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Vulnerability to HIV Infection Among the Borana Pastoral Community of Southern Ethiopia: a Persisting Challenge

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Vulnerability to HIV Infection Among the Borana Pastoral Community of Southern Ethiopia: a Persisting Challenge Journal name: HIV/AIDS - Research and Palliative Care Article Designation: Original Research Year: 2019 Volume: 11 HIV/AIDS - Research and Palliative Care Dovepress Running head verso: Serbessa Running head recto: Serbessa open access to scientific and medical research DOI: http://dx.doi.org/10.2147/HIV.S193035 Open Access Full Text Article ORIGINAL RESEARCH Vulnerability to HIV infection among the Borana pastoral community of Southern Ethiopia: a persisting challenge Mirgissa Kaba Serbessa Background: Vulnerability to HIV infection is a major concern in an effort to control further infections. What drives vulnerability among pastoral settings of Ethiopia is not well documented. Department of Preventive Medicine, School of Public Health, Addis Ababa Objectives: This study aims to identify drivers of vulnerability to HIV infection among the University, Addis Ababa, Ethiopia Borana pastoral community of Ethiopia. Methods: Data were collected during 2008–2009 as part of a PhD work and subsequently in 2014 and 2016, during a follow-up visit to Borana. Data on perceived threats of HIV, facilita- tors of vulnerability, coping mechanisms and perceived consequences were collected by trained research assistants using topic guides developed for this purpose. In-depth and key informant interviews and Focus Group Discussions (FGDs) with selected married men and women, opinion leaders, and HIV focal persons of public sectors and Non Governmental Organizations in Teltele, Arero, Yabelo and Moyale were carried out. Sample transcripts were checked for consistency and Video abstract completeness before data collection was completed. Two qualitative researchers read transcripts and suggested themes and subthemes in reference to the objective of the study. Transcripts were imported to MAXQDA software. Thematic analysis was applied to reduce data into defined themes. Findings were interpreted following the objective of the study. Findings: The results show that HIV is a major threat in Borana with individual and commu- nity level consequences. Concurrent extramarital sexual practices, men’s role in the selling of livestock and consequent encounters with “other” women facilitate vulnerability to HIV. Lack of information about HIV, availability and use of condoms, and failure to use local resources for HIV prevention were key limitations to coping with the problem. After nearly 40 years of HIV intervention in Ethiopia, coping mechanisms are not exploited in Borana. Conclusion: Vulnerability to HIV among the Borana pastoral community is facilitated by Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: multiple factors that work in tandem, thus calling for interventions that address the different http://youtu.be/tV2G5jG6c3w factors at the same time. Keywords: pastoral community, HIV and AIDS prevention, vulnerability, coping mechanisms, threats of HIV, perceived consequences of HIV, facilitators of HIV, pastoral community Introduction Available evidence on HIV and AIDS tends to be related to risk and vulnerability inter- changeably. While risk is an outcome of threats/hazards/stressors, vulnerability is the potential to be exposed to but lack of means to cope with threats/hazards/stressors.1,2 Correspondence: Mirgissa Kaba Serbessa According to Chambers,3 vulnerability is defenselessness against threat due to Department of Preventive Medicine, School of Public Health, PO Box 150182, exposure to shocks, stress and risk, but lacking the means to cope with the factors Addis Ababa University, Addis Ababa, facilitating vulnerability. Failure to cope with factors of vulnerability could be attributed Ethiopia Email [email protected] to physical weakness, economic impoverishment and poor social support mechanisms. submit your manuscript | www.dovepress.com HIV/AIDS - Research and Palliative Care 2019:11 69–76 69 Dovepress © 2019 Serbessa. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work http://dx.doi.org/10.2147/HIV.S193035 you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Serbessa Dovepress Guided by Chamber’s definition of vulnerability, Watts and Materials and methods Bohle4 suggested three factors that are believed to facilitate Study area the understanding of vulnerability. These are risk of exposure, The Oromo occupy about 40% of the land surface of Ethiopia lack of necessary resources to cope and being subjected to and constitutes the same proportion of the Ethiopian popu- the consequences. Several reports in the literature have since lation.20 The Borana community is considered as a senior been published to study how these factors together facilitate Oromo clan which has long maintained the Gada system of 5–7 vulnerability to HIV infection. social and political organization of the Oromo.19 The Gada An individual’s behavior has long been documented as a system has been the basis of social, cultural and political major risk factor contributing to vulnerability to HIV infec- Organization of the Oromo society since the early 13th cen- 8,9 tion. Such an emphasis on risk neglects the broader context tury with elections of their leader Abba Gadaa to the highest underlying the risk and creates a favorable opportunity for political position for the last 8 years.19 The Gada system has the spread of HIV infection. In this regard, it is documented been maintained by the Borana and neighboring Guji despite that due to their unique biological features, socio-cultural pressure from the central government over a long period. subordination and relative lack of the means to cope with Geographically, Borana is one of the 18 administrative HIV infection, women in Sub-Saharan Africa are 2.5 times zones in Oromia regional state. Borana zone is situated 10 more at risk of HIV infection as compared to men. As a in a relatively arid area of the southern part of Ethiopia result, design of responses against HIV is often guided by the bordering with Somalia to the east and Kenya to the south. notion of women as the most affected group although such In addition, the zone borders with Gujii and Bale zones of arguments appear to neglect cultural, social and economic the Oromia region to the north and northeast and Konso 11 domains of women and HIV as a problem. district of the Southern National Regional state to the west. In Ethiopia, there are limited studies on vulnerability par- The most recent census estimates the Borana population at ticularly in connection to the epidemic of HIV. However, there a little over 1 million. The zone is divided into 13 districts. are reports from epidemiological synthesis that documented Characteristically livestock rearing is the major economic 12 market places, urban settings, prisons etc as hotspots. The mainstay and people in all districts share common social same report and some others have further documented that and cultural features. Initially, three districts (Teltele, Arero female sex workers, mobile workers, in and out of school and Liben) were arbitrarily chosen for the study although youth, uniformed services, widows, divorcees and separated participants in subsequent key informant interviews were 12–14 women are most at risk. Furthermore, concurrent extra- drawn from Moyale and Yabelo districts of the zone guided marital sexual practices, polygamy and marrying a sister of by the snowball technique and based on the investigator’s a deceased wife are documented as facilitators of HIV infec- previous orientation of people in the zone. tion.15,16 Although it is not well documented, the tradition of keeping an extramarital sexual partner by men as well as Methods of data collection and analysis women, widow inheritance and polygamy appears to have A topic guide was developed following the objectives of the declined although they are still there in secret.15 Despite lack study. Accordingly key discussion points and probes were of studies on vulnerability to among the Borana population, a developed with a focus on whether HIV is perceived as a few behavioral and biological studies show relatively high HIV threat, facilitators of vulnerability, means to cope with the prevalence in the region as compared to similar settings.17,18 problem and perceived consequences of HIV. Using the guide, Informed by Watts and Bohle’s vulnerability framework,4 initial data were collected during October 2008 and April 2009 this paper aims to explore if the Borana pastoral community as part of a PhD dissertation. The same topic guide was used consider HIV as a threat, available means to cope with the threat to generate evidence under the same theme during a follow-up and identify factors facilitating vulnerability and consequences visit to the study setting twice in 2014 and 2016. During the of HIV infection. The finding from this study may help to initial visit in 2008–2009, a total of 69 in-depth interviews and challenge the long-established risk-focused studies on HIV eight Focus Group Discussions (FGDs), four with sexually infections and its compromised programmatic implication.
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