectives.

Marriage and family life
Every family belongs to a community, and families are expected to live according to values and set fam ilial norm s th at co rresp o n d w ith the m ores o f th e particular society.Phaswana (2000:204) argues that, although Christianity is now a dominant religion, the African traditional value system d ictates p attern s o f relationships.Amongst the Vhavenda, marriage has always been regarded a very important event in the life o f a m an/ woman.Traditional marriage involves the negotiation and payment o f bride wealth (mamalo).Mamalo is the cattle or money paid to the family o f the bride.According to Raliphada-Mulaudzi (1998:34), it was found in a study on nuptiality (marital) patterns o f the Shona o f Zimbabwe and conducted by Meekers (1994:256) that bride w ealth paym ents consisted o f several parts, which transfer specific rights to the groom, including sexual rights, the right to cohabit and the right to offspring bom from this union.This view is supported by Raliphada-Mulaudzi (1998:21), who maintains that paying mamalo gives a man rights over his wife's body sexually, and also the right to determ ine the num ber o f children he wants.In agreement with this notion, Mabogo (1990:60) states that amongst the Vhavenda, mamalo can be paid in instalments, with the last payments made afte r the b irth o f the first child.Raliphada-Mulaudzi (1998:22) observed th at m am alo p erp e tu a te s w o m en 's subordination and therefore the chances o f negotiating safe sex are limited in that situation.Polygamy is a common and acceptable practice among the Vhavenda.A community health nurse who taught about the practice o f safe sex in Venda and who emphasised having one partner, indicated that he was shocked when a student reminded him that it is lawful and culturally acceptable to have more than one wife in the former Republic ofVenda (Herbst 1990:23).It is therefore very important to know the cultural and sexual behaviour o f a society before embarking on health education.Knowledge o f a society's sexual behaviour, norms and p ra c tic e s m ay p ro v id e v alu ab le information to the policy-makers, as it will enable them to formulate policies and strategies to combat diseases, for example HIV/AIDS, which are also culturally congruent, holistic and acceptable.The above-mentioned findings presented in p re v io u s stu d ies th e re fo re clearly indicate a disparity between current HIV policy on prevention methods and a sensitivity to cultural practices.This article therefore aims to provide insight into how the gap between policy and practice can be narrowed.

Research design and methods
A qualitative exploratory design was used to conduct the study on which this article is b ased .
T he g ro u n d ed th eo ry m ethodology served as the research design for the study (Strauss & Corbin 1990:180).This approach was found to be appropriate as its roots are founded in the interpretive tradition of symbolic in te ra c tio n s.A cco rding to T albot (1995:445), grounded theory examines the social context o f human interaction.In addition, this methodology is well suited where there is little or no prior theory that has addressed the variable being studied in this approach.Theory is generated from and gro u n d ed in data th at is sy stem atically and sim u ltan e o u sly collected, coded, compared and analysed, using the constant comparative method (Polit & Hungler 1999:195).
The population for the research on which this article is reporting, was sampled from the V h avenda eth n ic group.The Vhavenda, who are mostly found in the northern part of Limpopo Province, were chosen as they are among the few groups that still honour traditional cultural practises.The original Vhavendaknow n as V h angona -have th eir language, culture and ancestral land.The population consists o f over 1 million people.The Venda region also comprises several n o n -in d ig e n o u s p eo p les, in clu d in g M asin g o , V halem ba, Vhandalamo and Vhalaudzi.
The sampling technique that was used is su pported by S trau ss and C orbin (1990:180), who argue that the initial interviews and observational guides in g rounded th eo ry are only u sed as guidelines that help the researcher to have focus.Sampling is therefore an evolving process during the process of data collection as concepts em erge.P urposive sam pling was used as a starting point because only people with the necessary information were selected.F u rth erm o re, P ow ers and K napp (1 990:98 ) su p p o rt th is m ethod o f sampling, arguing that key information interviewing involves selective use o f m em bers o f the c u ltu re w ho are particularly knowledgeable, insightful and articulated, or who have specialised knowledge that is not shared by the rest of the community (Streubert & Carpenter 1999:103).Data was collected until satu ra tio n w as reach ed .As data co llec tio n c o n tin u e d , th eo re tic al sampling was used.Theoretical sampling dictates that comparison groups should be selected based on their potential for contributing to the emerging themes.

