A CULTURAL APPROACH TO HIV/AIDS PREVENTION AND CARE UNESCO/UNAIDS RESEARCH PROJECT ANGOLA’S EXPERIENCE COUNTRY REPORT Dr. Maria Antonia Castelo Dr. Miguel Gaspan Dr. Balbina Ventura Félix STUDIES AND REPORTS, SPECIAL SERIES, ISSUE NO.4 CULTURAL POLICIES FOR DEVELOPMENT UNIT UNESCO 1999 The opinions expressedin this document are the responsibility of the authors and do not necessarily reflect the official position of UNESCO CLT-2000/WS/11 TABLE OF CONTENTS Page Preface... 6. cece c cece ene enn enn E EAE EEE EEE EE EE EE EERE; EEE EEE; EEE; ELAR EEE EEE EE EEE EE ES 1 List Of Abbreviations......... 00... ccc cece een een enn een n EEE EEE EERE EE EEE EEE EE EERE EEE 3 Acknowledgements. .......... cc cc cece cece nce eee enn enn n een enn E EEE eee E EEE EEE REE EEE EER ES 5 Overall Introduction. ........... ccc cece cece ee eee n enn n ee een enn E eee enna E EE EE EEE EEE EEE EERE 7 NOY HUGYAMSoR GOL 0)01cc),¢Son 7 ODJCCEIVES 0.ccccen nee een R EEE EERE E EEE EE EEE E EEE EEE REESE EERE EEE SEER EERE EE EE EES 7 Work Content........ ccc cece cece cence cence een ee een ee ee ence een nee eee n eee e eases eeaeeeeeeeeeeeeaeeeees 8 Study’s COMStraints.... 0.00... cece cece ence een e eee nen eee ene REESE EEE EERE EES een E EEE EE EE EES 8 PART 1: INSTITUTIONAL ASSESSMENT. ..............0... cc cece ccc cee ca ee ecene eee n eens 9 1 Imtroduction...... 0...ene e ene e nee endo scenes etna ee ee aeee enna entree es 9 2 Geographical LOCAtION....... 0.0... cece eenenn n nnn e een en EE Eee EE EERE EE EES 9 3 Social and Demographic Features of Angolan People..................ccceeeneeeeeeeeenes 9 3.1 Available Statistic Data...... 0... ccc ccc cece cece nee een e nee ee ene neneeeeeneanaeeees 9 SO od0)000-160)» nn 10 4 SOciO-ecONOMIC SitUAtiON........ cece cece eee eee e ene ne EEE eee en EEE EE Enea EE EEE ES 12 5 Health in Angola....... ccc. ccc ccc cece cece eee eee e een ene ee eee eee E ee ene RHEE E EEE EEE EEE EES 14 5.1 General Sanitary Situation............. cece cee cece eee cree e een ene eee ene eee eenanes 14 5.2 Organisation of the National Health System................ ccc ccc cese ee ee ee ee een een 15 5.3 Administrative and Functional Organisation.................cccceeeeeeeeeeeeeeeeeees 15 5.4 National Health Policy............ ccc cece ccc cece ener eee eee neces ee nnaeeseeeeenaanenes 15 5.5 Primary health care system manageMenNl................ ccc cec eee eneene eee enenaeee cess 16 6 AIDS in Angola...... cic c ccc enen nee en EEE EEE EERE EEE EEE EEE EEE EERE 17 6.1 General AIDS Situation. .......... cece cece cence een ene e ee een ener ee senna aes 17 6.2 Reported Cases.........ccccccccc ccc e cece eee ene eee n ene e eee n eee eee n ea eet ee been EEE eeas 17 6.3 Geographic Distribution. .......... 0... ccc cece cece eee e eee eee e eee teen neaee eee ennene ees 17 6.4 AIDS Evolution in Angola........... ccc cece cece nee e cece nn en eee eeneeneeeeennnnas 18 6.5 Types of Cases Reported ...........c ccc ccccc cn cc cece eee e ee een en nets eeneaeeeeeenennes 19 6.6 AIDS Gender Prevalence..............cc cece cece cece cee n eee ee cen nese eaneenaeeeeenaaes 19 6.7 Specific Group Situations. ........... cece eee eee nent een neat sense eae ee een naaes 19 6.8 Patterns of HIV Transmission................ccc cece cece eee eee eee een eneeeeeenaneeeeeaas 20 7 Analysis of the National AIDS Combat Programme.................cccceseeeeeeeee ee eee ees 21 7.1 Objectives and StrategiesS............ cc cccc ccc n cece cee ene e ee eee neeeeeeeneaee eee eeness 21 7.2 Primary ACtiONS...........cccc cence cence enn e nee een e Eee ene Atte E EEE EEE EES 22 7.3 COMSUAINES... 6... ccc e eee eee eee nee enn n eee ene eee e ee enna eee ena eaeeeaeeeeaanees 23 7.4 Organisation of NAP in the provinces.............. cece eee eeee eee ee neeeeeeennenee ease 25 8 NAP Partners......... cc cece cece ec cee cence cee cee ceececencceneeueeuceanseuaseesenceeneencs 27 8.1 UN and other international organisationS................c cece cece eceene eee eeneneeees 27 8.2 Angolan NGOS............ccc cece cece een een eee e eee eee e scene e Eee ene E EE EEE EES 27 COnclUSIONS......... 0c. cece ec eee cece ce cecceccecseuceuecuceeeceueencceucenceneeneeneteeseneeteeeneens 29 PART 2: AIDS AND SOCIO-ECONOMIC DEVELOPMENT.......................04. 31 1 Introduction... 2... cece ence ene nnn e nee nde e ene EEE EEE Ee EEE EEE AEE Eee a EEE 31 2 AIDS Economic Consequences...........cccccce eee eee eee eee n cece eens eee eee e ee ee enna anes 31 2.1 The Industrial SectOr....... 0.0... cece ccc cence ce cen nena ee ee nese eee ee enneeeee scenes 31 2.2 The Tertiary Sectr........ 0... c cece cece c ene een e eee een ee nee ee een nee eee e enna ae ea 32 2.3. The Household Agriculture Sector....... 0.0... cc cece cence cece ee eneeeeeeeeneneeeees 32 2.4 The Informal Sector......... 0... cece ence eee nent een nee e seen enaeeeeeesneaenees 33 3 Most Vulnerable Social Groups to the Spread of the Epidemic......................008 33 3.1 Women... cc cece ccc cece cc ee cee cence ee ceecencenceaceensenceaesenesseseceenceaveueeenes 33 3.2 Youth... cece ec cece eee cence een ecenccenscnnceaneteneeeeeeceansesneceentenees 35 3.3 Children. ... ccc cc cee cence eee ceeneceeceneceuneeenceeeeeeuncteneeeanceenes 36 COnclUSIONS.......... 0c. cece ec eee cece ce cacceccecseuceuecuccenceueenccauceucenecectesecenttneeenceneens 37 PART 3 : SOCIO-CULTURAL FACTORS AND THE SPREAD OF HIV/AIDS.cece ccc ene cccenneceeanececeneteceanreennerteeueeteeannes 39 1 Introduction... 0...cece ec cece cence cere cencceencennccenneeneceauceaneeeeeeeaneeenes 39 2 Ethno-linguistic Composition of Angolan Population................. cc cceeeeneeeeeaee eens 39 2.1 Bamttl Group... ...cc cc ccccc cece eee eee eee e eee n eee EEE EEE een een EEE EEE EEE Ea 39 2.2 Hogenote-Bushmen or Khoisan Group............ 0... cece eee eee ee eeee eee ee senna aees 40 2.3. Vatua Group - Pre-Bantt............ 0. cece cence cece eee nee e enna nents eee ee eens enees 40 3 Sociocultural Factors....... 00. ccc cece cece c cee c cee cecceeceeceuccaececencenceneenceencenveueeees 40 3.1 Sexual Education.......... cc ccc c cece cece eee nen eee eee e eee e teen neat etter neaenes Al 3.2 Lost of Traditional Values regarding Sexuality............... cc ccceee cence eee ee eees Al 3.3. Household Factors........ 