Data collection
Ethical considerations are important, as sex u ally tra n sm itte d d iseases are considered a private and confidential matter.Permission to conduct the study w as re q u ested in w ritin g from the N orthern Province and the Vhem be regional authorities.Respect is always o f g reat sig n ific a n c e am ong the Vhavenda and, being a Muvenda herself, the researcher followed all the protocols necessary in gaining entry to the setting and gaining trust from the participants.
The study on which this article is based, drew subjects from men and women living in or near the chief's kraal because of th e ir re p u ta tio n for havin g m ore information than the rest o f the group.The researcher went to the ch iefs kraal where she was given the names of people with relevant inform ation.In-depth in terv iew s w ere co n d u c te d at the participants' own homes.Information g ath ered w as used to id en tify the traditional healers who were involved with the treatment o f sexually transmitted d iseases, and th ese w ere then interviewed.The traditional healers were targeted as they could shed more light on the subject.In-depth interviews were later co n d u cted w ith th ree fem ale herbalists, seven traditional healers, four females and three males.Two botanists w ere also in terv iew ed the ages o f participants ranged between 40-65 years.

The question posed was: What are the indigenous health beliefs, a ttitu d e s an d p r a c tic e s th a t p o s e challenges to the promotion o f H IV/ AIDS prevention strategies?
Three research assistan ts from the University o f Venda were employed to assist with the interviews.They were selected on the basis that they were from the Vhavenda ethnic group, i.e. they knew the language and culture o f the p a rtic ip a n ts.The a ssista n ts w ere p o stg rad u a te stu d en ts from th ree different departments, namely Nursing Science, Gender Studies and Psychology.They were trained in interviewing and probing skills.A tape recorder was used to record the interviews and extensive notes w ere co m p iled d u rin g the in terv iew s.The in terv iew s w ere co n d u cted in T shivenda and later translated into English for a w ider readability.The research assistants assisted in taking notes, transcribing data and analysing data.Furthermore, Truth value was enhanced by ensuring that the research assistants remained in the field for six months in order to enhance credibility.This encouraged free com m unication, and c o n se q u en tly the p artic ip a n ts volunteered more sensitive information because o f the increased rapport.In addition, the researcher went back to the participants or telephoned them for clarification where she felt there was a void in the inform ation elucidated.Thorough field notes were taken directly after each in terv iew to ensure d ep e n d ab ility and co n firm a b ility .Investigator triangulation was achieved as more than one person was used to collect data.To fadlitate transferability the context o f the research was described thoroughly.

Data analysis
In grounded theory, data collection and data analysis occur simultaneously.Data was analysed according to the three steps of coding, as described by Strauss and Corbin (1990:54-247), namely open coding, axial coding and selective coding.Open coding is the first stage o f the constant comparative analysis process to capture what is going on in the data, using the actu al w ords o f the participants.During axial coding, also known as level II coding, categories started em erging and in the process irrelevant data was discarded.The emerging categories were grouped and co m pared to en su re th at they are mutually exclusive and that they do cover the behavioural variations (M unhall 2001:225).Lastly, selective coding, or the formation o f theoretical constructs, was used.During this process, the researcher kept returning to the data, revising research questions and seeking out additional or missing data.This process was followed until different themes were generated.
The fin d in g s w ere d isc u sse d w ith participants themselves at the end o f the research in order to get feedback from the participants and to ensure that the researcher had captured participants' own w ords and th e ir m eaning by discussing with them the interpretation o f data (K refting 1991:219;Talbot 1995:428).

Interpretation and discussion of findings
The findings o f the study revealed that cultural practices such as sex education, premarital counselling, polygamy and w idow in h eritan ce, p atria rch y and abstinence periods are believed to be influential in the prevention o f the spread o f sex u a lly tra n sm itte d d isease s, including HIV/AIDS.

Sex education
Respondents asserted that sex education was taught at initiation schools.Talking to your own child about sex education was not considered appropriate.This view is supported by fact sheets on HI V/ AIDS (Lindsay 2000:6-2) which state that there is a cloak of silence related to issues pertaining to sexual practises.Such matters are often associated with taboo and cause embarrassment, shame, guilt and rejection.The fact sheet goes further by emphasising that nurses and teachers also conform to this culture o f silence regarding sexual practices as they are from the same cultures as the clients.
Children have to go through certain rites o f passage.Boys and girls who have come o f age are sent to initiation school (vhukombani for girls and thondoni for boys).
G irls w ho have started experiencing their monthly periods, are warned that they are now o f childbearing age and should therefore refrain from having sexual relations with boys.This started on the hom e front.D uring vhukombani, the girl is sent away for the sole purpose o f sex education by "other p a re n ts" .T alking about in itiatio n schools, one of the respondents said: "Men were taught about sex during an initiation called tshitam bo, and f o r females there was u imbelwa.Girls were told that it is anathema to have sexual relations with a man before marriage.This made girls to be afraid to have sex before marriage, as they knew it was wrong to do so.So, all girls waited fo r marriage before having sex.Boys would also be told that i f they had sex before marriage, they would suffer unending headaches, swollen genitalia and other frightful diseases." Madima (1996:25) supports the above view when she maintains that a great deal of time at initiation schools is spent on sexual teaching.Girls are warned against being deflowered before marriage, and taught how to have sexual intercourse without "deflowering" taking place.Girls are therefore expected to stay virgins until they are married.Vaginal inspections (tshitavha ) to find out w hether the teen a g er is still a v irg in , are also conducted. Gluckmann (in Green 1994:95) refers to the existence of a similar practise among the Zulu people.C hastity is highly valued and is part o f the ethically enforced code.The girl-child knows that if she has lost her virginity before going to a ceremony called vhukomba (teenagehood) she is going to be a shame to her family, as virginity inspection will be conducted (M adim a 1996:25) He asse rts th at a polygamous family in which all partners are faithful to each other, or in which all partners practice safe sex is no more at risk than a monogamous family that has the same practices.In addition, this author also indicated that, because polygamy is no longer practised, men re p la ced the p ra c tic e by having mistresses, which makes it difficult for one to trace contacts.
In South Africa, polygamous marriages are covered by the R ecognition o f Customary Marriages Act, No. 120 of 1998.This Act makes provision for the recognition o f customary marriages.It is quite unfortunate that at the same time, the A ct p re d isp o se s and in creases women's vulnerability to HI V/AIDS.Men working in urban areas often marry two wives.The senior wife remains in the rural areas and is only visited during holidays, while the second wife lives with the husband in urban areas.This makes it possible for infections to be passed from one wife to the other.In polygamous re la tio n sh ip s w here a p artn e r has extramarital affairs, she/he is likely to put others in the relationship in danger.Similarly, a monogamous relationship that is characterised by unfaithfulness, is just as risky.

Widow inheritance
Another customary practice that emerged during the interview was that o f widow inheritance.According to this practice, the family o f the diseased has the right to distribute the will o f their son even if he was already married prior to his death.The husband's family chooses a new husband for the widow.If possible, her deceased husband's brother inherits her.The new husband will then inherit the widow, the children and any money or property that the deceased had.This practice is intended to protect the widow and the children, more especially the family name.This type o f practice makes people more vu ln erab le to sex u ally tran sm itte d infections.Where the deceased died because o f HIV/AIDS there is a chance that the surviving spouse will also be HIV positive.In that case an HIV negative brother will inherit the disease, thus spreading it to his other wives too.The adults will therefore die leaving children orphaned.Gausset (2001:512) defends the cultural practise o f widow inheritance by asse rtin g th at w om en need the support o f a man to raise children.This author therefore maintains that condom use should be emphasised and where people are suspecting HIV/AIDS as the cause of death, blood should be tested.Ironically, Gausset (2001:512) himself how ever com m ented on the dehumanising effect o f blood tests, as in most instances only the widow is tested while the brother of the diseased is often reluctant to be tested.

Abstinence periods
According to the cultural values of the Vhavenda society, there are periods in women's lives during which they are not to have any sexual contact, namely the time o f early widowhood, during the menopause, during menstruation, and during the postnatal period.This puts men in vulnerable positions as a result of having extramarital relationships.Thus, the chances o f contracting HIV/AIDS and infecting the spouse are high.This view is supported by (Louistaunau, & Sobo 1997:38).whoindicated that women are considered dirty during menstrual period and postnatal periods.