00... cece ccc eee nee enn e nent ee bene EEE enna eta Al 3.4 Factors associated to Patterns of Marriage...............cccccce eee eee eee eeeeeneeeeens 42 3.5 Post-birth Sexual Tab00...... 0... ccc cece cece ene eee ne nee ee ene ne eee e ene neeeeenaaes 44 3.6 Woman Status..........cc ccc ccc cece cece ee nee ene nee een enn E een ene EEE ee EEE EEE EES 44 COnclUSIONS......... 02. cece ec ccc cece ce caucceccecceuceuecuccenceneenccaeenceneeneeneteeseneeteeeneeas 44 PART 4: CASE 45 OD 1 Introduction. ..... 02.e cee cece cence cecte ee ccenceancceaeceeeeceanceeuteuneeeneceeuaeenes 45 PIN, Cor0nor0)(0).na 45 2.1 Election of the Study Methodology...............cc cece cece cee neee eee eenee ceteennenenes 45 2.2 Target Group..........cc cece cece cece eee nee ee eee cents teen eee eee eee eee ene ene eaeeeeneeees 46 2.3 Selection Criteria..... 0.0... ccc cee cece cece ene e ee eee eae eee enna ee eenaeeeeeaeeateeeeeeees 46 2.4 Group and Participants Features.............. ccc cceeese cence cece eee eeeeeeneaeeseeeennes 46 2.5 Data Gathering....... 0.0... cece cccee ce eee eee een n nee eee n nent ee enn e eects eee e ee ee etna 46 2.6 Work SeSSIONS..........0.ce cece eee cece cence een eee eats denne ee eens eee eee eeeeeneae eee eaed 47 3 Data Analysis and DISCUSSION ............... cc cece cece eee e eee ene e eee enna a enee enna a eeaeenees 48 000)UVES) C0)0tc nn 61 Recommendations............ ccc cece cece ec ccnccuccucceecenceuccencecceuceaecneceneenceneeenceneeseees 61 ANNEXE1 : Governmental Partners in the Fight Against AIDS.....................ce eee 63 ANNEXE2: Angolan Ethno-Linguistic Groups and Sub-groups................c0seeeeeeees 67 ANNEXE3: Survey Guide....... 2... ccc cece ccc e eee eee cence cece eee eee senna ees eeeeaeenes 69 ANNEXE4: Survey Guide 2 2.0... .. ccc ccc ccc cee n cence ene e nent enn eee eee enn en nets 71 ANNEXE5: Supplementto the Study ........ 0.0... cece ccc cece cece e cence eee eneeneeeeeeeneaees 73 Bibliography....... 00... cee cece cece eee een e ee neee eee e eee neat eens eeee tease etna ee eee neeaeenaeeee nee 79 PREFACE The failure of prevention campaigns is not only aresult of institutional factors. Social and Cultural factors also play an important role in the spread of the disease. In addition, AIDSis a disease that does not effect solely the health sector. Since it also effects the productive sector of the population, this disease could have unforeseeable consequences on the socio-economic developmentof a country. This study analyses the institutional responses to AIDS andthe effects of the disease on people from different economic backgrounds. It encompasses population groups that are active participants of the country’s production process and those most vulnerable to the spread of the disease. An analysis is also made of the many socio-cultural factors that facilitate the spread of AIDS. Moreover, a case study is elaborated in which people’s attitudes towards such factors are explored as well as the changes in behavioural patterns that the situation demands.