Patriarchy
The Vhavenda group proved to be a patriarchal society, where men still want to be in control.The findings showed that male respondents were not keen on using condom s and verb alised that condoms limit sexual satisfaction.One respondent described a condom as "a plastic that covers the penis, and thus making the penis unable to breathe".This b elief is supported by research conducted by Gausset (2001:516) who reiterates that there is a belief that using a condom is like eating a sweet with its w rapper.The re sp o n d en ts fu rth er explained that suggesting condoms may subject a woman to physical assault, separation or divorce.Furthermore, in laws and the woman's own parents may not support her if they are asked to mediate, and they may assume that she is practising infidelity.These findings show the serious impact of gender inequality on the prevention of HIV/AIDS.African societies in general tolerate multiple sexual partners for men, but exert moral and social sanctions on women (Brycenson 1995:176). Bhattiand Fikree (2002:115) state that: "A I though the condom is seen at present as the only effective preventive measure against the sexual transmission o f HIV/ STDs, fo r the majority o f African women the suggestion that their partners or husbands use condoms is either seen as evidence o f the woman s infidelity or perceived as defiance or insolence.At best, this may result in a breach o f relationship; at worst, in the woman being beaten or abandoned." In addition, the respondents in the current study show ed that it is not acceptable for women to refuse their husbands sex, as women are seen as su b o rd in ate to m en.
B rycenson (1995:175) concurs that the rapid spread o f H IV /A ID S is largely due to the powerless state in which African women find th em selv es w hen it com es to demanding fidelity or refusing sexual in tera ctio n .O bbo (in B rycenson 1995:176) adds that a woman who refuses sex is driving her husband to polygamy, be it o f a formal nature in terms o f new wives, or informally by having mistresses and girlfriends.
The above cultural practices portray wom en's subservience and silence in matters o f safe sex.The sexual customs and norms o f the Vhavenda put male needs and demands first in a marital relationship.By virtue o f their patriarchal status and perceived roles in traditional society, men have power over women.

Conclusions
The indigenous health beliefs, attitudes and practices o f the Vhavenda pose a challenge to the promotion o f HIV/AIDS prevention strategies.The findings of the research on which this article is based, showed that cultural practices such as polygamy, influence the spread of HIV/ AIDS as they are in contradiction of the strategy o f being faithful and sticking to one partner.C u ltu ral b e lie fs and practices, including the high values placed on p ractices such as widow in h eritan c e, in cre ase w o m e n 's vulnerability to HIV/AIDS.This makes it difficult for women to negotiate safe sex.
In addition, practices such as patriarchy and social acceptance o f m en's extra marital affairs, which is tolerated by social and cu ltu ral norm s, p erp etu ate the su b o rd in atio n o f w om en.
T hese practices put women at the greatest risk of contracting HIV/AIDS.It was also evident in the research results on which this article is reporting that it is not easy for parents to discuss sexuality issues with their children.
Although the above findings ham per HIV/AIDS preventive strategies, there are also ind igenous p ra ctices th at can facilitate the prevention o f HIV/AIDS.The research finding that concurred with the modem preventive strategies o f HIV/ AIDS is that regarding the practice of abstinence that is taught at initiation schools.Initiation schools serve as medium for informing children about sexuality issues.
The findings o f this study prove that the knowledge provided by this study may aid policy-makers in developing suitable and culturally sensitive policies.

Recommendations
Based on the research on which this artic le is re p o rtin g , the fo llo w in g recommendations are made: Awareness o f the dangers o f cultural practices that are detrimental to women's health, especially those practices that put women at risk o f HIV/AIDS, should be promoted.Examples o f such practices include polygam y and w idow inheritance.These practices, although embodied in customary law, need to be addressed and practised in a way that will not be detrimental to women's health.Sexual behaviour o f the com m unity needs to be aligned with HIV/AIDS strateg ie s in v o lv in g co m m unity stakeholders, such as religious groups, which could prove beneficial.
The issue o f p a tria rc h y sh o u ld be addressed by challenging discriminatory p ractices against girls and w om en.Women need to be empowered to be assertive and to be able to negotiate safe sex.Interventions intended to empower w om en should be co u p led w ith interventions to sensitise and educate m en.In a p a tria rc h a l society, all interventions that do not involve men can be regarded as external interference and may be resented as men may feel it erodes their power or control over their wives.
Traditional leaders and traditional healers need to be included in com m ittees responsible for planning strategies for improving the HIV/AIDS problem.This strategy should assist in incorporating the health beliefs and attitudes o f the communities.Health-care professionals and policy-makers should also be trained as regards cultural knowledge, attitudes and practices in relation to HIV/AIDS.Cultural practices that are harmless, such as abstinence and the value o f initiation schools, should be in teg ra te d into m odern h e a lth -c a re p re v e n tiv e strategies.It is recommended that the gap created by initiation schools be corrected by introducing sex education in the school curriculum.Sex education should take cultural needs, practices and b eliefs into c o n sid e ra tio n , by em phasising ab stin en ce in stead o f condom use.Education could also follow the initiation school curriculum, where the main focal point is on abstinence rather than on safe sex.The fact that youth can engage in safe sex often results in them having sex at a much earlier age and this subjects girls to v aginal tears th at in cre ase th e ir susceptibility to sexually transm itted diseases including HIV/AIDS.
It is clear from the findings o f the research on which this study is based, that the health beliefs, attitudes and practices o f the community should be taken into consideration and put into proper perspective.Nurses need to be culturally competent in order to provide culturally com petent care.F urther research needs be conducted on other indigenous reproductive health issues that may impact on the spread, treatment and preventive strategies o f HIV/AIDS.
Training curricula for health workers need to be designed to incorporate indigenous health-practice m ethods to enhance quality control and holistic health-care methods.This endeavour may promote prevention strategies that will facilitate and control the spread HIV/AIDS.This is important, as there is a need to provide ethno-nursing and culturally congruent care to the community.These guidelines may be used at basic and post-basic level, as well as by other teaching institutions.
In th eir en d e av o u r to re d u ce the p rev alen ce rate and the in c re a se d mortality rate o f the population due to HIV/AIDS, health-care policy-makers should strive to formulate policies and management, which include society's indigenous beliefs and practices.Cultural beliefs and practices as illustrated by the research findings o f the study on which this article is based, may serve as tools to enhance our strategies in health education.The tried and tested practices o f the community, such as abstinence, sh o u ld be em p h asised in re le v an t policies.The issue o f faithfulness is also o f fundamental importance, particularly in cases where com m unity members practise polygamy.
C u ltu re is dynam ic and capable o f ad a p tin g to new co n d itio n s.It is therefore im perative that our health system be reviewed to make provision for the inco rp o ratio n o f sound and effective practices from indigenous cultures to reduce the spread o f HIV/ AIDS and to eliminate or refine practices that are harmful and detrimental to our endeavour to deal with new challenges faced by society.
Measuresto ensure trustworthiness F or this study, the m eth o d s o f trustworthiness in the evaluation o f data quality as described by Lincoln and Guba (in Polit, Beck & Hungler 2001:426) were used.The literature control o f other studies also supported the findings.

Effects of Colonialism on perceptions of health professionals
.Lumadi  (1998:42)asserts that chiefs traditionally had pow ers to co n tro l tra d itio n a l practices, such as initiation schools (rites Gausset (2001:512)argues that it is not polygamy or monogamy that fuels the spread o f HIV/AIDS, but fidelity or the practice o f safe sex in extram arital re la tio n sh ip s.
woman as that o f a wife whose life is centred on her home and family.A woman proceeds to m arriage from under the authority o f her father to under that o f her husband, which is equally not to be ch allen g ed .T he re sp o n d en ts also emphasised that a woman was taught to respect her husband and to have no say in the ru n n in g o f the h o u seh o ld , including sexual matters.o f STD s since the man was alw ays indebted when it came to satisfying his wives.A t the end o f the circle, he needs to start again and so it goes.It also helped that the man did not sleep with stra n gers sin ce he knew his wives.(Laughter).A s fo r wives being tempted, it was ju s t a matter o f the wife being unfaithful.Even i f she was the only wife she would still do it."